EXECUTIVE SUMMARY

This report presents the results from the eleventh year of the Ecstasy and Related Drugs Reporting System (EDRS), a study monitoring ecstasy and related drug (ERD) use and market trends in Melbourne, Victoria. Key findings from interviews with 100 regular psychostimulant users (RPU), key expert (KE) interviews and external indicator data are included in this report. The 2013 EDRS Project was supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund.

Demographic characteristics of RPU

The mean age of participants interviewed as part of the 2013 RPU sample was 26 years (slightly older than in 2012). Other demographic characteristics were consistent with those measured in 2012; RPU interviewed in 2013 were typically heterosexual, well educated, from an English-speaking background, and few reported being in drug treatment. Higher proportions were currently in full-time employment and earning a higher mean weekly income ($693) in 2013, compared to 2012.

Patterns of drug use among RPU

In addition to ecstasy, in 2013 most RPU reported having recently used alcohol, tobacco and cannabis, unchanged from 2012. The reported recent use of the following drugs was significantly higher in 2013 than 2012: ecstasy powder (51% vs. 31%), LSD (52% vs. 38%) and nitrous oxide (48% vs. 22%), while the reported use of speed powder was significantly lower in 2013 (58% vs. 77% in 2012). The prevalence of other methamphetamine use remained at similar levels to 2012; 45% of participants reporting recent use of crystal methamphetamine and 8% reporting recent use of methamphetamine base. In 2013, data on lifetime and recent use of ecstasy crystals were collected for the first time in the EDRS, and 49% of respondents reporting recent of use ecstasy crystals. There was a notable increase in reporting of recent use of ketamine between 2012 and 2013 (35% vs. 46% respectively), the highest reported in the EDRS since 2003. Reports of recent cocaine use (reported by 46% of participants in 2013) remained comparable to EDRS respondents in previous years. The prevalence of benzodiazepine use (licit and illicit) increased for both lifetime (80%) and recent use (53%), compared to 2012. Almost half (47%) of the 2013 RPU sample reported recent use of new psychoactive substances (NPS), an increase from reports in 2012 (33%).

Ecstasy

Similar to previous years, the 2013 RPU sample reported first using ecstasy regularly at a mean age of 19 years, swallowing a median of two pills in a typical episode of use and commonly using other drugs in conjunction with ecstasy (92%). In 2013, 26% of RPU reported ecstasy as their ‘favourite’ drug compared to 35% in 2012. The price of one ecstasy pill remained consistent at $30 between 2012 and 2013. Fewer RPU reported perceiving ecstasy purity to be high in 2013 than in 2012 (18% vs. 32% respectively) while a significantly higher percentage reported ecstasy to be very easy to obtain (50% vs. 35% respectively). Consistent with previous years, on the last occasion of use RPU reported most commonly obtaining ecstasy from friends (62%), at a friend’s home (30%) and using ecstasy at a nightclub (28%).

Victoria Police Forensic Services Department’s analyses of ecstasy seizures show that the average purity decreased slightly from 33% in the 2011/2012 financial year to 30% in 2012/2013.

Methamphetamine

RPU were asked about different forms of methamphetamine: speed, crystal methamphetamine and methamphetamine base.

As in previous years, in 2013 RPU reported using a median of 0.5 gram of speed in a typical episode of use. Participants reported using speed on a median of four days in the past six months in 2013, lower than a median of six days in 2012. RPU reported typically paying $200 per gram for speed in 2013, unchanged from the previous three years. A significantly higher proportion of participants reported that speed quality was low in 2013 compared to reports in 2012 (23% vs. 8% respectively). Over two-thirds (68%) of the 2013 EDRS sample reported that ease of access to speed was stable in the past six months. Participants reported that on the last occasion of use they most commonly purchased speed from friends (55%), last obtained it at a friend’s home (50%), and last used it at their own home (27%).

In 2013, participants reported using a median of two points of crystal methamphetamine in a typical episode of use, slightly higher than the median of 1.5 points in 2012. The median reported days of use of crystal methamphetamine in the preceding six months increased from 8.5 days in 2012 to 10 days in 2013. The most commonly reported route of administration for crystal methamphetamine was smoking (87%). The median reported price per point of crystal methamphetamine was $80, slightly lower than 2012. In 2013, participants generally reported crystal methamphetamine purity as high (50%) or medium (28%), and very easy (78%) or easy (22%) to obtain in the preceding six months. RPU reported that on the last episode of use they most commonly purchased crystal methamphetamine from a friend (55%), obtained it at an agreed public location (34%) and used it at their own home (47%).

Only eight participants of the 2013 Victorian EDRS sample reported recent use of methamphetamine base and few were able to respond to questions about price, purity and availability.

Methamphetamine was described by the majority of KE interviewed in 2013 as the most widely used illicit drug following cannabis. They considered it to be a problematic drug due to a perception of increasing purity in the preceding 12 months resulting in RPU reaching higher intoxication levels and being intoxicated for longer periods.

