EXECUTIVE SUMMARY
 
This report presents the results of the Western Australian Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI), an ongoing study monitoring ecstasy and related drug markets within WA. It is part of a nationwide study, which commenced in New South Wales, Queensland and Victoria in 2000, with the addition of other states and territories in 2003. The survey design was informed by and modelled upon the pre-existing Illicit Drug Reporting System (IDRS), designed to monitor use of the main illicit drugs in Australia, developing a new survey for monitoring trends in the ecstasy and related drugs market.
 
The findings from each year not only provide a snapshot of the drug markets in WA, but also help to provide an evidence base for policy decisions, inform harm reduction messages, and provide directions for further investigation when issues of concern are detected. Continued monitoring of the ecstasy and related drug markets in WA 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.
 
The current report provides findings for the tenth year of data collection in WA obtained from three sources:
  1. Quantitative interviews with 90 current regular ecstasy/psychostimulant users (REU/RPU) residing in the Perth metropolitan area;
  2. Qualitative interviews with ten key experts (KE) who have regular contact with ecstasy users and are employed in areas including nightclub entertainment, health, outreach, and law enforcement; and
  3. Analysis of various indicator data from health and law enforcement sources.
 
CAVEAT
Throughout the annual EDRS reports, comparisons and analyses are made between the current year’s data and the previous year’s data in order to investigate trends and determine whether there have been any statistically significant changes. However, due to the small sample size of the WA EDRS in 2011 (N=28), the 2011 data was of questionable validity and therefore inappropriate for making reliable comparisons with the current 2012 data. Consequently, throughout this report, all 2012 data is compared to the 2010 EDRS data.
 
Demographic characteristics of REU/RPU
For the purpose of this study, REU is a population defined by the use of ecstasy pills, powder or capsules on at least a monthly basis. This population has been recruited for the past nine years of data collection, since the WA EDRS commenced in 2003. For the first time, in 2012 the WA EDRS expanded its selection criteria for recruitment of participants. This change was made in WA, as in some other states, in response to difficulties experienced in the 2011 EDRS recruitment process. In 2012 the selection criteria expanded to include both REU and RPU populations. For the purpose of this study, RPU is a population defined by the use of any psychostimulant drug/s (e.g., methamphetamine, MDA, cocaine, ketamine, GHB, LSD, mephedrone, or emerging psychoactive substances (EPS) such as 2C-B, 2C-I) on at least six occasions over the preceding six month period. In total 90 participants were recruited, 65 REU and 25 RPU. The mean age of the group was 24 years (range 17-41). There was a slightly greater proportion of males (60%, n=54) than females (40%, n=36). The vast majority (97%) were of English speaking background.
 
The majority of participants (77%) had completed high school and the median number of years of school education was 12 (range 10-12). Approximately two-thirds (67%) had completed a tertiary qualification. Reported employment situations were varied from full-time employment (28%), full-time study (4%), both employed and studying (21%) and unemployed (21%). Very few participants reported that they were currently in drug treatment (3%).
 
The majority of participants identified as heterosexual in orientation (96%) and over half (56%) reported that their current relationship status was ‘single’.
 
The majority reported living in either rented premises (53%) or their parents’/family house (39%). Participants earned a median of $634/week (range $40-$2,442).
 
Statistical tests of significance were conducted between the current sample and the 2010 sample to indicate recent trends in the data. The current sample exhibits demographic characteristics consistent with the 2010 sample, the only exceptions being a significant increase in the proportion that had completed a tertiary qualification and a $167 increase on the median weekly participant income.
 
Statistical tests of significance were also conducted between the 2012 REU (n=65) and RPU (n=25) samples to see how they compared in relation to demographic characteristics. Findings indicated that the two samples were very similar in all major demographics. The only significant difference between the two groups was that RPU had a significantly greater proportion of full-time students in comparison to REU. Further statistical comparisons were made between the 2012 REU sample (n=65) and the 2010 REU sample (N=100) to determine whether significant differences found in tertiary education could have been attributed to sampling differences in 2012 (i.e., changes to the selection criteria). The 2012 REU vs 2010 whole sample comparison remained significant, indicating that increases in tertiary education completions and median weekly income were unlikely to be due to sampling differences.
 
Drug use and markets in the 2012 EDRS
Ecstasy
Consumption patterns
The average age at which ecstasy was first used remained at 18 years, consistent with recent years. The proportion reporting ecstasy as their ‘drug of choice’ was 36%. The median number of days ecstasy was used in the preceding six month period was 8 days (10 days among REU) and average amount used in a ‘typical’ session was 1.8 tablets per session (2 tablets among REU).
 
