Meth/amphetamine and other stimulants

Key findings

  • Deaths involving methamphetamine and other stimulants are increasing in Australia.
  • There has been a rapid increase in the number of deaths involving methamphetamine and other stimulants), with the death rate in 2016 four times higher than that in 1999 (1.6 deaths compared to 0.4 deaths per 100,000 persons, respectively).
  • Between 2013 and 2016, the NDSHS found an increase in the proportion of people reporting mental illness who used methamphetamine (from 29% to 42%), ecstasy (from 17.9% to 27%) and cocaine (from 17.4% to 25%) in the previous 12 months.
  • Despite increasing harms, the reported consumption of methamphetamine decreased among the general population from 2.1% in 2013 to 1.4% in 2016.
  • Between 2013 and 2016, lifetime use of ecstasy increased for people in their 40s (from 11.8% to 14.8%) and 50s (from 1.7% to 2.4%) but decreased for people in their 20s (from 22.1% to 18.7%).
  • Reported cocaine use is increasing in Australia and is particularly prevalent among employed people, living in high socioeconomic areas.

Stimulants are a group of drugs that produce stimulatory effects by increasing nerve transmission in the brain and body [1]. Included in this group are:

  • Amphetamines used for therapeutic purposes to treat attention deficit-hyperactivity disorder (ADHD), but may also be used non-medically. 
  • Methamphetamine (also referred to as methylamphetamine) – a potent derivative of amphetamine that is commonly found in three forms: powder (speed), base and its most potent form, crystalline (ice or crystal). Due to slight structural differences, methamphetamine produces a stronger nervous system response than amphetamine [2].
  • 3, 4-methylenedioxymethamphetmine (MDMA)—commonly referred to as ‘ecstasy’, MDMA is an amphetamine derivative. (note ecstasy may contain a range of other drugs and substances and may contain no MDMA at all.
  • Cocaine – produced from a naturally occurring alkaloid found in the coca plant.

The focus in this section is on the illicit use of meth/amphetamine and other stimulants (Box STIM1).

Box STIM1: Defining amphetamines and other stimulants

Data sources on methamphetamine, amphetamine and other psychostimulants contain a variety of terms; in some instances these terms cover similar, but not the same range of drugs. This can be confusing when interpreting results across different data sources.

In this section, the terminology used reflects that adopted in the corresponding data source. Below is a description of each term used in these data sources and the types of drugs they encompass:

Amphetamine-type stimulants—covers a large range of drugs, which includes amphetamine, methylamphetamine and phenethylamines (a class of drug that includes MDMA or ‘ecstasy’).

  • Amphetamines—refers to a broad category of substances. According to the Australian Standard Classification of Drugs of Concern (ASCDC) (ABS 2011), this includes amphetamine, methylamphetamine, dexamphetamine, amphetamine analogues and amphetamines not elsewhere classified. This is the term used in the Alcohol and Other Drug Treatment Services (AODTS) National Minimum Dataset. 
  • Methamphetamine (also methylamphetamine) also comes in different forms, including powder/pills (speed), crystal methylamphetamine (crystal meth or ice), a sticky paste (base), and a liquid form.
  • Meth/amphetamine includes methylamphetamine and amphetamine and is the term used in the National Drug Strategy Household Survey (NDSHS)
  • Ecstasy (also MDMA) is often consumed in the form of a tablet, but can also be in powder or crystal form.
  • Cocaine is commonly consumed in powder form, which can be snorted or dissolved in water so it can be injected.
  • Psychostimulants (also stimulants) includes ecstasy, methamphetamine, cocaine and new psychoactive substances (NPS). This is the sampling criteria for participants of the Ecstasy and related Drugs Reporting System (EDRS).

Availability

Methamphetamine and other stimulants are readily available in Australia. Findings from the 2018 Illicit Drug Reporting System (IDRS) showed that the majority of people who inject drugs and use meth/amphetamine or cocaine report that it is ‘easy’ or ‘very easy’ to obtain [3] (Table S2.6). Similar findings from the 2018 Ecstasy and Related Drugs Reporting System (EDRS) also show that the majority of people who use ecstasy and other stimulants report that meth/amphetamine, ecstasy and cocaine are ‘easy’ or ‘very easy’ to obtain [4].