Victoria Police Forensic Services Department’s analyses of methamphetamine seizures show that the average purity increased from 57% in the 2011/2012 financial year to 60% in 2012/2013

Cocaine

In 2013, participants reported using a median of 0.5 gram of cocaine in a typical episode of use, which was consistent with 2012. RPU reported using cocaine on a median of two days in 2013 and almost all (98%) of those using cocaine recently reported snorting it. The median reported cost of cocaine in 2013 was $300 per gram, slightly lower than the $350 recorded in 2012. Of the recent cocaine users who were able to comment, 29% perceived cocaine purity as high, compared to 19% in 2012, and almost half (48%) described the purity of cocaine as stable in the preceding six months. In 2013, the percentage of participants reporting cocaine as difficult to obtain was significantly lower than in 2012 (29% vs. 42%). On the last episode of use, RPU reported most commonly obtaining cocaine from a friend (43%), at a friend’s home (38%) and used it at a pub or bar (23%).

Victoria Police Forensic Services Department’s analyses of cocaine seizures during the 2012/2013 financial year show that the average purity was 46%, slightly lower than in 2011/2012 (49%).

Ketamine

In 2013, higher proportions of RPU reported lifetime (76% vs. 63%) and recent (46% vs. 35%) use of ketamine than in 2012. Ketamine was used on a median of four days in the preceding six months in 2013 compared to a median of two days in 2012. Participants most commonly quantified their use of ketamine in ‘bumps’, reporting using a median of three bumps during a typical episode of use. Consistent with the previous two years, the median reported cost of ketamine in 2013 was $200 per gram. Of the participants who were able to comment, 74% perceived ketamine purity to be high, significantly more than 2012 (54%), and the majority (59%) described ketamine purity as stable in the preceding six months. Ketamine was reported as very easy to obtain by 37% of participants who were able to comment in 2013, whereas the majority of participants interviewed in 2012 reported ketamine to be easy or difficult to obtain. The majority (70%) of RPU reported most commonly obtaining their last purchase of ketamine from a friend, at a friend’s home (30%) and used most commonly at a nightclub (44%).

Gamma-hydroxy-butyrate (GHB)

The proportion of participants reporting recent use (14%) of GHB was the highest ever recorded in the Victorian EDRS. RPU reported recent GHB use on a median of two days in the preceding six months, a slight decrease from 2012. Consistent with 2012, a median of 4.5ml was reported as the amount used during a typical episode of use. Only six participants of the 2013 Victorian EDRS sample were able to respond to questions about the price, purity and availability of GHB.

LSD

Recent users of LSD reported irregular use of the drug on a median of three days in the preceding six months in 2013, comparable to the number of days of use reported in previous years. The median reported price per tab was $15 in 2013, unchanged among the EDRS sample since 2011. Eighty-three per cent of recent LSD users described the purity of LSD as medium to high, and LSD was reported to be easier to obtain in the preceding six months than reports in 2012 (22% vs. 3%). On the last occasion of use, RPU typically sourced LSD from a friend (71%), at their friend’s home (27%), and used it at their own home (26%).

Cannabis

Reports of recent cannabis use were common among RPU in 2013 (87%). Participants reported using cannabis on a median of 50 days (just over two days a week) in 2013, which was substantially lower than the 72 days reported by EDRS participants in 2012. Almost all (99%) of recent users reported smoking cannabis, and reported typically paying $15 for a gram of hydroponic cannabis and $12 for a gram of bush cannabis. In 2013, the potency of cannabis was typically reported as being medium to high for both hydroponic (86%) and bush cannabis (95%), comparable to reports in previous years. Almost all (97%) participants reported that hydroponic cannabis was easy or very easy to obtain, while 80% reported this for bush cannabis. KE reported cannabis use to be very common, mostly used via smoking and somewhat normalised among RPU with no perceived change in patterns of use in the past 12 months. Two KE perceived that RPU underestimate the risks of cannabis use both on long-term health and competency when driving.

Alcohol

As in previous years, all of the EDRS participants interviewed in 2013 reported lifetime use of alcohol, initiating drinking at a mean age of 14 years, while 93% reported use in the preceding six months. This group of RPU reported drinking on a median of 50 days (two times per week) in the preceding six months in 2013, a figure comparable to reports in 2012 (a median of 48 days). A significantly lower proportion of participants interviewed in 2013 reported: drinking alcohol on the last occasion they used ecstasy (66% vs. 80% in 2012); and drinking alcohol during a stimulant drug binge (63% vs. 82% in 2012), than participants of the 2012 EDRS. Alcohol continues to be one of the drugs KE most commonly cite as problematic. KE reported alcohol use to be widespread among RPU and often used with other drugs, which they perceived resulted in an increase in both violent behaviour and risk of overdose.

Health and other issues

Some RPU reported adverse consequences related to their drug consumption. Recent stimulant drug overdose was reported by 12% of RPU in 2013; typically attributed to ecstasy or amphetamines. Recent depressant drug overdose was reported by 13% of participants in 2013; typically attributed to alcohol and GHB. In 2013, RPU were administered the 10-item Kessler Psychological Distress Scale (K10) to measure the level of psychological distress experienced in the preceding four weeks; 35% were classified as experiencing moderate, 25% high and 5% very high psychological distress. Twelve per cent of respondents reported accessing a health or medical service in relation to their ERD use in the preceding six months.

