[PDF] - Ice Inquiry - Sydney Hearings SCII.001.012.0001 Professor Michael PDF Document

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Ice Inquiry - Sydney Hearings

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Professor Michael Farrell, 'Trends in methamphetamine use and harms' PowerPoint Presentation

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Professor Michael Farrell and Drug Trends Team

Trends in methamphetamine use and harms

Trends in methamphetamine use

UNSW

AUST R AL I A

Medicine National Drug and Alcohol Research Centre

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Sources of Data

National Household Surveys Other indirect methods Surveillance and other information Wastewater Analysis Health Data Police and Arrest Data

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Prevalence of methamphetamine use as measured in household surveys

Prevalence of methamphetamine use estimated in Australian surveys remains stable (2.1%, in 2010 and 2013 NDSHS) However, a shift towards using crystal over other forms among those who use methamphetamine.

21.7% in 2010
50.4% in 2013
57.3% in 2016

There has also been an increase in the frequency of use, weekly methamphetamine use increased in 2013

9.3% reported weekly or more use in 2010
15.5% in 2013
20.4% in 2016

(a) Used in the previous 12 months

Source: 2016 National Drug Strategy Household Survey

51 50 29 20 27 22 50 57 12 12 8 2 10 20 30 40 50 60 2007 2010 2013 2016

Forms of meth/amphetamine used, recent (a) users aged 14 years or older, 2007-2016 (percent)

Powder Crystal Liquid Base

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Issues with these data

Important to remember that household surveys

underestimates more stigmatised and less common forms of substance use

Less sensitive in detecting small changes in

prevalence

Ongoing discussion about the response rates in

household surveys, which are declining over time (across most household-based surveys of this kind, not just the NDSHS)

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“Direct” estimates of prevalence (household surveys) underestimate what is thought to be “true” prevalence

For example, in many countries the number of people estimated to have used heroin
nce in a given year, based on survey data, will be smaller than the number of people

in treatment for heroin dependence

“Indirect” prevalence estimates attempt to overcome these problems

This is an accepted approach to estimating prevalence in the illicit drug field and is

used in many countries across Europe, North America and in Australia

We have made such estimates for methamphetamine use in Australia over time
It is worth noting that a behaviour engaged in 2‐4% of the population will whatever

method is used result in figures that will have wide confidence intervals.

Making “indirect” prevalence estimates

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Indirect prevalence estimates: multiplier method

Text box: Hypothetical example of an estimate of the number of dependent amphetamine users based on treatment episodes for amphetamine dependence Benchmark data: the number of episodes across Australia in a given year for treatment of amphetamine dependence Multiplier: the inverse of the proportion of people who are dependent upon amphetamines who receive treatment in a given year In this hypothetical example, data suggest that 20,000 Australians received treatment for amphetamine dependence in a given year. Surveys of dependent amphetamine users indicate that 10% received treatment in a given year. This gives a multiplier of 10. Limitations of this method is clear in that it relies on the estimates derived from a survey at a given time in a given locality and may significantly vary across time and place. We remain of the view despite recent criticism that a multiplier based on a 10% treatment utilization is a reasonable and moderate estimate.

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Estimated number of people (15‐54 years) with regular and dependent methamphetamine use, Australia, 2002‐2014

50000 100000 150000 200000 250000 300000 350000 400000 450000 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-… 2010-… 2011-… 2012-… 2013-… Number of regular users

regular users - lower CI regular users regular users - upper CI

50000 100000 150000 200000 250000 300000 350000 400000 450000 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009… 2010… 2011… 2012… 2013… Number of dependent users

dependen t users - lower CI dependen t users dependen t users - upper CI

Degenhardt L, et al. Estimating the number of regular and dependent methamphetamine users in Australia, 2002–2014. Medical Journal of Australia. 2016;204(4):153

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Estimated prevalence of methamphetamine dependence by age group in Australia, 2002‐2013

0.50

1.00 1.50 2.00 2.50 Dependent users per 100 population 15-24 25-34 35-44 45-54

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Summary of indicator data

Consistent evidence of increases in purity,

availability and harms

However, two different explanations could be true:
increasing harms reflect an increased risk of adverse

consequences among a population of users that is not changing in size;

there are people “new” to methamphetamine use who

are developing harms;

…or a combination of both

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Is use increasing among existing users?

