EXECUTIVE SUMMARY

Demographic characteristics of REU
The sample of 75 regular ecstasy users (REU) interviewed in 2011 were typically in their early- to mid-twenties, with ages ranging from 17 to 39 years. Participants were generally well educated and either employed on a full- or part-time/casual basis or currently engaged in study. The majority (85%) had completed year 12, and 53% had completed tertiary qualifications after school (university or trade/technical). Few participants had come into contact with drug treatment agencies. These demographic characteristics are generally consistent with those reported among REU in the previous years of the study. However, a significantly smaller proportion reported current full-time study in 2011 relative to 2010 (11% vs. 27%), and there tended to be a greater proportion of unemployed participants (19% vs. 8%).

Patterns of polydrug use over time
Polydrug use was the norm among the REU interviewed, with most having used a range of drug classes in the preceding six months. Recent use of alcohol, tobacco, cannabis, amyl nitrite, methamphetamine powder, benzodiazepines, LSD, cocaine, nitrous oxide, and mephedrone was most common. Relative to 2010, a significantly greater proportion of the 2011 sample reported recent use of LSD (43% vs. 27%), MDA (21% vs. 5%), benzodiazepines (45% vs. 27%), and ‘other opioids’ (16% vs. 4%), and a significantly smaller proportion reported recent use of amyl nitrate (29% vs. 51%).

Ecstasy
On average, the participants interviewed in the present study had first started to use ecstasy on a regular basis at 19 years and had been using ecstasy for a period of 5 years. Ecstasy had typically been used in tablet (95%) or capsule (80%) form in the last six months, with use of ecstasy powder less common (26%). The proportion reporting recent use of ecstasy capsules increased significantly in 2010 and remained high in 2011.

Ecstasy was typically swallowed, but snorting of ecstasy was also common. In 2010 there was a significant increase in the snorting of ecstasy tablets (89% vs. 71%) and capsules (82% vs. 38%) relative to 2009. This increase was maintained in 2011 for capsules (82%) but not for tablets (77%).

There was a wide variation in the frequency of ecstasy use among the sample, ranging from monthly to several times a week. On average, ecstasy had been used fortnightly with a median of two tablets taken in a typical session. Ecstasy was typically last used at musicrelated venues including nightclubs and pubs; or in private residences.

There were some concerning patterns of use among the sample from a health perspective. More than one-tenth had used more than two tablets in a typical session of use (14%) or had recently used ecstasy in a ‘binge session’ (a continuous 48 hour period of drug use without sleep) (14%), and one-quarter had used ecstasy weekly or more frequently (23%). Whereas the long-term effects and risks of extended ecstasy use are not completely understood, evidence from toxicology studies in rats and neuropsychological studies in humans indicate that the safest pattern of use is to use the drug infrequently and in small amounts. Thus, those using the drug frequently or in large amounts for extended periods of time may be at a greater risk of neurological and neuropsychological harm.

Ecstasy was typically consumed in combination with other drugs – in a typical session, alcohol, cannabis, and tobacco were commonly used. A large majority (97%) reported drinking alcohol when last under the influence of ecstasy and nine-tenths of the sample (92%) had consumed more than five standard drinks. High levels of concomitant binge alcohol and ecstasy use is an issue of concern. There is an increased risk of dehydration when alcohol is combined with ecstasy, and larger quantities of alcohol can be consumed when under the influence of psycho-stimulants without experiencing immediate effects of intoxication; however, the harms associated with this use still occur. Moreover, there is emerging evidence from animal studies that alcohol may dramatically alter the pharmacology of 3,4-methylenedioxymethamphetamine (MDMA) in the brain, which may exacerbate the potential for neurological harm from the drug (Hamida et al., 2008).

Data from the NDSHS showed a steady increase in the national prevalence of ecstasy use in Australia between 1995 (0.9%) and 2007 (3.5%), with a significant decrease noted in 2010 (3.0%). The estimated prevalence of recent ecstasy use in Tasmania increased from 1.6% in 2004 to 2.4% in 2007, with a non-significant decrease found in 2010 (1.7%).

