This report presents the findings from the eleventh year in which data has been collected in South Australia. The Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI), monitors the price, purity and availability of „ecstasy‟ (MDMA) and other drugs such as methamphetamine, cocaine, gamma-hydroxybutyrate (GHB), d-lysergic acid (LSD), 3,4-methylendioxyamphetamine (MDA) and ketamine. It also examines the demographic characteristics and patterns of drug use among regular ecstasy users (REU), the prevalence of risk-taking and harms related to drug use, as well as the level of criminal involvement among this group. It utilises data from three sources: (a) surveys with regular ecstasy users (REU); (b) surveys with key experts (KE) who have contact with REU through the nature of their work; and (c) the analysis of existing data sources that contain information on ecstasy and related drugs (ERD). The EDRS surveys are not representative of ecstasy and other drug users in the general population. The REU are a sentinel group that provides information on patterns of drug use and market trends.
The findings from each year not only provide a snapshot of the ERD market in Australia, but in total they help to provide an evidence base for policy decisions; for helping inform harm reduction messages and to provide directions for further investigation when issues of concern are detected. Continued monitoring of the ERD markets in Australia will help add to our understanding of the use of these drugs; the price, purity and availability of these drugs and how these may impact on each other; and the associated harms which may stem from the use of these drugs.
Drug trends in this publication primarily represent trends in Adelaide, where new drug trends are likely to emerge. Patterns of drug use may vary among other groups of REU in Adelaide and in regional areas.
Demographic characteristics of regular ecstasy users
Seventy six participants were recruited to the 2011 sample. As in previous years, the REU interviewed were young, with a median age of 21 and two-thirds of the participants were male (68%). One-fifth of the sample reported being in full-time employment with a mean income of $459 per week. Most participants were well educated and over half had completed some kind of post school qualification, while 8% were full-time students. Virtually the entire sample identified as heterosexual and 4% were currently undergoing treatment for their drug use. In comparison to participants in 2010, the 2011 sample were generally similar, however, there were significant increases in age, heterosexuality and those who were working and studying.
Patterns of drug use among participants
Cannabis was the main drug of choice nominated by participants, meaning that for the first time in history of the SA EDRS, ecstasy had dropped out of favour as the preferred drug of choice among REU. There was also a significant increase in the proportion of REU nominating alcohol as their drug of choice, and a significant decrease in cocaine as a favourite drug. Aside from ecstasy, alcohol was the most commonly used drug among REU, followed by cannabis, tobacco and methamphetamine. As in 2010, polydrug use was common among this sample, with participants having tried a median of twelve different drugs in their lifetime, and eight within the preceding six months. In 2011, there were significant increases in the recent use of tobacco, crystal methamphetamine, nitrous oxide, benzodiazepines and pharmaceutical stimulants.
The proportion of participants who reported recent bingeing on ecstasy or other related drugs increased slightly in 2011. The type of drugs that participants reported as being used in a binge session differed somewhat to those in 2010. Larger proportions of participants reported binge use of ecstasy, crystal methamphetamine, cannabis, alcohol and tobacco.
Injecting drug use remained low in 2011, with only five participants reporting that they injected any drug within the preceding six months.
Although ecstasy appears to be dropping out of favour among REU, there has been little change in the parameters of ecstasy use, with the reported median age of first use, 'average' or 'most' amount used in a typical session, and median days of use in a six month period all remaining relatively stable. The proportion of participants reporting using more than one tablet in a typical session also remained stable at 83%. Over a third of REU reported that they had binged on ecstasy in the past six months, a slight increase from 2010. Swallowing was the main route of administration for ecstasy, and was used most commonly at nightclubs.
The proportion of participants who reported using other drugs 'with ecstasy' remained stable in 2011, whilst the use of other drugs to come down from ecstasy increased (although this was not significant). Cannabis was the most common drug used to come down from ecstasy, followed by alcohol, benzodiazepines and tobacco.
