Executive Summary

This report presents the results from the forth year of a study monitoring ecstasy and related drug (ERD) trends in Victoria. A feasibility trial of this research was conducted in 2000 and 2001 in NSW, QLD and SA, and in 2002 the study was continued in those jurisdictions. 2003 marked the first year of a two-year national trial of the study, with the addition of capital cities in Western Australia, the Northern Territory, the Australian Capital Territory, Tasmania and Victoria.

The demographic characteristics, patterns of drug use and perceptions of the price, purity and availability of ERD among a sample of regular ecstasy users (REU) are described in this report. Their severity of dependence on ecstasy and methamphetamines, perceptions of the effects of drug use (e.g. benefits and risks), health risk behaviours and criminal behaviour are also reported. These findings are triangulated with information from key expert (KE) and secondary indicator data sources in an attempt to minimise biases and weaknesses inherent to each source of data. These methods are employed to gain an understanding of the current ERD markets in Melbourne, Victoria. Where appropriate, 2006 findings are compared to findings from the previous three years and implications of the results and the nature and characteristics of ERD markets are discussed.

Demographic characteristics of regular ecstasy users (REU)
Reports from the 2006 Victorian REU sample and KE suggest that regular ecstasy users are equally likely to be male or female, to be aged in their early twenties, tend to be well-educated, either employed and/or studying and either living in rental accommodation or in the family home. The findings suggest that regular ecstasy users are unlikely to be involved in either the treatment or justice systems.

Patterns of drug use among REU
In addition to ecstasy, REU reported having ever and recently used a range of other drugs. The drugs used by the 2006 sample were comparable to previous years, with recent use of alcohol, cannabis, tobacco and speed commonly reported. Less than half the 2006 REU sample reported bingeing (defined as continuous use of drugs for more than 48 hours) on drugs in the six months prior to interview, most commonly on speed, ecstasy, alcohol and cannabis.

Ecstasy
The 2006 REU sample reported first use of ecstasy, on average, in their late teens, typically commencing regular use in their early twenties. Although there was a wide range of patterns of current ecstasy use reported by the 2006 REU sample, over half (53%) reported using ecstasy pills fortnightly or less frequently. The median number of ecstasy pills used in a session was reported as two, with a median of four used in a heavy session.

Ecstasy pills are most commonly used orally. Regular ecstasy users take ecstasy in a wide range of locations, most commonly nightclubs, dance parties/raves/doofs, private homes/parties and at live music events. The perceived (user defined) benefits of ecstasy use include fun, and enhanced bonding with others, mood and communication. The user-defined risks of ecstasy use include psychological/mental health concerns, physical harms and neuropsychological harms.
As in previous years, polydrug use was the norm among the 2006 EDRS participants, a pattern of use confirmed among ERD users more generally by the KE reports. Most of the 2006 REU sample reported the use of other drugs in combination with ecstasy (82%), and during the ‘come down’ from ecstasy (82%).
The price of ecstasy appears to have remained stable over the last four years, with ecstasy typically costing $30 per pill. The purity of ecstasy tends to be rated as medium or fluctuating. Ecstasy remains readily available, and is predominantly sourced from friends or known dealers in private residences and nightclubs.
Regular ecstasy users tend to have a number of people they can purchase ecstasy from and typically purchase for themselves. In addition to ecstasy, most regular ecstasy users can obtain a range of other drugs from the dealers, most commonly speed and cannabis.

Methamphetamine
Of the three forms of methamphetamine, speed is most widely used by regular ecstasy users (in terms of both lifetime and recent use), followed by crystal meth and then base. Regular ecstasy users commonly use speed in conjunction with ecstasy and during binges. Methamphetamines are used in a variety of locations, predominantly nightclubs and in private homes.

The price of methamphetamines has remained stable, with crystal meth (median of $360 per gram) more expensive than speed (median of $200 per gram). According to the REU reports, the purity of crystal meth is relatively high and stable, whereas the purity of speed is medium to high and less consistent. Speed remains readily available, with ease of access to crystal meth stable or declining. Both speed and crystal meth are most commonly acquired through friends and known dealers. Methamphetamine use has the potential to be associated with considerable harms (i.e. violence and mental and physical health problems).

Cocaine
Reports from the Victorian REU and KE suggest that a high proportion of regular ecstasy users have ever used cocaine, with a considerable number also reporting recent use. Those regular ecstasy users using cocaine tend to use it infrequently, typically snort it, and report using it in a wide range of locations, most commonly nightclubs, pubs and private homes.

Perhaps contributing to the relatively low frequency of recent use, cocaine is an expensive drug. The purity of cocaine is typically rated as medium, it is considered as readily available, with availability recently stable or increasing. Cocaine is commonly purchased from friends or known dealers in private homes.

