EXECUTIVE SUMMARY
The 2012 NSW Trends in Ecstasy and Related Drug Markets report represents the thirteenth year in which data has been collected in NSW on the markets for ecstasy and related drugs (ERD). The Ecstasy and related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI) is the most comprehensive and detailed study of ERD markets in NSW.
 
Using a similar methodology to the Illicit Drug Reporting System (IDRS), the EDRS monitors the price, purity and availability of "ecstasy" (3,4-methylenedioxymethamphetamine; MDMA) and other related drugs such as methamphetamine, cocaine, gamma-hydroxybutyrate (GHB), d-lysergic acid diethylamide (LSD) and ketamine. It also examines trends in the use and harms of these drugs. It utilises data from three sources: a) surveys with regular ecstasy users (REU); b) surveys with key experts (KE) who have contact with REU through the nature of their work; and c) the analysis of existing data sources that contain information on ecstasy and other drugs. REU are recruited because they are considered a sentinel group to detect illicit drug trends. The information from REU is, therefore, not representative of ecstasy and other drug users in the general population, but is indicative of emerging trends that may warrant further monitoring.
 
The findings from each year not only provide a snapshot of the drug markets in NSW, but also help to provide an evidence base for policy decisions, inform harm reduction messages, and provide directions for further investigation when issues of concern are detected. Continued monitoring of the ERD markets in NSW will help add to our understanding of the use of these drugs; the price, purity and availability of these drugs and how these may impact on each other; and the associated harms which may stem from the use of these drugs.
 
Executive Summary Snapshot
Demographics
  • 100 REU were sampled in the 2012 EDRS (64 male and 36 female).
  • Participants were young (mean age = 25 years), reasonably well educated and most commonly spoke English as their first language.
  • Very few participants reported being currently in drug treatment (3%).
  • These demographics have remained relatively stable over time aside from mild variations in unemployment status and income.
 
Patterns of drug use among REU
  • Participants had experience with a wide range of drugs, having used an average of 15 different drug types during their lifetimes and 7 different drug types over the past six months.
  • One-in-five reported having ever injected a drug.
  • Reductions were seen in the recent use of ketamine and lifetime use of other opiates.
  • Ecstasy was the main drug of choice for one-third of the sample.
  • One-quarter of the group had recently binged on ERD. The median number of binge episodes was 4 in the past six months.
 
Ecstasy
Consumption Patterns
  • Ecstasy was used on a median of 12.5 days over the past six months (i.e. approximately fortnightly).
  • Participants had used a median of 2 tablets during a „typical‟ occasion of use (range 1-15).
  • Swallowing was the main route of administration (92%).
  • The majority of REU (87%) reported using other drugs in combination with ecstasy the last time they used it, most commonly alcohol, tobacco, cannabis and LSD.
  • Three-fifths (61%) of participants used other drugs to help them come down from ecstasy the last time they used it (most commonly cannabis, tobacco and alcohol).
  • Ecstasy was most commonly last used at a nightclub (41%) and other public venues.
  • The proportion of the NSW population who reported using ecstasy within the last twelve months fell significantly from 3.5% in 2007 to 3% in 2010.
  • Approximately one-quarter (27%) of men interviewed for the Sydney Gay Community Periodic Survey reported having recently used ecstasy, which was a significant decline from the 2011 survey.
  • One-quarter (25%) of women in the Sydney Women and Sexual Health Survey had used ecstasy in the last six months.
  • KE noted that ecstasy use was common among young people and different forms were being used (i.e. caps, capsules) to better control the dose they received.
 
Market Characteristics
  • Price: $25 per tablet.
  • Purity: Currently medium and fluctuating.
  • Availability: Currently easy to very easy to obtain and stable.
  • Several KE had reason to believe that the purity of ecstasy was beginning to increase after a substantial period of low purity, and that ecstasy had become more available in NSW.
  • KE reported an increase in the forms of MDMA available, including in powder and crystal form.
 
Methamphetamine
The 2012 EDRS distinguished between three different forms of methamphetamine: methamphetamine powder ("speed‟); methamphetamine base ("base‟); and crystal methamphetamine ("crystal‟).
 
Consumption Patterns
i) Speed
  • Two-thirds of REU had ever used speed and one-third had done so recently.
  • Speed was used on a median of 2 days over the preceding six months and was primarily snorted (71%).
  • The frequency and quantity of use appeared to be stable from 2011 to 2012.
 
ii) Base
  • Two-fifths of the sample had ever used base and 9% had done so recently.
  • Base was used on a median of 2 days over the preceding six months and was primarily swallowed (67%).
  • The frequency and quantity of use appeared to be stable from 2011 to 2012.
 
iii) Crystal
  • One-third of the sample had ever used crystal and one-fifth had done so recently.
  • Crystal was used on a median of 8 days over the preceding six months and was primarily smoked (83%).
  • The frequency and quantity of use appeared to be stable from 2011 to 2012.
 
