EXECUTIVE SUMMARY

Key findings from the 2012 IDRS

The Illicit Drug Reporting System (IDRS) is intended to serve as a monitoring system, identifying emerging trends of local and national concern in illicit drug markets. The IDRS consists of three components: interviews with a sentinel group of people who regularly inject drugs (PWID) conducted in the capital cities of Australia; interviews with key experts (KE), professionals who have regular contact with illicit drug users through their work; and analysis and examination of indicator data sources related to illicit drugs. Australian Drug Trends 2012 draws largely on the PWID participant survey and indicator data components of the IDRS, while KE are relied upon to provide contextual information within jurisdictions. As such, this information is reported more fully in the individual state/territory reports, to which the reader is also referred.

Demographics of the participant sample

Ninety nine participants were recruited to the 2012 IDRS ACT participant survey component. The mean age of the ACT sample was 40 years (range 19-59 years) and 65% were male. The vast majority of the sample spoke English as their main language at home (97%), and 15% identified as being of Aboriginal and/or Torres Strait Islander descent. Almost four-fifths (77%) of the sample were currently unemployed, less than half (43%) reported a previous prison history and over half (54%) were in current treatment, mainly methadone.

Consumption pattern results

Current drug use

The mean age of first injection was 19 years. More than half of the sample, 52% reported that an amphetamine (including methamphetamine) was the first drug injected, followed by heroin (37%).
Heroin was nominated by a little over half (58%) of the sample as their drug of choice, followed by methamphetamine and cannabis.
The drug injected most often in the last month broadly followed the same pattern. Forty-nine percent of the sample reported injecting heroin most often in the last month, followed by methamphetamine (35%). Forty-one percent of participants reported daily injecting.

Heroin

Heroin use was reported as the main drug of choice among participants. Over half (58%) of the sample reported using heroin in the last six months on a median of 72 days. Twenty-six percent of recent heroin users reported daily heroin use. Nearly all of the recent heroin users injected. Small numbers reported using homebake heroin recently. The majority of recent heroin users reported mainly using ‘white/off-white’ coloured heroin compared to ‘brown’ heroin.

Methamphetamine

The IDRS distinguishes between methamphetamine powder (‘speed’), methamphetamine base, and crystal methamphetamine (‘ice’ or ‘crystal’). Almost four-fifths (77%) of the sample reported using one or more forms of methamphetamine recently on a median of 32 days. Recent speed use remained fairly stable, as did the recent use of base, while the recent use of ice/crystal increased from the previous year from 57% in 2011 to 66% in 2012. Ice/crystal was the form mainly used by the sample, followed by speed. Small numbers reported using any form of methamphetamine daily.

Cocaine

The recent use of cocaine remained low in the ACT with 16% reporting use in the preceding six months. The median days of use also remains low at two days, ranging from one to sixty-three days.

Cannabis

Most participants (81%) reported recent cannabis use. Daily use was common. Smoking cannabis in cones was more common than joints. Hydroponic cannabis continued to dominate the market.

Other opioids

Around half of the national sample reported recent use of methadone (any form) and around one-quarter reported recently injecting. Twenty-four percent of the sample reported the use of illicitly obtained methadone liquid in the six months preceding interview, and 8% the recent use of illicitly obtained methadone tablets (Physeptone).
Ten percent of the sample reported use of prescribed buprenorphine in the six months preceding interview and 20% the use of illicitly obtained buprenorphine.
Small numbers of the sample reported using prescribed buprenorphine-naloxone ‘tablet’, and buprenorphine-naloxone ‘film’; similar to proportions reporting the illicit use of these forms.
The recent use of prescribed morphine was reported by 9% of the sample compared to 30% for ‘illicit’ morphine
Recent prescribed oxycodone use was reported by just 2% of the sample compared to 34% for illicit oxycodone in the last six months.