Some notable changes in patterns of ecstasy use were observed in 2012 when compared to the 2010 sample. In 2012, significant increases were observed in both the lifetime and recent use of powder and capsule forms of ecstasy. This suggests that other less traditional forms of ecstasy may be making their way into the WA illicit drug market.
 
As found in previous years, pills were still the most common form of ecstasy used and almost the entire sample (93%) nominated swallowing as the main route of administration of ecstasy.
 
As in previous years, the majority reported using other drugs in combination with ecstasy on the last occasion of use. The drugs most commonly used with ecstasy were alcohol, tobacco, cannabis, pharmaceutical stimulants and crystal meth.
 
About two-fifths (39%) of the sample reported the use of other drugs to help them come down from ecstasy the last time they used it. The most commonly reported drug used to come down from ecstasy was cannabis.
 
Ecstasy was used in both public (56%) and private settings (44%). The most popular locations reported overall were ‘nightclubs’ (30%) and a ‘friend’s home’ (20%).
 
Price, purity and availability
Consistent with recent years, the median price per ecstasy pill was $35. The majority (57%) perceived the price of ecstasy as stable over the preceding six months.
 
The greatest proportion of the current sample rated the current purity of ecstasy ‘medium’ (35%), compared to the greatest proportion reporting ‘low’ in 2010 (45%). Perceptions regarding changes in purity during this period were mixed. Almost a third (30%) reported that purity was increasing, almost a third (29%) reported that purity was stable, and almost a third (29%) reported that it was fluctuating. While ‘decreasing’ was nominated by the highest proportion in 2010 (45%), it was nominated by the smallest proportion in 2012 (13%). It appears that previous perceptions of decreasing purity of ecstasy may be reversing in the current WA drug market.
 
Consistent with 2010, currently availability of ecstasy was predominantly perceived as ‘easy’ to obtain (65%). Availability over the preceding six months was rated as ‘stable’ by 44% of the current sample.
 
‘Friends’ have consistently been the most commonly reported person from whom ecstasy was last obtained, with 74% of the current sample reporting ‘friends’ as their last source of ecstasy. Accordingly, ‘friend’s home’ was the most commonly reported location from which ecstasy was last obtained, as reported by 47% of the current sample. Among the current sample, ecstasy was purchased from a median of two people in the previous six months, with a median of three tablets being purchased at a time. Ecstasy was most commonly purchased for ‘self and others’ (54%).
 
Methamphetamine
Consumption patterns
Approximately three-fifths of the sample (62%) reported lifetime use of methamphetamine powder or speed and over one-quarter (27%) reported recent use. Speed was used on an average of four days over the preceding six months. The median amount of speed used in a ‘typical’ and ‘heavy’ session was 0.5 grams. Snorting was the most common route of administration, reported by 75%, followed equally by swallowing and smoking (each 38%), and then by injecting (13%). There were no significant changes in the proportions reporting lifetime or recent use of speed between 2010 and 2012. Reported quantity and frequency of use also appears stable.
 
Lifetime use of methamphetamine base was reported by 8% and 1% reported recent use. Base was used on a median of two days in the preceding six months. The median amount used in a typical session was one point and the median amount used in a heavy session was two points. Smoking was reported as the route of administration. No further analyses were performed for base methamphetamine due to the extremely small numbers here.
 
Lifetime use of crystal methamphetamine was reported by 58% of the sample, which marked a significant increase from 40% in 2010. However, comparison of the current REU sample with the 2010 REU sample found no significant difference. This indicated that the significant increase was due to changes in the 2012 selection criteria (see section 2.1). This does not mean that the finding of increase in crystal methamphetamine use was invalid, but rather that these differences are due to the change in the selection criteria which were made precisely because the reduced availability of ecstasy was posing difficulties for recruitment for the EDRS in WA and other smaller jurisdictions. Recent use of crystal was reported by 33%, which did represent a significant increase from 22% in 2010. Crystal was used on an average of 10 days over the preceding six months. The median amount used in a typical session remained at one point, and the amount used in a heavy session remained at two points. The most common route of administration for crystal remained as smoking (90%), followed by snorting (30%), swallowing (13%) and then injecting (18%).
 
In 2012, the most commonly reported location spent under the influence on the last occasion of speed use was at home (42%); this was followed by at a nightclub (25%), and then a friend’s home, a private party and a public place (each 8%). For crystal, the most commonly reported last location where most time was under the influence was at a friend’s home (45%), and this was followed by own home and at a nightclub (each 25%).
 
