The similarity in the chemical action and arousal-producing effect of psychostimulant drugs is not reflected in similarly homogeneous use patterns. Patterns of use include chronic and dependent abuse by the socially marginalised, use by young, often socially well-integrated people in recreational settings, and the instrumental use of psychostimulants by certain occupational groups or in particular work settings. The morbidity and mortality associated with psychostimulant use is also influenced by the route of administration. Recreational use is usually associated with occasional use by swallowing and snorting these drugs. Injection is typically associated with higher levels of dependence and other health and social problems, as is smoking of some forms of psychostimulant drugs, such as crystalline methamphetamine or crack cocaine, where smoking results in a similar rapid onset and high bioavailability to that seen with injection of the drug.
There has been a significant increase in reported lifetime use of psychostimulant drugs in Australia since 1993 (Table 5) according to the Australian National Drug Strategy Household Survey (Australian Institute of Health and Welfare, 2002a)1. Amphetamine use is particularly prevalent and is the second most commonly used illicit drug after cannabis. In this sense, amphetamine use is relatively more common in Australia than many other countries (see 'Global overview of trends in psychostimulant use' for details). The following sections discuss the prevalence and patterns of each type of psychostimulant drug in more detail.
Table 5: Prevalence (%) of use of amphetamines, cocaine and ecstasy/designer drug use, 1993–2001 (Australian Institute of Health and Welfare, 2002a)
|Past year - Amphetamines|
|Past year - Cocaine|
|Past year - Ecstasy/designer drugs|
|Lifetime - Amphetamines|
|Lifetime - Cocaine|
|Lifetime - Ecstasy/designer drugs|
Note: Lifetime prevalence for 2001 represents 'ever used' in comparison with 'ever tried' in earlier years.Top of page
AmphetaminesAccording to the 2001 National Drug Strategy Household Survey (Australian Institute of Health and Welfare, 2002a), almost 1.5 million Australians had used amphetamines at least once in their lives and half a million people had used these drugs at some time during the preceding year. Those aged 20-29 years were most likely to have recently used amphetamines (11%), followed by those in the 14-19 years age group (6%), while recent use of illicit drugs including amphetamines was uncommonly reported by those in the over 40 age group (0.4%). The mean age of initiation to amphetamine use of approximately 20 years has remained largely unchanged since 1995 (Australian Institute of Health and Welfare, 2002a).
The most popular setting for the use of amphetamines by participants of the Australian National Drug Strategy Household Survey was 'in a home' (59% of recent users), then private parties (47%) and dance parties (46%). However, 13% of recent users reported that a car or other vehicle was the usual setting for amphetamine use, 8.5% used in public places and 8% used at work, school, TAFE or university. Most recent users reported obtaining the drug from friends or acquaintances (71%), while 23% used a 'dealer' (Australian Institute of Health and Welfare, 2002a).
It is rare for people to use only amphetamines and use of multiple drug classes is common. For example, 88% of recent users in the National Drug Strategy Household Survey reported concomitant use of alcohol, 71.5% cannabis and 43% ecstasy (Australian Institute of Health and Welfare, 2002a). Similarly, Darke and Hall (1995) found high levels of concomitant nicotine, alcohol and cannabis use (>90%) and hallucinogen, benzodiazepine and opiate use (>50%) among a sample of 301 primary amphetamine users.
The frequency of amphetamine use in Australia varies, particularly among user groups described above. Among the estimated 534,000 recent users of amphetamines in 2001, 12% reported regular daily or weekly consumption, although 45.5% reported only yearly or twice yearly use (Australian Institute of Health and Welfare, 2002a). Recent users used around 1 gram of amphetamines on a typical using day, with 'powder' form the most frequently used (84% of respondents) followed by 'crystal' (38%) (Australian Institute of Health and Welfare, 2002a).
Users of amphetamines can be loosely categorised as 'recreational' (those who use irregularly in a social setting), intermittent binge users or regular daily users. Occupational users of amphetamines may also represent a distinct group, as may those who use the drug as an anorectic to effect weight loss. Intranasal or oral ingestion are common routes of administration by novice and recreational users, while a significant proportion (particularly regular users) move on to injecting (Hall & Hando, 1994).
