Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Prevalence and patterns of psychostimulant use among specific populations

Page last updated: April 2004

Student populations
Party drug scene
Gay community
Police detainees
Indigenous community
Injecting drug users (IDUs)
Trauma and emergency settings
Treatment settings
Hospital settings
Arrests and seizures

Student populations

This chapter includes a brief overview of the extent of psychostimulant use among students. The reader is referred to Chapter 9: Psychostimulants and young people, for a detailed description of patterns of psychostimulant use among youth and related issues.

Psychostimulant drugs have been tried by between 4% and 7% of Australian school students aged 12 to 17 years, with use increasing to levels similar to the overall general population by 16-17 years of age (see Table 6). Amphetamines are the most commonly used psychostimulant drug, also being the third most commonly used illicit drug after cannabis and inhalants (White, 2001). The use of amphetamines among school students occurs in about 7% of students, although exposure to amphetamines ranges from around 3% of students aged 12 years to 10–12% of those aged 16–17 years. Recent use of amphetamines (past year) had occurred among 5.5% of students and again is highest among 16–17 year olds (8.2% and 9.6% respectively). While use may be low among the younger age groups, it is important to note that early onset of use, alongside other factors, is a risk factor for development of drug dependence in later life (Glantz & Pickens, 1992). Use of cocaine and ecstasy was lower than for amphetamines, with 3.5% and 4% of students having ever used these drugs respectively.

Use of psychostimulant drugs was only slightly higher among boys than girls compared with gender ratios seen among the general population (two males: one female). This was particularly true for amphetamine use, with 7.7% of boys and 6.5% of girls ever having used the drug and a similar ratio for recent use (6.0% male vs. 5.1% female). This ratio is roughly equivalent to a ratio of approximately six males to every five females. Higher rates of amphetamine use among young women than seen in older age groups may reflect a relative increase in use of psychostimulant drugs among young females.

Similar to patterns of use among the general population described in the previous section, use of psychostimulant drugs in the previous week (a proxy for more regular use of the drug) occurred among less than 2% of students.Top of page

Table 6: Prevalence of psychostimulant use among Australian school students, 1999

AmphetaminesEcstasyCocaine
Past year use - boys
6.0
3.5
2.9
Past year use - girls
5.1
2.7
2.1
Past year use - total
5.5
3.1
2.7
Ever used - boys
7.7
4.6
4.1
Ever used - girls
6.5
3.4
3.0
Ever used - total
7.1
4.0
3.5

Party drug scene

Use of psychostimulants, particularly ecstasy type drugs, is commonplace among the dance party scene. Sentinel surveys of ecstasy users among the dance party scene in Sydney have found that most used two to three times a month and swallowed one to two tablets per occasion (Topp, Breen et al., 2002). The other psychostimulant drugs — amphetamines, methamphetamine and cocaine — were also taken by a large group of ecstasy users and were used more often than other drugs such as LSD, benzodiazepines, inhalants (amyl nitrate and nitrous oxide), heroin and ketamine. These were used infrequently by less than half of the ecstasy users sampled. Alcohol and cannabis were also commonly and frequently used by this group.

Use of methamphetamine became more prevalent among the Sydney dance party scene in 2001. One in five party drug users interviewed in Sydney during 2001 had used base methamphetamine recently, while one-quarter had used the crystalline form of the drug. Even though similar numbers had been exposed to both ice and base, the base form of the drug was used more often. Most of this group used base once a month compared with only having used ice once in the past six months. Similar to use among IDUs, powder methamphetamine was still by far the most common form of the drug used in the dance party scene (Topp, Breen et al., 2002). By way of comparison, cocaine was typically used less than once a month by around half the sample, this level of use remained stable across the period from 1997–2001.

Gay community

The use of psychostimulants among members of the gay community in Australia is widespread (see Table 7), particularly among those who are socially 'attached' to the gay community (Ireland, Southgate, Knox, van de Ven et al., 1999). In Australia, the use of drugs in combination with music, dancing and sexual contact has been identified as a means to celebrate gay identity with psychostimulants in particular being used to enhance energy for dancing and partying (Ireland et al., 1999). Although drug use has frequently been found to increase the risk of engaging in unsafe sexual practices in many studies, there appears to be various other contributing factors among the gay community such as the nature of sexual relationships, misunderstanding of risks, impulsivity, the situational context of sexual activity, stress responses and age (see Ireland et al for a review of these studies).