Other drugs

Around two-thirds (70%) of the sample reported using ecstasy in their lifetime with 12% reporting use in the last six months.
While fairly large proportions of participants reported having used hallucinogens at some stage in their lifetimes (77%), recent use remained fairly low, with seven percent reporting use in the six months preceding interview.
Half of the sample reported using some form of alprazolam in their lifetime, with the majority of those reporting illicit use.
The majority (76%) of the sample had reported the use of benzodiazepines (including alprazolam) at some stage in their lifetime. Sixty-three percent reported the recent use of benzodiazepines on a median of 48 days. Only small numbers (7%) reported recently injecting benzodiazepines on a median of six days in the last six months.
Thirteen percent of the sample reported recently using pharmaceutical stimulants on a median of five days in the last six months.
The lifetime use of Seroquel® was reported by 52% of the sample, 20% reported recently using Seroquel®.
Lifetime use of inhalants was reported by19% of the sample; however, only small numbers reported using inhalants in the last six months (3%).
Two-thirds of the sample reported having drunk alcohol in the preceding six months, with those who had consumed alcohol having done so on an average of twice weekly. Almost a quarter (23%) of the sample reported daily use of alcohol.
As in previous years, tobacco was widely used among the 2012 sample, with 94% having used it in the preceding six months. The vast majority of participants were daily smokers.

Drug Market: price, purity, availability and purchasing patterns

Heroin

Heroin was typically $50 per cap and remained stable compared to 2011. The median price for a gram was $300. The majority of the participants reported heroin purity as ‘medium’. Heroin was considered either ‘easy’ or ‘very easy’ to obtain in the last six months and this was stable. The most common source when purchasing heroin was through a known dealer or friend. The most common place of purchase was at an agreed public location.

Methamphetamine

Methamphetamines were reported to be around $50 per point for speed, $20 for base and $100 for ice/crystal. Price was considered as ‘stable’ over the last six months by the majority of participants. The purity of speed was considered ‘medium’, base ‘low’ and ice/crystal ‘high’. All forms for methamphetamine were generally considered ‘easy’ or ‘very easy’ to obtain. Participants purchased all forms of methamphetamine from a variety of sources, most commonly friends and known dealers. An agreed public location was the most common place of purchase.

Cocaine

Small numbers were able to comment on the price, purity, availability and purchasing of cocaine. The price of a gram and a cap of cocaine were $350 and $50 respectively. The purity of cocaine was considered ‘medium’ with most reporting purity as stable over the last six months. The availability of cocaine was reported as ‘easy’ to obtain. Purchasing from a friend and known dealers.

Cannabis

The median cost of a gram of hydroponic cannabis was $20. While the median cost of an ounce of hydroponic cannabis was $290. Price for both forms of cannabis (bush and hydroponic) was reported as ‘stable’ over the last six months. Participants reported the potency of hydro as ‘high’ and bush ‘medium’. This remained stable over the last six months. The availability of both forms of cannabis was considered ‘very easy’ or ‘easy’ to obtain. Either form of cannabis was typically purchased through a friend or known dealer from either a friend or dealer’s home.

Methadone

The majority of those who commented reported the price of ‘illicit’ methadone syrup to be a median of $1 per millilitre. Reports on the availability of ‘illicit’ methadone were mixed with 42% reporting it as ‘easy’ to obtain, 37% reporting it as ‘difficult’ to obtain and 21% reporting it as ‘very easy’ to obtain. Price and availability remained stable over the last six months. The majority of participants reported purchasing methadone through a friend, usually home delivered.

Buprenorphine

Only very small numbers commented on the price, purity and availability of buprenorphine in the ACT. The availability of ‘illicit’ buprenorphine was reported as ‘very easy’ or ‘easy’ to obtain. Both price and availability were reported as stable over the last six months. The most common source was through a friend, usually home delivered.

Buprenorphine-naloxone

Only one participant was able to comment on the price and availability of illicit buprenorphine-naloxone (Suboxone®). As such, median price and availability will not be reported for the ACT for 2012. Please see the National IDRS report for further information.

