Ecstasy and related drugs (ERDs): An update Paul Dillon Drug and Alcohol Research and Training Australia

Ecstasy and related drugs (ERDs) A wide variety of substances used when frequenting entertainment venues including dance parties, nightclubs, bars, etc little research due to low prevalence of use and low level of harm associated with use ERDs to be discussed in this presentation will be: ecstasy and methamphetamine others may alcohol, cocaine, LSD, ketamine, GHB, amyl nitrate, anti-depressants and a range of other illicits and pharmaceuticals

Ecstasy and related drugs (ERDs) ERDs users tended to use recreationally and did not: experience severe problems attend treatment services come into contact with law enforcement For a long time, much of the information was anecdotal reports from users, dealers and those who work with the ERDs using community increasing research data now being collected

Lifetime Drug Use – 14 years and over 2007 National Drug Household Survey % This graph reports the proportion of the population aged 14 years or older in Australia who reported using the drug (including alcohol and tobacco) at least once in their lifetime

Lifetime – non-use – 14 years and over 2007 National Drug Household Survey % This graph reports the proportion of the population aged 14 years or older in Australia who reported never using the drug (including alcohol and tobacco)

Recent Drug Use – 14 years and over 2007 National Drug Household Survey % This graph reports the proportion of the population aged 14 years or older in Australia who reported recently using the drug (including alcohol and tobacco). Recent use is defined as using in the last 12 months

Recent non-use – 14 years and over 2007 National Drug Household Survey % This graph reports the proportion of the population aged 14 years or older in Australia who reported not recently using the drug (including alcohol and tobacco). Recent use is defined as using in the last 12 months

2007 NHS: Changes in drug use over time 2007 National Drug Household Survey %

Alcohol consumption, litres of pure alcohol per capita, population 15 years and over 1963 -2003 OECD Health Data 2004; ABS 2004

Are young people simply ‘doing what we did’? Although parents believe that alcohol use is a ‘rite of passage’ and that their teenagers are simply ‘doing what they did’ – there is evidence to suggest that we are seeing very different patterns of drinking. Of those that do drink …. they begin drinking earlier they drink more, more often they now drink spirits vodka being the preferred for young women and rum or bourbon for young males

Hospitalisation due to drug use and acute alcohol intoxication – 2005-2006 AIHW National Hospital Morbidity Database Rate – per 100,000 population Age group (years)

Hospitalisation due to drug use and acute alcohol intoxication – 2005-2006 ABS Australian Social Trends (2008) There were almost 3,000 hospital separations among young peple aged 15-24 years due to acute intoxication with alcohol in 2005-06 for young men the rate for alcohol intoxication increased from 66 to 107 per 100,000 from 1998-99 to 2005-06 for young women, the rate doubled over this time from 46 to 99 separations per 100,000 In 2005-06, male and female teenagers aged 15-19 years had the highest hospital separation rates for acute intoxication among all age groups

Ecstasy Not used by 91% of the Australian population 94% of 14-19 year olds have not used (95% have not in past year) 76% of 20-29 year olds have not used (89% have not in past year) Short-term effects euphoria - feeling of well-being increased closeness with others jaw clenching and teeth grinding Long-term effects has been linked to some deaths. Some users experience depression and some memory and cognitive impairment

Ecstasy The effect of ecstasy can be divided into three stages, although not everyone will have the same experience: ‘coming up’ - lasts for between 5-20 minutes the ‘plateau’ - approximately 4 hours ‘coming down’ - can last for days Effects will depend on how the drug is administered and if other drugs are used

Prevalence of ecstasy use, selected countries, 2004 UNODC, 2006 % Shown more clearly in this graph

Prevalence of cocaine use, selected countries, 2004 UNODC, 2006 % Shown more clearly in this graph

Ecstasy: How have things changed Ecstasy: How have things changed? 2004 National Drug Household Survey Results (Australian Institute of Health and Welfare, 2005) % Both lifetime and recent GHB use have been reported by increasing proportions of party drug users across sampling years In 2003, one third (33%) of the NSW sample reported lifetime GHB use and about one fifth (21%) reported using GHB in the six months preceding interview

Ecstasy use across age groups 2007 National Drug Household Survey % Shown more clearly in this graph

Recent use of ecstasy by gender 2007 National Drug Household Survey % Shown more clearly in this graph

Reported negative physical effects (Gascoigne, Dillon & Copeland, 2004) % Shown more clearly in this graph

Reported negative psychological effects (Gascoigne, Dillon & Copeland, 2004) % Shown more clearly in this graph

Ecstasy: What messages are we sending? “When it happens, thermal melt-down isn’t pretty. Your body literally cooks from the inside. Muscles turn to liquid. Organs such as the kidney and the liver collapse. It’s just one of the possible consequences of taking ecstasy.” But is it the most likely consequence? how rare is this? how credible is this to the user group? this may be the most shocking and tragic consequence – but if it doesn’t have credibility is it going to be accepted by users? The use of ecstasy continues to grow in Australia, with almost 8% of the population aged 14 years and over ever having used the drug. Recent studies have indicated that there are now a wider range of users, higher quantity and frequency of use, intraveneous use and higher rates of polydrug use leading to an increase in ecstasy-related harms. Media coverage around ecstasy has primarily focused on high-profile deaths, whilst much of the rest of the information provided has dealt with the physical health effects of the drug, such as overheating and dehydration. This presentation will examine what we know about the effect of ecstasy use on mental health. Incorporating some of the most recent international research findings on the area, as well as Australian data, this presentation will give an overview of this important issue. It will also suggest ways of using this information to provide prevention messages to young people and harm reduction advice to current users.