Perceived availability was the highest for crystal methamphetamine (94% of both IDRS and EDRS users rated it ‘easy or very easy’ to obtain), while perceived availability for other forms of methamphetamine was lower. Perceived availability of ecstasy in all forms has declined over the last three years, with the highest availability reported for capsules (85% of EDRS users rated it ‘easy’ or ‘very easy’ to obtain), followed by pill (82%), crystal (73%) and powder (68%) forms [4]. Cocaine was rated ‘easy’ or ‘very easy’ to obtain by 64% of IDRS users and 62% of EDRS users [3,4].

Meth/amphetamine, ecstasy and cocaine are commonly sourced by users from friends (55%) or dealers (33%) [4].

In 2016–17, nearly a third of national illicit drug seizures (32.9%) and arrests (30.7%) were for ATS (including MDMA) [2]. The number of national ATS arrests in 2016–17 was 47,531, an increase of 196.2% from the 16,047 arrests reported in 2007–08 [2,5]. The number of national ATS seizures has increased by 185.2% over the last decade, with 37,351 seizures in 2016–17, up from 13,097 in 2007–08. In 2016–17, ATS made up 27.5% of the total weight of illicit drugs seized nationally. The total weight of ATS seized nationally has also increased by 271.9% over the last decade, from 2,035.8 kilograms in 2007–08 to 7,571.9 kilograms in 2016–17, the third highest weight on record [2,6].

Methamphetamine is domestically produced, with considerable quantities of the drug also detected at the Australian border [7]. In 2016–17, there were 2,905 amphetamine-type stimulant (excluding MDMA) detections at the Australian border, weighing 1,833.9 kilograms. The 30,513 national amphetamines seizures in 2016–17 weighed 3,821.0 kilograms and accounted for 81.7% of the number and 50.5% of the weight of national ATS seizures this reporting period [2].

The number of MDMA (ecstasy) detections at the Australian border was 4,763 in 2016–17, the highest number of detections on record, while the weight of MDMA detections was 890.2 kilograms. The number of national MDMA seizures was 6,550 in 2016–17, and the total weight of MDMA seized nationally was 1,426.7 kilograms, accounting for 18.8% of all ATS seized nationally [2].

In 2016–17 there were increases in the number and weight of cocaine detections at the Australian border, as well as national cocaine seizures and arrests, all of which were at record levels.  Over the last decade, the number of cocaine detections at the Australian border increased by 492.5%, from 627 in 2007–08 to a record 3,715 in 2016–17. The weight of cocaine detected has also increased by 70.9%, from 649.3 kilograms in 2007–08 to a record 1,109.5 kilograms in 2016–17 [2,6].

The number of national cocaine seizures has increased by 259.3% over the last decade, from 1,271 in 2007–08 to a record 4,567 seizures in 2016–17. The total weight of cocaine seized nationally increased by 595.6% over the same period, from 664.7 kilograms in 2007–08 to 4,623.3 kilograms in 2016–17, the highest weight on record [2, 7]. The number of national cocaine arrests has also increased by 403.1% over the past decade, from 669 in 2007–08 to a record 3,366 in 2016–17 [2,7].

Consumption

There are differences in trends and patterns of consumption in Australia according to the type of stimulant used.

Meth/amphetamine

  • 1.4% of people aged 14 and over in Australia reported using meth/amphetamine in the last 12 months (Figure STIM1).
  • Aboriginal and Torres Strait Islander people are 2.2 times more likely to use methamphetamine than non-Indigenous Australians [5].
  • 31% of regular psychostimulant users reported use of any form of methamphetamine in the previous 6 months [7].
  • 71% of people who inject drugs reported use of any form of meth/amphetamine in the previous 6 months [3].

Self-reported data on methamphetamine consumption in the general Australian population has been declining since it peaked at 3.4% in 2001. There was also a significant decline between 2013 and 2016, from 2.1% to 1.4%. This decline was mainly driven by a substantial decrease among people aged in their 20s, whereby recent use of meth/amphetamine halved among this age group between 2013 and 2016 for both males and females [5] (Table S2.44).

In 2013, there was a change in the main form of methamphetamine used by the general population, with ‘ice’ replacing powder as the preferred form of the drug. In 2016, this trend continued with 57% of meth/amphetamine users reporting that crystal/ice was the main form used in the previous 12 months. Over the same period, use of powder significantly decreased. While overall recent meth/amphetamine use declined between 2013 and 2016, the proportion of the total population using crystal/ice remained relatively stable between 2013 and 2016 and has increased since 2010 [5].

