EXECUTIVE SUMMARY

The Illicit Drug Reporting System (IDRS) is a monitoring system designed to identify emerging trends of local and national concern in illicit drug markets. The reporting system comprises data collected each year from three sources: interviews with a sentinel group of people who regularly inject drugs (participants); interviews with key experts; and analysis of pre-existing data related to illicit drugs.

Demographic characteristics of participants
One hundred and two people who regularly inject drugs participated in the 2011 IDRS survey in South East Queensland. The mean age of participants was 38 years, 79% were male, 82% were unemployed, 32% had a trade/technical qualification, 8% a university/college qualification, 47% were currently involved in some sort of drug treatment, and 66% had a prison history.

Consumption pattern results

Current drug use
The mean age of first drug injection was 20 years, with 61% first injecting methamphetamines and 35% first injecting heroin.
Heroin was nominated as drug of choice by 51% of participants, and methamphetamines by 17%. Heroin and methamphetamines were the drugs most commonly injected in the previous month, and they were also the most common drugs last injected.

Heroin
Overall heroin use declined, with 65% of participants using heroin in the preceding six months and 15% using it daily (p<0.05). Two in five participants reported heroin as the drug most often injected. Use of homebake remained low.

Methamphetamine
In 2011, 71% of participants reported use of methamphetamines in the previous six months compared with 59% in 2010. The proportion of participants using each of the four forms of methamphetamine in the previous six months was crystal 50%, speed 40%, base 37%, and liquid 6%. Methamphetamine was the drug of choice for 17% of participants, and 34% reported that it was the drug most often injected in the past month.

Cocaine
Cocaine use remained stable, with 13% using it in the previous six months. Frequency of use was low (i.e. a median of two days in the preceding six months).

Cannabis
As in previous years, the majority of participants had used cannabis in the preceding six months, with 42% of participants using it daily. Hydro continued to be used more often than bush.

Other opioids
Methadone and buprenorphine-naloxone were the two most commonly used forms of prescribed substitution pharmacotherapy; buprenorphine was the most commonly used form of substitution pharmacotherapy used illicitly.

Amongst participants prescribed methadone or buprenorphine, injection of some doses was relatively common, but was less common amongst participants prescribed buprenorphine-naloxone. The majority of participants who used non-prescribed substitution pharmacotherapy injected them.

Recent use of illicit morphine (non-prescribed) remained stable at 39%, with most participants injecting it. Use of licit oxycodone was rare, but 34% of participants reported recently using illicit oxycodone with nearly all injecting. Two in five participants reported using over the counter codeine (predominantly Nurofen Plus®) on a median of seven days in the preceding six months.

A third of participants had recently used other opiates such as pethidine, Panadeine Forte®, opium.

Other drugs
Just under a quarter (23%) of participants had used ecstasy in the preceding six months, with 7% injecting. Hallucinogens were used by a small minority with 12% reporting use in the previous six months on a median of two days, with none injecting.

Two in five participants reported illicit use of Alprazalom (e.g. Xanax®, Kalma®, Alprax®) in the previous six months; and a third reported recent illicit use of other benzodiazepines. Altogether 76% of participants had used benzodiazepines (licit or illicit) in the preceding six months.

Use of pharmaceutical stimulants (e.g. dexamphetamine and methylphenidate) in the previous six months was rare (4%), as was use of inhalants (4%).
The majority of respondents (68%) reported recent alcohol use. Almost all participants used tobacco in the previous six months (96%), with 94% reporting daily use.

Drug market: Price, purity, availability and purchasing patterns
Heroin
Price of heroin was consistent with previous years at $400 per gram and $50 per cap, and was readily available. Purity was generally reported as medium or low, but one in five considered that it fluctuates. Most participants purchased heroin from a known dealer or friends, with 63% of purchases occurring at an agreed public location.

Methamphetamine
Price of speed was $100 per point, base $80 per point, and crystal/ice $100 per point. All three forms (speed, base, and ice/crystal) were generally considered easy or very easy to obtain. There was no clear consensus on their purity; although all forms were most likely to be rated as high or medium. All forms of methamphetamine were considered to be readily available.

Cocaine
Very few participants commented on the market, and there was no clear consensus on price, purity, availability, and purchasing patterns.

Cannabis
The potency of cannabis continued to be rated as high, particularly hydro. Price remained fairly stable at around $25 per gram for both hydro and bush. Hydro was considered to be easy or very easy to obtain by 93% of participants and bush by 80%. Both hydro and bush were most likely to be purchased from a friend, and to be purchased at a friend’s house.