Ketamine
Reports from the 2006 Victorian REU and KE reflect decreasing levels of both lifetime and recent ketamine use among regular ecstasy users since 2003. Those reporting recent ketamine use typically use it infrequently, in a range of public and private locations.

The purity of ketamine is generally reported as medium or high. Reports of ketamine availability are inconsistent, with a recent trend of stable availability. Ketamine is most commonly purchased from friends and known dealers in private homes and dance parties/raves/doofs.

GHB
Reports from the 2006 Victorian EDRS suggest moderate prevalence of lifetime and low prevalence of recent GHB use among regular ecstasy users. Indeed, fewer of the 2006 REU sample reported recent GHB use than previous years. REU tend to use GBH infrequently across a wide range of locations, predominantly private homes, dance parties and nightclubs.

GHB remains inexpensive (median $3 per ml) and is currently considered to be of medium purity. GHB also remains readily available, although this may have recently decreased. GHB tends to be purchased from friends in their homes. There remains concern regarding GHB among professionals working in a range of capacities with regular ecstasy users.

LSD
Evidence suggests a high prevalence of lifetime use of LSD with moderate levels of recent use among regular ecstasy users. Recent users report infrequent use of LSD across a wide range of locations, predominantly ‘outdoors’, live music events and dance parties.

LSD is relatively cheap (median $12 per tab) and the price has remained stable. Current LSD purity is regarded as high, with purity described as stable. There is little consistency in the reported current availability of LSD, although availability tends to be reported as stable over the previous six months. Regular ecstasy users most commonly purchase LSD from dealers in private homes.

MDA
Reports suggest low prevalence of lifetime and recent use of MDA among regular ecstasy users. It is not possible to comment on trends in the price, purity and availability of MDA given the small number of respondents able to comment in 2006.

Cannabis
Evidence suggests high prevalence of both ‘lifetime’ and recent cannabis use among REU, with relatively frequent recent use common. Cannabis is commonly used during the comedown period from ecstasy and during ERD binges. Questions were asked about the markets for hydroponic and bush cannabis for the first time in 2006. According to REU reports, bush and hydroponic cannabis are of comparable and stable price, although hydroponic cannabis is perceived to have a higher potency than bush cannabis. Both hydroponic and bush cannabis are readily available and are purchased from friends and known dealers in private homes.

Alcohol
The findings suggest almost universal lifetime and recent use of alcohol by regular ecstasy users, and high prevalence of alcohol use in conjunction with, and during comedown from, ecstasy. Indeed, the findings suggest that considerable proportions of REU drink at levels which may cause acute and/or long terms harms.

Patterns of other drug use
Reports from the Victorian REU and KE suggest very high lifetime and recent use of tobacco, with many REU being daily smokers. There also appears to be relatively high prevalence of lifetime and recent use of magic mushrooms in this population, although low frequency of use is typical. Although there appears to be relatively high prevalence of lifetime and recent use of benzodiazepines with use approximately monthly, low levels of lifetime and recent use of antidepressants among REU were reported. Approximately half of REU report lifetime use of inhalants and about one-quarter report low levels of recent use, and reports suggest low levels of lifetime and recent use of heroin and ‘other opiates’ among REU.

Drug information seeking behaviour
The 2006 REU sample were asked about their use of methods to determine the content and purity of ecstasy pills and other drugs, their knowledge of the limitations of available pill testing methods, and how pill test results would influence their drug use behaviour.

The majority of the Victorian sample reported attempting to find out the content and purity of ecstasy at least some of the time, most commonly asking friends who had taken it or asking dealers. Slightly less than one-third of the sample reported personal use of testing kits. There was a moderate level of awareness of the limitations of testing kits among those who reported having used them, with nearly two-thirds able to comment on the limitations. The findings suggest that the results of pill testing may influence the drug use behaviour of regular ecstasy users: over half of those participants reporting personal use of testing kits reported that they would not take a pill if test results indicated that it contained ketamine, and approximately three-quarters reported that they would not take a pill if test results indicated that it contained opiates, 4-bromo-2, 5-dimethoxyphenthylamine (2CB/2CI) or an ‘unknown’ pill (producing no reaction in a reagent test). The majority of respondents reported that they would not take a pill if test results indicated that it contained paramethoxyamphetamine (PMA) or dextromethorphan (DXM).

Participants were also asked what information sources they would find most useful if they were made locally available; with web sites, testing kits and venue outreach workers receiving the most support.