Price, purity and availability
The median price per point of powder methamphetamine was $100, compared to $50 which has been consistently reported in previous years. Only one participant commented on the price per gram and that was $400. Similar to speed, the median price per point of crystal methamphetamine was $100, which again compared to $50 which has been consistently reported in previous years. The median price per gram of crystal was $525. It should be noted that price data was provided by small numbers of participants and, therefore, this information should be interpreted with caution. The majority reported that the prices for powder and crystal forms of methamphetamine were stable.
 
The purity of powder methamphetamine was rated mainly as medium (50%), followed by high (25%). The purity of crystal methamphetamine was rated mainly as high (68%). The greatest proportions reported that both powder and crystal methamphetamine purity was stable over the preceding six months. No participants reported that powder or crystal purity was decreasing.
 
The availability of crystal was most commonly rated as easy (58%), followed by very easy (42%). The availability of powder was most commonly rated as very easy (58%), followed by easy (33%). There were no participants that rated powder or crystal methamphetamine availability as very difficult to obtain. The availability of both crystal and powder forms of methamphetamine were perceived as stable over the preceding six months.
 
There were no participants who were able to comment on the price, purity of availability of base methamphetamine.
 
For powder and crystal forms of methamphetamine, the most commonly reported person from whom it was last obtained was friends. Accordingly, the most commonly reported location from where powder and crystal was last obtained was a friend’s home.
 
Cocaine
Cocaine consumption
Cocaine was the third most commonly reported drug of choice, following ecstasy and cannabis, and was nominated by 16% of the sample.
Lifetime use of cocaine was reported by 71% of the sample and 31% reported recent use. With the exception of last year’s findings (that have been excluded from comparison as per the report caveat), this figure for lifetime use is the highest recorded since the WA EDRS commenced in 2003. This figure also marks a significant increase from 49% in 2010. Further investigation comparing the 2010 and 2012 REU samples indicated that this significant increase was not due to sampling differences (i.e., changes to selection criteria, see section 2.1). Recent use remained comparable at 31%, compared to 26% in 2010.
 
In 2012, cocaine was used on an average of four days over the preceding six months, which was comparable with previous years. Snorting was the most commonly reported route of administration (100%), followed by swallowing (29%). No participants reported smoking or injecting cocaine in the preceding six months. The median quantity reported for a ‘typical’ session was half a gram and for a ‘heavy’ session was one gram, which remained unchanged from 2010.
 
Cocaine was most commonly used at a friend’s home (42%), followed by a nightclub or own home (each 17%).
 
Price, purity and availability
The median price per gram of cocaine was $325, which is comparable with previous years. The majority (63%) perceived the price of cocaine as stable over the preceding six months. Purity of cocaine was most commonly rated as medium (36%), followed by low (27%). The majority also perceived the purity of cocaine to be stable over the preceding six months. Availability was most commonly reported as difficult (46%) and again the majority perceived availability as stable.
 
Friends were the most commonly reported person from whom cocaine was last obtained (67%). Accordingly, friend’s home was the most commonly reported location from where cocaine was last obtained (58%).
 
Ketamine
Ketamine consumption
Rates of ketamine use have remained consistently low in WA. In 2012, use of ketamine remained relatively unchanged from 2010 with 18% (14% in 2010) reporting lifetime use and only 3% (4% in 2010) reporting recent use. Of the three respondents who reported ketamine use in this period, the average number of days used was approximately four, compared to three in 2010. Measurements of the quantity of ketamine used have varied across years, with lines, tablets and grams being reported in 2012, whereas bumps have been reported in previous years. This makes comparisons of quantities used across years difficult. Both snorting and swallowing were reported as routes of administration.
 
Price, purity and availability
No participants commented on price, purity or availability of ketamine.
 
GHB
GHB consumption
In 2012, 3% of the sample reported lifetime use of GHB and no participants reported recent use. This was the same as 2010 findings.
 
Price, purity and availability
No participants commented on the price, purity or availability of GHB.
 
LSD
LSD consumption
LSD was the fourth most commonly reported drug of choice and was nominated by 9% of the sample.
 
Lifetime use of LSD was reported by 57% of the current sample and recent use was reported by 35%. These rates are comparable with previous years. LSD was used on an average of five days or a median of two days over the preceding six months. The frequency of LSD use also remained comparable with previous years.
 
The median amount of LSD used in a ‘typical’ session was 1.4 tabs and the median amount used in a ‘heavy’ session was approximately 1.9 tabs. Oral consumption or sub-lingual use was the only route of administration reported.
 
