Demographic characteristics of Regular Ecstasy Users (REU)
Although both males and females of all ages use ecstasy, use was more common among males in both years (70% and 73%). The average age of the regular ecstasy users decreased by almost a decade this year, going from 33 years in 2003 to 24 years in 2004. The ecstasy users interviewed were relatively well educated, with most having completed at least 11 years of education (10 years in 2003) and a substantial proportion (46%) had tertiary or trade qualifications (56% in 2003). Two thirds of 2004 REU interviewed were employed in some form compared to 39% last year. Previous incarceration proportions dropped from 36% in 2003 to 16% in the current year. Only one person reported they were currently in treatment whereas 13% were last year. A third of the sample had ever injected a drug compared to two-thirds last year.

Patterns of drug use among REU
Polydrug use was the norm among the regular ecstasy users interviewed in both years. Ecstasy was the drug of choice for most of the respondents in both years (47% in 2004 and 36% in 2003), followed by cannabis in 2004 and methamphetamines in 2003. A large proportion reported recent use of alcohol, cannabis, tobacco, and methamphetamines in both years. Again this year, drugs typically seen as 'ecstasy related drugs' (cocaine, MDA, ketamine and GHB) showed a low incidence of recent use.

Ecstasy
On average, the sample of regular ecstasy users started to use ecstasy at 19 years (compared to 24 years in 2003), and began using it regularly when they were 20 years (compared to 27 years on 2003). Patterns of ecstasy use varied over the two years. In 2004 the proportion using ecstasy weekly or more increased (39% vs 19%), usual (1 vs 2) and heavy (2 vs 3) quantities increased, and bingeing with ecstasy decreased. A higher proportion reported that ecstasy was their favourite drug in 2004. In both years most of the sample used other drugs with ecstasy but use of other drugs whilst coming down from ecstasy reduced from 84% in 2003 to 58% in 2004.

In both years most of the sample recently swallowed ecstasy and in 2004 the proportion that had recently injected it decreased. Ecstasy was most commonly purchased in tablet form for $50 and this price was 'stable' in the six months preceding interview in both years. In 2004 most users said that the current purity of ecstasy was 'medium' or 'high' and that this had been 'fluctuating' over the past six months, in 2003 the purity was 'medium' and 'stable'. Most users reported the availability of ecstasy as 'very easy' and that this had been 'stable' over the past six months in both years.

A majority of users said they scored ecstasy from a friend in both years, but in 2003 it was most scored at a friends home and in 2004 in was mostly scored at a nightclub. In 2004 most regular ecstasy users reported that they usually and had last used ecstasy at a nightclub, in 2004 they usually and last used at home.

In 2004 almost one fifth (18%) of the sample obtained a Severity of Dependence Scale (SDS) score indicative of problematic or dependent use. In 2004 the most common perceived benefits associated with ecstasy use were 'enhancement of mood' and 'fun', and in 2003 it was 'social enhancement' and 'enhancement of mood/feeling'. The most common perceived risk with ecstasy use was to the 'unknown drug contaminants or cutting agents' in the tab and in 2003 it was risks to 'ones physical health'.

Methamphetamine
In 2004 majority of the sample had also used speed in the past six months (72%, 91% in 2003) and substantial proportions had used crystal (35%, 40% in 2003) and base (45%, 32% in 2003). The average age for methamphetamine initiation has decreased since 2003 - speed 18 years vs 20 years, base 20 years vs 23 years and crystal 20 years vs 26 years. In both years a quarter reported they had used speed weekly or more in the six months preceding the interview. In 2004, 25% had use base (15% in 2003) and 12% used crystal (7% in 2003) at the same frequency. Recent injection of all forms of methamphetamine by recent users dropped drastically in 2004 - speed 66% vs 14%, base 73% vs 22%, and crystal 60% vs 24%. Swallowing overtook injection as the most common route of administration for all forms of methamphetamine in 2004.

Forty one percent of the current sample had ever used pharmaceutical stimulants at and average age of 18 years. Recent users would typically use 10 tabs or 12 tabs in a heavy use episode. Ten percent reported using weekly or more. Most of the recent users swallowed pharmaceutical stimulants, and one fifth had injected them.