In 2012, the Victorian specialist alcohol and other drug telephone counselling service DirectLine received calls identifying ecstasy (0.5%), amphetamine and/or other stimulants (19%), cocaine (0.7%) and cannabis (11%) as drugs of concern. Data from ambulance attendances at non-fatal drug-related events in Victoria suggest that attendances involving ecstasy declined by almost half in 2010 compared to 2009 (236 vs. 409 respectively) but remained relatively stable in 2011 (212 attendances) and 2012 (236 attendances). In contrast, attendances involving amphetamines have increased since 2009 (425 attendances), with 533 attendances occurring in 2010, 768 attendances in 2011 and 1,155 attendances in 2012 .

Risk behaviour

A larger proportion of participants reported ever injecting a drug in 2013 than in 2012 (22% vs. 13% respectively). Only 12 RPU reported injecting a drug in the preceding six months in 2013.

Fifty-two per cent of the 2013 EDRS sample reported recent penetrative sex with a casual partner in the past six months, and 37% of these reported not using a condom the last time they had sex when sober. Forty-nine participants reported having had sex with a casual partner while under the influence of alcohol and/or drugs in the preceding six months. Among this group, 43% reported not using a condom with a casual partner the last time they had sex while under the influence.

A significantly higher proportion (74%) of participants reported ever having a sexual health check-up, compared to 2012 (49%), and 24% had been diagnosed with a sexually transmitted infection at some point in their lifetime.

Sixty-five per cent of the 2013 RPU sample reported having driven a car/motorcycle/vehicle in the six months prior to being interviewed, a rate similar to previous years. Of those who had driven in the previous six months, 23% believed they had driven while over the legal blood alcohol limit (for their licence type) in the preceding six months and 54% reporting driving soon after consuming illicit drugs.

Risky alcohol use was measured among participants in 2013. Sixty-seven per cent of RPU scored eight or more on the World Health Organization’s (WHO) Alcohol Use Disorders Identification Test (AUDIT) – a level at which alcohol intake is considered hazardous – a figure lower than that measured in 2012 (80%).

Law enforcement-related trends associated with ERD use

In 2013, 11% of the RPU sample reported that they had been arrested in the past 12 months and 26% reported engaging in any type of crime in the preceding month, a figure lower than reports in 2012 (49%). Drug dealing was the most common type of crime reported by the RPU sample (18%).

New psychoactive substances

The most common NPS used recently by RPU interviewed in 2013 were DMT (25%), 2C-B (18%) and the synthetic cannabinoid branded Kronic (12%). Value for money, a high level of perceived purity, reaching a better high and experiencing fewer side effects compared to other illicit drugs, were examples of motivations nominated for using 2C-B and mephedrone by participants. Common effects of 2C-B and mephedrone were described as: having an urge to move and talk, no appetite for food, and euphoria. In 2013, all KE who commented on NPS reported an increase in the prevalence of use. Several perceived NPS as a problematic drug type group due to their relatively new existence within the illicit drug market, resulting in RPU being more likely to be unsure of what they have consumed.

Conclusions

The results reported here describe ERD use and trends in 2013 in Melbourne, Victoria, and enable comparisons with the findings of the previous ERDS studies. The key findings were as follows: The reported recent use of ecstasy powder, LSD and nitrous oxide increased significantly in 2013 compared to 2012. Reports of recent speed powder use were significantly lower in 2013, while the prevalence of other forms of methamphetamine use remained stable. Almost half the sample reported recent NPS use, typically DMT, 2C-B and the synthetic cannabinoid branded Kronic. Compared to 2012, a lower proportion of the 2013 sample scored in the hazardous level category for alcohol consumption measured by the AUDIT, and fewer RPU reported both, drinking alcohol on the last occasion they used ecstasy and drinking alcohol during a stimulant drug binge. A significantly higher proportion of participants reported having a sexual health check-up at some point in their lifetime, compared to 2012, while fewer participants reported recent (past month) criminal activity.

Implications

Patterns of polydrug use, binge drug use, the frequency and locations where drugs are reportedly used, and the availability of many drugs, have largely remained stable across the 11 years of data collection. Other findings, such as the emergence of ecstasy crystals, possible return of high methamphetamine purity, high percentage of alcohol use (some at potentially harmful levels) evident in recent years, and the increased use of NPS 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 and sexual health risks.

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

On the basis of the findings of the 2013 Victorian EDRS, we recommend:

further exploration of methods to reduce and prevent the use of alcohol at harmful levels;

tailored research and ongoing surveillance activities capable of capturing information on NPS as the prevalence of use increases;

raising health workers’ awareness of NPS to increase their ability to detect related drug overdoses and enhance surveillance activities;

further research into the health and behavioural effects of NPS in order to gain a greater understanding of these drugs, and develop clinical and public health responses;

further investigation into how to improve RPU’s utilisation of health services;

further investigation of how to educate RPU about the risks associated with behaviour such as sexual intercourse while under the influence of drugs; and

targeted research examining the high levels of drug- and drink-driving reported by participants.