Friend’s home was the most commonly reported location of last use (33%), followed by outdoors (29%).
 
Price, purity and availability
The median price for a tab of LSD in WA was $20, compared to $25 which has been consistently reported for the past six years. The majority (68%) reported that the price of LSD had been stable over the preceding six months.
 
The vast majority rated the current purity of LSD as high (74%) and no participants rated LSD purity as low. This compares to 43% rating LSD purity as high in 2010. The majority (59%) also perceived the purity of LSD as stable over the preceding six months.
 
Almost three-quarters (70%) reported that LSD was either very easy (40%) or easy (30%) to obtain. Similar availability was reported in 2010. Again, the majority perceived the availability of LSD as stable.
 
Friends were the most commonly reported person from whom cocaine was last obtained (57%). Accordingly, friend’s home was the most commonly reported location from where cocaine was last obtained (33%).
 
Cannabis
Cannabis consumption
Prevalence of cannabis use has been consistently high in WA across survey years. In 2012, cannabis was the second most commonly reported drug of choice, second only to ecstasy and was nominated by 21% of the sample.
 
Patterns of cannabis use among the current sample were comparable to those found in 2010. In 2012, lifetime use was reported by 99% and recent use was reported by 77% of the sample. Frequency of use also remained comparable to previous years, with cannabis being used on an average of 71 days over the preceding six months.
 
The median amount used during the last session was three cones or two joints. The most commonly reported route of administration was smoking (99%), followed by swallowing (40%).
 
Own home was the most commonly reported location of last use for both hydro (55%) and bush (56%) cannabis, followed by friend’s home.
 
Price, purity and availability
The median price per ounce of hydro cannabis was $350 which remained unchanged from 2010. The median price per ounce of bush cannabis was $300 which was not significantly different from $280 in 2010. The median price per gram of hydro and bush forms of cannabis remained unchanged from 2010 at $25. Price during the preceding six months was reported as stable by the majority (66% for hydro cannabis and 75% for bush cannabis).
 
Current purity of hydro was rated by the majority as high (66%), while the majority rated purity of bush as medium (55%). No participants rated the purity of hydro as low. Purity of both cannabis forms were perceived as stable over the preceding six months (68% for hydro, 79% for bush).
 
There were no participants commenting on the price, purity or availability of hashish cannabis. The greatest proportion of the sample (65%) reported that availability of hydro was very easy, while the greatest proportion (46%) reported that availability of bush was easy. No participants reported that hydro was very difficult to obtain. The majority perceived the availability of hydro as stable over the preceding six months (72%), as did those reporting on bush (73%).
 
The most commonly reported person from whom cannabis was last obtained was friends for both hydro and bush (each 64%). Accordingly, friend’s home was the most commonly reported location from where cannabis was last obtained.
 
Patterns of other drug use
Across survey years, alcohol use has consistently been reported by almost the entire sample. In 2012, this was no exception, with lifetime use reported by 100% and recent use reported by 96%. Alcohol was used on a median of 48 days over the preceding six months, which equates to approximately twice a week. Very few (n=6) participants reported drinking alcohol daily.
 
Tobacco use remained comparable with previous years. Lifetime use was reported by 96% of the current sample and recent use was reported by 67%. Tobacco was used on a median of 158 days. Almost half (45%, n=30) of those who reported recent smoking were daily smokers. Therefore, almost one-third (32%) of the entire sample were daily smokers.
 
In recent years reported rates of GHB use have been consistently low. In 2012 this was no exception, with only three participants reporting lifetime use of GHB and no participants reporting recent use of GHB.
 
Lifetime and recent use of MDA remained relatively unchanged from 2010. Lifetime use was reported by 11% and recent use was reported by 5%. MDA was used on an average of four days over the preceding six months.
 
Pharmaceutical stimulants, such as dexamphetamine and methylphenidate were included in the survey as a distinct drug class in 2005 and separated into illicit and licit (i.e. prescribed) use in 2007. Prevalence of pharmaceutical stimulant use across survey years has been consistently high. In 2012, the highest rates of lifetime use since the WA EDRS commenced (93%) were recorded, as well as one of the highest rates of recent use (67%). The majority of this use was illicit (97%). Therefore, almost the entire sample had used a pharmaceutical stimulant at some point in their lifetime and approximately two-thirds had used recently. These rates are similar to that of cannabis. While there were no significant increases in use between 2010 and 2012, there is a trend of an overall steady increase in use over the past six years. Illicit pharmaceutical stimulants were used on a median of six days over the preceding six months, which equates to approximately once a month.
 