  • Speed and base were commonly used in public settings, and crystal was used in a mix of private and public settings.
  • The use of methamphetamine among the NSW general population remained stable from 2007 (2.3%) to 2010 (2.1%).
  • The use of speed and crystal by respondents in the Sydney Gay Community Periodic Survey has significantly declined over time since 2008. However, a slight, though significant, increase in the proportion of participants reporting the use of crystal was reported in 2012.
  • Fifteen per cent of women interviewed in the Sydney Women and Sexual Health Survey had used speed and five per cent had used crystal recently. These figures have remained relatively stable since 2010.
  • Most KE expressed concern for crystal use and the associated acute and long term health problems. KE also reported that there was poor knowledge of stimulant treatment options amongst users.
 
Market Characteristics:
i) Speed
  • Price: $75 per gram, which is a slight decrease from 2011.
  • Purity: Currently medium to high, appears to be stable.
  • Availability: Reports variable.
 
ii) Base
  • Price: $170 per gram and reportedly stable.
  • Purity: Currently low, appears to be stable.
  • Availability: Reports variable.
 
iii) Crystal
  • Price: $50 per point and reportedly stable.
  • Purity: Reports variable for current purity and stability.
  • Availability: Currently easy to obtain and stable.
 
Key experts agreed that speed and base had become more difficult to access, however, there were mixed reports on the availability of crystal.
 
Cocaine
Consumption Patterns
  • The majority of the group (81%) had tried cocaine at least once, and 57% had used it recently.
  • Cocaine was used on a median of 3 days (i.e. once every two months) over the preceding six months.
  • The proportions using cocaine, the frequency and quantities used had all remained stable from 2011 to 2012.
  • Recent use of cocaine among the NSW general population increased significantly from 1.6% in 2007 to 2.1% in 2010.
  • Approximately one-fifth of participants in both the Sydney Gay Community Periodic Survey and the Sydney Women and Sexual Health Survey reported recent use of cocaine.
  • KE reported that cocaine users want more control over the doses consumed and their level of intoxication.
  • Poor knowledge of available drug treatments and usage amongst affluent cocaine users had also been observed by KE.
 
Market Characteristics
  • Price: $300 per gram, stable.
  • Purity: Variable although appears to have increased.
  • Availability: Currently easy to obtain, stable.
  • KE reported that cocaine purity was high, however, the purity had fluctuated. It was also noted that there were signs to suggest an increase in cocaine availability.
 
Ketamine
Consumption Patterns
  • Almost half of the sample had tried ketamine at least once and a quarter had used it recently.
  • Ketamine was used on a median of 3 days (i.e. less than monthly) over the preceding six months.
  • There was a significant decrease in proportions reporting recent ketamine use from 2011 to 2012, although quantities used remained mostly stable.
  • Recent use of ketamine among the NSW general population remained low and stable.
  • There was a significant decline in the use of ketamine among participants of the Sydney Gay Community Periodic Survey from 2008-2012.
  • Recent ketamine use amongst women interviewed in the Sydney Women and Sexual Health Survey has remained relatively stable since 2006, with six per cent reporting ketamine use in 2012.
  • KE reported that although ketamine was still available in Sydney, there had been a recent decrease in its popularity.
 
Market Characteristics
  • Price: $150 per gram, stable.
  • Purity: Currently high and stable.
  • Availability: Reports variable.
  • KE reported that the availability and popularity of ketamine was low, however, when it was seen it was commonly in powder form.
 
GHB
Consumption Patterns
  • One-fifth of the sample had tried GHB at least once and 11% had used it recently.
  • GHB was used on a median of 2 days (i.e. less than monthly) over the preceding six months.
  • The frequency and quantity of use of GHB remained stable from 2011 to 2012.
  • Recent use of GHB among the NSW general population remained low and stable.
  • From 2008 to 2012 the use of GHB among participants of the Sydney Gay Community Periodic Survey has significantly declined.
  • GHB use among LBQ women in the Sydney Women and Sexual Health Survey has remained relatively stable across time, with four per cent reporting recent GHB use in 2012.
  • KE were concerned that since GBL was often available in Sydney, irregular users may not have been informed of this and may be at risk of overdose if they took GBL when expecting to take GHB.
  • Several KE were also concerned about the increasing use of GHB among male heterosexuals, as it was felt that this group was not aware of the risks of overdose or how to deal with the situation if it arose.
 