Overall, ecstasy is the most common drug used among the gay community. Although similarly high levels of methamphetamine use can be seen in Queensland and Adelaide, methamphetamine is also more common among other population groups in these areas. Use of cocaine among gay men is lower than for ecstasy and methamphetamine (Hull, Rawstorne, van de Ven, Prestage et al., 2002). Levels of psychostimulant use are not as high among all subgroups of gay men. For example, among Asian men in Sydney levels are lower with 16% having used ecstasy recently, followed by methamphetamine (9%) and then cocaine (4%) (Mao, van de Ven, Prestage, Wang et al., 2003).

An interesting feature to note is that methamphetamine was the most commonly injected drug among gay men, with relatively few indicating injection of other drugs including heroin. This stands in contrast to IDUs surveyed through needle and syringe programs (NSPs), where heroin is still commonly injected (see Injecting drug users (IDUs) section below for details).Top of page

Table 7: Prevalence of psychostimulant use in the past six months among gay men in different Australian regions, 2001

SydneyMelbourneQueenslandAdelaide
Use - Ecstasy
47.6
32.4
31.3
17.2
Use - Speed
35.0
23.1
29.6
18.4
Use - Cocaine
23.3
11.0
9.0
7.3
Use - Any drug
55.0
Injection - Ecstasy
1.9
1.1
2.2
1.4
Injection - Speed
5.3
2.7
7.6
3.5
Injection - Cocaine
2.1
0.5
1.4
1.1
Injection - Any drug
10
4.1

Police detainees

The Australian Institute of Criminology Drug Use Monitoring in Australia (DUMA) project collects information from people detained by police in seven sites across Australia every three months. To validate the self-report data, a urine drug screen is also obtained from participating detainees. Information is confidential and voluntarily supplied and the data obtained is an indicator of current drug use by those involved in criminal activity. Across years 2000 to 2002, Perth had the highest number of adult male detainees test positive to amphetamines, 33%–42%; followed by Adelaide (31%–38%); Southport (26%–33%) and Brisbane (21%–29%) (Makkai & McGregor, 2003).

The investigators reported an increase in positive urine screens for MDMA across the data collection period from 0.5% in 2000 to 1.1% in 2002, although prevalence of use in this population remains fairly low. Similarly, cocaine use was infrequently detected among this sample, with an average of only 4% across all sites testing positive to cocaine. However, the DUMA data supported the findings from the Illicit Drug Reporting System (IDRS) of an increase in use of other drugs, particularly cocaine, in the context of reduced availability of heroin in 2000-01 (Makkai & McGregor, 2003).

Indigenous community

There is scant published data regarding IDU among Indigenous communities. However, one study by Larson, Shannon and Eldridge (1999) reported that amphetamines were the most commonly injected drugs by a group of 77 known illicit drug users in Brisbane. All but one respondent had injected amphetamines and 73% reported amphetamines to be the last drug injected.

In the same year, an examination of hospital separation data recorded between 1980–95 was undertaken in Western Australia to determine the extent of recorded illicit drug problems among Indigenous and non-Indigenous Australians (Patterson, Holman, English et al., 1999). Data revealed a substantial increase in admissions of Indigenous people for amphetamine abuse, dependence and psychostimulant poisoning from 1980–85 to 1991–95 (Table 8). Despite similar increases in admission rates for non-Indigenous patients, the proportion of Indigenous admissions for amphetamine abuse and dependence are proportionately greater than would be expected, given that Indigenous people represent about 3% of the population.

More recently, Shoobridge, Vincent, Biven and Allsop (2000) reported results of interviews conducted with 25 Indigenous people in South Australia (19 males, median age 30 years), to determine the prevalence and impact of IDU on a small community. The investigators reported that injection of more than one drug class during the preceding 12 months was common (mean two classes). Amphetamines (76%) were the third most commonly used drug after tobacco (96%) and cannabis (88%) during the previous 12 months and a total of 96% of the sample had used amphetamines some time during their lives. Nearly half of the sample nominated an amphetamine as the first drug they had injected and the investigators noted unsafe injecting practices including some needle or other equipment sharing. Those interviewed reported considerable concerns regarding the negative social, financial and health consequences of their IDU on the small community (Shoobridge et al., 2000).

