Executive summary

Demographic characteristics of injecting drug users (IDU)
One hundred and fifty seven IDU participated in the 2004 IDRS. Sixty-eight percent were male, 83% were unemployed and the average age of respondents was 34 years. Fifty-eight percent had not completed any further education after school, 40% had obtained a trade or technical qualification and 3% had completed a university degree. Sixty seven percent had a previous prison history. The average age of first injection was 20.1 years.

Patterns of drug use among IDU:

Heroin
Consistent with previous years, the vast majority of the IDU sample nominated heroin as their drug of choice (78%), the drug they had injected most often in the month preceding interview (80%) and the most recent drug they had injected (80%). However, the median number of days’ use in the preceding six months has decreased quite markedly from 170 days in 2003 to 120 days in 2004. In accordance with this, the proportion of IDU reporting daily heroin use1 in the preceding six months decreased further from 47% in 2003 to 38% in 2004, which is consistent with increasing numbers reporting current engagement in drug treatment (47% in 2003 to 60% in 2004). There were fewer IDU reporting daily use than prior to the heroin shortage in 2001.

The median price for a gram of heroin ($300) and a cap of heroin ($50) remained stable in 2004. Prices remained higher than those reported in 2000.

Heroin availability remained similar to 2003 levels, with the overwhelming majority (93%) of IDU reporting that heroin was ‘easy’ to ‘very easy’ to obtain (compared to 91% in 2003). Sixty-six percent thought that availability had remained stable (70% in 2003). Seven percent reported that heroin was ‘difficult’ to obtain (no change from 2003) and 18% (20% in 2003) thought it had become more difficult.

Seventy-four percent of IDU thought that heroin was of ‘low’ to ‘medium’ purity. NSW police seizure data indicated that the median purity of low-level heroin seizures remains low (approximately 30%) and has not returned to levels reported prior to 2001.

Key Expert comments on the price and availability of heroin were consistent with IDU reports.

The indicator data analysed showed relatively stable rates in 2003/2004 (compared to the previous year) of recorded police incidents for heroin possession/use; ambulance callouts to heroin overdoses; detections of heroin in suspected drug-related deaths; and overdose presentations to emergency departments. Numbers across these data collections remained substantially lower than figures recorded prior to 2001, suggesting that the NSW heroin market has not returned to pre-shortage levels.

Methamphetamine
Fifty six percent of IDU had used some form of methamphetamine (speed, base or ice) in the preceding six months, a proportion comparable to 2003 (53%). Similar proportions reported use of speed (35%; 31% in 2003) and base (31%; 32% in 2003), while there was a slight increase in proportions using ice (45%; 38% in 2003).

A ‘point’, i.e. 0.1 of a gram, was a popular purchase amount for all three forms of methamphetamine, and the median price remained stable at $50 for speed, base and ice.

Speed remained readily available with 79% of IDU commenting reporting that it was ‘very easy’ or ‘easy’ to obtain, and that availability had remained stable (68%). Base was also ‘easy’ or ‘very easy’ to obtain (77%), with availability remaining stable (63%). Availability of ice increased substantially in 2003, with 79% reporting that it was ‘easy’ to ‘very easy’ to obtain. These figures remain similar to those reported in 2003, and consistent with this, 58% of IDU commenting thought that ice availability had remained stable.

Key Experts reported on a range of methamphetamine forms, with ice the most commonly mentioned, and comments were consistent with those of IDU. Indicator data presented a rather mixed picture, with some indicators remaining higher in the last twelve months than previously (e.g. recorded incidents of possession/use, calls to telephone helplines), while others have remained relatively stable (amphetamine related deaths) or decreased (overdose).

Cocaine
The prevalence and frequency of cocaine use remained relatively low following a substantial decrease in 2003. Forty-seven percent of IDU reported cocaine use in the preceding six months (compared to 53% in 2003 and 79% in 2002) and the median number of days’ use remained at approximately once per month (6 days), as compared with five days in 2003 and 24 days in 2002. Prevalence rates were the lowest reported since 1997.

