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 people who regularly inject drugs participated in the 2012 IDRS survey in South East Queensland. The mean age of participants was 38 years, 76% were male, 82% were unemployed, 47% had a trade/technical qualification, 8% had a university/college qualification, 37% were currently involved in some sort of drug treatment, and 59% had a prison history.

Consumption pattern results

Current drug use

The mean age of first drug injection was 20 years, with 58% first injecting methamphetamines and 29% first injecting heroin.

Heroin was nominated as drug of choice by 55% of participants, and methamphetamines by 20%. Heroin and methamphetamines were the drugs most commonly injected in the previous month, and they were also the most common drugs last injected.

Heroin: Heroin use was stable, with 65% of participants using heroin in the preceding six months. Amongst those who recently used heroin, median use was 72 days, with about one in five using daily. Almost half of participants (47%) reported heroin as the drug most often injected. Use of homebake remained low.

Methamphetamine: Use of methamphetamines in the previous six months decreased from 71% in 2011 to 53% in 2012 (p<0.05). The proportion of participants using each of the four forms of methamphetamine in the previous six months was crystal 44%, speed 30%, base 21%, and liquid 5%. Methamphetamine was the drug of choice for 20% of participants, and 26% reported that it was the drug most often injected in the past month.

Cocaine: Cocaine use continued to be uncommon, with the proportion reporting use in the previous six months dropping from 13% in 2011 to 4% in 2012 (p<0.05). Frequency of use was low.

Cannabis: As in previous years, the majority of participants (70%) had used cannabis in the preceding six months, with 40% using it daily. Hydro continued to be used more often than bush; cones more often than joints.

Other opioids: Methadone and buprenorphine-naloxone (Suboxone®) were the two most commonly used forms of prescribed substitution pharmacotherapy, but buprenorphine (Subutex®) was the most commonly used form of substitution pharmacotherapy used illicitly. The majority of participants who used illicit substitution pharmacotherapy injected it.

Recent use of illicit morphine (non-prescribed) remained stable at 34%, with most participants injecting it. Recent use of licit oxycodone was uncommon (7%), but 29% of participants reported recently using illicit oxycodone with most injecting. Lifetime use of non-medicinal use of over-the-counter codeine (predominantly Nurofen Plus®) was reported by 17% and 7%reported recent use.

Nearly one in five of participants had recently used other opiates such as pethidine, Panadeine Forte®, opium.

Other drugs: Recent use of ecstasy decreased from 23% in 2011 to 7% in 2012 (p<0.05). Hallucinogens use was rare, with 4% reporting use in the previous six months, with none injecting.

About three in five participants (62%) had used benzodiazepines (licit or illicit) in the preceding six months. Illicit use of Alprazolam was reported by 35%, and one in five reported illicit use of other benzodiazepines.

Illicit use of pharmaceutical stimulants (e.g. dexamphetamine and methylphenidate) in the previous six months was rare (3%), as was use of inhalants (2%).

Three in five participants reported alcohol use in the preceding six months. Almost all participants used tobacco (98%), and 89% used it daily.

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. Purity was generally reported as low or medium, with mixed ratings on whether purity had recently changed. Heroin was rated as readily available by most, but 25% rated availability as difficult. Two-thirds of participants last purchased from a known dealer, and half had made their last purchase at an agreed public location.

Methamphetamine: Price of speed was $100 per point, base $75 per point, and crystal/ice $100 per point. Price was commonly considered to be stable or increasing for all forms. Purity of speed was mainly considered to be medium. Rating of the purity of base and crystal/ice was more varied, although for both forms about half considered it to be high. All forms of methamphetamine were considered to be readily available.

Cocaine: Only two participants commented on the cocaine market, and both considered the market to be stable.

Cannabis: The potency of cannabis continued to be rated as high, particularly hydro. Price for both hydro and bush was stable, and both were readily available. The most recent purchase of both hydro and bush was generally from a friend or known dealer, with a friend’s home being the most common place of purchase.

Methadone: Most of the participants who commented on the methadone market considered price to be stable, with a median price of one millilitre being $1. There was no consistency about availability, although most did not consider there had been recent changes in availability. Methadone was most likely to be purchased from a friend, and the place of purchase to be a public location.