In 2004 the average usual amount of speed used decreased from one gram to half a gram and the heavy amount used also decreased from two grams to one gram. In both years over half of the recent speed users had recently binged with speed. In both years the average amount of base used in a typical session was one point. In 2004 the average amount used in a heavy session decreased from two and a half points to one point. In both years similar proportions recently binged with base. On average crystal users reported typically using one point or 2 points in a heavy episode in both years. In 2004 recent bingeing with crystal reduced by half (40% vs 20%). In 2004 17% of recent methamphetamine users obtained a SDS score indicative of problematic or dependent use.

In 2004 speed was most commonly purchased for a median of $100 per gram ($50 per point in 2003), base for a median of $50 per point (same in 2003) and crystal for a median of $50 per point ($65 per point in 2003). A majority of users of each form of methamphetamine in both years said this price was 'stable'. Most respondents reported the purity of: speed as 'low' and 'stable' ('fluctuating' in 2003), base as 'medium' and 'stable' ('fluctuating' in 2003), and crystal as 'high' and 'stable' in both years. Speed users in both years reported the availability as 'very easy', and 'stable', base users in 2004 reported the availability as 'easy', and 'stable' ('very easy' and 'stable' in 2003), and crystal users in both years reported the availability as 'easy' and 'stable'.

In 2004 speed and crystal users mostly scored from their friends, base users scored from known dealers, and all mostly scored at their friend's home. In 2003 most users of all types of methamphetamine scored from their friends at their friends home.

Cocaine
In the current year lifetime cocaine used dropped (50% vs 39%) and recent use increased (5% vs 15%) compared to 2003. Among those that recently used, cocaine use was infrequent with a median of one days use in the preceding six months in 2004, compared to six days in 2003. In both years recent cocaine users most commonly snorted; in 2003 only one person had injected, but in 2004 36% of recent users had injected.

In 2004 usual (0.5 grams) and heavy (0.75 grams) quantities used were very similar and in 2003 only one person reported a usual quantity of one gram and a heavy quantity of four injections. Only one person had recently binged with cocaine in 2004 and two had done the same in 2003. In 2004 cocaine was usually used at home or at private parties.

The median price for a gram of cocaine in 2004 was reported to be $250 ($280 in 2003). Most users in 2004 reported that the price for cocaine had been 'stable' with no response pattern in 2003. The purity of cocaine was reported to be 'medium' in both years and half 'didn't know' about the change in purity over the last the six months in 2004, but in 2003 it was reported to be 'decreasing'. Most participants who commented on the availability stated that cocaine was 'difficult to very difficult' to obtain in 2004 (no pattern in 2003) and this had been 'stable' over the past six months in 2004, but half in 2003 said it was becoming 'more difficult'.

Ketamine
Ketamine lifetime (18% vs 32%) and recent (7% vs 18%) use increased in 2004 compared to 2003. Recent users in 2004 had used it for a median of two days (one day in 2003) and used two bumps in usual and heavy episodes. In 2003 one bump was usually used and two bumps were used in heavy episodes. The majority of those that had recently used ketamine had swallowed it in both years, but just over a third had injected it in both years as well. In 2004 respondents reported usually using ketamine at home.

The median price per bump in 2004 was reported at $200 ($40 for 0.5grams in 2003), and most did not know if this price had recently changed. Ketamine purity was rated 'high' and 'stable' in both years. Ketamine availability was described as 'difficult to very difficult' to obtain in both years, with very mixed reports of change in availability

GHB
As with last year no one had ever used 1,4B but this year one person had ever used GBL at age 36, but had not used it recently. In 2004 20% of the sample reported lifetime use of GHB (17% in 2003) and only 6% had used GHB in the six months preceding interview (4% in 2003). Among the few that reported GHB use, 4% had ever injected it in 2004, but recently all swallowed the drug in both years. GHB had been recently used for a median of two and a half days (eight days in 2003) and people were using 11.1mls in usual and heavy episodes. The usual amount used in 2003 was 16mls and 17mls in heavy episodes.

One person reported the price of GHB at $3 per ml, with change in price comments varied, but no one could answer these questions on 2003. There were no consistent pattens with comments on GHB purity and availability in 2004 and again no one could answer these questions in 2003.

LSD
In 2004 lifetime LSD use decreased (80% vs 63%) and recent use increased (25% vs 31%) compared to 2003. On average, the users interviewed had first used LSD at 18 years old in both years. A small proportion (14%) reported they had used LSD fortnightly or more in 2004 and in 2003 it was 8%. A small proportion (5%) of recent users had recently injected LSD in 2004 (12% in 2003), although most reported swallowing it in both years.