Price, purity and availability of ecstasy
The median last purchase price for one tablet of ecstasy was $30 (range $15-$40), reflecting a decrease relative to 2010 ($35). The median last purchase price for a capsule of ecstasy was also $30. No recent price changes were evident, with three-fifths (65%) indicating that the price had recently remained stable.

Relative to 2009 (10%) a significantly greater proportion of the 2010 (41%) and 2011 (47%) samples indicated that ecstasy was currently low in purity.

The proportion reporting that ecstasy was ‘easy’ or ‘very easy’ to obtain was significantly lower in 2010 (61%) and 2011 (70%) relative to 2009 (83%). While a recent decrease in availability was noted in 2010, availability was reported to be relatively stable in 2011.

In summary, there is evidence for a change in the ecstasy market in Hobart over the past few years with indications of a reduction in the price and perceived purity and availability of the drug.

Ecstasy markets and patterns of purchasing
Consistent with previous years, ecstasy was typically purchased from friends and obtained from a friend’s home, the respondent’s own home, or a nightclub/pub. Three-fifths (62%) indicated they typically purchased ecstasy both for themselves and others, with a median of three tablets purchased per occasion.

Although the ecstasy market is predominantly based on individuals sourcing the drug for other friends while making no cash profit, those that purchase ecstasy in larger quantities may be putting themselves at risk of being arrested as a provider rather than a consumer of the drug. Under Tasmanian legislation, the offences of possession, supply, and trafficking of a controlled substance are based on various factors including ‘intent’ and are not necessarily determined by the quantity of the seized substance. However, the offence of trafficking, which carries the largest penalty, may be determined by possession of a trafficable amount of a controlled substance. For ecstasy (MDMA), this trafficable amount is 10 grams.

Methamphetamine
Use of methamphetamine was relatively common among REU in 2011, with over one-half (52%) reporting recent use of some form of methamphetamine in the preceding six months. This is comparable to rates in 2010 (48%) and 2009 (52%), but significantly lower than proportions in previous years samples (63-82%). This finding is consistent with a downward trend in methamphetamine use among the general population in recent years (NDSHS; AIHW, 2007).

Methamphetamine was used on a median of three days during this period (once every two months on average) in relatively small amounts (2 points).

Recent use of methamphetamine powder was most common (47%), with low levels of use of methamphetamine base (8%) and crystal methamphetamine (5%). The proportion reporting recent use of methamphetamine powder (47%) was similar to 2010 and 2009 (40% and 46% respectively) but fewer relative to preceding years (62-77%).

Methamphetamine powder was typically swallowed or snorted, base was typically swallowed or injected, whereas crystal was typically smoked.

The median last purchase price for one ‘point’ (0.1 g) of all methamphetamine forms was $35, which is lower than previous years ($40). The median last purchase price for one gram of methamphetamine powder ($250) was consistent with prices reported over the past two years and remained lower than that reported prior to 2009 ($300-350).

Methamphetamine powder was reported to be medium to high in purity and was considered to be ‘easy’ or ‘very easy’ to obtain among those who commented. Small sample sizes in relation to crystal and base and low levels of recent use among the current cohort both indicate very low availability of these forms in 2011.

Cocaine
Two-fifths (39%) of the 2011 REU sample reported recent use of cocaine, which is similar to the proportion among the 2009 (31%) and 2010 (49%) samples. Prior to 2006, recent use of cocaine was significantly less common with less than one-fifth reporting recent use (7-20%). The upward trend observed in recent cocaine use is consistent with national and Tasmanian population trends (NDSHS: AIHW, 2007, 2011).

Cocaine was typically snorted and was used on a median frequency of one day (range 1-30 days) in the last six months, less than the median of three days reported among the 2010 sample. An average of 0.5 grams was used in a typical session. Cocaine was typically last used at a nightclub, public bar, or private residence.

The median last purchase price for one gram of cocaine was $300 (range $200-400) and no consistent price trends were noted.

Cocaine was reported to be ‘medium’ in purity and this purity was reported to have remained ‘stable’ in the last six months.