The reported price of ecstasy was relatively stable compared to 2010. This was confirmed by half of the sample who reported that price had remained stable over the preceding six months; although one-fifth did report that the price had increased. Availability continued to be considered 'easy' or 'very easy' by participants, with a small decrease in the proportion of participants who considered it to be difficult. The majority of REU reported that current purity of ecstasy was low, although there was a significant increase in the proportion of REU who perceived purity to be medium. The Australian Crime Commission (ACC) reported that the median purity of South Australian Police (SAPOL) seizures of phenethylamines in 2009/10 continued to decrease and was reported to be 6.8 % (an almost threefold decrease from 2008/09).
Ecstasy was generally purchased for both self and others, with one participant reporting purchasing ecstasy for others only. Ecstasy was purchased from a median of three people in the six months prior to interview. The majority of participants purchased ecstasy one to 12 times in that period, with seventeen percent purchasing ecstasy between 13-24 times in that period. REU obtained a median of four pills on the last occasion of purchase, a significant decrease from 2010. Ecstasy was mainly purchased from friends or known dealers and at a private residence or nightclub.
In 2011, the proportions of the participant sample reporting recent use of powder and base remained relatively stable, whilst there was a significant increase in the use of crystal methamphetamine. The frequency of use within the preceding six months remained relatively stable, and low (range 4-5.5 days) for all three forms of methamphetamine. In the six months prior to interview, smoking of crystal methamphetamine continued to be the preferred route of administration. Swallowing and smoking as a route of administration have become the primary methods of administering base; and swallowing and snorting were the preferred methods for administering powder methamphetamine.
The price for a point of both powder and base remained stable in 2011, whilst the price for a point of crystal methamphetamine increased to $95. There were fairly substantial increases in the prices for a gram of the different forms of methamphetamine, however, due to small numbers these figures should be viewed with caution.
The purity of powder and base was largely perceived as medium, and participants reported that this had remained stable within the last six months. The majority of participants reported crystal purity as high, and again it was reported that this had remained stable in the preceding six months of interview. In contrast, seizures analysed by South Australia Police (SAPOL) revealed that the median purity of methamphetamine in 2009/10 had almost halved compared to 2008/09. All forms of methamphetamine were considered easy to very easy to obtain recently, with methamphetamine base appearing to be the easiest to purchase according to participant reports.
Overall, participants mostly reported obtaining all three forms of methamphetamine from friends or a known dealer, and at their friend's home.
Of the illicit drugs, most key experts (KE) considered methamphetamine to be an issue of particular concern at the moment. This was attributed to its increasing prevalence, its addictive nature, and the effects (health, mental and social) that it has on both the individual and their family/friends.
As mentioned previously, there was a significant decrease in the proportion of REU who nominated cocaine as their preferred drug of choice in 2011. However, the proportion of participants who reported lifetime and recent use of cocaine remained relatively stable. Frequency of use remained low and stable among those who reported recent use. Participants largely reported that the purity of cocaine was low, with a third believing it to be medium. Reports regarding the availability of cocaine were mixed, with equal proportions reporting that it was easy or difficult to obtain. Availability was largely reported to have remained stable over the preceding six months.
Few KE reported having contact with cocaine users, however those that did reported that there may have been a slight increase in the use of cocaine (although prevalence was reported to still be very low). One KE reported that levamisole is starting to be added to cocaine, which is an issue of great concern. Levamisole is a pharmaceutical drug which is thought to reduce blood pressure, and so manufacturers may be adding it to counteract the increased blood pressure that accompanies cocaine use. This is extremely problematic with US based studies revealing that cocaine related fatalities have been attributed to the presence of levamisole.
Almost one-third of the participant sample in 2011 reported recent use of LSD, stable from 2010. Frequency of LSD use was stable and remained consistently low. The amount of LSD used in a typical and heavy session remained stable, and the majority of participants reported being at a private venue (own/friend's home) at last time of intoxication.
The median price of LSD was slightly higher than that reported in 2010. The purity of LSD was perceived as high, and participants largely believed this had remained stable over the past six months. The availability of LSD changed quite considerably in 2011, with almost equal proportions reporting that LSD was easy or difficult to obtain.
Virtually all of the KE reported that the prevalence of LSD was very low, and that they had seen very little of it among their clientele. Two KE noted that LSD had dropped off and appeared to have been replaced with 2, 5-dimethoxy-4-iodoamphetamine (Death on Impact - DOI).
