AmphetaminesRegions with established amphetamine or methamphetamine use include parts of Southeast Asia, Australia and New Zealand, North America and certain parts of Europe (United Kingdom (UK), the Czech Republic and Scandinavian countries). The use of methamphetamine in particular is increasing in many regions and there is concern that the trend will continue despite heightened awareness of the adverse consequences (Rawson, Anglin & Ling, 2002; United Nations Office on Drugs and Crime, 2003).
The AmericasUse of methamphetamine in the Americas appears concentrated in North America, particularly in the USA, although there have been reports of increasing use in countries in Central and South America (United Nations Economic and Social Council, 2003). Clinical researchers in the USA have identified a growing market of methamphetamine consumers, particularly in the western and mid-western states (Rawson, Anglin et al., 2002). Clinical reports are supported by epidemiological data that reveal a three-fold increase in the incidence of methamphetamine use and a reduction in age of initiation from 22 years to 18 years (Substance Abuse and Mental Health Services Administration (SAMHSA), 2002). Methamphetamine is now being used along with other drugs at dance venues such as raves in the USA and use of the crystalline form of the drug ('ice') has been associated with significant problems. Use of methamphetamine is still at lower levels than seen in Australia, with around 4% of the general population having ever used the drug, although this should be interpreted in light of the relatively higher levels of cocaine use in the USA.
EuropeMost 'amphetamines' used in Europe are in the form of amphetamine sulphate. Methamphetamine problems have been largely restricted to the Czech Republic.
However, there has been some evidence of sporadic methamphetamine availability in other European countries. Use of amphetamines in Western Europe is still well below 5% lifetime prevalence for most countries — comparatively much lower than levels reported among the general population in Australia.
The UK (England and Wales) reports notably high rates of amphetamine use, with 11% of the general population having ever tried these drugs, although only 3% had used amphetamines in the past year. These levels of use are akin to those seen in Australia (see the prevalence and patterns of use section later in this chapter). Amphetamines are also dominant in the Scandinavian countries of Sweden, Finland and Norway where the majority of problem drug users (ie. injection or regular long duration use) primarily use amphetamines. This stands in contrast to other European countries where the majority of injectors or heavy drug users take opioids (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2002; Hibell, Andersson, Ahlström, Balakireva et al., 2000).Top of page
Asia-Pacific regionOver three-quarters of the world's production of amphetamine-type stimulants (ATS) occurs in Southeast Asia. Given this scenario it is not surprising that one of the most notable drug trends over recent years has been the dramatic increase in ATS use in this region. Particularly large increases in use have been seen in Thailand, while historically methamphetamine use has been the dominant pattern of drug use in Japan and the Philippines. Lower levels of use are seen in other parts of the region, although recently use in these areas also appears to be increasing, with use spreading to broader population groups.
In Thailand, methamphetamine use has been spreading since 1970 but this increase became more intense from 1996 and its use has now dispersed throughout the country. Methamphetamine has now replaced heroin as the most common drug for which drug users seek treatment, with over half of new treatment recipients in the country being methamphetamine users in 2000. Most methamphetamine available in Thailand is in the form of tablets, referred to locally as 'yaabaa', which is typically smoked 2-3 times per day.Young people and students have become the main users of methamphetamine, while drugs like ecstasy, ketamine and cocaine are more commonly used by youth in entertainment places (Chaiyawong, 2002).
Japan has experienced several waves of widespread methamphetamine use, the first immediately following the Second World War when stockpiles used by combat personnel became widely available to the general public. Although drug use among the general population is low, methamphetamine is reported to be 'the most widely abused drug in Japan' (Matsumoto, Kamijo, Muiyakawa, Endo et al., 2002) and accounts for the majority of reported cases of drug dependence or abuse in Japan. Injection is the predominant mode of administration, although smoking the drug has increased in popularity over the past decade (Ministry of Health, Labour and Welfare, 2002).
Methamphetamine is also the most common illicit drug used in the Philippines, where there is an estimated 1.8 million users of the drug (1999 National Household Survey) and methamphetamine accounts for the majority of drug-related treatment admissions. The main form of methamphetamine used in the Philippines is the high purity crystalline form called shabu (or 'ice'). Most users smoke the drug, although there have been reports of methamphetamine injection (Balmes, 2002).
Use of ATS has also increased in China where there is also substantial production and trafficking of the drug, including the high purity crystalline methamphetamine that is used in the neighbouring countries of Japan and the Philippines. Use of amphetamine-type drugs in China includes 'ice' but also other forms of ATS, particularly ecstasy, known locally as 'shake head pill'. There has been an increase in the use of ATS pills in several other Southeast Asian countries, such as Vietnam, Laos People's Democratic Republic (PDR) and Cambodia. Use in these countries is still relatively low. However, there are signs that use is beginning to spread (Zhimin, Xianxiang & Jiaqi, in press).
The dramatic increase in the supply and consumption of ATS within the Southeast Asian region has implications for Australia because of the geographic proximity and the potential 'spill over' of the market into Australia. Importation of high purity crystalline methamphetamine from Southeast Asia to Australia is already occurring. The use of this form of the drug presents a particular concern because of the increased risk of dependence, psychosis and other health and social consequences. At the same time, domestic production and use of methamphetamine has also increased. New Zealand has witnessed a similar increase in methamphetamine use, with past year prevalence increasing from 2.9% in 1998 to 5.0% in 2001 (Wilkins, Bhatta & Casswell, 2002) and increased availability of more pure forms of methamphetamine, referred to locally as 'pure' or 'p'. The increased use of methamphetamine, particularly more pure forms of the drug, has also prompted concern about the impact on increasing levels of psychosis and violent behaviour associated with use of the drug and options for treating dependence. A later section of this chapter discusses patterns of methamphetamine use in Australia in more detail.Top of page
EcstasyExperimental or infrequent use of 'ecstasy' type drugs appears to be on the rise in many regions of the world. This increase is most noticeable across the Americas and in Central and Eastern Europe, where increased exposure to ecstasy use among young people has been documented. Increases in ecstasy use have also been noted in Australia and in some countries in Southeast Asia.