With regards to use of other pharmaceutical medications, there were no significant changes seen in both lifetime and recent use of benzodiazepines. Lifetime use was reported by 46% and recent use was reported by 25%. Use of benzodiazepines was also separated into illicit and licit use, and illicit use was again the more commonly reported form of use (79%).
 
Use of anti-depressants was similar across survey years, with lifetime use reported by 29% of the sample and recent use reported by 8%. The median number of days used during the preceding six months remained unchanged at 180 days. Unlike pharmaceutical stimulants and benzodiazepines, antidepressant use was predominantly licit.
 
Participants were also asked about the use of inhalants amyl nitrate and nitrous oxide. Use of amyl nitrate remained similar to previous years, with lifetime use reported by 24% and recent use reported by 10%. Use of nitrous oxide also remained comparable to previous years, with lifetime use reported by 53% of the sample and recent use reported by 26%. Across survey years nitrous oxide has consistently been the more popular inhalant among REU/RPU.
 
With the exception of 2011, which saw an unintended overrepresentation of heroin and other opiate users likely due to difficulties in recruiting REU, rates of opiate use across survey years have been low. In 2012, there were no significant differences seen in lifetime and recent use of heroin from 2010, with only 6% reporting lifetime use and 1% reporting recent use. There were also no significant changes in either lifetime or recent use of methadone and buprenorphine. Only 2% reported lifetime use of methadone and no participants reported recent use. Similarly, only 3% reported buprenorphine use and no participants reported recent use. Use of ‘other opiates’, such as morphine, pethidine and over-the-counter medications containing codeine, has fluctuated across survey years. In 2012, there were no significant changes in ‘other opiate’ use, with 37% reporting lifetime use and 14% reporting recent use. Both licit (39%) and illicit use was reported (72%). Lifetime use of over-the-counter codeine was reported by 20% and recent use was reported by 14%.
 
In 2012, there was a significant increase in both lifetime and recent use of hallucinogenic mushrooms. Lifetime use was reported by the majority of participants (70%), while almost half (43%) reported recent use compared to 43% and 12% respectively in 2010. With the exception of last year (see Caveat), this represents the highest rates of both lifetime and recent use of mushrooms seen since the EDRS commenced in 2003. Further investigation comparing the 2010 and 2012 REU samples indicated that this significant increase was not due to sampling differences (i.e., changes to selection criteria, see section 2.1). For those who reported recent use, mushrooms were used on a median of one day over the preceding six months.
 
For the first time in 2009, participants were asked to report on their use of over-the-counter stimulants, such as cold and flu medications containing pseudoephedrine, for recreational use. While 2010 saw a significant increase in use, 2012 saw a significant decrease in both lifetime and recent use. Only 8% reported lifetime use and only 2% reported recent use, marking the lowest rates of use seen since 2009.
 
For the first time in 2010, REU were asked to report on steroid use. Rates of use since 2010 have consistently remained extremely low. In 2012, only two participants reported lifetime steroid use, while only one reported using steroids recently.
 
From 2010 onward, the EDRS has attempted to systematically investigate a group of drugs known as ‘research chemicals’ (also known as analogues, legal highs, herbal highs, party pills). For the purpose of the report, these drugs are referred to as emerging psychoactive substances (EPS). The most commonly reported EPS ever used among the current sample were synthetic cannabinoids (42%), DMT (32%), mephedrone (16%) and BZP (14%). However, as in previous years, reported recent use of these drugs has remained low, with the exception of DMT (22%) and synthetic cannabinoids (18%).
 
Health-related issues
Since 2007, EDRS respondents were asked about overdose on a stimulant drug and on a depressant drug. In 2012, there was a significant increase in the number of reported stimulant overdoses, with approximately half of the REU/RPU sample (51%) reporting one at some point in their lifetime, up from 21% in 2010. Further investigation comparing the 2010 and 2012 REU samples indicated that this significant increase was not due to sampling differences (i.e., changes to selection criteria, see section 2.1). The median amount of times stimulant overdose had occurred was two times, compared to one time in 2010. Additionally, the most recent overdose was 5 months ago in 2012, in comparison to 20 months ago in 2010. There were no significant changes in reported depressant overdoses, with 38% reporting one at some point in their lifetime. The median amount of times a depressant overdose had occurred was two times and the most recent overdose was 12 months ago. The most commonly implicated drug in stimulant overdoses was ecstasy, while the most commonly implicated drug in depressant overdoses was alcohol.
 