The prevalence of cannabis use remained exceptionally high in 2011, with 94% of the sample reporting lifetime use and 92% reporting use within the preceding six months. The frequency of recent cannabis use by participants was lower than reported in 2010, dropping to a median of 50 days within a six month period. Participants reported 'usually' obtaining cannabis from a friend in the six months prior to interview. The price reported for a bag of hydro /bush remained stable in 2011, as did the availability (with participants reporting that cannabis was easy or very easy to obtain). The purity of hydro was reported as high and bush as medium, with the purity of both types of cannabis perceived as stable in the previous six months.
As in previous years, the large majority of the participant sample reported recent use of alcohol, although frequency of use did drop to a median of 48 days in a six month period (approximately twice a week). Many KE considered alcohol to be a particularly problematic drug due to its widespread prevalence, availability and social acceptability. Binge drinking was raised as an issue of particular concern. Almost the entire sample reported lifetime use of tobacco, and there were significant increases in both lifetime and past six month use of tobacco.
Fifteen percent of participants reported recent use of illicit benzodiazepines, at a frequency of about once a month. A very small proportion of participants reported recent use of illicit antidepressants.
Recent use of nitrous oxide increased significantly in 2011, with a third of the sample reporting use within the preceding six months. The prevalence of recent amyl nitrate use also increased, although this was not found to be significant. Frequency of use remained low for both inhalants. There were no significant changes in the use of ketamine, GHB or MDA.
Lifetime use of illicit pharmaceutical stimulants remained stable in 2011; however, use within the preceding six months increased significantly from 2010. One quarter of the sample reported that they had used magic mushrooms in the six months prior to interview, although frequency remained low. Recent use of heroin, over the counter (OTC) codeine and steroids remained stable in 2011.
Emerging psychoactive substances
Participants in 2011 were asked about their use of a range of research chemicals (RC). Those most recently used were 4-bromo-2,5-dimethoxyphenethylamine (2CB) (29%) and 2,5-dimethoxy-4-iodophenethylamine (2CI) (16%), both of which increased significantly in 2011. Several KE noted an increase in use of benzylpiperizine (BZP) and 3-trifluoromethylphenylpiperazine (TFMPP) which, when combined, produce an effect very similar to 3, 4-methylendioxymethamphetamine (MDMA). It was also reported that due to the decreasing availability of ecstasy, manufacturers seemed to be experimenting with new mixes so that consumers really had no idea of what was in their pill. That is, consumers often buy pills which are being sold as ecstasy, however, forensic analysis has revealed that these pills contain very little/no MDMA.
Health related issues
There were significant increases in lifetime and recent (past 12 month) overdoses, for both stimulants and depressants.
Sixteen percent of participants reported having accessed one or more medical or health service in the six months prior to interview in relation to their use of ecstasy and related drugs; this was a decrease compared to 2010 in which 24% reported seeking professional help. The most commonly accessed service in relation to 'any' drug use, by the few participants able to comment, was a general practitioner.
The proportion of clients attending Drug and Alcohol Services South Australia (DASSA) treatment services, with ecstasy as the primary drug of concern, decreased in 2011 and still remained relatively low compared to other illicit drugs. The proportion of clients nominating amphetamines as the primary drug of concern increased in 2011, with amphetamines being the second most commonly nominated primary drug of concern by clients of DASSA (after alcohol).
In 2011, there were increases in the prevalence of REU who reported experiencing problems as a result of their drug use, with a significant increase being noted for risk associated problems. Alcohol was nominated as the main drug associated with all types of harms.
In 2011, twenty-nine percent of the participants were assessed at high to very high risk of psychological distress as measured by the Kessler Psychological Distress Scale (K10), in the four-weeks prior to the survey.
Injecting risk behaviour
Sixteen percent of the sample reported that they had ever injected any drug. Five participants reported recently injecting any drug in 2011, most commonly some form of methamphetamine. With regard to longer-term trends, there was no evidence of a change in the prevalence of recent injecting amongst participants across the years. Of those who had injected in the past six months, only one participant reported that they had shared needles or injecting equipment.