Further studies into the impact of psychostimulants on the Indigenous community in various locations throughout Australia is required to inform the development of culturally and geographically appropriate public health interventions.Top of page

Table 8: Numbers of first-time hospital admissions with illicit drug problems in Western Australia, 1980–1995 (Patterson et al., 1999)

Indigenous admissions (numbers)
1980–1985
Indigenous admissions (numbers)
1986–1990
Indigenous admissions (numbers)
1991–1995
Non-Indigenous admissions (numbers)
1980–1985
Non-Indigenous admissions (numbers)
1986–1990
Non-Indigenous admissions (numbers)
1991–1995
Cocaine abuse
6
10
43
Cocaine dependence
6
7
7
Amphetamine abuse
3
81
31
89
980
Amphetamine dependence
3
28
13
32
200
Psychostimulant poisoning
4
10
35
84
134

Injecting drug users (IDUs)

Methamphetamine and cocaine are the most commonly injected psychostimulants, with injection of ecstasy being rare. Methamphetamine injection is far more common than cocaine injection, with cocaine injection occurring mostly in Sydney. The Australian Needle and Syringe Program Survey reports data collected from a cross section of national needle and syringe program users, including information on the last drug injected and hepatitis B, C and HIV status (MacDonald et al., 2002). About 2% of IDUs surveyed through the annual NSP Survey reported cocaine as their last injection, in comparison with around 20-30% for amphetamines (mostly methamphetamine).

There are vast inter-jurisdictional differences in methamphetamine injection, with the highest proportion seen in Queensland, South Australia and Western Australia (see Table 9). It is not possible to say whether this means there are 'more' methamphetamine injectors in these states, as it is not known how many IDUs exist within each state.

Evidence suggests that there has been a recent swing away from heroin injection towards the injection of amphetamines among IDUs. According to MacDonald, Zhou and Breen (2002), "there was a consistent pattern of increased reporting of amphetamines and decreased reporting of heroin as the last drug injected in all states and territories" (p. 1). Reports of heroin as the last drug injected dropped from 56% in 2000 to 36% in 2001. Conversely, reports of an amphetamine as the last drug injected rose from 22% in 2000 to 37% in 2001. A preference for amphetamines over heroin may be due, in part, to a reduction of supply and the subsequent increase in cost of heroin during 2000-2001 (eg, Rouen, Dolan, Day, Topp et al., 2002) and the wide availability and comparatively low cost of amphetamines nationally (Topp, Kaye et al., 2002). However, the increase in the use of amphetamines was reported several years before the so-called heroin 'drought' and has continued since, suggesting that increasing methamphetamine injection seems to be an ongoing trend.

The IDRS, coordinated by the National Drug and Alcohol Research Centre (NDARC), New South Wales, has been collecting data from IDUs and key informants from selected locations nationally since 1997. Data regarding availability, purity, price and patterns of drug use is collected and combined with data from other key sources to provide an opportunity for comparisons across specific jurisdictions.

Data from the IDRS confirms that cocaine use is prevalent among IDUs in some cities (e.g. Sydney, New South Wales) (Darke, Kaye & Topp, 2002b), while cocaine is virtually unobtainable in others (e.g. Hobart,Tasmania) (Bruno & Mclean, 2002).

During the heroin shortage, reported use of cocaine by IDUs in New South Wales rose from 63% in 2000 to 84% in 2001 and six-month frequency of use increased from 12 as the median number of using days to 90 using days (Darke et al., 2002b; Day,Topp, Rouen, Darke et al., 2003). Similar rises were detected in Victoria, with Melbourne IDUs reporting an increase in the last six-month injection of cocaine from 6% in 2000 to 20% in 2001 (Fry & Miller, 2002). Research suggests that injectors use cocaine more frequently than non-injectors and are more likely to be dependent (Kaye & Darke, 2000; van Beek et al., 2001). Due to the short half-life of cocaine and rapid reduction in acute effect, users tend to inject the drug more frequently than those whose first drug of choice is heroin or an amphetamine (van Beek et al., 2001). This has particular implications for the health of cocaine users due to risks associated with frequent use (e.g. vein damage and mental health disorders), particularly in the context of the increasing popularity of injection. Risks associated with cocaine use are discussed in detail in Chapter 4: Risks associated with psychostimulant use.