In 2012, 17% of the sample reported accessing a medical or health service in relation to their drug use in the last six months. The most common services accessed were general practitioners (n=7) and psychologists (n=5). There were a variety of physical and psychological health issues nominated as the main issue. The most common drug a general practitioner was seen in relation to was ecstasy. The most common drug a psychologist was seen in relation to was also ecstasy.
 
The Kessler Psychological Distress Scale (K10) was included in the EDRS from 2006 as a screening tool for symptoms of depression and anxiety. In 2012, the most common categories were no or low distress or moderate psychological distress (each 40%), followed by high psychological distress scored by 18%. Very high levels of distress were scored by only 1%. These results were not significantly different to those found in 2010.
 
Questions regarding mental health problems were included for the first time in the 2008 EDRS. This included asking participants whether they had had any mental health problems (including self-diagnoses) in the last six months. In 2012, 28% of participants reported having had mental health problems in the preceding six months, comparable to 27% in 2010. Of these participants, the main mental health problems specified were anxiety (60%) and depression (56%). Of these, 64% reported attending a health professional in the past six months. Additionally, 61% of those reporting a mental health problem also reported that they were prescribed a medication in the last six months. Medications prescribed included anti-depressants, anti-psychotics and benzodiazepines. The most commonly prescribed medications were anti-depressants (55%).
 
Risk behaviours
In 2012, respondents reported on a range of risk behaviours related to injecting drug use, blood-borne viruses, sexual practices, driving behaviours, and alcohol use.
 
In relation to injecting drug use, the proportions reporting lifetime and recent injection were comparable to that of 2010. Lifetime injection was again reported by 10% of the sample and injecting in the last six months was reported by 67% of these (60% in 2010). In 2012, the most commonly reported drug ever injected and recently injected was crystal methamphetamine followed by powder methamphetamine or speed. In 2010, the most commonly reported was speed followed by crystal.
 
Participants were asked a range of questions related to both blood-borne virus (BBV) vaccination and testing and sexually transmitted infection (STI) testing. A minority of participants reported vaccination for HBV (36%) and the majority reported that they had never been tested for HBV, HCV or HIV. Only two participants reported a positive test result for a BBV and this was for HCV. Both of these participants had reported a history of injecting drug use. Close to half of the sample (44%) reported having a sexual health check-up (such as a swab, urine, or other blood test) in the past year, while 23% reported having a check-up more than one year ago. Approximately one-quarter (23%) reported that they have never had a sexual health check-up. The majority (79%) of participants reported that they had never been diagnosed with a STI, 13% reported an STI diagnosis more than one year ago, and 7% reported a diagnosis in the past year. Of these, Chlamydia was most common diagnosis (61%).
 
Participants were asked to report how often protective barriers were used with casual sex partners in the preceding six months. Of the current sample, 68% reported engaging in penetrative sex with a casual partner in the last six months. The greatest proportion (22%) reported having three to five partners during this period. Of these participants, almost everyone (97%) reported having casual sex whilst under the influence of alcohol or other drugs. Further, approximately one-third (32%) reported that casual sex whilst under the influence occurred more than ten times over the past six months. The most commonly reported drugs used in this context were alcohol and ecstasy. More than half (58%) of those reporting recent casual sex reported that they did not use a protective barrier with their last causal partner while under the influence. The most commonly reported reason for not using a barrier was ‘it wasn’t mentioned’. Similarly, almost half (48%) reported that they did not use a protective barrier with their last causal partner while sober.
 
Of the current sample, 91% had driven a car in the preceding six months. Among these participants, 59% reported driving whilst affected by alcohol and 55% reported driving over the legal alcohol limit, findings which were comparable to that in 2010. The median number of times these respondents had driven over the alcohol limit in the last six months was three times (i.e. on average once every two months). Just under half reported that they had undergone roadside breath testing in this period (42%) and, of these respondents, 21% (n=7) reported testing over the legal blood alcohol limit. These findings were again comparable with 2010.
 
Of the current sample that had driven in the preceding six months, 55% reported driving after taking an illicit drug. Of these participants, the median number of times driven under the influence of an illicit drug was three times. The most commonly reported drugs used prior to driving were cannabis (64%) and ecstasy (56%). When questioned about their perceived level of impairment while driving, 42% reported their drug use had ‘no impact’ and 33% reported that it was ‘slightly impaired’. In 2012, four respondents were roadside drug tested, three tests returned negative results and one test result was never received.
 