Ecstasy and mental health “Marijuana affects different people in different ways. And no one can predict what it will do to you. Psychological problems -sometimes small, sometimes major and long term - are just one possibility.” Could we provide similar for ecstasy users? even though the research isn’t conclusive - many ecstasy users report psychological problems – depression, anxiety, paranoia, etc young people are more concerned about their mental health than ever before would this be a more useful message? The use of ecstasy continues to grow in Australia, with almost 8% of the population aged 14 years and over ever having used the drug. Recent studies have indicated that there are now a wider range of users, higher quantity and frequency of use, intraveneous use and higher rates of polydrug use leading to an increase in ecstasy-related harms. Media coverage around ecstasy has primarily focused on high-profile deaths, whilst much of the rest of the information provided has dealt with the physical health effects of the drug, such as overheating and dehydration. This presentation will examine what we know about the effect of ecstasy use on mental health. Incorporating some of the most recent international research findings on the area, as well as Australian data, this presentation will give an overview of this important issue. It will also suggest ways of using this information to provide prevention messages to young people and harm reduction advice to current users.

Methamphetamine Not used by 94% of the Australian population 14-19 year olds - 99% have not used in the past 12 months 20-29 year olds - 91% have not used in the past 12 months Short-term effects may include: euphoria, feeling of well-being nausea and anxiety - sweating increased blood pressure and pulse rate jaw clenching and teeth grinding

Methamphetamine Long-term effects (physical) (psychological) poor appetite - sleep problems seizures - fatigue and a loss of energy liver and kidney failure - respiratory depression high blood pressure and rapid and irregular heartbeat (psychological) anxiety and paranoia - extreme mood swings panic attacks - compulsive repetition of actions injury associated with dangerous acts arising from disinhibited behaviour

Prevalence of amphetamine use, selected countries 2004 UNODC 2006 % Shown more clearly in this graph

Meth/amphetamine use - general population 2007 National Drug Household Survey Results % This slides presents data from the National Drug Strategy household Survey As we can see from the slide the use of amphetamines ever has increased over the years. Recent use in the last 12 months increased in 1998 and has remained fairly stable.

Recent use of methamphetamine by gender 2007 National Drug Household Survey % Shown more clearly in this graph

Methamphetamine Crystal methamphetamine is imported into Australia from China, Hong Kong, Japan, the Philippines, South Korea and Taiwan into Australia

Methamphetamine – Speed powder Most methamphetamine in Australia comes in powder form Speed powder varies in texture from very fine to more coarse and crystalline, and can also vary in colour from white to yellow, pink or brownish These variations are mainly due to the different purifying processes used by backyard chemists

Methamphetamine - Base Base - sticky, gluggy, waxy or oily form of damp powder – the first step in the manufacturing process to produce methamphetamine and is an oil oil is not popular, as it is difficult to inject or snort, so manufacturers attempt to purify the product into a crystal the result is often messy and impure (a tell-tale sign is a yellowish or brownish tinge) - it doesn’t crystallize

Crystalline methamphetamine The most publicised form of methamphetamine and also the most expensive (can cost up to $400 per gram) As a result it is usually sold in smaller amounts – ‘points’ (0.1 of a gram) The purest form of the drug – it can be up to 80-90% pure. Of course this results in more problems for the users including psychosis and dependence

Drink spiking The media says: drink spiking is on the increase the drugs used to spike drinks are often tasteless and odourless – making them almost impossible to detect rohypnol, ketamine and GHB are among those that are used We have no hard data on the prevalence of drink spiking … most information is based on anecdotes – media has ignored this and perpetuated myths

Drink spiking Drink spiking does happen - everyone should be on their guard Does it only happen at nightclubs and carried out by strangers? more likely to happen in own home, or the home of someone you know and be carried out by someone you have met or know well Alcohol is the drug most likely to be used – and although many say that the drugs used are tasteless and odourless – this is unlikely

Drink spiking Drink spiking is a crime – putting something into someone’s drink without their knowledge, even extra alcohol, is illegal if your drink has a strange taste, feels gritty or you’re just not sure – stop drinking! tell your friends about your concern make plans and stick to them remember that a drink spiker is less likely to target a sober person – you are at greater risk if you have been drinking alcohol!

Drink spiking Drink spiking undoubtedly occurs – evidence would indicate that alcohol is the usual drug used If other drugs are used – it is more likely to occur in a home than in a club (where the perpetrator has little control) We must give strong messages to potential perpetrators and also tips to young people on how to avoid being targeted Health professionals should not perpetuate myths about drink spiking – e.g., Progesterox