Non-prescribed codeine use trending down

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What were the top 10 drug trends of 2019? And how do codeine and other opioids fit into the picture?

Cocaine, ketamine and amyl nitrate use have all gone up in the past year, while non-prescribed use of opioids such as morphine, codeine and oxycodone have come down, according to new findings released on Wednesday.

Dr Amy Peacock, Research Fellow at the National Drug & Alcohol Research Centre (NDARC), UNSW Sydney, presented the findings of the latest Drug Trends report at the centre’s annual research symposium.

The report gathered data from two samples in mid-2019: the Illicit Drug Reporting System (IDRS) that interviewed people who inject drugs (n= 902), and the Ecstasy and Related Drugs Reporting System (EDRS) that interviewed people who use stimulants (n= 797).

Dr Peacock shared the top 10 “drug trends” of 2019 based on the IDRS and EDRS data.

10 – Cocaine

Use of cocaine has gone up again from last year among people who use ecstasy. Internationally there are also increasing reports of cocaine manufacture. In Australia when people are asked about the form they’re using, it’s typically the powder cocaine form. Police data also reveals increased availability due to an increased number of seizures.

9 – Ketamine & amyl nitrate

Data show an increase in ketamine compared to 2018, from 35% in 2018 to 41% in 2019 among the EDRS sample. However use is relatively infrequent, with NSW and Victoria reporting higher rates of use. Dr Peacock says harm reduction messages that health practitioners need to focus on sharing include encouraging this group to avoid alcohol—which is quite dangerous due to potential risk of overdose—to avoid driving while using, and communicating potential issues with urinary tract issues with frequent use. Amyl nitrate use also increased from 22% to 38% over the past year in the EDRS sample.

8 – E-cigarettes

One in five report any recent use of e-cigarettes in the sample. “The reason why they’re such a big concern, there’s been a lot of discussion about what’s happening in the US, with more than 1000 cases of lung injury,” says Dr Peacock.

This is mostly related to use of cannabis with e-cigarettes.

The EDRS sample shows they are typically using e-cigarettes relatively infrequently. Among those that do use e-cigarettes, 69% are using with nicotine, 3% with cannabis, 16% with nicotine and cannabis, and 11% neither. The IDRS sample was more likely to report using e-cigarettes as a smoking cessation tool than the EDRS sample.

7 – Opioids

Heroin use is relatively stable in sample, while non-prescribed morphine and oxycodone use has come down. “That decline has been particularly salient since 2014, when there was a change in the formulation to the abuse deterrent formulation,” Dr Peacock told AJP.

“It’s stabilised in the last year or two. In parallel to that, there was a concern that morphine [use] would go up with the change in formulation,” but she says this didn’t happen.

“We also looked at non-prescribed use of codeine, it was about one in 10 use codeine non-prescribed.”

Dr Peacock says both the IDRS and EDRS samples saw non-prescribed codeine use go down.

“In IDRS, it was 9% who reported non-prescribed use of codeine—and that’s both the low-dose or the high-dose product, obviously all of it requiring a prescription now,” she told AJP.

“It’s not that it’s completely disappeared amongst the sample. One of the challenges was previously we didn’t disaggregate the high-dose codeine that was prescribed versus the over-the-counter.

“However we’ve always asked about use of low-dose codeine use for non-pain purposes, and that has gone down,” she said.

“But in terms of looking at the trend of codeine overall, it’s a bit difficult because we don’t have that data consistently over time.”

Dr Peacock pointed out that there are usually other factors at play when it comes to opioid-induced deaths. “It’s very rare to see these opioids deaths rising in isolation without other drugs [being involved],” she said.

Drugs deemed to be contributory in opioid-induced death in 2017 (n= 1153) included: benzodiazepines (56%), antidepressants (32%), antipsychotics (19%), alcohol (16%), pregabalin (7%).

6 – Naloxone

Most of the IDRS sample were aware of naloxone, and there has been an increase of awareness in recent years. Three in 20 participants (IDRS) reported an opioid overdose in the past year (15%). One in 20 participants had been resuscitated with naloxone by someone trained through the take-home naloxone program.

5 – Drug treatment and mental health

Among the IDRS sample, 41% were currently in drug treatment. Meanwhile 41% had not accessed treatment but through they needed it. Among the EDRS sample, only 6% were currently in drug treatment. Meanwhile over half the national sample (57%) self-reported that they had experienced a mental health problem in the previous six months, with the most common concerns being anxiety, depression and PTSD.

4 – Modes of purchasing

Looking at how people had purchased illicit or non-prescribed drugs in the past 12 months, 82% had done so face-to-face, with 73% using social networking sites, 10% the darknet market, and 5% the surface web market.

3 – Ecstasy

This year capsules overtook pills as the form of ecstasy most used in the EDRS sample. The median days of capsule use increased, the price has gone down to $20 a capsule, and there’s been a rise in the perceived availability of capsules, says Dr Peacock. Thirty-six percent reported that they used depressant drugs during last occasion of stimulant use, while 10% used cannabis, and 3% used hallucinogens and dissociatives. Last time they used ecstasy, 22% used vitamin supplements.

2 – Music festivals

In the EDRS sample, seven in 10 had been to an Australian music festival in the last year (68%), 93% had used an illicit drug at their last music festival, 83% had used alcohol, 5% through they needed medical help following their illicit drug use, and 2% actually sought medical help. People were aware of onsite medical services (87% of festival attendees in the EDRS sample, those who regularly use ecstasy).

1 – Drug checking (‘pill testing’)

One in 10 of IDRS sample had ever tested their drugs, while four in 10 of the EDRS participants had ever tested their drugs. The majority (71%) of the IDRS sample used a personal testing kit (e.g. chemical reagent tests) and 87% of the EDRS sample did so.

“This signals to us that people want information, it tells them about the presence or not of a drug and they’re relatively low cost and legal to purchase,” says Dr Peacock.

“However there are some caveats to this, as they don’t provide the full array of information that people might need, and interpretation can be subjective.”

See the key findings from the EDRS and IDRS

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