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Monitoring Trends in Illicit Drug Use in Australia

Monitoring Trends in Illicit Drug Use in Australia. Wayne Hall School of Population Health, University of Queensland and Louisa Degenhardt and Natasha Sindicich National Drug and Alcohol Research Centre, University of New South Wales.

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Monitoring Trends in Illicit Drug Use in Australia

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  1. Monitoring Trends in Illicit Drug Use in Australia Wayne Hall School of Population Health, University of Queensland and Louisa Degenhardt and Natasha Sindicich National Drug and Alcohol Research Centre, University of New South Wales

  2. Australian Monitoring of Illicit Drug Use 1: General Population • National School Surveys: • Content • Frequency • Limitations • Household surveys (2-3 yearly since 1985) • trends in lifetime and past year use • best for cannabis • less useful for cocaine, heroin and IDU • Declining response rate: now under 50%

  3. Patterns of illicit drug use in Australia, 2007 persons aged 20-29

  4. Trends in recent use among Australian males 20-29 years

  5. Trends in recent use among Australian males 20-29 years

  6. Trends in recent use among Australian males 20-29 years

  7. Monitoring of Illicit Drug Use 2: Mortality & Morbidity Data • Mortality data: drug related deaths • Good toxicology data on suspicious deaths • Available on line: best for opioids • Morbidity data • Hospital separations that are drug-related • dependence, OD, intoxication, psychoses • Treatment seeking populations • National Minimum Data Set • National Opioid Substitution Treatment data

  8. Opioid Overdose Mortality per million Australian adults, 15-44 years, 1964-1997

  9. Trends in proportion of male overdose deaths 1964-1997

  10. Trends in opioid overdose age at death 1964-1997

  11. Cohort trends in opioid overdose death in males, 1964-1997

  12. Age at which overdose deaths exceeded 5% of all deaths

  13. Monitoring of Illicit Drug Use 3: Trends in Special Populations • Drug Use Monitoring in Australia (DUMA) • Established 1999 based on US ADAM • Quarterly urinalyses & surveys of arrestees in 5 states • Illicit Drug Reporting System (IDRS) • Developed 1994-5 • In operation in NSW since 1996 • National study since 2000 • Ecstasy-related Drug Reporting System (EDRS) • Developed 2000; in operation since 2001 • National study since 2003

  14. Aims of IDRS & EDRS • Act as early warning systems to detect changing patterns of use and harm • Data on price, purity, and availability of illicit drugs • Monitor patterns of use, trends & harms over time • Priorities for specialised/detailed research • Provide an evidence base for policy

  15. Drugs focused on IDRS

  16. Drugs focused on EDRS

  17. Methodology • Three parts: • Drug user interviews • Key expert interviews • Indicator data • Data collected Australia wide on an annual basis • IDRS in NSW since 1996 and national since 2000 • EDRS national data since 2003

  18. Sample criteria user survey

  19. Surveys of IDU/REU • Sentinel populations of polydrug users • Knowledgeable about: • drug prices & availability of • opiates, amphetamine, cannabis, cocaine • ecstasy and related drug markets • emerging drugs: illicit or pharmaceutical • Polydrug users whose drug use reflects: • availability & price of different drugs • changes in route of administration • new drug use, e.g. pharmaceuticals, OTC

  20. Key Experts • Law enforcement officials • Health workers • NSEP and outreach workers • Treatment staff • Users groups • Drug researchers • Specialised knowledge complements • user surveys and indicator data

  21. Leading Indicators • Originally • law enforcement data on drug price & purity • Other survey data e.g. NSP attendees • Alcohol and Drug Information Service calls • Later added • Ambulance data on suspected overdoses • On line coronial data on drug-related deaths • Drug use among Sydney MSIC clients

  22. Annual meetings of researchers and policy makers • Rationality is a social process • Debate about data and its implications • Triangulation of IDRS data • Against experiences of key informants • Testing against other information • Especially lagging indicators • Exploring alternative explanations

  23. What has the IDRS shown: heroin use 1996-2008? • Heroin epidemic circa 1996-1999 • Younger users initiating via smoking • Increased purity & decreased price • Rising fatal & non-fatal overdose rate • Public injecting • Abrupt reduction in heroin supply • Start of 2001 in all states and territories • 40% decline in OD deaths in 2001 • sustained thereafter • Brown Heroin available since 2006

  24. Frequency of NSW heroin use, 1996-2008(source: NSW IDRS IDU surveys) Note: Maximum days = 180

  25. Number of ambulance callouts to NSW heroin overdoses 1995-2007

  26. Effects on Treatment Services • More long term users entered MMT • “New” heroin users less often sought help • Small increase in treatment seeking for amphetamines and cocaine

  27. Changes in Crime • Drug distribution became more covert • Dealers sold other drugs, varying between states • In Adelaide, Brisbane and Melbourne: • methamphetamines • In Sydney • cocaine injection in street-based sex workers • Violent crime • short term increase in violent acquisitive crime in Sydney • Property crime • short term increase in Sydney • then a long steady decline that has continued

  28. What has the IDRS shown about stimulant use ? • Increased cocaine use in NSW • confined to inner-city Sydney IDU • increased purity & decreased price • More methamphetamine use since 2003 • Especially in ACT & Tasmania • Speed and crystal meth the most used forms • Small increases in: • Treatment seeking for problem use • Increased hospitalisations for psychoses

  29. Cocaine use 1996 – 2008(source: NSW IDRS IDU survey)

  30. Harms related to opioid and amphetamine use (1) Overdose (ED; NSW only) Arrests (National) Source: Emergency Department Information System, NSW Department of Health Source:ABCI, 2001, 2002; ACC 2003, 2004 & 2005

  31. Harms related to opioid and amphetamine use (2) Accidental deaths (National) Hospital separations (National) Source: ABS Causes of Death Database; Degenhardt, Roxburgh, (2007a; 2007b) Source: National Hospital Morbidity Database; Roxburgh & Degenhardt (2006)

  32. What has the EDRS shown about ERD markets (1)? Drug of choice, 2003-2008

  33. What has the EDRS shown about ERD markets (2)? Recent use

  34. What don’t they tell us? • Trends outside cities • General population patterns of use • sentinel groups targeted • The size of the drug market • how many users are there? • Other research to address these issues

  35. So what do they tell us? • What’s new • drugs • harms, extent of harms • price, purity, availability • What’s the same since last year • (or the year before…) • What we need to keep an eye on • Where additional research is required to investigate the significance of any trend

  36. Acknowledgements • IDRS/EDRS a product of many hands • Original work at NDARC • Julie Hando; Lisa Maher; Shane Darke • their many successors • Researchers in each jurisdiction • Key Experts in Health & LE • Injecting Drug Users and Regular Ecstasy Users

  37. Further information IDRS and EDRS http://ndarc.med.unsw.edu.au then click ‘Drug Trends’ 2008 reports were released on April 1, 2009.

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