Availability also remained similar to 2003, with 29% reporting it ‘difficult’ or ‘very difficult’ to obtain, compared with 33% in 2003. Sixty-six percent thought it was ‘easy’ or ‘very easy’ (compared with 66% in 2003, and a decrease from 74% in 2002). Just over half the sample (55%; comparable to 54% in 2003) thought availability had remained stable, while 20% thought it had become more difficult (28% thought so in 2003).

The median price for a gram of cocaine has increased for the first time since the commencement of the IDRS in 1996, with prices for other amounts remaining stable.

Key Expert comments and indicator data were generally consistent with those of IDU.

Cannabis
The cannabis market has remained relatively unchanged since the commencement of the IDRS, and the majority of IDU (79%) continued to report cannabis use. Frequency of use among these IDU remained at 180 days (daily use) in 2004.

The price of hydroponic cannabis was $20 per gram and the overwhelming majority (95%) of IDU reported that it was readily available. The price per gram of bush cannabis was the same as for hydro ($20), but larger amounts were slightly cheaper than for hydro. Bush was less readily available, with 54% reporting it to be ‘easy’ to ‘very easy’ to obtain. Potency of hydroponic cannabis was reported to be ‘high’ and bush was reported to be ‘medium’.

Key Expert reports on cannabis were consistent with those of IDU. Indicator data also reflected the stability of the market, with very little change occurring over the past year.

Use of illicit pharmaceuticals:

Illicit Methadone
Almost one third of IDU reported use of illicit methadone syrup in the preceding six months (an increase from 18% in 2003), although the number of days on which they had done so remained relatively sporadic (approximately once per month). Approximately half of this group had been engaged in methadone treatment during this period, indicating that methadone was being diverted to IDU engaged in treatment, as well as to those who were not.

Just over one fifth (22%) of IDU reported injecting illicit methadone syrup in the preceding six months, and just over half (60%) of this group were engaged in methadone treatment during this period.

Fifteen percent of IDU reported illicit methadone syrup as the form they had used most in the preceding six months, 13% (n=3) of whom were engaged in treatment in the preceding six months.

Illicit methadone was considered to be readily available with 72% reporting that it was ‘easy’ to ‘very easy’ to obtain. A quarter reported it was ‘difficult’. Twenty-five percent of IDU reported buying illicit methadone in the past six months, primarily from street dealers and friends.

Smaller proportions of IDU reported using illicit physeptone tablets (1%; n=2) in the preceding six months, one of whom was engaged in methadone treatment.

Illicit Buprenorphine
Small percentages (8%) reported the use of illicit buprenorphine in the preceding six months, with only a minority (8%, n=1) reporting engagement in buprenorphine treatment during this period. Five percent of IDU reported injecting illicit buprenorphine in the preceding six months on a median of two days, none of whom were in treatment. Eight percent of IDU reported illicit buprenorphine as the form they had used most in the preceding six months, one of whom was engaged in treatment. These figures are comparable to 2003 data.

Morphine
Prevalence of morphine use (29%) and injection (25%) in the preceding six months has increased slightly since 2001. Frequency of morphine use has remained relatively stable at a median of four days. Morphine was predominantly obtained from illicit sources. MS Contin was the most common brand of morphine used, with 100mg tablets costing a reported median price of $20. Twenty-one percent reported buying morphine (15% in 2003), predominantly from street dealers.

Morphine was not considered to be readily available, although larger proportions than previous years reported it to be ‘easy’ (30%) to ‘very easy’ (23%) to obtain.

Other opioids
The proportion of IDU reporting recent use and injection of other opioids such as pethidine and codeine remained stable at 22% (use; 23% in 2003) and 4% (injection; 2% in 2003). Frequency of use remained stable (median of six days, compared to five days in 2003). Panadeine Forte, a pharmaceutical drug containing 30mg codeine, continued to be the main form used and approximately half (53%) of those reporting other opioid use had obtained them illicitly.

Benzodiazepines
Despite a restriction in the availability of benzodiazepine gel capsule preparations (Euhypnos, Nocturne, Normison & Temaze) being introduced on 1 May 2002, and the subsequent removal from these drugs from the pharmaceutical market in March 2004, IDU continued to use and inject benzodiazepines. Prevalence of benzodiazepine use and injection remained relatively stable at 67% and 13%, respectively (62% and 19% in 2003). However, the median number of days on which benzodiazepines were used increased sharply (60 days in 2004 as compared with 18 days in 2003) and the median number of days on which they were injected decreased (9 days in 2003 as compared with 20 days in 2003). Among those reporting daily use, 30% (n=9) reported intravenous use in the preceding six months. Half the sample reported benzodiazepines reported sourcing them illicitly, and Valium/diazepam, Serepax/oxazepam and Normison/temazepam were the most commonly reported forms used.

