Cocaine and ketamine use up, ecstasy down: reports reveal the major trends in Australian drug use during 2021

UNSW Sydney’s National Drug and Alcohol Research Centre (NDARC) has released its annual reports into trends in drug use across Australia.

The first report, based on the National Ecstasy and related Drugs Reporting System (EDRS), presents the results of interviews with 774 people from across Australian capital cities who regularly use ecstasy and other illicit stimulants.

The second report, based on the Illicit Drug Reporting System (IDRS), reveals insights from interviews with 888 people in Australia’s capital cities aged 18 years or older who injected illicit drugs at least once monthly in the preceding six months.

Program lead for Drug Trends, Dr Rachel Sutherland, said the results from the EDRS and IDRS interviews were not representative of all people who consume illicit drugs, nor of illicit drug use in the general population.

“These data are intended to provide evidence indicative of emerging issues that warrant further monitoring,” she said.

Dr Sutherland said the EDRS report revealed significant changes in drug use in 2021.

“Among our sample of people who regularly use ecstasy and other illicit stimulants, we found a significant increase in people reporting the use of cocaine, ketamine, non-prescribed pharmaceutical stimulants, hallucinogenic mushrooms, and e-cigarettes,” she said.

“In contrast, there was a significant decrease in ecstasy use.”

Significant changes – all captured in the report as percentage of people in the sample reporting use in the past six months – include:

• Cocaine use increased from 68 per cent in 2020 to 80 per cent in 2021, the highest per cent observed since national monitoring began in 2003, although frequency of use remained low, with 7 per cent of people reporting weekly or more frequent use.
• Ecstasy capsules use declined, from 83 per cent in 2020 to 70 per cent in 2021, as did the use of ecstasy pills (53 per cent in 2020 to 42 per cent in 2021) and ecstasy powder (35 per cent in 2020 to 26 per cent in 2021). The price of all forms of ecstasy significantly increased in 2021, and there were significant declines in the perceived purity and availability of ecstasy capsules and crystal, suggesting a disruption to the MDMA market compared to 2020.
• Ketamine use increased from 43 per cent in 2020 to 52 per cent in 2021, representing the largest per cent reporting recent use since monitoring began. Frequency of use, however, remained low and stable at a median of three days in the past six months.
• Non-prescribed pharmaceutical stimulants use increased from 39 per cent in 2020 to 46 per cent in 2021, as did hallucinogenic mushroom use (30 per cent in 2020 to 45 per cent in 2021), although frequency of use remained low for both.
• Almost three-fifths (58 per cent) of the national sample reported using e-cigarettes, an increase from 39 per cent in 2020. Frequency of use also increased, from a median of 7 days in 2020 to 30 days in 2021.

“These fluctuations, particularly in the illicit drug market, are cause for concern,” said Dr Sutherland.

“Further, most of these surveys occurred before the current wave of COVID-19 cases and government restrictions, so it is possible that there may have been even further fluctuations in drug use and markets. Using illegal drugs always carries risk, but this risk can be exacerbated in volatile markets.”

Dr Sutherland said even a decrease in drug use could bring worrying consequences with it.

“Some would think that a decrease in ecstasy use could be seen as a positive change, but we have to be mindful that many people have stopped or reduced their use of ecstasy due to fewer opportunities to use the drug in lockdown, because of fewer music festivals, dance parties, and social gatherings. This means there could now be a decrease in people’s tolerance to ecstasy,” said Dr Sutherland.

“As we come out of lockdown, and people start to resume or increase their use of drugs like ecstasy, there may be increased risk of overdose. We encourage anyone who uses drugs, particularly those who are resuming use after a period of abstinence or reduced use, to employ harm reduction strategies - use caution when dosing, start low and go slow.”

Worrying increase in methamphetamine use 

The second report released by the Drug Trends program included interviews with 888 people who regularly inject illicit drugs as part of the Illicit Drug Reporting System (IDRS). Like the EDRS report, participants report on drug use in the past six months.

In 2021, 80 per cent of participants reported methamphetamine use, higher than the 72 per cent observed in 2020, although similar to the 78 per cent observed in 2019.

“The increase in methamphetamine use is extremely worrying, as are the findings that frequency of use increased from a median of 48 days in 2020, to 72 days in 2021,” Dr Sutherland said.

The report also found that the cost of a point of crystal methamphetamine (‘ice’) decreased from $100 in 2020 to $50 in 2021, which is similar to prices that were observed in 2016-2019. There was also an increase in participants perceiving the purity of crystal methamphetamine to be ‘high’, as well as an increase in participants perceiving availability to be ‘easy’ or ‘very easy’.

“Last year, our findings seemed to indicate that there was a disruption to the methamphetamine market. It appears that the market may have since recovered, although there are likely to be jurisdictional differences and ongoing fluctuations,” said Dr Sutherland.

“We are concerned that this potential recovery of the methamphetamine market, combined with increases in use, could lead to an increase in hospitalisations, and may also result in increased treatment demand. Given that many of these services are already at capacity, greater investment in methamphetamine treatment and support is critical.”