The increase in the use of base and ice methamphetamine also became very apparent among IDUs during the 2001 heroin shortage. At this time an estimated 76% of IDUs in Australia had recently used methamphetamine, a notable increase from previous years. The increase of 2001 appeared to have stabilised in 2002. Still, 73% of IDUs reported recent use of methamphetamine and the presence of the more potent forms of methamphetamine was still evident. For example, one-quarter of the IDUs surveyed through the IDRS in Sydney had recently used crystalline methamphetamine and/or methamphetamine base, while exposure was substantially higher than this in South Australia (56%),Western Australia (74%) and Queensland (39%). This level of exposure to methamphetamine base and ice was similar to that seen in 2001, although markedly higher than previous years. For example, in 1999 only a handful of injectors in Sydney reported use of ice (3%) and 'base' methamphetamine was being reported for the first time. Even though exposure to base and ice were similar among injectors, ice was used less frequently than either base or powder methamphetamine. Powder methamphetamine was still the most common form of the drug used by injectors.Top of page

Table 9: Percentage of IDUs who report methamphetamine as their last drug injected, 2000-01 (MacDonald et al., 2002)

Methamphetamine last injection (%) in 2000Methamphetamine last injection (%) in 2001
Australian Capital Territory
6
41
New South Wales
12
17
Northern Territory
27
36
Queensland
38
51
South Australia
30
52
Tasmania
22
21
Victoria
6
25
Western Australia
23
56
Total
21
37

Note: Data represent findings from the Australian Needle and Syringe Program Survey, NCHECR.

Trauma and emergency settings

Data pertaining to emergency presentations is not routinely recorded in Australia. However, investigators are able to track trends in the USA and the prevalence of psychostimulant use among acute presentations to emergency departments appears to be increasing in some areas of the USA. Schermer and Wisner (1999) reviewed toxicology results of all patients admitted to a large emergency department in California from 1989–1994. They found that the prevalence of methamphetamine positive toxicology nearly doubled from 7.4% in 1989 to 13.4% in 1994, while positive cocaine toxicology had only a modest rise from 5.8% to 6.2%. Methamphetamine-positive patients were most commonly injured in motor vehicle collisions or motorcycle collisions; cocaine-positive patients were most commonly injured by assaults, gunshot wounds, or stab wounds.

However, in Australia, emergency incidents related to the use of psychostimulants are also emerging as an area of concern. In 2001 the Queensland Ambulance Service (QAS) recorded more attendances to ATS-related incidents (n=219) than to non-fatal heroin overdoses (n=196) (Bates, Clark, Henderson & Davey, 2003).

The mean age of the patients requiring emergency assistance for ATS use was 23 years for females and 25 years for males. Although the data relating to ATS-related attendances in preceding years is not yet available for comparison, QAS staff have reported an increased demand for emergency responses to ATS cases over the past three years, with attendances complicated by the need to manage patients' behavioural disturbances such as agitation and potential for aggression (Australian Crime Commission, 2003).Top of page

Treatment settings

The Alcohol and Other Drug (AOD) Treatment Services National Minimum Data Set (NMDS) collects data on a routine basis on clients attending government and non-government treatment agencies (Australian Institute of Health and Welfare, 2003a). These data do not include treatment data from Queensland and also exclude methadone maintenance treatment, half-way houses, sobering up shelters and correctional institutions. However, they still provide an indication of the numbers seeking treatment primarily for psychostimulant use.

Data on the overall treatment demand for psychostimulants relative to other drugs can be seen in Table 10. Amphetamines represent the principal drug of concern for 9% of all clients that received treatment during 2000-01, being the third most common illicit drug for which Australians sought treatment after cannabis and opioids (30.6% and 14.2% of all drug and alcohol treatment clients respectively). In comparison less than 1% of treatment clients sought help primarily for ecstasy or cocaine.

Data from the NMDS has only been collected routinely since 2000-01. However, the national census on Clients of Treatment Service Agencies (COTSA) has been undertaken in 1990, 1992, 1995 and 2001 (Shand & Mattick, 2001) and provides a snapshot of people seeking treatment from government and non-government services on the day of the census. These have shown a steady increase in the proportion of amphetamine-related treatment admissions from around 4% (174 and 226 cases for 1990 and 1992 respectively) in the early 1990s to 6.5% in 1995 (308 cases) and 8.3% in 2001 (412 cases).