Sexual risk behaviour
Evidence of risky sexual behaviour was again apparent among the participant sample in 2011. Of the participants who reported having had penetrative sex with a casual partner in the last six months, about half of the sample reported that they did not use protection during their last sexual encounter, regardless of whether they were sober or intoxicated. In addition, the vast majority of those who reported recent penetrative sex, reported having done so whilst under the influence of drugs – most commonly alcohol followed by cannabis and ecstasy.
Driving risk behaviour
Two-thirds of those who had driven in the six months prior to interview reported that they had driven whilst under the influence of alcohol; of these participants the majority reported driving over the legal blood alcohol concentration (BAC) limit on a median of two occasions in that period. Sixty percent of participants reported driving within an hour of consuming an illicit drug, and these participants had done so on a median of eight times in the six months prior to interview. Cannabis and ecstasy were the most commonly used illicit drugs while driving.
Alcohol risk behaviours
The Alcohol Use Disorders Identification Test (AUDIT) is a brief screening tool which is used to identify individuals with alcohol problems. Using this test, participants scored a mean of 15.8, with males having significantly higher scores than females. Ninety percent of the sample scored eight or more; these are levels at which alcohol intake may be considered hazardous.
Law-enforcement related trends
Compared to 2010, there was a significant increase in the prevalence of past month criminal activity among REU (22% in 2010 versus 46% in 2011). Drug dealing continued to be the most common offence which had been committed, followed by property offences. Fraud and violent crime remained low among REU. The number of participants reporting past-year arrest remained stable.
Special topics of interest
Heavy Smoking Index nicotine dependence
Two-thirds of the sample reported that the level of police activity had remained stable over the preceding six months, while one-third reported an increase in activity. Among those who had smoked daily, over one-third reported waiting 60 minutes or longer before smoking their first cigarette, and 49% reported smoking 10 or less cigarettes a day. Approximately one-quarter of daily smokers scored 4 or above indicating moderate-high dependence, with the mean Heavy Smoking Index (HSI) score being 2.2
Online drug-related activity
The majority of participants reported daily use of the internet, with only 9% of the sample reporting that they hadn't been online in the six months preceding interview. Of those who had used the internet in the last six months, 59% reported going online to obtain information about drugs.
Sleep patterns and practice associated with drug use
Over a third of the sample reported that the quality of their sleep was 'good' in the month preceding interview, although this seemed to decline on weekends. Thirty-seven percent of participants reported experiencing some form of sleep problem, and 42% reported that drug use had had a negative impact upon their quality of sleep. Perhaps as a result of this, almost a third of the sample reporting using sleep medications in the preceding month, the most common being Valium (diazepam).
Pleasure, happiness and quality of life scale
Participants were asked about the contribution of 15 life aspects to each of the three concepts: pleasure; happiness; and quality of life (QOL). The results indicate that quality of life is quite high among ecstasy users in SA, with participants scoring a mean of seven (out of ten) on the quality of life scale. REU reported that taking drugs contributed to feelings of pleasure quite considerably, but less so to their quality of life.
Almost half of the sample obtained a score of zero on the ecstasy Severity of Dependence Scale (SDS), and just under a quarter obtained a score of 1 on the scale. This indicates that the majority of respondents reported no or few symptoms of dependence in relation to ecstasy use.
The results reported here describe trends in the use of ERD in 2011 in Adelaide, South Australia, and provide comparisons with the findings of the 2010 study. Many characteristics of ERD in the current study were comparable to previous years and remained stable. The notable changes in 2011 centred on the increase use of drugs other than ecstasy, particularly crystal methamphetamine, 2CI and 2CB – possibly as a result of continued reports of difficulties in obtaining ecstasy and the reports of decrease in the purity of ecstasy. Alcohol was most commonly associated with drug-related harms. Furthermore there was inconsistent condom use, driving under the influence of alcohol and other drugs, and a significant increase in past month criminal activity.
The findings from the 2011 SA EDRS have policy and research implications, and several recommendations are outlined below. It is worth noting that several of these issues may have already received attention and/or may be in the process of further investigation.