Overall, injection is a common route of administration particularly among heavier dependent users, with amphetamine injectors accounting for around one in five injecting drug users (IDUs) in Australia (Australian Institute of Health and Welfare, 2002a; Breen, Degenhardt, Roxburgh, Bruno et al., 2003). Once users make the transition to injecting, they are unlikely to return to snorting or swallowing as their preferred mode of administration. On the whole, injection of methamphetamine is associated with more frequent use, higher risk of dependence, poorer social functioning and psychological morbidity (Darke, Cohen, Ross, Hando & Hall, 1994).
Injection of amphetamines is also seen among established populations of heroin users. For example, during the heroin shortage of 2001 there was a shift toward injection of psychostimulant drugs, including amphetamines, among IDUs who would otherwise see heroin as their drug of choice (Weatherburn, Jones, Freeman & Makkai, 2003). However, transitions back and forth between the injection of amphetamines and heroin were demonstrated prior to this time (Darke, Cohen et al., 1994). Use of amphetamines by those on methadone maintenance programs for opioid dependence has also been highlighted (Swensen, Ilett, Dusci, Hackett et al., 1993).
In summary, the use of amphetamines is most commonly seen as part of a polydrug use pattern among IDUs (Darke & Hall, 1995).
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CocaineCocaine use among the general population in Australia has always been low in comparison to other psychostimulant drugs (amphetamines and ecstasy). Cocaine use in Australia is also much lower than levels of cocaine use seen in the Americas and is probably more similar to levels of use seen in European countries. Use tends to remain more concentrated among younger people in conjunction with social occasions and among subgroups of IDUs. In Australia, a little more than 4% of the general population reported using cocaine at least once in their lives and 1.3% reported use in the previous 12 months (Australian Institute of Health and Welfare, 2002a). Cocaine is often used in combination with other drugs in Australia, particularly alcohol and cannabis (Australian Institute of Health and Welfare, 2002a) and this polydrug use pattern has been reported elsewhere (Chen & Kandel, 2002; John, Kwiatkowski & Booth, 2001; Pennings, Leccese & Wolff, 2002).
Like amphetamines and other drugs generally, males more commonly reported lifetime use of cocaine than females (5.3% compared with 3.5%), while the highest lifetime ever use was found among those aged 20–29 years (10%), followed by the 30–39 year age group at 6.5%. Those who had used in the previous 12 months (4.3%) were more likely to be males and aged between 20 and 29 years. The mean age of initiation to cocaine use has been fairly stable since 1995 and is approximately 22 years of age (Australian Institute of Health and Welfare, 2002a).
Like users of amphetamines, users of cocaine can be classed as occasional or recreational, intermittent binge users, or regular users. Of the recent users in the 2001 Household Survey, 65% reported yearly or twice yearly use; approximately 20% used every few months; and 16% used daily, weekly or once per month. The most common route of administration of cocaine by respondents in the 2001 Household Survey was intranasal snorting, which is consistent with reports from other countries (e.g., Boys et al., 2001; Chen & Kandel, 2002). However, there has been a significant increase in those reporting cocaine as the last drug injected by users of needle and syringe programs nationally (see the Prevalence and patterns of psychostimulant use among specific populations section). This is consistent with work by Hando et al in the late 1990s that found two distinct groups of cocaine users in Sydney, those from a low socio-economic group who predominantly injected cocaine and those from a higher socio-economic group who tended to prefer intranasal administration.
Cocaine can be snorted, ingested or injected. Crack cocaine, the use of which remains uncommon in Australia, is usually smoked.
Injecting cocaine users in Australia tended to be heroin users who began injecting cocaine with its increased availability around 1997–98. From 1995–2000, reports of recent cocaine injection were fairly stable at 1–2% of respondents but in 2001, this rose considerably to 7% (MacDonald et al., 2002) during the heroin shortage when it was thought to 'fill the gap' from the decreased supply of heroin (Weatherburn et al., 2003). Injection of cocaine was related to increased risk of a variety of physical and mental health problems, such as injection-related problems, chaotic lifestyle and paranoia (Kaye, Darke & Topp, 2001; van Beek, Dwyer & Malcolm, 2001). Female sex workers in Sydney who used cocaine heavily were also found to be at greater risk for a wide variety of adverse physical and psychological health consequences including sexually transmitted diseases and hepatitis (van Beek et al., 2001).
