KEY FINDINGS AND 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 2013 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 RPU with other existing and emerging substances. Data from 2011 revealed growing interest in hallucinogens, specifically LSD and mushrooms. Furthermore participants in 2011 reported higher use of GHB and ketamine compared to previous years.
Data from 2012 reflected a similar pattern; although there were no significant changes to individual drug use patterns, there was an increase in the mean number of drug types used by the sample. In 2012, it was evident that there was a return of ecstasy purity after a significant decline in 2008/09.
The Illicit Drug Data Report of 2008/09 suggested that the drop in ecstasy purity from 2008-2011 was a result of the decreased availability of precursor substances due to the destruction of stockpiles in South-East Asia (Australian Crime Commission, 2009). Data from the 2013 survey has confirmed the return of ecstasy purity with participants reporting levels comparable to pre-2008 data.
However, in 2013, participants reported the lowest mean number of drug types used as well as a drop in the use of cocaine and amphetamines speed, base and crystal. Despite this drop, the use of LSD continued to increase with more than half the sample using LSD in the past 6-months.
It will be interesting to monitor the change in this figure over the coming year, especially after the recent media attention towards new psychoactive substances, especially 25I-NBOMe, colloquially known as ‘synthetic-LSD’.
New psychoactive substances
In 2013, we continued to see an upward trend in the use of new psychoactive substances (NPS) amongst Sydney RPU. With three-quarters of RPU reporting that they had used an NPS before, and half (51%) using an NPS 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 RPU reporting lifetime use of 2C-E and mephedrone, a notable proportion had reported recent use of 2C-I (6%) 2C-B (17%), DMT (9%), DXM (7%) and synthetic cannabinoids (25%). 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 overall rate of use of NPS 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 NPS, 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 NPS 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 RPU cohort in 2013. 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 RPU 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 RPU who reported bingeing on alcohol whilst consuming ecstasy.
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 RPU also reporting recent tobacco use, and about one-quarter 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 (e.g. e-cigarettes) 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. Binging on drugs further increases the risks associated with drug use. 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. Given that 25% of individuals binged on ecstasy and related drugs, over half had used multiple drugs during a binge session and 9% had recently ingested a capsule of unknown contents, 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 RPU of combinations of multiple drugs warrants continued education regarding the harms associated with such behaviour.
Increase in the use of LSD
Further investigation on the medical and mental health issues surrounding the use of LSD is warranted, as it is concerning to note that in 2013 the proportion of RPU that reported recent use of LSD was the highest recorded since the commencement of the EDRS in 2003. This number has steadily increased from 18% in 2008 to 51% in 2013. when looking at usage patterns from 2013, RPUs who used LSD recently only used it a median of 2 days in a 6 month period which is in stark contrast to drugs such as alcohol, tobacco, cannabis, ecstasy and crystal methamphetamine, all of which are associated with mental and physical health concerns (Agrawal, Budney & Lynskey, 2012; Wu, Ringwalt, Weiss & Blazer, 2009; Nasirzadeh, Eslami, Sharifirad & Hasanzadeh, 2013).
It may be that due to the nature of LSD as a recreational drug, people simply do not take enough to promote the development of problems that are more common in other drug use. Although this may not be a problem currently (as recent users do not show signs of increased frequency of use), it may be in the future if frequency of use increases.
Furthermore, given the steady rise in the use of new psychoactive substances (NPS), individuals may be using other drugs with similar psychedelic properties or are unknowingly purchasing NPS when they intended to purchase LSD (and similar, well-known psychedelics such as psilocybin mushrooms). With a limited knowledge of the effects of these NPS, future research should be directed towards the health effects of both traditional psychedelics and NPS.
Gavin Entwistle, Lucy Burns