The AUDIT (Saunders et al. 1993) was completed for the sixth consecutive year. The AUDIT was designed by the World Health Organization (WHO) as a brief screening scale to identify individuals with alcohol problems. Total scores of eight or more are recommended as indicators of hazardous and harmful alcohol use. In the 2012 WA EDRS sample the mean AUDIT score was 15. There were 71 participants (79%) who scored higher than the cut off of eight, indicating hazardous or harmful alcohol use, which compares to 72% in 2010.
 
Criminal and police activity
The proportion of participants reporting criminal activity in 2012 was 29%, compared to 35% in 2010. Of these participants, ‘drug dealing’ was the most commonly reported criminal activity (24%) and, of those that had dealt drugs, most engaged in this activity less than once a week (79%). Of the current sample, 11% had been arrested in the last 12 months, compared to 13% in 2010. The most commonly reported reason for arrest was for an alcohol and driving offence.
 
In 2012, just over half (51%) reported that they perceived police activity as ‘stable’ over the preceding six months.
 
Fagerstrom test for nicotine dependence
For the second year consecutively, EDRS participants who smoked daily were asked questions from the Fagerstrom test for nicotine dependence. Ten percent (n=3) of daily smokers scored above five indicating high to very high nicotine dependence.
 
Ecstasy dependence
In 2012, the participants in the EDRS were asked questions from the SDS to investigate ecstasy dependence. The SDS is a five-item questionnaire designed to measure the degree of dependence on a variety of drugs. There were just four participants (4%) in the sample who scored above the dependency cut off of four, and they were all male. Therefore, the vast majority of participants (96%) did not score high enough to be considered dependent on ecstasy.
 
Policy
In 2012, additional questions were asked to provide data about how people who use drugs perceive Australian drug policy, building on research undertaken as part of the wider Drug Policy Modelling Program (DPMP) project “Public opinion and drug policy: engaging the “affected community”. The policy questions were drawn from the National Drug Strategy Household Survey (Australian Institute of Health and Welfare, 2008) to ensure comparability with general population responses. Overall, the majority of participants supported most of the harm reduction measures aimed at reducing problems associated with heroin use. When asked to comment on level of support for the legalisation of a variety of drugs for personal use, the majority were in support of cannabis (73%) and many were also in support of ecstasy (44%). The majority did not support increased penalties for the sale and supply of cannabis, ecstasy or cocaine; however, many were in support of increased penalties for methamphetamine and heroin.
 
Neurological history
People with a neurological illness or injury may be at greater risk of experiencing adverse effects associated with drug use. In 2012, the EDRS examined the prevalence of selected neurological illnesses and also of traumatic brain injury (TBI) among REU/RPU. While stroke and hypoxia were not reported in the current sample and epilepsy was extremely uncommon (2%), TBI was reported by 47% of participants. Comparisons with existing community samples suggest this rate may be higher than that of other samples; however, due to differences in data collection, comparisons are limited and must be approached with caution.
 
Body image
Research has highlighted a link between psychostimulant use and body image, suggesting that adolescent girls and young women with negative weight perceptions are more likely to engage in both licit and illicit substance use (Leventhal, 1983; Nieri, Kulis, Keith & Hurdle, 2005; Weathers & Billingsley, 1982). Questions were included in the 2012 EDRS that aimed to enhance understanding of the relationship between illicit psychostimulant (IPS) drug use and body image. Of the current sample, 14% reported ever using IPS to lose or maintain weight, of which 85% were female. The most commonly reported drug used was dexamphetamine (70%). Only four participants reported recent use of IPS to lose or maintain weight.
 
Implications regarding trends in use
There are a number of drug trends findings in this year’s EDRS which will be looked at with interest in 2013 to see whether they continue. These include: (1) the suggestion in the 2012 data that the previous decline in availability and purity of ecstasy in WA may be coming to an end; (2) the increase in lifetime and recent use of powder and capsule, rather than the traditional pill form of ecstasy; (3) patterns of crystal methamphetamine use among the EDRS sample which appears related to the change in the EDRS selection criteria (see below); (4) the doubling of the price of a point of both crystal and powder amphetamine from 2010 to 2012; and (5) increases in lifetime, but not recent use of cocaine.
 