Market Characteristics
  • Price: $9 per mL, stable.
  • Purity: Medium to high, variable.
  • Availability: Currently easy to obtain, stable.
  • KE comments indicated that GHB price, purity and availability were stable, however, there was a vast predominance of GBL rather than GHB.
 
LSD
Consumption Patterns
  • The vast majority of the sample had tried LSD at least once and almost half had used it recently.
  • LSD was used on a median of 3 days (i.e. once every two months) over the preceding six months.
  • Unlike most other drugs, LSD was often used in outdoor settings.
  • The use of LSD among the sample appeared to be increasing over the past five years.
  • The use of hallucinogens among the NSW general population increased significantly from 0.6% in 2007 to 1.4% in 2010.
  • The use of LSD among participants of both the Sydney Gay Community Periodic Survey and Sydney Women and Sexual Health Survey remained relatively low and stable over time.
  • KE comments indicated that there had been an increase in hallucinogens amongst party goers, but there was uncertainty as to whether this was due to an increase in LSD or other emerging drugs with hallucinogenic effects such as 2C-B.
 
Market Characteristics
  • Price: $20 per tab, stable.
  • Purity: Currently high, stable.
  • Availability: Currently easy to very easy to obtain, stable.
  • KE reported that LSD purity and price were stable and availability was high. KE felt that most LSD had been imported via postal channels.
 
Cannabis
Consumption Patterns
  • Almost every participant had tried cannabis at least once and the vast majority had used it recently.
  • Cannabis was used on a median of 48 days (i.e. twice per week) over the preceding six months.
  • The use of cannabis had remained relatively stable over time.
  • The use of cannabis among the NSW general population increased significantly from 9.1% in 2007 to 10.3% in 2010.
  • The use of cannabis among participants of the Sydney Gay Community Periodic Survey has continued to decline over time.
  • About one-third of women in the Sydney Women and Sexual Health Survey reported recent use of cannabis, which has remained stable over time.
  • KE revealed that cannabis use was more problematic with young users. KE working with this age group observed difficulty educating them on the long term effects of cannabis use.
 
Market Characteristics
i) Hydro
  • Price: $20 per gram; $290 per ounce, stable.
  • Potency: Currently high, stable.
  • Availability: Currently very easy to obtain, stable.
 
ii) Bush
  • Price: $20 per gram; $265 per ounce, stable.
  • Potency: Currently medium, stable.
  • Availability: Currently easy to obtain, stable.
 
KE reported an increased cultivation of bush, which reflects its high availability. KE expected that with hydro and bush both comparable in potency, there would be minimal price differences between the two.
 
Other drug use
Alcohol
Almost all 2012 NSW REU reported lifetime use (98%) and recent use (95%) of alcohol. KE reported that alcohol continued to be one of the most problematic drugs among REU, particularly amongst young people and festival goers. They also noted that the problematic alcohol use often occurred in self-serve environments where quantities were uncontrolled.
 
Tobacco
The majority of REU had used tobacco at least once (96%) and 91% had smoked within the past six months.
 
Benzodiazepines

One-third of the group had recently used benzodiazepines. Illicit use was more common than licit use. KE reported widespread benzodiazepine use amongst a variety of people, however, the risks of using this substance were poorly understood by users.

 
Antidepressants
One-in-ten REU had recently used antidepressants. Licit use was more common than illicit use.
 
Inhalants
Amyl nitrite was used more commonly among this group (37%) than nitrous oxide (12%).
 
MDA
KE reported an increased presence of MDA in Sydney.
 
Heroin and other opiates
Nine REU reported recent heroin use. Recent use of other opiates were slightly more common for those illicitly obtained. KE felt that the use of heroin and other opiates was uncommon amongst REU because of the stigma associated with injecting.
 
Mushrooms
21% of the sample had recently used mushrooms.
 
Pharmaceutical stimulants
One-quarter of the group had recently used pharmaceutical stimulants. Illicit use was more common than licit use.
 
Over the counter drugs
12% reported recent use of over the counter codeine-containing products for non-pain use, and 4% reported recent use of over the counter stimulants for non-medicinal use.
 
Emerging Psychoactive Substance (EPS) use
In 2012, over half (51%) of the NSW EDRS sample had consumed an EPS in the previous six month period. The most commonly used psychoactive substances over the preceding six months were 2C-B (17%), herbal highs (13%), synthetic cannabinoids (12%) and DMT (11%). KE reported that although EPS are not overly prevalent amongst REU, they have the potential to be very problematic.
 