Methadone
Most of the participants who commented on the methadone market considered price to be stable. The median price of a milliliter was $1. Over half rated access as difficult, with most regarding accessibility as stable. Methadone was most likely to have been purchased from a friend, and the purchase place to have been a public location.

Buprenorphine
Price and availability was usually regarded as stable, with the median price of 2 milligrams being $15 and 8 milligrams $30.

Buprenorphine-naloxone
Price and availability was generally considered stable, with a 2 milligram tablet costing $10 and an 8 milligram tablet costing around $30.

Morphine
The price of 100 milligrams of morphine was around $60, with price considered to be generally stable or increasing. MS Contin® was the most common brand of morphine used, followed by Kapanol®. Morphine was reported as readily available and was obtained from a variety of source people and venues.

Oxycodone
The price of 80 milligrams of illicit oxycodone was around $50, with most participants considering price to be stable. About half (52%) rated availability as difficult, with the remainder rating it as easy or very easy. Oxycodone was most commonly sourced from a friend and purchased at an agreed public location.

Health-related trends associated with drug use
Overdose and drug-related fatalities
Nearly half of participants (48%) had overdosed on heroin in their lifetime. Of these, 21% had overdosed in the preceding year and 23% had overdosed more than three times in their lifetime. Twenty-nine per cent of all participants reported an overdose on a drug other than heroin in their lifetime, with most reporting doing so once only. By far the most overdose cases attended by Queensland Ambulance Service were for alcohol, followed by antidepressants, benzodiazepines, and then heroin.

Drug treatment
Drug treatment status was similar to 2010 with 47% of participants in treatment which was mainly opioid substitution pharmacotherapy.

Injecting risk behaviours
Needle and syringe programs were the main source of needles and syringes. One in five of the participants borrowed used needles and 28% lent used needles. Two-thirds shared equipment other than needles.

Mental health problems, psychological distress and general health
Self-reported mental health problems were common (63%), with the most common problems being depression and anxiety. Participants were considerably more likely to score in the ‘high’ or ‘very high distress’ categories than the general Australian public as measured by the Kessler Psychological Distress Scale (K10) (67% versus 9%).
Participants’ scores on the Short-Form 12-Item Health Survey (SF-12®) indicated they had poorer mental and physical health than the population average. Seventy-one per cent of participants reported a long-standing physical health condition, illness, disability or infirmity. Sixty-eight per cent of participants had visited a GP in the previous four weeks, and nearly a quarter had visited a drug and alcohol counsellor.

Driving risk behavior
Of the 45% of participants who had driven a vehicle in the previous six months, one in five reported driving under the influence of alcohol, and almost four in five reported driving soon after taking an illicit drug. Most of these participants (69%) considered that the drug/s taken prior to driving had no impact on their driving ability.

Trends in law enforcement associated with drug use
Reports of criminal activity
Drug dealing and property crime were the most frequently reported criminal activity.

Arrests
Over half (56%) of participants reported being arrested in the preceding 12 months, with the most likely reasons being use/possession of drugs (32%) and property crime .

Expenditure on illicit drugs
Those participants who purchased illicit drugs on the previous day reported spending a mean of $112.

Special topics of interest
Pharmaceutical opioids
The most common reasons given for using pharmaceutical opioids were to obtain an opioid effect (52%) and for pain relief (40%). Seventeen per cent of those who had recently used pharmaceutical opioids stated they had been refused them for pain due to their injecting history.

Over the counter codeine (OTC)
Two in five participants had recently used OTC codeine, and 8% reported use for non-medical purposes.

Online drug-related activity
The internet was infrequently used for drug-related activity. Very few participants depended on text messaging to obtain drugs.

Policy issues
Needle and syringe programs, methadone/buprenorphine maintenance programs, treatment with drugs other than methadone, regulated injecting rooms, and trial of prescribed heroin were all well supported. Less well supported were rapid detoxification therapy and use of naltrexone.

Most participants (85%) either supported or strongly supported the personal use of cannabis, with only low levels of support for personal use of ecstasy and cocaine. Consistent with this, most participants (84%) opposed or strongly opposed increased penalties for the sale or supply of cannabis. Responses were more mixed for other drugs.

Pleasure, happiness and quality of life
The mean rating of overall quality of life on a scale from 0 (very bad) to 10 (excellent) was 5. On a scale from 0 (nil) to 100 (a lot), the mean contribution to pleasure of taking drugs was 71, to happiness 70, and to quality of life 55.