Surveys of regular injecting drugs users also showed significant declines in the use of crystal methamphetamine between 2016 and 2017 [3] (Tables S2.49). This is contrary to results from the NDSHS, where the usage of the crystal form of meth/amphetamine remained steady.

According to the Drug Use Monitoring in Australia (DUMA) program, 52.9% of police detainees tested positive to amphetamines, the highest percentage reported in the last decade. Of the detainees testing positive for any amphetamine, the majority tested positive for methamphetamine. The proportion of detainees testing positive to methamphetamine increased, from 49.0% in 2015–16 to 51.4% in 2016–17. For the second consecutive reporting period, the proportion of detainees testing positive to methamphetamine was higher than proportion of detainees testing positive to cannabis. In 2015–16, the majority of detainees whose most serious offence was property related tested positive to amphetamines (63%), as did most traffic (60%) and drug offenders (59%) [8].

Of Australia’s prison entrants in 2015, 67% had used illicit drugs, with the most common drug being methamphetamine (50%).

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Ecstasy

  • 2.2% of people aged 14 and over in Australia used ecstasy in the previous 12 months (Figure STIM1).
  • The prevalence in recent ecstasy use in 2016 was higher in males (2.6% compared with females 1.8%).
  • Between 2010 and 2016, recent use of ecstasy has generally declined across Australia (3.0% in 2010 to 2.2% in 2016).
  • Ecstasy is the reported drug of choice for participants of the EDRS who are regular psychostimulant users [4].

Between 2013 and 2016, lifetime use of ecstasy increased for people in their 40s and 50s but decreased for people in their 20s. Recent ecstasy use has been declining since peaking in 2007. Since 2001, recent use has generally decreased among the younger age group but remained similar over the same period for people aged 30 and over [5] (Table S2.46).

In 2016–17, about 2% of police detainees tested positive to MDMA. Since DUMA commenced in 1999, the number of detainees testing positive to MDMA has remained low—under three percent [2, 10] (Table S3.61).

Cocaine

  • 2.5% of people aged 14 and over in Australia used cocaine in the last 12 months [5].
  • The prevalence in recent cocaine use in 2016 was higher in males (3.1%) than females (2.0%).
  • 13% of injecting drug users used cocaine in the last 6 months [3].
  • 48% of regular psychostimulant users used cocaine in the last 6 months [4].

According to the NDSHS, the proportion of people aged 14 and over using cocaine has been increasing in Australia since 2004. Between 2001 and 2016, lifetime cocaine use increased across all age groups except for those aged 14–19, and significantly increased between 2013 and 2016 for people in their 30s and 40s. Recent use of cocaine has increased across most age groups and for both sexes since 2001 and is at the highest rate seen over the last 15 years [4] (Table S2.47).

Cocaine use is infrequently reported among people who inject drugs, with only 1% nominating cocaine as their preferred drug and 13% reporting use at least once in the last six months [3] (Table S2.50). For participants of the EDRS, cocaine was the second most commonly used stimulant drug (after ecstasy) with 59% reporting recent use in 2018, the highest percentage of participants in the study’s history [4] (Table S2.49).

Data from the DUMA program showed an increase in the proportion of police detainees testing positive to cocaine, from 0.9% in 2015–16 to 1.8% in 2016–17 [2].

Geographic trends

Recent data from the National Wastewater Drug Monitoring Program (NWDMP) shows that:

  • Methamphetamine remains the highest consumed illicit drug monitored by the program (for substances that have available dose data), with the estimated regional average consumption of methamphetamine continuing to exceed estimated capital city average consumption.  
  • In comparison with other illicit drugs monitored by the program, the estimated consumption of MDMA was low across the country, with the regional average consumption of MDMA higher than capital city average consumption.
  • The capital city average consumption of cocaine was higher than the regional average [9].

This is consistent with the results from previous NWDMP reports [9]. It is important to note that the NWDMP does not measure all drug types.   

Data from the 2016 NDSHS showed that:

  • Recent use of meth/amphetamine declined between 2013 and 2016 across all states and territories, with the highest proportion of recent use reported in in Western Australia (2.7%) (Table S2.44).
  • People living in Remote and Very Remote areas were 2.5 times more likely than those from Major Cities to have used methamphetamine in 2016 (3.5% compared with 1.4%). Similarly, those living in the lowest socioeconomic areas were twice as likely to have used meth/amphetamine as those living in the highest socioeconomic areas (1.8% compared with 0.9%) (Figure STIM2).
  • NSW recorded the highest recent use of cocaine 3.4% and use was most prevalent among those who were employed and lived in Major cities or the highest socioeconomic areas (Table S2.48).
  • Western Australia recorded the highest proportion of recent use of ecstasy in 2016 (3.2%), overtaking the Northern Territory [5] (Table S2.46).
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Explore state and territory data on the use of methamphetamine and other stimulants in Australia.