Most reported they typically used use one tab in usual episodes in both years, and for heavy episodes it was one tab in 2004 but two tabs in 2003. Recent bingeing with LSD amongst recent users decreased in 2004 from 12% to 9%.

In both years LSD was most commonly purchased in tab form for $25 and a majority or users said this price was 'stable'. In both years users said that the current purity of LSD was 'fluctuating' and that it had been 'fluctuating' over the past six months. Availability of LSD differed over the two years. In 2004 it was 'difficult' to obtain and this had been 'stable' over the past six months. In 2003 it was 'easy to very easy' to obtain and this had been 'stable'. LSD was most commonly used in nightclubs in 2004 and was typically scored from a friend in the users own home.

MDA
Twenty eight percent of the sample reported lifetime use of MDA (21% in 2003) but only ten percent had used MDA in the six months preceding interview (6% in 2003). Swallowing was the most common recent route of recent administration in both years. In 2004 the quantity of MDA used declined. In usual episodes it dropped from two caps to one cap, and in heavy episodes it dropped from five caps to two caps. Among those that used MDA, use was infrequent in both years - three days in the six months preceding interview in 2004 and two days in 2003.

A cap of MDA was reportedly purchased in 2004 for a median of $55 ($60 per cap in 2003) and this price had been 'stable' over the prior six months in 2004. The one respondent who knew about MDA purity in 2004 and reported it to be 'high' and 'stable' which was the same as the previous year. The two people who commented on MDA availability in 2004 said it was 'very easy' or 'difficult' and that it had remained 'stable' or 'fluctuated'. In 2003 it was reported as 'difficult' and 'stable'.

Patterns of 'other drug' use
Compared to 2003, cannabis, alcohol and tobacco use remained high. The proportion of the sample who reported using all other drugs in 2004 reduced profoundly, except for inhalant use, where lifetime use remained stable but recent use increased.

Proportions for lifetime and recent use of other drug varied in 2004; cannabis (100%, 87%), alcohol (97%, 93%), Tobacco (92%, 82%), Heroin (27%, 3%), Amyl nitrite (41%, 25%), Nitrous oxide (44%, 16%), Methadone (10%, 1%), Buprenorphine (6%, 3%), Other opiates (21%, 8%), Anti-depressants (24%, 11%), Benzodiazepines (24, 10%).

The mean age for first using tobacco, alcohol and cannabis was early teens, this was the same in 2004. The mean age for first using ecstasy, speed, pharmaceutical stimulants, LSD, nitrous oxide, heroin, antidepressants and benzodiazepines was late teens in 2004, however, in 2003 it was early twenties for benzodiazepines, heroin and antidepressants. The mean age for first using buprenorphine in 2004 was 26 years and in 2003 it was 32 years.

Tobacco was the most frequently used drug at a median of 180 days in the last six months, with cannabis and buprenorphine not too far behind in 2004. In 2003 cannabis and tobacco were both used for a median of 180 days. In 2004 cocaine, LSD and nitrous oxide were the least frequently used drugs, all with a median of one days use in the last six months, and in 2003 buprenorphine and heroin were the least frequently used other drugs for a median of 7 and 5 days respectively.

Proportions of the 2004 sample who had ever injected specific drugs varied; alcohol (4%), heroin (17%), methadone (6%), buprenorphine (4%), other opiates (11%), antidepressants (1%) and benzodiazepines (9%), however these figures were all smaller than the previous year. In 2004 all other drugs were most commonly swallowed in the prior six months, except cannabis, which was mostly smoked, and heroin, which had two recent users, one swallowed and one injected.

Two thirds of those who recently drank alcohol would drink more that 5 standard drinks when using ecstasy (62% in 2003) and 15% would do the same whilst coming down from ecstasy (75% in 2003). In 2004 most people who had recently used anti-depressants, were utilising prescribed anti-depressants and taking them only as prescribed. Other drug that the 2004 sample reported using were aerosols, physeptone, rohypnol, mushrooms, xanax, glue, steroids, kava, travelcalm, and butane.

Risk behaviour
One third of the sample had ever injected a drug using a median of four different drugs with speed being the most common recently injected drug. Most injectors had learnt to inject from a friend or partner and 20% had first injected under the influence, most commonly cannabis. Most people injected themselves, substantial proportions would share injecting paraphernalia but no one reported sharing needles. While most people injected in a home, substantial proportions would inject in public venues.

