Executive summary

In 1995 the National Drug and Alcohol Research Centre was commissioned by the Commonwealth Department of Health and Family Services (CDHFS) to revise the Illicit Drug Reporting System (IDRS) first implemented in Australia in 1989. It was intended that the revised system provide a co-ordinated approach to the monitoring of data associated with the use of opiates, cocaine, amphetamines and cannabis, and that this information act as an early warning indicator of the availability and use of the main drug categories.

As part of a 12 month trial for a revised Illicit Drug Reporting System, NDARC conducted a quantitative survey of injecting drug users (IDU), supplemented with qualitative key informant interviews with professionals working in the drug field and illicit drug users. Issues such as drug of choice, route of administration, type and number of illicit drug users, intensity of illicit drug use, drug-related problems, manufacture and distribution of drugs, price and purity, and reactions to government strategies were considered by both the quantitative IDU surveyand qualitative key informant methods. Additional indicators from other surveys, health and law enforcement data bases were also collected. An ethnographic component to the trial is reported elsewhere (Maher, 1996).

Survey of injecting drug users (IDU)
One hundred and fifty-two injecting drug users from inner and south western Sydney were interviewed between October 1995 and February 1996. The IDU were recruited using multiple methods including advertisements in rock magazines, and needed to satisfy the entry criteria of having injected at least monthly in the 6 months prior to the interview. Interviews were conducted at places convenient to the IDU, such as coffee shops and hotels, taking 20-30 minutes to administer.

It was anticipated that IDU would be well placed as a sentinel group to report on trends over a wide variety of drug classes and analysis confirmed subjects were clearly polydrug users, familiar with a range of drugs and drug trends.

Other principal findings include the lower mean age of both the inner city (IC) and south west (SW) samples compared to that reported in previous Sydney studies. This finding was consistent with reports from the IDU themselves that there are more younger heroin users entering the market. The higher proportion of female injectors in the IC sample also deserves mention as traditionally samples of IDU have been approximately two thirds males. The data may indicate a trend toward more female injecting, which is also congruous with the perceptions of the IC sample.

A finding that has major implications is the large proportion of subjects from both geographical areas who had made a transition from amphetamine injecting to heroin injecting. This may well be the source of new and younger heroin users. The high rates of injection of methadone syrup and the use of benzodiazepines among both samples should also be noted.

Key informant study
A total of forty-four key informants, including professionals recruited from health, law enforcement, research and outreach fields, and users from both treatment and non-treatment sources were interviewed as part of the key informant study, representing a range of illicit drug use patterns.

In order to compare the efficacy of techniques, interviews were conducted with key informants in a group setting and, for a proportion of participants, on an individual basis also. The majority of key informants (90%) were contacted following the group discussions for evaluation purposes, as well as being provided with a summary of the group findings to indicate the extent of their agreement with comments made.

Key informants suggested, and most agreed, that the following trends in illicit drug use had occurred during the last 12 months:

Opiates

The average age of heroin users had decreased;
There had been an increase in heroin smoking in southwest Sydney among both Asian and non-Asian populations;
Methadone clients and heroin injectors throughout Sydney were using increasing amounts of benzodiazepines, & inner city populations were using more cocaine;
There was an increased risk of overdose among heroin injectors from concurrent alcohol and other drug use;
An increase in methadone injection had occurred;
There was increased risk of HCV transmission;
The availability of heroin had increased in southwest Sydney;
More people were travelling to Cabramatta to purchase heroin.

Stimulants

Amphetamine injection had increased;
There was an indication that some primary amphetamine users were making a transition to regular heroin use;
The purity and price of amphetamine had decreased and its availability increased;
There had been an increase in cocaine injection among some inner city injectors, and intranasal use had increased among inner city professionals;
There were more cocaine-related problems including health problems and violence;
The price of cocaine had decreased and its availability had increased;
The availability of MDMA had increased.

Cannabis

The popularity of hydroponically grown cannabis had increased, with equipment being cheaper, more available and of a higher quality;
The quality and supply of cannabis had become more consistent with the increased use of hydroponics.

Other indicators
A range of early warning indicators available on an annual basis were sought which would complement and validate the original data, including general and special population survey data, and health and law enforcement data. Ideally, these indicators needed to also: be nationally available, be in an accessible format, not require any special collections, be collected annually, include 50 or more cases, be brief, be collected in the main study site, and include details on the main illicit drug types. Except for AOD telephone advisory data and law enforcement statistics, few indicators were collected annually, satisfying the early warning criteria. The following summary of indicators was thus expanded to include additional data which met the remaining criteria and improved our understanding of the illicit drug situation.

In terms of previous survey findings, the national household surveys indicate that cannabis and amphetamine have remained the most popular illicit drugs during the 1990s, particularly among males and young adults. Cocaine and heroin were less commonly used by the general population. An increase in MDMA use was noted between 1991-1993. Targeted surveys of homeless and detained youth found that they were large consumers of illicit drugs, more so than secondary school students. Persons from non-English speaking backgrounds were unlikely to use most illicit drugs. Cannabis use was higher among Aboriginal persons compared to the general population. Injecting drug users were consistently found to be large polydrug users, often using most of the four main illicit drugs.

Data on the characteristics of clients presenting to drug treatment agencies in NSW and nationally show significant increases for those with primary cannabis and amphetamine problems. However, opiates remained the most frequently reported illicit drug problem. Heroin overdose, both fatal and non-fatal, was relatively common and was often related to concurrent polydrug use. The Alcohol and Drug Information Service received the most number of phone inquiries relating to cannabis during 1995, followed by heroin then amphetamine. The number of phone calls by clinicians to the Specialist Advisory Service fluctuated during 1995, although cannabis, heroin then amphetamine issues were again the most common purpose of calls. A national review of risk behaviours for HIV infection found that the self-reported rate of IDUs sharing needles remained consistently low (below 50%) since 1989, dropping to below 20% in 1994. The proportion of prisoners reporting a history of injecting was around 50%, and the considerable risk behaviour that occurs in these environments was not declining. Relatively high prevalence and incidence of HCV and HBV was noted, particularly among IDU populations.

From NSW police statistics, large fluctuations in the quantity of cannabis leaf and heroin seized by the DEA were recorded during 1995. Fewer and more consistent seizures were made of cocaine, amphetamine and MDMA. Mean purity levels of around 50% for both cocaine and heroin were recorded during 1995, with some fluctuations. Purity levels were lower and more stable for amphetamine analogues (eg. MDMA) (28%) and amphetamines (5%). According to DEA price statistics, decreases in gram and ounce purchases of heroin, and gram purchases of cannabis heads occurred during 1995. Increases in the price of gram purchases of cocaine, street gram purchases of amphetamine, and ounce purchases of cannabis heads and leaf also occurred.