FINDINGS AND IMPLICATIONS
The NT branch of the EDRS aims ultimately to monitor trends in the Darwin ecstasy and related drug (ERD) markets and to investigate harms associated with ERD use. The 2013 NT 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 few years, there has been growing evidence of increasing experimentation among ERD users with other existing and emerging substances. Data from the last two data collection points (2009 and 2013) revealed growing interest in drugs such as LSD and ketamine. Since 2008, the data indicated an upward trend in the mean number of drugs ever tried, which may be attributable to the expanding new psychoactive substances (NPS) market. With the reported significant decline in recent speed and base use, it will be interesting to monitor the changes in drug use patterns in 2014 in light of these ongoing fluctuations in the marketplace.
New psychoactive substances
2013 was the first year that data was collected on the use of NPS amongst Darwin ERD users. With three-fifths reporting having ever used NPS and one-quarter reporting use of 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.
Notably, the overall rates of use of NPS were 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.
As in past years, alcohol continued to be highly prevalent amongst the NT EDRS cohort in 2013. In conjunction with this, alcohol was the drug of choice for the majority of the sample. The results from this year’s survey showed that hazardous alcohol consumption is a concern in this population, particularly as a large majority of ERD users scored in the harmful range for alcohol consumption which may be indicative of alcohol-related disorders and dependence. Given this, evidence-based interventions to reduce the harms associated with high-risk alcohol use (including binge drinking) are warranted.
Cannabis and tobacco use
With the vast majority of ERD users reporting recent cannabis and tobacco use, there is a need to for interventions that target the smoking of these substances 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 reducing cannabis or tobacco use.
Health service utilisation
Half of the 2013 sample engaged with some form of health service over the past six months. However, only one participant accessed a health service specifically to discuss their drug use. While further investigation on how to increase ERD users’ utilisation of health services is warranted, emphasis should also be placed on starting conversations about drug use when ERD users are at health services.
In terms of psychological distress levels, about one-third of the cohort reported ‘distress’ to some degree. Interestingly though, only 9% reported a mental health problem. Of these participants, the majority sought health assistance from a health professional and subsequently were prescribed medication. This finding suggests that of those ERD users who did self-report a mental health problem, they were deemed suitable for medication. However, additional resources should also be allocated to educate and engage this population about their mental health well-being and avenues to access support.
The 2013 NT EDRS identified a substantial proportion of participants who had recently driven while under the influence of alcohol and/or drugs. Driving under the influence of alcohol or other drugs has been a reoccurring theme in the NT over the past few years, with previous KE interviews identifying the lack of alternative transport options in Darwin as a possible contributing factor.
Research is warranted to assess whether ERD users are driving under the influence because there is a lack of education about the risks of driving after consuming alcohol or drugs, or if there are insufficient transport alternatives after episodes of use, or if a combination of these factors is playing a role in young people engaging in this risky behavior. It is suggested that education and law enforcement interventions that focus on harm-minimisation are developed and evaluated to determine the effectiveness of these approaches, and whether they could be adapted to target sub-groups who are most at risk.
A considerable proportion of people constantly travel in and out of Darwin, including backpackers, travellers and seasonal workers. In previous years, backpackers have been identified by the NT EDRS as a sub-group who engages in ERD use in Darwin, which includes those who have purchased ERD in other jurisdictions and transported them to Darwin to consume. This year, the NT EDRS surveyed a sub-sample of backpackers to better understand the use of ERD amongst this group and associated risk factors.
Of notable concern was the proportion of backpackers reporting recent overdoses on depressant drugs (most commonly alcohol) and the anecdotal comments from female backpackers that they would often accept drugs as gifts without any awareness of the drug type or class. It is critical that information about alcohol and drug use is disseminated amongst this vulnerable sub-group to increase their awareness of potentially harmful drug combinations, and to encourage them to be more aware of the drugs they are consuming and potential risks involved.
The backpacker sample revealed a number of other key differences in relation to health and law enforcement. Over the six months prior to the interviews, backpackers were less likely to have accessed a health service and driven a vehicle under the influence of alcohol or drugs. In contrast, backpackers were more likely to have had casual penetrative sex under the influence of drugs, and were more likely to have engaged in recent criminal activity and been arrested in the past year. Possible explanations for these findings include the high costs of living in the NT and limited employment opportunities for backpackers to earn a stable income during their travels.
While this research provides preliminary findings on the consumption patterns and risk behaviours of backpackers, further research examining backpackers who visit Australia is required to assess their areas of risk, and consequently produce an evidence-base to inform appropriate educational campaigns and harm-minimisation strategies.
Elizabeth Whittaker, Lucy Burns