Health-related harms associated with ecstasy and related drug use
Overdose, Deaths and Hospital Admissions
  • One-third of participants reported having overdosed on a stimulant drug throughout their lifetime.
  • Over one-third reported having ever overdosed on a depressant drug.
  • Deaths associated with ecstasy, ketamine and cannabis have remained stable in the past year. A slight increase was observed in deaths associated with methamphetamines in 2011/12. There were no deaths during 2011/12 where GHB was detected.
  • Hospital admissions in which amphetamine was the principal diagnosis appeared to have remained stable in NSW. Hospital admissions where cocaine or cannabis was the principal diagnosis appeared to be increasing over time.
 
Service Usage
  • Only 16% of respondents reported that they had recently accessed a medical or health service in relation to their drug use.
  • Calls to ADIS and FDS regarding ecstasy have gradually increased from 2011 to 2012. Calls regarding amphetamines, cocaine, ketamine, GHB and LSD have remained relatively stable from 2011 to 2012.
 
Mental Health
  • Participants commonly reported that their drug use caused repeated social problems (33%), resulted in exposure to risk of injury (30%) and/or interfered with responsibilities (45%). Recurrent drug-related legal problems were uncommon (6%).
  • One-third of the group had recently experienced a mental health problem. Mood and anxiety disorders were those most commonly reported.
  • Participants completed the K10. One-third of the group fell into the „high‟ or „very high‟ distress categories.
 
Risk behaviour
  • One-fifth of the sample had ever injected a drug and 13% had done so recently.
  • Half of the group had completed a hepatitis B vaccination schedule.
  • Rates of testing for blood-borne viral infections (BBVI) were low with 19% having recently tested for hepatitis C, 20% for human immunodeficiency virus (HIV) and 42% having recently had a sexual health check-up.
  • Three-quarters of the sample had recently had penetrative sex with a casual partner. Approximately two-fifths did not use a sexual barrier on the last occasion (regardless of whether or not they were intoxicated). The main reasons were either that it was not mentioned or the partner was using contraception.
  • Over half the sample had recently driven a vehicle. Of these, two-thirds had done so while over the legal blood alcohol limit and more than half had after having taken an illicit drug.
  • Participants completed the Alcohol Use Disorders Identification Test (AUDIT). The majority (78%) of the group fell in the "harmful drinking‟ range.
 
Criminal activity
  • Fourteen percent of REU had reportedly been arrested over the past year.
  • One-third of REU had committed a crime within the past month. Most commonly drug dealing and property crimes.
  • The number of arrests for ecstasy use/possession seemed to have increased since mid-2011. Increases were also noted in the numbers of arrests for use/possession of amphetamines and cocaine. The number of arrests for use or possession of cannabis in both inner Sydney and NSW appeared to decline mid-2011, which was followed by an increase in 2012.
  • The majority of participants (86%) reported that half or more of their friends had used ecstasy during the previous six months.
  • The vast majority (94%) believed that the quantity of drugs possessed would affect the type of charge received.
 
Special topics of interest
  • More than half of the total NSW sample smoked cigarettes daily. One-tenth of daily smokers in NSW were classified as highly dependent on nicotine.
  • Using the Severity of Dependence Scale (SDS), ecstasy dependence was reported by 25 per cent of REUs when using a cut-off score of three or more, or by 14 per cent of REU‟s when using a cut-off score of four or more.
  • The majority of participants supported the legalisation of cannabis for personal use, and about half supported the legislation of ecstasy for personal use.
  • One-third had ever lost consciousness due to a knock to the head.
  • One-tenth of REU reported ever using illicit psychostimulants to lose or maintain weight, with methamphetamine being the most commonly used IPS.
 
Implications
The NSW branch of the EDRS aims ultimately to monitor trends in the Sydney ecstasy and related drug (ERD) markets and to investigate harms associated with ERD use. The 2012 NSW EDRS revealed ongoing changes in drug markets and indications of drug related harms which are discussed below.
 
Ongoing fluctuation in ERD markets
Over the past three years, there has been growing evidence of increasing experimentation among REU with other existing and emerging substances. Data from 2010 revealed growing interest in drugs such as LSD and GHB in particular subcultures around the city. This interest appeared ongoing, with 2011 data revealing increased use of hallucinogens (including mushrooms and LSD) among REU and the general Australian population. In 2012, the data indicated an upward trend in the mean number of drugs ever tried, which may be attributable to the expanding EPS market. With the reported significant decline in recent ketamine use, and the increasing purity of ecstasy, it will be interesting to monitor the changes in drug use patterns in 2013 in light of these ongoing fluctuations in the marketplace.
 