Risk behaviour
The findings of the 2006 EDRS suggest low levels of injecting drug use by regular ecstasy users. The findings suggest that the sharing of needles is rare among those regular ecstasy users reporting injecting, although the sharing of other injecting equipment (i.e. spoons or other mixing equipment, water and/or filters) is more common. This population appears not to experience difficulties in accessing injecting equipment, most commonly accessing equipment through needle syringe programs (NSP). Among regular ecstasy users reporting recent injection there appears to be low levels of Hepatitis B virus (HBV) vaccination and low levels of Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection. These findings, however, need to be interpreted with caution, given the small numbers of participants reporting injection as a route of administration.

Regular ecstasy users appear to be a relatively sexually active group, among whom condom use with regular sex partners is infrequent, but with casual partners relatively frequent. Unsurprisingly, this group tends to report having sex while under the influence of drugs. A small proportion of those who had had casual sex under the influence in the past six months reported that they never used condoms when doing so.

The current study also suggests that risky driving practises are relatively common among regular ecstasy users: over two-thirds of the REU sample who reported having driven in the six months prior to interview reported having driven soon after (i.e. within one hour) of taking any illicit drug/s and more than one-third reported having driven under the influence of alcohol (i.e. over the legal limit). Those reporting driving after using illicit drugs most commonly did so following ecstasy, speed and/or cannabis use. Respondents were asked how impaired they felt the last time they drove soon after taking a drug, with the vast majority reporting they felt only slightly or not at all impaired. 2006 REU participants were also asked what degree of risk they associated with driving after taking a range of drugs, with the highest degrees of risk associated with LSD (d-lysergic acid), ketamine and GHB (gamma-hydroxy-butyrate), as well as with driving over the legal blood alcohol concentration (BAC).

Health related issues
A range of potential harms associated with ERD use is examined as part of the EDRS, including the experience of overdose, dependence, psychological distress and the use of drug-related treatment services.

The findings suggest that overdose is only experienced by a small proportion of regular ecstasy users, although it is still considered a significant harm by some KE.

Although the majority of the REU sample tended not to have scores on the Severity Dependence Scale (SDS) indicative of amphetamine dependence, a small proportion did so. Similarly, only a small proportion of the sample scored in the high risk range on the measure of psychological distress.

The findings indicate that regular ecstasy users tend not to utilise health and treatment services for their ERD use. This appears to be a result of a number of factors including services not being necessary due to generally infrequent patterns of use and low levels of harms and, among those experiencing harms, a lack of recognition that such harms are associated with ERD use. GPs and counsellors appear to be the treatment types most commonly accessed by regular ecstasy users.

Consistent with previous years, the reports of the 2006 REU sample suggest that relatively high levels of non-health related problems are experienced by regular ecstasy users: participants reported high rates of occupational/study, financial and relationship/social problems due to their use of ERD in the six months preceding interview. It is important to note, however, that the majority of these problems are considered as relatively minor by users, and that few participants reported legal/police problems associated with their ERD use.

Criminal activity, policing and market changes
The evidence suggests that the majority of regular ecstasy users do not undertake criminal activities. Over one-quarter of the 2006 REU sample, however, had been involved in drug dealing in the month prior to interview. These relatively high levels of dealing were also corroborated by the KE.
Nearly one-half of the 2006 participants believed police activity had increased in the last six months, most frequently citing increased presence of sniffer dogs, increased police presence and drug-driving testing buses. Despite such perceived changes, however, the majority of participants reported that police activity had not made it more difficult to obtain ERD in the six months prior to interview.

Conclusions
The results reported here describe trends in the market for ecstasy and related drugs in Melbourne, Victoria, and provide comparisons with the findings of the 2003 to 2005 studies. Many characteristics of ERD use reported in the previous Victorian and national (e.g. Stafford et al., 2006) reports are confirmed in the current study, perhaps suggesting a level of stability in this illicit market. Regular ecstasy users are typically aged in their mid-twenties, are well educated and tend to be employed and/or students. Polydrug use appears to be the norm among regular ecstasy users, with a range of drugs used in conjunction with, and during the comedown from, ecstasy. Bingeing on drugs also appears to be common by this population, although few engage in intravenous drug use.

Many of the drugs investigated in this research (i.e. ecstasy, speed) were identified as readily available, although some classes of drug (i.e. cocaine and crystal meth) appear more difficult to access or are highly variable in their availability. Similarly, there was a degree of variability in the frequency with which some drugs were used. Ecstasy, speed and cannabis were used regularly, whereas, cocaine was used infrequently and opportunistically.

In general, risk behaviours, health-related problems and criminal activity among REU were relatively uncommon. However, considerable proportions of REU reported driving soon after taking drugs (both ERD and alcohol) and participating in dealing. Problems associated with ERD use tend to involve work, study and social relationships, and were reported by a substantial proportion of participants.

