In a previous review of the literature, Hall and Hando (1993) described the history of psychostimulant use in Australia and the United States of America (USA), which is briefly summarised here (the reader is referred to the original work for further details).

Since the medical introduction of cocaine in the 1880s, several 'epidemics' of use have been described. It has been proposed that such extensive use was due to a belief in the relative safety of the use of cocaine in conjunction with its wide availability. A second wave of widespread cocaine use occurred in the USA during the mid 1980s and included abuse of the newly introduced 'crack cocaine' which was the drug of choice for poor, marginalised African American youth. Crack was freely available, affordable and produced intense euphoria in the user. However, due to the short half-life of the drug and rebound dysphoria following abstinence, some heavy users experienced a severe dependence syndrome. The psychosocial impact of the United States (US) cocaine epidemic became increasingly clear.

Following the American experience and historical evidence to suggest that Australian drug use patterns tended to follow those of the USA, local authorities became concerned that a cocaine epidemic would also hit Australia. As a result, a substantial number of studies were undertaken to explore the prevalence and patterns of cocaine use among youth and known IDUs in Australia during the late 1980s and early 1990s (Hando & Hall, 1993).That body of evidence revealed that, although it was not uncommon for illicit drug users to have tried cocaine, and similarities in user demographics and patterns of use did indeed exist between the USA and Australia, the expected cocaine epidemic had failed to arrive.

Hall and Hando argued that while the focus of attention was on cocaine use during the 1980s, an emerging Australian amphetamine epidemic was somewhat eclipsed until the early 1990s.While undertaking the earlier cocaine studies, researchers became incidentally aware of the high prevalence of amphetamine use among illicit drug users, the discovery of which prompted a wave of amphetamine-specific research (see Hando & Hall, 1993 for a review of these studies).

Unlike cocaine, which needed to be imported from international markets, amphetamines were being locally produced from freely available chemical precursors and were therefore cheaper to purchase and readily obtained. Amphetamine use waned from the mid 1990s with the emergence of heroin as the major form of injecting or problematic drug use in Australia. This trend was most notable in the southeast of the country (i.e., Sydney, Canberra and Melbourne) while amphetamine use remained more common in other parts of Australia.

Several years on, cocaine emerged on the Sydney drug market. This trend was observed as the uptake of cocaine injection among the existing heroin using population in Sydney in late 1997 to 1998. Heroin users continued to use heroin, alongside cocaine. Cocaine use has since become a regular feature of the drug situation in Sydney, although the overall level of use has not continued to increase, with the exception of an increase in use among IDUs during the 2001 heroin shortage (MacDonald, Zhou & Breen, 2002). Similarly, use remains fairly circumscribed to Sydney and to a lesser extent other major cities in Australia.Top of page

Not long after the emergence of cocaine use in Sydney, reports of more pure forms of amphetamines began to emerge. By this time, amphetamines available on the Australian market were almost exclusively the more potent analogue of 'methamphetamine'. From the time of the first reports of more potent forms of methamphetamine in 1999 there has been a steady increase in use across a range of drug using populations, this being most apparent among IDUs during the heroin shortage of 2001 (McKetin, Darke, Bruno, Dwyer et al., 2000; Topp, Kaye, Bruno, Longo et al., 2002). There has been a corresponding increase in problems associated with methamphetamine use over this time as discussed later in this chapter.

Over this time ecstasy also emerged as a popular drug, especially its use in recreational or party settings. This amphetamine analogue, methylenedioxymethamphetamine (ecstasy), was legal in the mid 1980s until concerns over its widespread use and potentially negative effects led the American Food and Drug Administration (FDA) to schedule the drug. During the late 1980s ecstasy also became popular in Australia among subgroups of gay and heterosexual youth to enhance energy and sociability at all-night dance parties or 'raves' (Solowij, Hall & Lee, 1992).