The majority of those who commented on the availability of cocaine indicated that it was currently ‘difficult’ or ‘very difficult’ to obtain, and availability was reported to have recently remained stable in the last six months.

Cocaine had typically been purchased last from friends or dealers either at private residences or public bars.

LSD and other psychedelics
Over three-fifths (65%) of the 2011 sample had used LSD at some stage of their lives. Consistent with previous EDRS samples, lifetime use of LSD was more common among males relative to females. Two-fifths (43%) had used LSD in the six months preceding the interview which is significantly greater relative to the proportion in 2010 (27%).

One tab or one drop of liquid LSD (range 0.25-5) was taken orally in a typical session of use and LSD had been used on a median of 3.5 days (range 1-48 days) in the preceding six months.

LSD was last used at private residences such as the consumer’s own home or a friend’s home, as well as live music events.

The median last price for one tab of LSD in 2011 was $20 (range $10-35) which is lower relative to the median price of $25 reported in 2010 but relatively consistent with the years prior to this ($15-20).

The purity of LSD was considered by REU to be ‘high’ (59%) or ‘medium’ (35%) and to have remained stable during the last six months.

A large majority of those commenting indicated that LSD was ‘very easy’ (44%) or ‘easy’ (39%) to obtain and that availability had recently been stable (61%).

LSD was typically last obtained from friends and was most commonly last obtained from private residences, live music events, and nightclubs.

One-quarter (23%) of the 2011 sample had recently used psychedelic mushrooms, with recent use more common among younger (<24 years) than older (≥24 years) participants (based on a median split for age). Mushrooms had been used on a median of 3 days in the last six months, or approximately once every two months on average. Almost one-half (45%) of all participants had recently used some form of psychedelic drug (either LSD or mushrooms) in the last six months.

Cannabis
Over three-fifths (67%) of the 2011 sample had used cannabis during the six months preceding the interview. Cannabis had typically been smoked, with around one-third recently ingesting the drug. There has been less recent use, and a lower median frequency of use among the EDRS cohorts between 2007 and 2011 relative to previous years. While the NDSHS indicated that cannabis use was decreasing in the general population nationally between 2004 (11.3%) and 2007 (9.1%), there was a significant increase in use between 2007 and 2010 (10.3%). In contrast the recent use in Tasmania continued to decrease (but not significantly) between 2007 (10.8%) and 2010 (8.6%).

The median frequency of cannabis use was 24 days (range 1-180 days) or approximately once per week. Daily cannabis smoking was relatively uncommon (8%). The median quantities used on the last day of use during this time were 5 cones (range 1-24) or 1 joint (range 0.3-5).

The median last purchase price for one ounce of ‘hydro’ was $287.50 (range $225-350) and $225 for ‘bush’. The median weight for one $25 bag of hydro was 1.75 grams (range 1.1-2.5 grams), compared to 2.25 grams (1.5-3 grams) for bush. However, few participants commented on the market characteristics of cannabis in 2011 and these data should therefore be interpreted with caution.

The potency of ‘hydro’ was reported to be high (63%) and the potency of ‘bush’ was reported to be medium (60%).

Both ‘bush’ and ‘hydro’ were reported to be ‘easy’ or ‘very easy’ to obtain, and this level of availability was perceived to have remained stable during the six months preceding the interview.

Alcohol
The entire 2011 REU sample had recently consumed alcohol, on an average of two to three days a week in the last six months. A majority (83%) had used alcohol at least weekly (but not daily), which is substantially higher than the estimate of prevalence in the general population (43.9%, among those aged 20-29 nationally – a comparable age group to the current REU cohort).

Tobacco
Tobacco had recently been used by over four-fifths (83%) of the 2011 REU sample, with two-fifths (38%) reporting daily use in the last six months, which is greater (but not significantly) relative to the proportion in 2010 and similar to 2009 (28% and 42% respectively). This proportion of daily smokers is higher than the 2010 population estimate for this age group (20-29) both in Tasmania (25.5%) and nationally (18%).