In Europe the use of ecstasy type drugs has become an established aspect of specific recreational settings (dance parties) where the drug is taken among youth, combined with increasing experimentation with other synthetic drugs. With respect to the use of ecstasy there has been a clear upward trend in both Western and Eastern European cities (Bless, Kemmesies & Diemel, 2000). However, the most recent data from the European Union region shows that lifetime experience of ecstasy among the general population is still well below 5% in most countries (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2002), which is slightly lower than levels seen in Australia (6%) (Australian Institute of Health and Welfare, 2002a). However, much of the 'ecstasy' taken in Australia may actually be methamphetamine pills, so it is difficult to make accurate comparisons across countries (Australian Bureau of Criminal Intelligence, 2002).
Increased ecstasy use is a particular concern in the USA at the moment. Around 4% of the population have ever used ecstasy, with exposure to the drug having increased significantly since 2000 (2.9% vs. 3.6%) (Substance Abuse and Mental Health Services Administration (SAMHSA), 2002). Increased ecstasy use has been noted in many regions of the country and has been reflected in a rise in the number of emergency room admissions where ecstasy has been implicated (Community Epidemiological Work Group (CEWG), 2002). Increased use of ecstasy was particularly notable among older school students where levels of use in the past year have risen sharply from around 4% in 1996-98 to just over 9% in 2001 (Johnston, O'Malley & Bachman, 2002). Designer drugs such as ecstasy have also emerged as popular drugs in Canada, mainly among youth. In Ontario, past-year ecstasy use among students had increased from 0.6% in 1993 to 6% in 2001 (Adlaf, Paglia & Ivis, 2000).
Ecstasy is typically the domain of Western and developed countries; however, increasing ecstasy use has not been restricted to these areas. Over the past decade ecstasy use has increasingly become the concern of other regions, including Africa, South and Central America and the Caribbean and parts of Asia (United Nations Economic and Social Council, 2003). In Southeast Asia, ecstasy use is typically restricted to youth from higher socio-economic brackets where the drug is taken in at entertainment venues. However, there have been reports of ecstasy use among other population groups, but an increase in the consumption of 'pills' that may contain either methamphetamine, ecstasy or other drugs has made it difficult to monitor trends in use (Poshyachinda, Perngparn & Ngowabunpat, 2002; Zhimin et al., in press). This is particularly the case in Australia, where it has been estimated that 80% of the pills sold as ecstasy contain methamphetamine (Australian Bureau of Criminal Intelligence, 2002).Top of page
CocaineConsumption of cocaine tends to be concentrated in the Americas, with relatively lower levels in other parts of the world. This is hardly surprising considering that the global supply of cocaine originates almost exclusively from the South American countries of Peru, Bolivia and Columbia.Trafficking of cocaine in this region dwarfs other regions, with over 200 tonnes of the drug seized annually — around 90% of global cocaine seizures.
In line with supply-side trends, cocaine is the second most common illicit drug used after cannabis in North America. Exposure to cocaine among the general population in the USA is high, with around one in ten people (11.2%) having ever used the drug. An estimated 1.7 million people (0.7%) were current cocaine users, while 406,000 (0.2%) were current crack users, having used the drug in the past month (Substance Abuse and Mental Health Services Administration (SAMHSA), 2001). Similar to the USA, cocaine is the second most common illicit drug used in Canada after cannabis. Cocaine is also the most commonly injected drug, although smoking of crack cocaine has become more popular among IDUs in recent years, especially in Vancouver, where crack cocaine is also injected (Archibald, 2002). Mexico is also experiencing high levels of problematic cocaine use.The Drug Information Report System (DIRS) in Mexico noted that cocaine use surpassed use of cannabis and inhalants in 1998 to be the most common form of drug use among problematic drug users. Cocaine use among school students in Mexico also increased over the last decade with 5.2% of students reporting first use, to be the second most common illicit drug used after cannabis (5.8%) (Natera Rey, 2002). Levels of cocaine use also appear high in other parts of the Americas, with relatively high levels of cocaine use found among school students in Columbia, with crack cocaine using being the dominant form of problematic drug use seen in the Caribbean (Caribbean Epidemiology Centre (CAREC), 2001; Secretaría Nacional Antidrogas (SENAD), 2002).
Lower levels of cocaine use are seen in Western Europe where the drug has been tried by between 1% and 6% of the population. Prevalence of recent use is usually less than 1% although this is not without exception (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2002). Cocaine use is increasing among young people in the UK. Of those in the 16–24 years age group interviewed for the British Crime Survey, 5% reported use of cocaine in the previous year, which was five times more than those who reported recent use in 1994 (Boys, Marsden & Strang, 2001). There has also been concern about high or increasing levels of cocaine use in selected European countries (e.g. Denmark, Germany, Greece and Spain) (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2002).
Use of cocaine is also relatively low in other parts of the world. Pockets of cocaine use have been noted in some major urban areas in Africa, including cities in Nigeria, Morocco, Kenya and South Africa, some of these centres being transit points for trafficking of cocaine. Use of cocaine in these areas appears to be confined to small groups in urban areas, although lack of comprehensive data makes assessment of the situation difficult. Cocaine use is not a salient feature of the drug situation in Asia, while use in Australia is a relatively recent phenomenon and even then cocaine has remained at low levels, as discussed later in this chapter.