Morphine

The median price for each brand of ‘illicit’ morphine remained stable over the last six months. Half reported that ‘illicit’ morphine was ‘easy’ to obtain whilst 29% reported it to be ‘difficult’. The majority reported purchasing ‘illicit’ morphine through a friend most commonly at a friend’s home

Oxycodone

Only small numbers were able to comment on the prices of illicit oxycodone with the majority reporting the price had remained stable over the previous 6 months. Reports of availability were mixed with 60% reporting the availability of ‘illicit’ oxycodone as ‘easy’ or ‘very easy’, while 40% reported availability as ‘’very difficult’ or ‘difficult’. The majority reported purchasing ‘illicit’ oxycodone through a friend or street dealer.

Health-related trends associated with drug use

Overdose and drug related fatalities

About a third (30%) of IDRS participants had experienced a heroin overdose in the past 12 months. Eight-five percent of participants who had experienced a heroin overdose in the past year reported receiving treatment immediately after the overdose.

Drug treatment

Over half (54%) of the IDRS sample reported current treatment, mainly methadone with a median of 72 months in treatment.

Hospital separations

The number of opioid-related hospital separations remained stable between 2007/08 and 2008/09, the most recent data available at the time of publication. Separations relating to opioid use were higher than for methamphetamine at the national level, and figures for the latter remained relatively stable.
Cocaine-related hospital separations remained low relative to those for heroin and methamphetamine. Cannabis-related separations have remained relatively stable between 2007/08 and 2008/09.

Injecting risk behaviours

Needle and syringe programs were by far the most common source of needles and syringes in the preceding six months (97%), followed by chemists (44%). Receptive sharing (‘borrowing’) of needles/syringes was reported by 8% of participants in the month preceding interview, usually with a regular sex partner. While 17% reported that somebody had used a needle after them (lent) in the month preceding interview.
The majority of IDRS participants reported last injecting in a private location (90%), with smaller proportions last injecting in a public location such as in a public toilet, on the street or in a car. Almost two-thirds (16%) of the IDRS sample experienced an injection-related problem in the preceding month, most commonly significant scarring or bruising and difficulty injecting (e.g. in finding a vein).

Blood-borne viral infections

In Australia, hepatitis C virus (HCV) continued to be more commonly notified than hepatitis B virus (HBV). The prevalence of human immunodeficiency virus (HIV) among those people who inject drugs in Australia has also remained stable at relatively low rates over the past decade, with HCV more commonly reported.

Alcohol use disorders Identification test - consumption

Sixty-four percent of males and 50% females scored 5 or more on the AUDIT-C, indicating the need for further assessment.
The mean score on the AUDIT-C was 5.9 among those who drank alcohol recently.

Mental health problems and psychological distress

Thirty-five percent of the IDRS sample self-reported a mental health problem in the preceding six months, most commonly depression (80% of respondents) and/or anxiety (51%).
Around half of those who had experienced a problem reported attending a mental health professional in the preceding six months.
Fifty-nine percent of participants who reported experiencing a mental health problem had been prescribed medication for this problem during the past six months, most commonly benzodiazepines (80%), antidepressants (50%) and/or antipsychotics (44%).
Higher levels of psychological distress, as measured by the Kessler Psychological Distress Scale (K10), were reported by the IDRS sample compared to the Australian general population, with 26% reporting ‘high’ distress (7.4% in the general population) and 27% reporting ‘very high’ distress (2.4% in the general population). Those reporting a ‘very high’ level of distress have been identified as possibly requiring clinical assistance.
IDRS participants scored a mean of 34.9 for the mental component score and 42.3 for the physical component score on the Short Form 12-item Health Survey (SF-12).
IDRS had significantly lower mental and physical component scores compared to the Australian population.
Scores indicated that IDRS participants had poorer mental and physical health than the population average.

Health service assess

The majority of participants reported visiting a GP in the last four weeks on a median of two occasions, followed by an OST doctor on a median of one occasion in the last four weeks. One-third (29%) of those who saw a GP reported visiting on one occasion for a substance use reason and 72% of those who saw an OST doctor had visited on one occasion for a substance use reason.