Emerging Psychoactive Substances (EPS)
In 2012, we continued to see an upward trend in the use of emerging psychoactive substances (EPS) amongst Sydney REU. With three-quarters of REU reporting that they had used an EPS before, and half (51%) using an EPS in the last six months, there is an apparent need to continue monitoring these relatively new substances and acquiring a better understanding of the harms associated with these drugs. Although there had been a significant decline in 2012 in the proportion of REU reporting lifetime use of 2C-E and mephedrone, a notable proportion had reported recent use of 2C-B (17%), herbal highs (13%), synthetic cannabinoids (12%), and capsules of „unknown contents‟ (8%). However, it still remains unclear whether these drugs are more common in scattered subcultures which may not be well sampled using the EDRS methodology.
 
Notably, the rates of use of these substances was greater than drugs such as ketamine, which had received substantially greater media and research attention, and for which harm reduction information was relatively widely available. There is a lack of research on the health and behavioural outcomes of using EPS, which in turn poses a significant risk to both the consumers and health workers in this area. It is critical that research continues to identify the associated risks of EPS use, so as to assist health professionals and law enforcement personnel to make informed decisions on appropriate interventions and harm reduction strategies.
 
Alcohol and tobacco use
As in past years, alcohol and tobacco use continued to be highly prevalent amongst the NSW REU cohort in 2012. Given this, focused interventions to reduce the harms associated with high risk alcohol (including binge drinking) and tobacco use are warranted.
 
Hazardous alcohol consumption is a concern in this population, particularly as a large majority of REU scored in the harmful range for alcohol consumption, which may be indicative of alcohol related disorders and dependence. Of particular concern was the proportion of REU who reported bingeing on alcohol whilst consuming ecstasy in the present study. There is emerging evidence from animal studies to suggest that the interaction between these two drugs dramatically alters the pharmacology of MDMA in the brain, which in turn may exacerbate neurological harms or other associated problems, such as dependence. Furthermore, there is increased risk of dehydration when both alcohol and ecstasy are consumed, and individuals may end up consuming large quantities of alcohol because the immediate effects of intoxication are delayed when ecstasy has been consumed. Continued dissemination of harm reduction messages to reduce and prevent the use of alcohol at harmful levels is recommended in light of these findings.
 
With the vast majority of REU also reporting recent tobacco use, and about two-thirds smoking daily, there is a clear need to focus interventions targeting tobacco use amongst this population. Further research is required to determine whether traditional interventions (e.g. nicotine gum) are a suitable fit for this group, or whether novel tailored interventions would have more success in reducing tobacco use.
 
Polydrug use and awareness of associated risks
Given that the NSW EDRS sample typically consumed ecstasy in combination with other drugs, it is clear that polydrug use and its related harms are an issue of concern for this cohort. Simultaneous consumption of different drugs may have harmful and unpredictable consequences, such as intoxication being enhanced due to the drug interactions arising from the concoction of drugs consumed. Further research into the interactions of drugs, and treatment approaches and harm reduction interventions are warranted to better understand safe consumption patterns and overdose risks.
 
It is also critical that information regarding polydrug use is widely disseminated amongst this cohort. Although only about one-in-ten REU reported consuming capsules where they did not know what it contained, by increasing the cohort's awareness of potentially harmful drug combinations, this may encourage them to be more aware of the drugs they are consuming and of the potential risks involved. Continued use by REU of multiple drugs in combination warrant continued education regarding the harms associated with such behaviour.
 
Limited awareness of, and access to, mental health services
Further investigation on how to improve REU utilisation of health services is warranted, as it is concerning to note that the 2012 sample had the lowest recorded proportion of REU who recently accessed medical or health services in the last seven years. Despite this, approximately one-third of REU reported that they had recently experienced a mental health problem, which is higher than self-reported rates over the past few years.
 
Of those who had sought help from a health professional, about three-quarters had been prescribed medication, which is more than double the rate reported in 2011. This two-fold increase in prescriptions suggests that of those REU who did self-report a mental health problem, they were eligible for medication. It is reasonable to suggest that there may be a lack of awareness of, or access to, mental health services amongst this population, as one-third of REU did not seek help for their mental health problem. Additional resources should be allocated to educating and engaging this population about their mental health and avenues to access support.

Resources

Author(s)

Elizabeth Whittaker, Laura Scott, Lucy Burns
Date Commenced
19 Apr 2013
Resource Type
Drug Trends Jurisdictional Reports