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75 87 85 81 31 181 32 42 3 14 17 11

20 40 60 80 100

% of Participants

Powder

Recent methamphetamine use

6 26 19 48 18 12 6 14 29 74 69 76

20 40 60 80 100

Crystal

EDR S

National 2018 EDRS: 21% IDRS: 20% National 2018: EDRS: 17% IDRS: 75%

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Use among people with established histories of heavy/injecting substance use

IDRS has been across Australia

Australian since 2000 and includes surveys with people who inject drugs in capital cities

High, stable levels of

methamphetamine injection

verall among people who inject

drugs regularly (IDRS)

Crystal methamphetamine

increasingly used

Weekly+ use at highest levels

(one in three)

Evidence supporting increasing

use in people who inject drugs

10 20 30 40 50 60 70 80 90 100

IDRS % weekly+ methamphetamine injection IDRS% weekly+ crystal injection IDRS % any methamphetamine injection IDRS % any crystal injection

Source: Degenhardt et al., 2017

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EDRS has been run

across Australia since early 2000s

Includes surveys with

regular ecstasy users in capital cities each year

No evidence that

methamphetamine or crystal methamphetamine increasing in EDRS samples

Use among existing methamphetamine users?

10 20 30 40 50 60 70 80 90 100

EDRS % weekly+ methamphetamine use EDRS % weekly+ crystal use EDRS % any methamphetamine use EDRS % any crystal use

Source: Degenhardt et al., 2017

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Median price powder methamphetamine, IDRS NSW

50 50 50 99 250 200 100 200 300 400 500 600 700 800 Median price ($) Point Gram

Gibbs D, Peacock A. New South Wales Drug Trends 2018: Key findings from the Illicit Drug Reporting System (IDRS) Interviews. Sydney: NDARC, UNSW.

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Past six month use of any methamphetamine and crystal for IDRS (Left) and EDRS (Right)

Any methamphetamine use within the last 6 months Crystal methamphetamine use within the last 6 months

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Is there any evidence of “new” users?

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Increasing treatment episodes among people smoking methamphetamine

50 100 150 200 250 300 350 400 450 500

Sep-2002 Feb-2003 Jul-2003 Dec-2003 May-2004 Oct-2004 Mar-2005 Aug-2005 Jan-2006 Jun-2006 Nov-2006 Apr-2007 Sep-2007 Feb-2008 Jul-2008 Dec-2008 May-2009 Oct-2009 Mar-2010 Aug-2010 Jan-2011 Jun-2011 Nov-2011 Apr-2012 Sep-2012 Feb-2013

smokes injects total

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Increases in first‐time stimulant admissions, including among 18‐24 year olds

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Summary

…these data suggest that it may be a combination
f both increases in use among people with

established substance use careers (e.g. people who inject drugs)

…and people who are smoking the drug
…and these include people who are young adults
…and those who are coming to the attention or

law enforcement or health for the first time with these problems

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125 100 75 50 25 2000

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2002 2004 2006 2008 2010 2012 2014 2016 Date of separation

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Amphetamine‐induced deaths in Australia

Note. Deaths are for all-ages and 2015 and 2016 estimates are preliminary. Small cell

sizes may have been randomised to protect confidentiality.

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Demographics & circumstances

N=1649

Age Years Potential Life Lost 36.9 yrs 43.9 yrs Male 78% Employed 34% In Rx 8% History IDU 56% Location Metropolitan Rural & regional 59% 41%

Year Drug

M oplokl•
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Toxicology: Methamphetamine concentrations, 2009‐2015

0.05 0.1 0.15 0.2 0.25 2009 2010 2011 2012 2013 2014 2015 Median concentration mg/L YEAR

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Manner of Death

712 367 300 245 25 100 200 300 400 500 600 700 800 Number of cases Manner of death

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Rates of MDMA‐related deaths per 100,000 population, Australia 2001 to 2016

0.00 0.05 0.10 0.15 0.20 0.25 0.30 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rates per 100,000 population Drug toxicity deaths Other cause deaths Total deaths

Time Period 2 Shortage of safrole Time Period 3 Increased MDMA manufacture, Time Period 1 – prior to shortage of the precursor safrole used to manufacture MDMA Source: Roxburgh et al, in-confidence (unpublished data)

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Estimated methylamphetamine consumption for August 2018 in mass consumed per day (left axis) and doses per day (right axis) per thousand people

Source: National Wastewater Drug Monitoring Program – Report 6, 2018

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Estimated methylamphetamine consumption per jurisdiction for August 2018 in mg consumption per day per thousand people

Source: National Wastewater Drug Monitoring Program – Report 6, 2018

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Thanks to our participants in the studies mentioned here

Acknowledgements – and thank you

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