Gender breakdown among amphetamine treatment clients is very similar to that among amphetamine users in the general population, being a ratio of 64% male to 36% female and most are aged between 20–29 years (56%).Treatment seeking amphetamine users tend to be slightly older than the amphetamine users in the general population (73% vs. 78% under 30 years of age) as would be expected due to the natural lag between uptake of drug use and treatment seeking.

Relative to opioid drugs or alcohol, methamphetamine users appear to have relatively low contact with treatment services specifically for their amphetamine use. Roughly 7,000 methamphetamine users received treatment in 2000-012, in comparison with the 63,000 who used the drug regularly during this period. The low level of contact with services may reflect a low demand for services, or lack of appropriate and accessible services for this population. Around one-third (35%) of amphetamine clients self-refer for treatment, which is typical for drug treatment clients in general (34%).

The majority of amphetamine clients inject the drug (75%) with smaller proportions smoking (3.3%), swallowing (9.5%) or snorting (3.8%) the drug. This is not surprising given evidence of injecting being associated with higher levels of dependence, but has important implications for treatment interventions targeting amphetamine users, particularly in terms of preventing the spread of blood borne viruses.Top of page

Table 10: Number and percentage of drug and alcohol treatment clients by drug type, 2000-01 (Australian Institute of Health and Welfare, 2003a)

Number of male clientsNumber of female clientsNumber of total clients% of sample (N=76,944)a
Alcohol
18,221
7,500
25,889
33.6
Opioids
14,867
7,871
23,230
30.2
Cannabis
7,775
2,930
10,798
14.0
Amphetamines
4,451
2,499
6,979
9.1
Cocaine
225
60
291
0.4
Ecstasy
91
48
139
0.2
Benzodiazepines
768
852
1,635
2.1
Other
3,977
2,922
6,968
9.1

a Includes 1,065 missing cases.

Hospital settings

In the year 2000–01, there were 2,384 hospital separations in Australia for mental and behavioural disorders due to psychostimulant use including caffeine (see Table 11) (Australian Institute of Health and Welfare, 2003b), this representing a stark increase on previous years. Most of this increase is due to psychotic disorders due to psychostimulant use, which increased from 200 in 1998-99 to 1,028 in 1999–2000 and a further but smaller increase to 1,252 in 2000–01. While this may be associated with the change in diagnostic coding from ICD-9 to ICD-10 in 1997–98, such a dramatic increase was not seen for disorders related to other drug classes. Hospital separations for psychostimulant use do not include those due to cocaine use. In comparison with other psychostimulant drugs there were few hospital admissions due to cocaine use, with 146 in 1998–99, 92 in 1999–2000 and 164 in 2000–01.

Most psychostimulant separations were for a psychotic disorder due to psychostimulant use (52%) followed by dependence (24%) and harmful use (15%). Of those with psychosis, most were treated in specialised psychiatric facilities (84%). Care of dependence was more likely to occur outside of psychiatric hospitals, with 70% of dependence separations being from a general hospital facility.

Average duration of hospital care for psychostimulant use was approximately five days. In terms of the duration of care required to treat problems, psychostimulants accounted for 12,194 patient days of care in 2000–01, similar to the number of care days for cannabis (14,060) and just under half that for opioids (29,464).

Patients seen in hospitals for psychostimulant use were older than psychostimulant users in the general population, but most were still aged less than 30 years (67%). Similar to the gender breakdown among the general population and the treatment population, 67% of hospital separations due to psychostimulant use were male.