Implications
This fourth consecutive year of the Victorian EDRS study has provided further indication of the patterns and characteristics of ERD use and related consequences in Melbourne. Patterns of polydrug use, binge drug use, the frequency and locations where some drugs are used, and the availability of many drugs have shown a degree of consistency across the four years of data collection. Other characteristics, such as the prevalence of recent GHB, cocaine use and crystal meth were inconsistent across time and warrant further exploration. The EDRS has also provided unique information on a range of issues of relevance to ERD using populations such as drug-driving behaviour.

With increasing community interest in the patterns and characteristics of ERD use, the Victorian EDRS represents a key knowledge base from which to further explore these local markets. The primary aim of the national EDRS was to provide a ‘snapshot’ of the characteristics of regular ecstasy use in Australia. Although the data collection methods described in this report have limitations, the findings provide information that can be used to inform other research with the capacity to target emergent questions relating to regular ecstasy use (see below).

The findings of the 2006 Victorian EDRS suggest the following recommendations:

Polydrug use by REU, associated harms, and explorations of harm reduction strategies used by REU warrant further investigation. In particular, the high levels of alcohol use reported by the REU sample, both in conjunction with ecstasy and during the comedown, as well as during binges, needs to be examined further, with new harm reduction messages targeting such behaviours potentially required.
The findings of the EDRS studies illustrate the wide range of settings in which ERD are used. Considering that harm reduction messages have traditionally been designed for and implemented in rave settings, such findings have implications for the development and implementation of harm reductions in a wider range of settings. For example, specific resources targeting home-based users and those using in nightclubs is also required (i.e. the expansion of the RaveSafe model of peer education to a equivalent nightclub based initiative).
More thorough and targeted research examining the extent and nature of injecting drug use in ecstasy-using populations is required. Although reports from the 2004, 2005 and 2006 Victorian REU suggest only low levels of injecting drug use, the sharing of injecting equipment other than needles (i.e. spoons or other mixing equipment, water and/or filters) is relatively common among those reporting injecting. Further, there appears to be low levels of HBV vaccination among this group. Interventions specifically targeting this population and addressing these issues (i.e. risks of sharing ‘any’ injecting equipment and increasing awareness of HBV vaccination) may usefully be developed and potentially disseminated via NSP (the most commonly reported sources of injecting equipment). The findings and implications of the current research need to be interpreted with caution, however, given the small numbers, with further research clearly warranted.
Problems relating to financial, work/study and relationship/social outcomes need further exploration to provide a better understanding of the harms associated with regular ecstasy use. Increased understanding of such issues may have implications for the development of both prevention and harm reduction strategies, such as tools encouraging problem recognition and providing strategies to reduce and/or cease ERD use.
The findings of the 2005 Party Drug Initiative (PDI) suggest that a small proportion of regular ecstasy users experience dependence on methamphetamines. This needs to be explored further, in terms of the implications for such users, their perceptions of such dependence, and the utilisation of treatment services. Levels of dependence of this population on other drugs commonly used (i.e. cannabis) could also be usefully explored.
The findings of the 2005 Victorian PDI also provide evidence of low levels of treatment utilisation among regular ecstasy users. Although this may primarily be a result of low levels of harm and need of treatment among this group, there is also some evidence to suggest a lack of problem recognition and a reluctance to seek treatment among those regular ecstasy users experiencing harms. Barriers to treatment beyond lack of problem recognition (i.e. lack of knowledge of treatment options available, stigma associated with treatment utilisation) should be explored. Such research may usefully inform the development of a tool designed to increase recognition of problematic use and encourage treatment utilisation among those experiencing harms.
The high levels of driving under the influence of both alcohol and ERD reported by participants is a major concern. Targeted research is needed in this area, particularly in the context of Victoria’s new ‘drug-driving’ testing initiatives and the impact such initiatives have on behaviour. Attitudes towards these initiatives and drug-driving more generally need to be assessed to allow for education and awareness campaigns to be developed.
Although experienced by a minority of regular ecstasy users, overdose events are a significant concern. Little is known about the circumstances around overdose, hampering efforts to both prevent and treat such events. Further research examining such factors is a priority. Overdose events present potential opportunities to provide individuals with information about their overdose, harm minimisation strategies and general drug information. There is, however, a current lack of appropriate resources to provide such information.
Relatively high levels of dealing were reported by the 2006 REU sample. Issues such as the legal status of on-selling and dealing/supplying to friends need to be examined in greater detail, potentially informing the development of resources designed to raise awareness of such issues and the potential penalties of such behaviour.

Citation: Johnston, J., Quinn, B. & Jenkinson, R. (2007) Victorian Trends in Ecstasy and Related Drug Markets 2006: Findings from the Ecstasy and Related Drugs Reporting System (EDRS). Sydney: National Drug and Alcohol Research Centre.