In line with low levels of cocaine use in Australia, few people receive drug treatment primarily for cocaine use or are admitted to hospital for cocaine-related mental disorders relative to other psychostimulant drugs (see Table 10). Despite this, significant harms have been noted even among non-injecting users, such as death from cardiac toxicity (see Chapter 6: Management of acute toxicity, for a detailed discussion). The potentially life-threatening nature of problems related to cocaine use highlight the need not to be complacent about this form of drug use.Top of page
EcstasyEcstasy use has also increased in Australia. Data from the National Drug Strategy Household Survey indicated that nearly one million people had used ecstasy at some time during their lives and levels of use in the past year reached around 3% of the adult population in 2001 (Australian Institute of Health and Welfare, 2002a). As was the case with amphetamines, younger age was associated with ecstasy use. Nearly one in five of the 20–29 year old group had ever used ecstasy and one in ten had used it in the preceding 12 months. Again, users were more likely to be male.
The mean age of initiation to ecstasy use has been fairly stable since 1995 and like cocaine was approximately 22 years of age for those in the Household Survey. However, an Australian study of 329 ecstasy users reported a median age of initiation (ie. the age at which first use most frequently occurred) as 18 years (Topp, Hando, Dillon, Roche & Solowij, 1999). This discrepancy probably reflects the latter sample being comprised mainly of regular users of the drug, who in general are likely to initiate use at a younger age.
The majority of users (73%) procured ecstasy from a friend or acquaintance, while 23% obtained the drug from a dealer. Similar to the settings for use of other psychostimulants, many people used at home (46%) or private parties (54%), but the use of ecstasy at dance parties or a rave was higher at 70% (Australian Institute of Health and Welfare, 2002a). Monitoring of ecstasy use among 'party drug users' also suggests an increased demand for the drug although patterns of use have remained reasonably stable since the mid 1990s (Topp, Breen, Kaye & Darke, 2002). One recent trend is that a large proportion of 'pills' that are often sold as ecstasy actually contain methamphetamine (Australian Bureau of Criminal Intelligence, 2002). In Australia as elsewhere in the world, ecstasy users report high levels of recent alcohol, cannabis, amphetamine, LSD and tobacco use (>70%), while recent use of solvents and benzodiazepines were lower but still notable (>30%) (Topp et al., 1999).
Results of a descriptive study undertaken in the late 1990s demonstrated patterns of use among a sample of 329 ecstasy users recruited from Sydney, Brisbane and Melbourne (Topp et al., 1999). Mean duration of use was three years and female subjects reported a younger age of initiation (17 years) than the male participants (19 years). Most (89%) had used ecstasy at least monthly and the median days of ecstasy use in the preceding six months was ten (12% had used on more than 24 days). Subjects tended to use one tablet on a typical using day, although almost half (44%) reported using more than one tablet. A third of the respondents had 'binged' on ecstasy (used continuously without sleep for 48 hours or more), the longest binge reportedly lasting for 14 days. Ecstasy was most often swallowed, although it had been injected by 16% of the sample at some time in their using career and 10% had injected it in the preceding six months (Topp et al., 1999).
As pointed out by Topp et al (1999), the results of early studies into ecstasy painted a fairly benign picture of the natural history of use: a spontaneous tapering or cessation of mainly oral use by many individuals, limited adverse physical or psychological effects and few cases of injecting ecstasy use were reported.
Data obtained in 1990 from 100 ecstasy users in Sydney led Solowij, Hall and Lee (1992) to conclude that ecstasy did not lend itself to regular use due to a high tolerance potential for positive effects, coupled with experiences of increased negative effects over time. Typically, users took ecstasy intermittently or recreationally, in combination with other drugs, to enhance sociability and increase energy, particularly for all-night dance parties. Although more recent international research has demonstrated that while there is still a strong likelihood that many users will spontaneously cease ecstasy use (von Sydow, Lieb, Pfister, Hofler & Wittchen, 2002), a range of serious adverse effects of use, some fatal, have been reported in Australia (eg, Gowing, Henry-Edwards, Irvine & Ali, 2002) and elsewhere (Kalant, 2001; Parrott, 2002).
1 Note that the wording of the question relating to lifetime use of illicit drugs was altered slightly for the 2001 survey. In previous surveys, respondents were asked if they had ever 'tried' drugs, but in 2001 they were asked if they had ever 'used' drugs. Hence, lifetime use data in 2001 is not strictly comparable to previous years and care must be taken when comparing prevalence rates across time.Top of page