Ice Inquiry - Sydney Hearings SCII.001.012.0001 Professor Michael Farrell, 'Trends in methamphetamine use and harms' PowerPoint Presentation
SCII.001.012.0001 Trends in methamphetamine use and harms UNSW Professor Michael Farrell and Drug Trends Team AUST R AL I A Medicine National Drug and Alcohol Research Centre Trends in methamphetamine use 1
SCII.001.012.0002 Sources of Data National Household Surveys Other indirect methods Surveillance and other information Wastewater Analysis Health Data Police and Arrest Data ND RC National Drug&. 3 Alcohol Research Centre Prevalence of methamphetamine use as measured in household surveys Prevalence of methamphetamine use estimated in Australian Forms of meth/amphetamine used, recent (a) surveys remains stable (2.1%, in 2010 and 2013 NDSHS) users aged 14 years or older, 2007-2016 (percent) 57 60 However, a shift towards using crystal over other forms among 51 50 50 those who use methamphetamine. 50 • 21.7% in 2010 40 • 50.4% in 2013 29 27 • 57.3% in 2016 30 22 20 20 There has also been an increase in the frequency of use, 12 12 8 weekly methamphetamine use increased in 2013 10 2 • 9.3% reported weekly or more use in 2010 0 • 15.5% in 2013 2007 2010 2013 2016 • 20.4% in 2016 Powder Crystal Liquid Base (a) Used in the previous 12 months Source: 2016 National Drug Strategy Household Survey ND RC National Drug&. 4 Alcohol Research Centre 2
SCII.001.012.0003 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) ND RC National Drug&. 5 Alcohol Research Centre Making “indirect” prevalence estimates “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 once 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. The Difference is Research 3
SCII.001.012.0004 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. The Difference is Research Estimated number of people (15 ‐ 54 years) with regular and dependent methamphetamine use, Australia, 2002 ‐ 2014 450000 450000 400000 400000 350000 350000 Number of dependent users 300000 dependen Number of regular users regular 300000 t users - users - lower CI lower CI 250000 250000 dependen regular t users users 200000 200000 dependen t users - regular 150000 upper CI 150000 users - upper CI 100000 100000 50000 50000 0 2009… 2010… 2011… 2012… 2013… 0 2009-… 2010-… 2011-… 2012-… 2013-… 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 Degenhardt L, et al. Estimating the number of regular and The Difference is Research dependent methamphetamine users in Australia, 2002–2014. Medical Journal of Australia. 2016;204(4):153 4
~ ~ ➔ SCII.001.012.0005 Estimated prevalence of methamphetamine dependence by age group in Australia, 2002 ‐ 2013 2.50 Dependent users per 100 population 2.00 ,,, - - - - ' ' ' 1 - ,,, - - . 1.50 - - .. "" - -- - - ... 15-24 ., ,,, - ,,, 25-34 - ./ "; - / 1.00 ----. ~ .... V-,, 35-44 ' --- 11---- ' 45-54 - ~ ±----·-- !,,._ 0.50 _,,,.,... i i i 'i: 'i: i: llii llii Ji( )( - The Difference is Research 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 ND RC National Drug&. 10 Alcohol Research Centre 5
SCII.001.012.0006 Is use increasing among existing users? Recent methamphetamine use National National Crystal Powder 2018 2018: EDRS: 21% 100 EDRS: 17% 100 IDRS: 20% IDRS: 75% 81 76 74 80 80 % of Participants 87 85 69 75 60 48 60 EDR 42 40 S 29 40 3 31 32 20 26 181 14 20 19 6 18 12 0 17 11 6 14 0 The Difference is Research 6
SCII.001.012.0007 Use among people with established histories of heavy/injecting substance use • IDRS has been across Australia 100 -- Australian since 2000 and 90 IDRS % weekly+ includes surveys with people who methamphetamine 80 injection inject drugs in capital cities -- • High, stable levels of 70 IDRS% weekly+ methamphetamine injection crystal injection 60 overall among people who inject -- 50 drugs regularly (IDRS) IDRS % any 40 • Crystal methamphetamine methamphetamine injection increasingly used 30 • Weekly+ use at highest levels 20 IDRS % any crystal injection (one in three) 10 • Evidence supporting increasing 0 use in people who inject drugs Source: Degenhardt et al., 2017 ND RC National Drug&. 13 Alcohol Research Centre Use among existing methamphetamine users? • EDRS has been run 100 across Australia since 90 early 2000s EDRS % weekly+ 80 methamphetamine • Includes surveys with use 70 regular ecstasy users in EDRS % weekly+ capital cities each year 60 crystal use • No evidence that 50 methamphetamine or 40 EDRS % any crystal methamphetamine methamphetamine use 30 increasing in EDRS samples 20 EDRS % any crystal use 10 0 ND RC Source: Degenhardt et al., 2017 National Drug&. 14 Alcohol Research Centre 7
~ ~ ■ ~ ~ ~ ~ ~ ~ ~ ■ ~ SCII.001.012.0008 Median price powder methamphetamine, IDRS NSW 800 700 600 Median price ($) 500 400 300 250 200 .I. I 200 II . I . I.I. I . I.I 99 100 I .1 50 50 50 1 1 II 1 1 1 1 1 1 0 c°' .__n, ,(\ ,__'o s:,'- s:,'1- s:,"> s:,'o '-"' '-" .__t,.. ""' '\,# ~"'"" '1-"'<f' ~,$- '\,<:s '\,<:s 'I-"' 'I-"' 'I-"' 'I-"' Point Gram Gibbs D, Peacock A. New South Wales Drug Trends 2018: Key The Difference is Research findings from the Illicit Drug Reporting System (IDRS) Interviews. Sydney: NDARC, UNSW. Past six month use of any methamphetamine and crystal for IDRS (Left) and EDRS (Right) TAS - 79% \f TAS - 46%D 16 % U 24% Any methamphetamine use within the last 6 months Crystal methamphetamine use within the last 6 The Difference is Research months 8
ND RC 100 150 200 250 300 350 400 450 500 methamphetamine Increasing treatment episodes among people smoking Is there any evidence of “new” users? 50 0 Alcohol Research Centre National Drug&. 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 total injects smokes SCII.001.012.0009 18 9
SCII.001.012.0010 Increases in first ‐ time stimulant admissions, including among 18 ‐ 24 year olds 1 25 1 00 "' C 75 0 ·~ E "O <( 50 25 0 2000 2002 2004 2006 2008 20 10 20 12 20 14 2016 Date of sepa rat io n ND RC National Drug&. 19 Alcohol Research Centre Summary • …these data suggest that it may be a combination of 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 ND RC National Drug&. 20 Alcohol Research Centre 10
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