Driving risk behaviour

Driving under the influence of alcohol was reported by 28% of participants who had driven in the preceding six months. Seventy-seven percent of recent drivers reported driving soon after taking an illicit drug during that time (mainly heroin). The median time between taking drugs and driving was 30 minutes (range=1-720 mins).
Random roadside saliva drug driving testing was introduced into the ACT during 2012 and two participants reported having been saliva drug tested with no positive results reported.

Law enforcement-related trends associated with drug use

Reports of criminal activity

Participant reports of criminal activity remained stable compared to previous years, with 35% of the sample reporting engagement in criminal behaviour in the preceding month. The most common types of crime committed were drug dealing and property crime.

Arrests

Twenty-two percent of the national sample reported having been arrested in the preceding 12 months.
The most recent indicator data available on consumer and provider arrests were for the financial year 2010/11. In 2010/11, numbers of consumer and provider arrests for ‘all drugs’ were lower than 2009/10 numbers.
The number of arrests for amphetamine-type stimulants (including Phenethylamines such as 3,4-methylenedioxymethamphetamine [MDMA]) and cannabis were less, while arrests for cocaine were higher.
Cannabis arrests continued to account for the majority of all drug-related arrests in Australia.

Expenditure on illicit drugs

Among the sample who commented, 69% reported spending money on illicit drugs the day before interview. The median amount spent by those who had purchased drugs was $80.

Special topics of interest

Fägerstrom Test for Nicotine Dependence

Among those who reported daily smoking, half reported having their cigarette within the first five minutes of waking. Thirty-eight percent of daily smokers reported smoking between 11-20 cigarettes a day.
Thirty-eight percent of daily smokers also found it difficult to refrain from smoking in forbidden places.
Two-thirds reported that they would hate giving up the first cigarette in the morning.
Nearly half of daily smokers scored 6 or above indicating high/very high nicotine dependence. The mean Heavy Index Score was 4.9.

Pharmaceutical Opioids

Sixty-seven percent of the sample recently used pharmaceutical opioids such as methadone, oxycodone.
Of those who recently used pharmaceutical opioids, over half reported using them to treat self-dependence and around one-third for pain relief.
Twenty-two percent of those who commented reported being refused pharmaceutical medications due to injecting history.
Of those who commented, 33% were prescribed pharmaceutical medications for pain relief in the six months.
Of those who commented, 40% reported sourcing information about pill filtering from an NSP.

Brief Pain Inventory

One-quarter of the national sample experienced pain (other than everyday pain) on the day of interview.
Of those who experienced pain, 84% reported the pain as chronic non-cancer pain and 16% acute pain.
The mean ‘pain severity score’ was 4.0, and the mean ‘pain interference score’ was 4.4.
The mean score for ‘relief from pain medication’ was 3.4.
Of those who experienced pain, around half reported trouble obtaining pain relief medication in the last six months.

Opioid and Stimulate Dependence

Of those who recently used a stimulant drug (mainly methamphetamine) and commented, the median SDS was 3.0, with 49% scoring four or above indicating dependence.
Of those who recently used an opioid drug (mainly heroin) and commented, the median SDS score was 7.0, with 66% scoring five or above indicating presence of dependence.

Injection-related injuries and diseases

The IDRS gathered information on injection-related injuries and diseases which were then compared to the injection-related injuries and diseases project.
The most common injection-related injury reported ever by the IDRS sample and in the IRID project was a dirty hit (71% and 68% respectively).
In the last six months, the most common injection-related injuries or diseases reported by the IDRS sample was swelling near the injection site (33%).

Neurological history

Life prevalence of epilepsy and cerebrovascular disease (e.g. stroke) was higher in the IDRS sample than the general population.
About half of the IDRS sample reported a lifetime history of a Traumatic Brain Injury on a median of three occasions.
The median age of most severe Traumatic Brain Injury was 24 years.
About one-third of the group reported being under the influence of alcohol, and 38% were under the influence of at least one drug (mainly heroin) at the time.

Possession laws

Eighty-five percent of the sample believed the quantity of drugs they were caught with would affect the type of charge received.
Of those who believed this, the median number of two grams for heroin and methamphetamine was the quantity thought to affect the type of charge.