Buprenorphine: Price and availability of buprenorphine was generally considered stable, with the median price of 2 mg reported as $10 and 8 mg as $35.

Buprenorphine-naloxone: Price and availability of buprenorphine-naloxone was generally considered stable by the small number of participants who commented.

Morphine: The median price for 100 milligrams of morphine was $70 for MS Contin© and $60 for Kapanol©, with price changes generally rated as stable or increasing. MS Contin® was the most common brand of morphine used, followed by Kapanol®. Morphine was mostly rated as readily available and was obtained from a variety of source people at various locations.

Oxycodone: The median price of 80 milligrams of oxycodone was $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. Illicit oxycodone was most commonly sourced from a friend (58%).

Health-related trends associated with drug use

Overdose and drug-related fatalities

Nearly half of participants (46%) had accidently overdosed on heroin in their lifetime, and of these 29% had overdosed in the preceding year. Additionally, 18% had accidently overdosed on a depressant drug other than heroin in their lifetime.

Alcohol was overwhelmingly the most common drug implicated in overdose cases attended by Queensland Ambulance Service, followed by antidepressants, benzodiazepines, and then heroin.

Drug treatment

About a third of participants (35%) were currently in drug treatment which was predominantly opioid substitution pharmacotherapy.

Injecting risk behaviours

All participants had sourced needles from a needle and syringe program, and 23% had also sourced from a chemist.

Recent borrowing of used needles decreased from 20% in 2011 to 7% in 2012 (p<0.05); and 19% lent used needles compared with 28% in 2011. The proportion sharing other equipment (predominantly spoons/mixing containers) was stable at 36%. Forty-four per cent of participants re-used one of their own needles at least once in the previous month.

Mental health problems, psychological distress and general health

Over half of participants (56%) self-reported a mental health problem, with the most common problems being depression and anxiety. Compared with the general Australian population, IDRS participants were much more likely to score in the high distress or very high distress categories of the Kessler Psychological Distress Scale (K10) (59% compared with 2%).

Participants’ scores on the SF-12 health survey indicated they had poorer mental and physical health than the population average. Nearly a third of participants (32%) had accessed a health professional in the previous four weeks.

Driving risk behavior

Of the 54% of participants who had driven in the past six months, 11% reported driving under the influence of alcohol, and 83% reported driving soon after taking an illicit drug. Most of these participants 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

Two in five participants reported criminal involvement in the previous month. Dealing was the most often reported criminal activity followed by property crime.

Arrests

Just under half (46%) of participants reported being arrested in the preceding 12 months with the most common reasons being property crime followed by use/possession of drugs.

Expenditure on illicit drugs

The median reported expenditure on illicit drugs the previous day was $70.

Special topics of interest

Fagerstrom Test for Nicotine Dependence

A third of daily smokers had scores on the Fagerstrom Test for Nicotine Dependence indicating high nicotine dependence; and 16% had scores indicating very high dependence.

Pharmaceutical opioids

Seven in ten participants reported using pharmaceutical opioids in the previous six months. The most common reason for use was to treat self-dependence followed by seeking an opioid effect and pain relief.

Brief Pain Inventory

A quarter of participants had experienced pain on the day of interview, predominantly non-cancer pain.

Opioid and stimulant dependence

Seventy-seven per cent of recent opioid users obtained a score on the Severity of Dependence Scale indicating possible opioid dependence; and 41% of recent stimulant users obtained a score indicating stimulant dependence.

Opioid substitution medication injection

Buprenorphine (Subutex®) was the most commonly injected opioid substitution medication, with one in five participants recently injecting it. The proportion recently injecting buprenorphine-naloxone (Suboxone®) was similar, with 16% injecting the tablet form and 3% the film.

Injection-related injuries and diseases

The most common problem near injection site amongst all participants was temporary redness, followed equally by temporary swelling and hives.

Neurological history

About half of participants (53%) had experienced a traumatic brain injury, with a median of two incidences over a lifetime.

Possession laws

Many participants appeared to be unaware of drug trafficking thresholds.