Associated harms
The proportion of IDU sharing needles increased, with 13% reporting that they had used a needle after someone else in the preceding month (7% in 2003) and 21% reporting that someone else used a needle after them (12% in 2003). The proportion reporting shared use of other injecting equipment such as filters and water also increased slightly (52%, compared to 43% in 2003).

Since 2001, there has been a steady increase in the proportions of IDU reporting a private home as both their usual injection location (from 55% in 2001 to 69% in 2004) and the location of their last injection (from 47% in 2001 to 64% in 2004). Less than a fifth of IDU reported that their usual location was a public place (17%; as compared to 42% in 2001) and less than a quarter reported it as their most recent location for injection (24% in 2004, as compared to 49% in 2001). Twelve percent reported that they usually injected at the Medically Supervised Injecting Centre in Kings Cross, and 11% reported it had been the location in which they had last injected (these figures were 8% and 7% in 2003, respectively).

Sixty-four percent of IDU reported injection related health problems in the past month (compared to 60% in 2003), with 38% reporting multiple problems (from 30% in 2003). Consistent with previous years, prominent scarring/bruising of injection sites (46%) and difficulty injecting (40%) were the most frequent problems reported. Over half of the sample (61%) reported ever having overdosed. Two percent reported an overdose in the month preceding interview, while figures for overdose within the past twelve months were slightly higher at 16%.

There was little change in the proportion (83%) of IDU who reported spending money on drugs on the day prior to interview, although the median amount of money spent decreased slightly from $100 in 2003 to $80 in 2004. Decreases were also observed in the proportions who had spend $100 or more (from 46% in 2003 to 36% in 2004) and $200 or more (from 23% in 20003 to 13% in 2004).

Half the sample (53%) of the sample reported experiencing a mental health problem other than drug use in the preceding six months, and 60% of this group reported seeking advice from a mental health professional during this time (usually a GP). Depression continued to be the most commonly reported mental health problem (24%, compared to 16% in 2003), followed by anxiety (10%; 5% in 2003).

Proportions reporting involvement in criminal activity in the month preceding interview (51%) remained relatively stable, and the most commonly reported offences were property crime (33%; 31% in 2003) and drug dealing (28%; 36% in 2003). Forty-three percent of IDU had been arrested in the previous twelve months, representing little change from 49% in 2003. As in previous years, approximately two thirds of IDU perceived that police activity had increased in the preceding six months. Half the sample reported that this activity had had an impact on their ability to obtain drugs, representing an increase from 33% who said so in 2003.

Implications
The findings of the 2004 NSW IDRS indicate that further attention is required in the following areas:

Further research into drug trends and associated harms of methamphetamine use studying a group of primary methamphetamine users (McKetin et al., in preparation).
Development of effective treatment programmes for methamphetamine users, and development of strategies to engage and retain users in these programmes.
More detailed research into the nature of the cocaine market (that supplies IDU) in Sydney.
Careful monitoring by medical practitioners relating to the diversion of methadone and other opioids. Increasing trends towards this have been noted in other jurisdictions.
Ongoing surveillance of patterns and prevalence of benzodiazepine use, and careful monitoring by medical practitioners of the clinical need for their prescription.
Increasing focus on the development of educational material regarding overdose and the dangers of sharing injecting equipment other than needles.
Increase awareness of the need for treatment of the concomitant mental health problems that many IDU may be experiencing in addition to their drug dependence. Despite the fact that many IDU were aware that they had such problems, relatively few were receiving help for them. The patterns of comorbidity among this group need to be assessed and effective methods of intervention considered in future work. In particular, the likelihood that comorbid mental health problems may affect treatment outcome needs to be acknowledged and addressed by both mental health and drug treatment services.

Citation: Black, E., Degenhardt, L. and Stafford, J. (2005) NSW Drug Trends 2004: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.