Mephedrone (4-methylmethcathinone)
The proportion of REU reporting recent use of mephedrone in 2011 (27%) was significantly fewer relative to the significant increase noted in 2010 (47%). Mephedrone was snorted or swallowed on a median of 3 days in the last six months, indicating a decrease in frequency of use relative to 2010 (6 days). Of those who commented on the last source of mephedrone (n=19), a majority had last obtained mephedrone from a friend (58%) or dealer (32%), with the remainder (11%) obtaining the drug from the internet.

Patterns of other drug use
Consistent with previous years, less than one-tenth reported recent use of ketamine (8%) or GHB/GBL/1,4B (3%).

Almost one-third (29%) reported recent use of amyl nitrite which is significantly less than the proportion in 2009 and 2010 (51%). Frequency of use was relatively low at approximately once every two months.

One-third (36%) reported low frequency (less than monthly) use of nitrous oxide.

Over two-fifths (45%) of REU had used benzodiazepines during the last six months, compared to a significantly smaller proportion in 2010 (27%). One-third (36%) reported recent illicit use of benzodiazepines, which is higher relative to 2010 (23%) and much higher than recent estimates of prevalence in the general population (1.5%). However, use of illicit benzodiazepines was relatively low in frequency, at 5.5 days in the last six months.

Less than one-tenth of the sample (8%) had recently used antidepressants; 7% reported recent licit use and 1% reported recent illicit use.

The use of other pharmaceuticals and opioid drugs was relatively rare among the regular ecstasy users interviewed in the current study, and those that had recently used these drugs had generally done so infrequently. Over one-tenth (15%) of REU reported recent illicit use of pharmaceutical stimulants (such as dexamphetamine or methylphenidate) in 2011. The median frequency of use was 5 days (range 3-20 days) in the last six months. Only small proportions of the 2011 sample had recently used heroin (8%), methadone (4%), and buprenorphine (3%). However, nearly one-fifth (16%) had recently used other opioids (restricted opioid pharmaceuticals such as morphine and oxycodone, and alkaloid poppy derivatives), a significantly greater proportion relative to 2010 (4%). Less than one-tenth reported recent use of codeine (9%) or stimulant based (5%) over-the-counter preparations.

Recent use of other emerging psychoactive substances was relatively low; however, one tenth of the sample reported recent use of capsules of ‘unknown contents’ (15%) or use of ‘herbal highs’ (11%).

Health-related issues
Overdose. Two-fifths (41%) of the 2011 REU sample reported an overdose episode in the last six months. While this is substantially higher than previous years (6-18%), 2011 data is not directly comparable to previous years due to a broadening of the definition of overdose applied. In 2011, 13% reported a recent overdose episode on a stimulant drug (e.g., methamphetamine, ecstasy and other stimulants) and 32% reported a recent overdose on a depressant drug (e.g., alcohol and other opioids). While these symptoms of overdose were not medically trivial, most participants had not received any formal medical treatment in relation to an overdose episode.

Ecstasy dependence. One-tenth (12%) of REU reported experiencing significant symptoms of dependence in relation to ecstasy.

Methamphetamine dependence. Less than one-tenth (5%) of those who had recently used methamphetamine had experienced significant symptoms of dependence in relation to methamphetamine.

Access to health services. Despite regular substance use, just over one-tenth (13%) of REU had accessed health services in relation to drug use in the last six months, and when they did so, this was most commonly a GP (50%), a counsellor (17%) or an emergency department (17%). Participants were most likely to access services in relation to the use of alcohol (42%), polydrug use (17%), or opioid use (17%).

Mental health problems. One-quarter (27%) of the 2011 REU sample reported experience of mental health problems during the six months prior to the interview, most commonly anxiety (60%) and/or depression (50%). Over two-thirds (70%) of those who had experienced mental health problems had attended a health professional in relation to these problems during this time.

Psychological distress. Mean scores on the Kessler psychological distress scale (K10) were higher among the current sample of REU relative to the general Australian population (National Health Survey 2007/08; ABS, 2009). The proportion of the sample with scores categorised as ‘very high’ was similar to the general Australian population; however, the proportion of REU with scores classified as ‘high’ was significantly greater than the general population. Those classified in the ‘high’ range have increased rates of experience of mental health problems and may benefit from interventions with health professionals.