High proportions were tested for HCV and HIV and half the sample had been vaccinated against HBV. Almost all REU had penetrative sex in the prior six months, most with one or two partners. The majority never used condoms with regular partners but always used condoms with casual partners. A high proportion had sex under the influence of drugs, most commonly ecstasy and generally once a month or more.

Approximately half the sample had tattoos and/or piercings, small proportions were done non-professionally, but none with a used needle. Almost two thirds of the sample drove within one hour of taking drugs, most commonly ecstasy and cannabis.

Health related issues
In 2004 nine people had overdosed in the last six months, with ecstasy and cannabis being the most common main drugs involved. REUs in 2004 elicited a median ecstasy SDS score of 1, with 7% reaching a score indicative of problematic use and 11% obtaining a score indicative of dependence. Recent methamphetamine users in 2004 elicited a median methamphetamine SDS score of 0, with 4% reaching a score indicative of problematic use and 13% obtaining a score indicative of dependence. A quarter of the 2004 sample had accessed a health or medical service (most commonly psychiatrists and psychologists) in the past six months in relation to their drug use.

Almost half the sample had recently experienced financial problems in both years and in both years this was most commonly attributed to ecstasy. Almost half the 2004 sample had recently experienced relationship/social problems (31% in 2003) in 2004 this was most commonly attributed to ecstasy, but in 2003 in was attributed to speed. Almost half the 2004 sample had recently experienced work/study problems (18% in 2003) in 2004 this was most commonly attributed to ecstasy, but in 2003 in was attributed to speed. Only 7% the 2004 sample had recently experienced legal problems (14% in 2003) in 2004 this was most commonly attributed to cannabis, but in 2003 in was attributed to ecstasy.

Criminal activity, policing and market changes
A third of the sample had committed a crime in the past month, which consisted mostly of drug dealing in both years. Just over a quarter of the 2004 participants would use criminal methods to pay for their ecstasy, the most common approach being dealing drugs for ecstasy profit. The proportion of REU that had been arrested in the previous 12 months dropped from 25% to 15% this year. Half of the 2004 sample thought that police activity towards ERDUs had increased recently (38% in 2003), however threequarters said this had not made it harder for them to score their drugs (64% in 2003).

A third of the 2004sample believed that new things were happening in the drug scene, these involved changes in drug use patterns, the type of drugs being used, the type of people using drugs, and in the supply of drugs.

Implications
The patterns of use and market characteristics of ecstasy and related drugs have received relatively little attention in the NT although it would appear from this study and the 2003 PDI that this market is well established, that the use of these drugs has become 'normalised' as an aspect of 'going out' behaviour and that it carries risks of related harms. The findings from the Northern Territory 2003 and 2004 Party Drugs Initiative suggest that the following issues receive attention from policy makers, researchers and health professionals:

• Substantial proportions of REU reported recently bingeing on ecstasy, recent alcohol use and also using large amounts of alcohol in conjunction with ecstasy, and this is supported by KE comment. It is also clear that polydrug use is the norm. These patterns of use may increase the risk of harm associated with ecstasy use and so appropriate prevention and harm minimisation strategies should be developed and targeted towards REU.
• As in 2003, the majority of ecstasy users acknowledge that their use involves the risk of a range psychological, neurological and physical harms and substantial proportions of the 2004 sample reported problematic or dependent use of either ecstasy or methamphetamines. At the same time only one person was in some form of drug treatment at the time of interview. In light of what may be an imbalance between risky behaviour and treatment seeking, health professionals, services and other relevant agencies should be encouraged to further develop their capacity to detect ecstasy use amongst their clientele; and health promotion resources specific to ecstasy and related drug use, particularly among young people, be developed and distributed.
• It is known that the content of 'ecstasy' tablets is variable and that they may contain little or no 'ecstasy' per se. The single risk reported most by REU was not knowing what is in the tablets they consume. The risks associated with consumption of either contaminants, unknown or unanticipated drugs may be reduced by:

1. the analysis of seizures by law enforcement agencies in the Northern Territory. The analysis of the composition of the tablets sold locally as 'ecstasy' is required to better understand the potential harms faced by local consumers
2. locally available 'ecstasy testing kits' may allow consumers to be more informed about the drugs they believe they are using.

• Further analysis of the different sub-groups of users and their drug using profiles, in particular, indigenous use of ecstasy and related drugs, the use of these drugs in the workplace and by tourist visitors to the NT.

Citation: Newman, J. and Moon, C. (2005) NT Trends in Ecstasy and Drug Related Markets 2004: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.