National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69
1.9 Routes of administration
Meth/amphetamine can be consumed by a variety of methods or routes of administration, including oral (swallowing), nasal (snorting), inhalation (smoking), vaginal/anal (shelving/ shafting), and intravenous (injection). The method of administration depends both on the form of the drug and the norms of different groups of users (Mundy, 2001), and is a significant mediating factor on the effect of a drug. Various routes of administration are preferred because they can enhance or facilitate drug effects. A study of the Sydney methamphetamine market found that the majority of amphetamine users who had tried powder, base and crystal methamphetamine preferred the purer forms of the drug to achieve ‘a more intense and longer lasting high’ (McKetin, McLaren & Kelly, 2005). Intranasal or oral ingestion are common routes of administration by novice and recreational users, while injection is a common route of administration among heavier dependent users (Ross, 2007).
As noted, the route of administration also differs according to the form. Among the national sample for the 2006 EDRS, speed powder was most commonly ‘snorted’ (75%) or ‘swallowed’ (73%), base was most commonly ‘swallowed’ (84%), and crystal methamphetamine was most commonly ‘smoked’ (79%) in the previous six months (Dunn et al. 2007). Small proportions reported injecting in the last six months: 12% reported injecting speed, 18% reported injecting base, and 20% reported injecting crystal methamphetamine (Dunn et al., 2007). The main route of administration for ecstasy in the previous six months was ‘swallowing’, reported by 94% of the national sample (Dunn et al., 2007).
The route of administration also varies according to the user. In contrast to those who participate in the EDRS survey, regular amphetamine users in a study of methamphetamine use in Sydney were most likely to inject the three common forms of ATS – powder, base and crystal (McKetin, McLaren & Kelly, 2005). However, one-third reported that they usually snort powder and one quarter reported usually swallowing base. A quarter (25%) reported that their initial administration of the drug was through injecting and 63% had injected on the most recent use. Twenty-six percent reported that they injected daily and 38% reported injecting twice or more a week.
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By definition (e.g., participants are recruited on the basis of regular injecting), the main route of administration for participants in the IDRS is injecting. Among police detainees, 70% reported that they had injected methamphetamine in the past 12 months and of those who had injected in the past 30 days, the average number of injections was 27 times during this period (Mouzos et al., 2007). Dependence on methamphetamine may partly be a function of route of administration. Among 310 regular methamphetamine users in Sydney, 67% of those who injected were dependent compared to 58% of those who smoked and 30% of those who snorted or swallowed the drug (McKetin, McLaren & Kelly, 2005). It was noted at one of the consultations that methamphetamine users themselves have distinct views about differences between injecting and non-injecting users, with a perception that injectors were ‘more dependent’ or ‘more severe addicts’ and more ‘socially irresponsible’ than noninjecting users.
Smoking methamphetamine has emerged as a trend in Australia following the increased availability of crystalline methamphetamine in 1999. Methamphetamine vaporises when heated and when inhaled, is rapidly absorbed into the pulmonary blood flow, giving an almost instant and intense drug effect (Australian National Council on Drugs, 2007). Crystal methamphetamine is typically smoked using a glass pipe, but it can be smoked using a ‘bong’ (water pipe used for smoking cannabis) or using a non-flammable surface (Australian National Council on Drugs, 2007). Methamphetamine is often smoked in social situations, where the methamphetamine pipe is passed among friends (Australian National Council on Drugs, 2007). The smoking of crystal amphetamine among young recreational drug users is a significant new trend because of the potential smoking has, given peer group influences, to introduce a younger, less experienced person to engage in a more risky pattern of drug use, and increase their risk of becoming dependent on methamphetamine (McKetin, McLaren & Kelly, 2005). One response in some jurisdictions has been to ban smoking equipment; however, there was concern at some consultations that such bans could influence smokers to move to injecting as a means of obtaining an instant drug effect.
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