Other problems. Over one-half (59%) of the 2011 sample reported a recurrent drug-related problem, suggestive of possible substance abuse, a significant increase relative to 2010. This overall increase was largely due to an increase in the proportion who reported that they had recurrently been under the influence of substances in situations that could have put themselves or others at risk (40% vs. 22%). In addition, one-quarter (27%) reported that drug use had recurrently interfered with their responsibilities at home, work, or school during the six months preceding the interview and smaller proportions had experienced recurrent social/relationship (15%) problems or legal/police problems (5%) in relation to drug use. Problems were most commonly attributed to ecstasy, cannabis, and alcohol.

Drug treatment data
While a consistent number of calls have been made to the Tasmanian Alcohol and Drug Information Service over the last few years in relation to ecstasy (4-17 calls), these account for a small percentage (between 0.7% and 2.6%) of the calls made to this service.

Data from the National Minimum Data Set (NMDS) for alcohol and other drug treatment services in Tasmania show that ecstasy was the principal drug of concern in only 1.9% of all treatment episodes in the 2009/10 period (equating to approximately 28 treatment episodes out of a total of 1,454).

There has been a substantial reduction in Tasmanian cannabis-related hospital admissions over the last two reporting periods with 32 cases reported in 2008/09. This marks a return to admission rates that are slightly lower but more comparable to the national rates (per million population), as Tasmanian admission rates were substantially higher than the national rates in the 2006/07 reporting period.

Tasmanian and national hospital admission rates for methamphetamine increased steadily between 1999/00 and 2002/03, followed by a plateau between 2003/04 and 2005/06. In 2006/07 there was a substantial increase in Tasmanian rates, to a level considerably higher than the national figure reported in both 2006/07 and 2007/08. In 2008/09 there was a substantial reduction in Tasmanian admissions, with a rate well below the national admission rate observed for this period (76 vs. 157 admissions per million population).

Risk behaviours
Injecting drug use. One-tenth (13%) of the 2011 REU sample had recently used substances intravenously. Heroin, methamphetamine, and other opioids were typically the first drug ever injected and the most common drug ever and recently injected. Sharing of needles and equipment was not common.

Blood-borne viral infections. Three-fifths (60%) of the 2011 REU sample had been vaccinated for hepatitis B, over half (54%) had been tested for hepatitis C, and three-fifths (60%) had been tested for HIV.

Sexual risk behaviour. Over three-fifths (64%) of REU reported penetrative sex with a casual partner during the six months preceding the interview and three-fifths (59%) reported sex with a casual partner while under the influence of drugs, most commonly alcohol, ecstasy, or cannabis. When under the influence of ERDs, only around one-fifth reported ‘always’ using protective barriers with a casual partner and approximately one-quarter ‘never’ used protective barriers. Over one-half (57%) of those who reported sex with a casual partner indicated that they did not use any protective barriers on the last occasion in the last six months.

One-fifth (20%) of the sample reported that they had never had a sexual health check-up. A majority of the sample (81%) reported that they had never been diagnosed with a STI and the remainder had been diagnosed in the last year (1%) or more than a year ago (18%). The most commonly diagnosed STIs were chlamydia (93%) and herpes (21%).

Drug driving. Of those who had driven a car, over one-third (37%) reported driving at a time when they perceived themselves to be over the legal alcohol limit during the last six months, and two-fifths (40%) reported driving within an hour of taking illicit drugs in the last six months. Most commonly, participants reported driving under the influence of cannabis, ecstasy, or methamphetamine powder.

The proportion of REU reporting DUI of ecstasy and methamphetamine has gradually declined over the last six years while DUI of cannabis has remained relatively stable. In addition, DUI of ecstasy was perceived to be more risky in terms of crash risk and to some extent risk of apprehension (being ‘caught’ by police) in 2011 when compared to attitudes among the 2007 sample. DUI of cannabis was perceived to be more risky in terms of risk of apprehension but not crash risk in 2011.