Implications regarding health
The high level of alcohol use among the current sample is of concern. The majority of the sample obtained AUDIT scores that indicate hazardous and harmful use of alcohol. Additionally, more than half of the sample (57%) consumed alcohol on a ‘more than weekly’ basis. Alcohol was also the main drug implicated in depressant overdoses. Reported symptoms included vomiting, losing consciousness and collapsing. These findings are consistent with previous years and have implications for continued harm reduction efforts targeting risky alcohol use among REU/RPU.
Alcohol use in combination with other drug use presents additional concern. Among the current sample, the use of stimulant drugs concurrently with alcohol was common. Almost three-quarters of the sample (71%) reported using alcohol with ecstasy and, among these respondents, the majority (83%) reported consuming more than five standard drinks. Additionally, there was a significant increase in stimulant overdoses this year, and alcohol was implicated as a contributing drug in many of these cases. Likewise, stimulant drugs such as ecstasy and pharmaceutical stimulants were also implicated in depressant overdose cases. These findings are again consistent with previous years, and indicate that, despite negative symptoms associated with consuming alcohol in combination with stimulants, this behaviour continues to be common. This finding has implications for harm reduction efforts targeting the concurrent use of alcohol and stimulants like ecstasy, pharmaceutical stimulants and energy drinks.
 
The significant increase (from 21% in 2010 to 51% in 2012) in stimulant overdoses in isolation also warrants concern. Among reported stimulant overdoses, ecstasy was the most commonly implicated drug. The most commonly reported main symptom was ‘extreme anxiety’. This increase in overdoses raises several questions. Firstly, were these overdoses a result of drug related factors (such as simply consuming too much, consuming an adulterated pill, and/or combining more than one substance), were they the result of individual factors (such as not maintaining adequate hydration or food intake, sleep deprivation, and/or not being in a good psychological state prior to use), were they a result of environmental factors (such as extreme heat or weather conditions and/or overcrowding), or were these overdoses a result of a combination of these factors. While these questions remain, this finding has implications for targeted campaigns educating REU/RPU about drug, individual and environmental risk factors for stimulant overdose and education about harm reduction strategies to help minimise the risk when engaging in stimulant use. This finding also has implications for continued close monitoring of stimulant overdoses and perhaps further investigation into risk factors contributing to these overdoses. Additionally, the vast majority reported that there was no sober person present to assist them at the time of overdose, and the majority did not seek out any help or medical treatment. This finding has further implications for harm reduction efforts targeting help-seeking behaviours among REU/RPU.
 
The finding that almost half of the sample (47%) had experienced a traumatic brain injury (TBI), and that 26% had been under the influence of alcohol and 12% under the influence of other drugs during the most severe TBI, raises concern and may warrant further investigation. Causes of the TBIs were not investigated in the current study; it is only known whether the participant was under the influence at the time of the TBI. Further investigation into where TBIs occurred and what caused the TBIs might be useful in determining how to reduce the occurrence of TBIs while under the influence of alcohol or other drugs.
 
Implications related to changes in methodology
It was predicted in the 2010 EDRS report that if ecstasy purity continued to decline, that a shift away from ecstasy and toward other stimulant drugs like methamphetamine and research chemicals could occur. It was expected that if this trend away from ecstasy did eventuate, that there could be significant implications for recruiting EDRS participants based on the existing selection criteria. During the 2011 WA EDRS recruitment process, considerable difficulties were experienced, which was believed to be a result of declines in the perceived purity and availability of ecstasy. These recruitment difficulties suggested that the predicted trend away from ecstasy could have been occurring, and it was therefore proposed that alterations to methodology be considered in future years to account for this trend. Consequently, in response to these issues, the 2012 WA EDRS selection criteria were expanded to include both regular ecstasy users (REU) and regular psychostimulant users (RPU). While recruitment efforts again failed to attract the same number of eligible participants (65 REU, 25 RPU) as seen in previous years (100 REU), it was a considerable improvement on 2011 (28 REU).
 
While expanding the selection criteria helped increase the sample size, these changes presented their own unique challenges, particularly in relation to making valid statistical comparisons across data collection periods. Given that recruitment criteria were different across years, it was possible that any significant differences found across years could have be accounted for by sample differences related to changes in the selection criteria. To rule this explanation out, additional analyses were conducted throughout the report by comparing REU samples across years, as well as comparing the current REU sample to current RPU sample. Therefore, if the 2012 selection criteria are adopted in subsequent data collection periods, comparability of data across years and sample differences need to be considered.
 
Another issue to consider in relation to these methodological changes is that user perceptions from the 2012 WA EDRS show preliminary indications that both purity and availability may be recovering in If this is the case, it needs to be considered whether 2012 selection criteria changes are continued in future data collection periods.

Resources

Author(s)

Jodie Grigg, Simon Lenton
Date Commenced
19 Apr 2013
Resource Type
Drug Trends Jurisdictional Reports