It should be noted that these data represent only mental and behavioural problems due to psychostimulant use and not physical health problems. Moreover, these data do not reflect the incidence of mental and behavioural disorders due to psychostimulant use in the overall population. Also, trends seen in these data may be affected by variations in factors such as service provision, hospital practices and diagnostic coding practices.Top of page

Table 11: Australian hospital separations for mental and behavioural disorders due to use of psychostimulants including caffeine by principal diagnosis, 1998–99 to 2000–01 (Australian Institute of Health and Welfare, 2003a)

1998–991999–002000–01
Acute intoxication
30 (3.2%)
132 (6.5%)
112 (4.7%)
Harmful use
87 (9.3%)
288 (14.1%)
318 (13.3%)
Dependence
370 (39.5%)
453 (22.2%)
545 (22.9%)
Withdrawal
25 (2.7%)
75 (3.7%)
97 (4.1%)
Withdrawal with delirium
1 (0.1%)
11 (0.5%)
9 (0.4%)
Psychotic disorder
200 (21.3%)
1,028 (50.3%)
1,252 (52.5%)
Amnesic syndrome
0 (0%)
5 (0.2%)
2 (0.1%)
Residual and late-onset psychotic disorder
1 (0.1%)
4 (0.2%)
1 (0.0%)
Other mental and behavioural disorders
5 (0.5%)
12 (0.6%)
13 (0.6%)
Unspecified
219 (23.4%)
36 (1.8%)
35 (1.5%)
Total
938 (100%)
2,044 (100%)
2,384 (100%)

Note: These figures do not include hospital separations for cocaine.

Arrests and seizures

Arrest and seizure data refer to ATS as a class of drugs including amphetamines, methamphetamine and ecstasy related drugs. The supply of ATS in Australia has increased dramatically over the past five years, with seizures increasing tenfold from 156 kg in 1996–97 to just over 1.8 tonnes in 2001–02 (Australian Bureau of Criminal Intelligence, 2002). Of ATS, most 'amphetamines' consist of domestically produced methamphetamine, although there has been a recent increase in the importation of methamphetamine, particularly high purity crystalline methamphetamine. Most ecstasy available in Australia is thought to be imported. Table 12 shows the increase in both arrests for ATS providers and consumers over the past five years.

Overall, the number of arrests in Australia for ATS is over tenfold more than for cocaine. Border detections of cocaine have increased since 1998-99 from under 100 kg per year to the largest ever seizure of 938 kg in Western Australia in July 2001.

A recent trend in ATS is the emergence of different physical forms of methamphetamine. Most 'amphetamines' available in Australia are actually methamphetamine and this has increasingly been the case over the past decade. In 2001–02 methamphetamine made up 97% of all seizures of either methamphetamine or amphetamines. While the most readily available form of the drug remains low purity powder methamphetamine, increasing availability of so-called 'base' methamphetamine and high purity crystalline methamphetamine has steadily increased since around 1998. It is assumed that the 'ice' available in Australia is imported rather than locally produced, although there has been a single recent detection of a clandestine laboratory in Australia producing ice. The so-called base methamphetamine available in Australia is probably not actually true base methamphetamine, which is an oil, but the same form of methamphetamine found in the powder form of the drug (ie. methamphetamine hydrochloride). The gluggy, oily or wet appearance is thought to result from residual products left over from the manufacture process. This form of methamphetamine is usually more pure as it has not been 'cut' to the same extent as the classic powder form of the drug.

Methamphetamine tablets also appear to be increasingly common, the main market for these being among the 'party drug' scene where they are sold as ecstasy (INCSR, 2002). The Australian Bureau of Criminal Intelligence in its Australian Illicit Drug Report 2000–01 estimated that 80% of the tablets sold as 'ecstasy' in Australia today are actually locally manufactured methamphetamine tablets.Top of page

Table 12: Number of arrests for ATS and cocaine in Australia, 1997–98 to 2001–02

1997–981998–991999–00a2000–01b2001–02c
ATS - Consumer
3,349
4,976
6,252
6,721
5,815
ATS - Provider
1,417
1,608
1,829
2,113
2,212
ATS - Total
4,766
6,584
8,081
8,834
8,027
Cocaine - Consumer
378
462
253
405
378
Cocaine - Provider
146
109
180
246
234
Cocaine - Total
524
571
433
651
612

a 1999–2000 data exclude 493 arrests where drug type was not recorded and 1,725 arrests where consumer/provider information was not recorded.
b 2000–01 data exclude 1,543 arrests where consumer/provider information was not recorded. Figures for 2000-01 have been amended to include revised figures from South Australia.
c 2001–02 data exclude 588 arrests where consumer/provider information was not recorded.

Footnotes

2 Note. This figure excludes people seeking drug treatment in Queensland.

Top of page