Alcohol Use Disorders Identification Test (AUDIT). One-third (36%) of REU who completed the AUDIT scored in zone 4 (those in this zone may be referred to evaluation and possible treatment for alcohol dependence) which is significantly greater than the proportion categorised in zone 4 among the 2010 sample (21%). A further 26% scored in zone 3 (harmful or hazardous drinking), one-third (32%) scored in zone 2 (alcohol use in excess of low-risk guidelines), and just 6% scored in zone 1 (a level reflecting low-risk drinking or abstinence).

Binge drug use. One-fifth (22%) had recently ‘binged’ on ecstasy or related drugs (a continuous period of use for more than 48 hours without sleep), on a median of two occasions in the last six months. Substances most commonly used in a binge session of use were ecstasy, alcohol, cannabis, methamphetamine, energy drinks, LSD or cocaine.

Criminal activity, policing and market changes.The self-reported level of criminal activity among the 2011 REU sample was relatively low. With the exception of property crime (15%), around one-tenth of the REU interviewed had committed other criminal offences during the one month preceding the interview. Almost one-fifth (16%) had been arrested during the preceding 12 months, generally for reasons unrelated to drug use.

Law enforcement data
There was a substantial increase in the number of both consumer and provider arrests and seizures in relation to ecstasy between 2006/07 and 2009/10 relative to any previous years. In 2010/11 a substantial reduction in both the numbers of arrests and number of seizures was noted relative to recent years. It is possible that the decrease in ecstasy seizures is related to the changes in the ecstasy market reported by REU (i.e., decreased price, purity, and availability of the drug in Hobart) and the recent increase in the use and availability of capsules containing substances such as mephedrone or ‘unknown substances’ among REU.

While the number of methamphetamine-related arrests substantially increased in the 2006/07 and 2007/08 periods, there have been reductions in recent years with a substantial reduction in arrests between the 2010/11 and 2009/10 reporting periods (95 vs. 128). The number of methamphetamine-related seizures increased gradually between 1999/00 and 2006/07. Since this time there has been a reduction; however, an increase in both the weight and number of seizures was noted in 2010/11 relative to 2009/10.

Since 2006/07 the number of cannabis-related arrests and cautions has remained relatively stable while the weight and number of seizures have increased gradually. This upward trend has continued, with an increase in both the weight and number of seizures observed in 2010/11 relative to 2009/10.

The total number of drug diversions or cautions and the number diverted to health interventions were substantially lower in 2010/11 compared to 2009/10. A reduction was also noted in the number of ecstasy-related diversions (8 vs. 25).

The number of individuals before the Hobart Magistrates Court and the number of individuals incarcerated at Hobart Prison in relation to drug offences were greater in 2010/11 relative to 2009/10. However, in 2010/11, the Magistrates Court introduced a new data coding system (ASOC 2008), which means direct comparisons with data from previous years should be made with caution.

Special topics of interest
Online drug-related activity. A large majority of REU (88%) had been online during the last six months. Among those who had been online during this time, 35% had been online to get information about drugs (most commonly ecstasy, LSD and mushrooms) but none reported posting information about drugs during this time. One-half of REU who sought online information reported engaging in a range of behaviours due to information they had accessed online. These included: trying a drug not used before (33%), altering a drug dose (8%), stopping use of drug (8%), and using a new combination or route of administration (4%).

Sleep patterns. Almost one-third (31%) of REU reported problems with sleep and over one-quarter (28%) reported that their current drug use had impacted negatively on sleep. One-quarter (27%) of the sample reported that they had used sleep medication in the past month (most typically less than once a week) with Valium (diazepam) most commonly used.

Heavy Smoking Index. Over one-quarter (27%) of daily smokers reported smoking their first cigarette within 5 minutes of waking and one-third (32%) between 5 to 30 minutes of waking. One-half (50%) of daily smokers reported smoking 10 or less cigarettes per day with the remainder smoking more than this. One-third of daily smokers (32%) scored 4 or above indicating moderate to high nicotine dependence.