In 2013, for the eleventh consecutive year, the Australian Capital Territory (ACT) Ecstasy and Related Drugs Reporting System (EDRS) provides an opportunity to examine trends within the ACT through interviews with a sentinel group of people who regularly use ecstasy or other psychostimulant drugs ‘regular psychostimulant users’ (RPU), interviews with key experts (KE), and the collation of indicator data. This is done with the aim of informing further research and contributing to the evidence base from which policy decisions can be made. The continued monitoring of ecstasy and related drug markets within the ACT for changes in the price, purity, availability, use patterns and issues associated with drug use will add to our understanding of drug markets and our ability to inform policies to minimise harms. The findings of the 2013 ACT EDRS indicate that further attention is required in the following areas:

Polydrug use
As in previous years, the majority of ACT EDRS participants in 2013 were polydrug users. Ninety-four percent of participants reported that the last time they used ecstasy or other psychostimulants, they had used other drugs at the same time. The drugs most commonly used in combination with psychostimulants by RPU were ecstasy, tobacco, alcohol, cannabis and speed. Polydrug use can increase or alter adverse effects in ways that are often unpredictable and problems relating to intoxication may be enhanced due to the drug interactions arising from polydrug use. Treatment approaches and harm reduction interventions need to take this into account, especially in relation to the effects of drugs, safer use, withdrawal and overdose risk.

Ecstasy
This year we began gathering data on MDMA crystals in response to reports last year indicating the arrival of this form in the market. This introduction of MDMA crystals has not seen an increase in overall use of ecstasy, suggesting that RPU are using diverse forms and in some cases may be changing their preferred form. Despite the diversification of forms used, there was no significant change in frequency or level of ecstasy use compared to 2012.

Alcohol
The use of alcohol remains problematic amongst RPU, with use occurring once to twice a week. Furthermore, high proportions of RPU report using alcohol during binge sessions. In the 2013 EDRS, RPU were administered the Alcohol Use Disorders Identification Test (AUDIT). Using this measure, 11% of respondents scored in Zone 4 of the AUDIT, indicating the need for evaluation for possible alcohol dependence. KE also reported that alcohol use was common amongst RPU and that binge drinking was frequent.

Alcohol was one of the main drugs associated with recurring social and relationship problems, legal problems and increased exposure to risky situations. While it is important to focus on the risks associated with illicit drug use, the excessive use of alcohol is of great concern amongst this group, as this type of polydrug use carries a high level of risk.

Cannabis
The use of cannabis also remains high and problematic. The median frequency of use has decreased in 2013 to approximately every second day but this decrease is not considered statistically significant. As in previous years, cannabis was commonly reported as a drug associated with recurring social and relationship problems, legal problems, increased exposure to risky situations and recurring problems associated with lack of responsibility at home, work or study. Efforts to target users with information concerning harms associated with its use, including dependence and comorbid mental health problems, remain important.

Other drugs
In 2013 smaller proportions of RPU reported using antidepressants, heroin, methadone, buprenorphine, other opioids, GHB, MDA, ketamine and pharmaceutical stimulants. This may be due to the younger age of the 2013 cohort demonstrating they are less experienced than their older counterparts. Measures to engage this younger group with health messages is important.