Harms

The short and long-term effects associated with the use of methamphetamine and other stimulants are provided in Table STIM1. 

Table STIM1: Short and long-term effects associated with the use of methamphetamine and other stimulants

Drug type

Short-term effects

Long-term effects

Methamphetamine (includes powder, base and crystal/ice)

  • Increased energy
  • Sense of euphoria and wellbeing
  • Increased attention and alertness
  • Increased talkativeness
  • Increased heart rate, breathing and body temperature
  • Decreased appetite
  • Jaw clenching and teeth grinding
  • Nausea and vomiting
  • A dry mouth
  • Changes in libido
  • Nervousness, anxiety and paranoia
  • Aggression and violence
  • Mood and anxiety disorders
  • Cardiovascular problems
  • Haemorrhagic stroke
  • Poor concentration and memory
  • Psychotic symptoms such as paranoia and hallucinations
  • Weight loss
  • Chest pains

Ecstasy/MDMA

  • Sense of euphoria and wellbeing
  • Feelings of intimacy with others
  • Confidence
  • Lack of inhibitions
  • Nausea
  • Sweating
  • Increased blood pressure and pulse rate
  • Jaw clenching and teeth grinding
  • Depression
  • Anxiety
  • Memory and cognitive impairment

Cocaine

  • Sense of euphoria and wellbeing
  • Increased blood pressure, heart rate and body temperature
  • Increased alertness and energy
  • Sexual arousal
  • Loss of appetite
  • Sleep disorders
  • Sexual problems such as impotence
  • Nose bleeds, sinusitis and damage to the nasal wall from snorting
  • Cardiovascular problems
  • Stroke
  • Paranoia, depression and anxiety
  • Cocaine-induced psychosis

Source: Adapted from [2,10,11].

Burden of disease and injury

Amphetamine use was responsible for 0.4% of the total burden of disease and injuries in Australia in 2011 and 18.9% of the total burden due to illicit drug use [12] (Table S2.69).

Of the burden due to amphetamine use, amphetamine dependence contributed 36%, accidental poisoning 21% and road traffic injuries—motor vehicle occupants 20%. Other diseases that contributed burden due to amphetamine use included suicide and self-inflicted injuries 17% and road traffic injuries—motorcyclists 6% [12].

Cocaine use contributed 0.2% of the total burden of disease and injuries in 2011 and 8.9% of the total burden due to illicit drug use (Table S2.69). Of the burden due to cocaine use, suicide and self-inflicted injuries accounted for 55% and cocaine dependence 34% [12].

Mental health

The consumption of meth/amphetamine and other stimulants can be associated with considerable negative impact on mental health and this appears to be increasing.

The NDSHS found a statistically significant increase from 2013 to 2016 in the proportion of people who used meth/amphetamine (from 29% to 42%), ecstasy (from 17.9% to 27%) and cocaine (from 17.4% to 25%) in the previous 12 months reporting mental illness (Figure STIM3; Tables S2.74).

There were also significant increases in the proportion of meth/amphetamine and ecstasy users who report ‘high to very high’ levels of psychological distress [4] (Tables S2.73). 

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Deaths

There has been a rapid increase in the number of deaths related to methamphetamine and other stimulants (including amphetamines, methamphetamine, ecstasy/MDMA and caffeine) in Australia, with the death rate in 2016 four times higher than that in 1999 (1.6 deaths compared to 0.4 deaths per 100,000 persons respectively) [13].

The National Drug and Alcohol Research Centre (NDARC) reported that in 2016 there were 105 amphetamine-induced deaths among Australians aged 15–64 years—a rate of 0.7 per 100,000 people. This was the highest rate since monitoring commenced. There were also fewer than 20 cocaine-induced deaths among Australians aged 15–64 years—consistent with previous years [14].

Recent research examining methamphetamine-related deaths in isolation from other stimulants, found that mortality rates have almost doubled during a period of 7-years between 2009 and 2015. The most common manner of methamphetamine-related death was accidental drug toxicity; however, natural disease (e.g. coronary disease, stroke, kidney disease, and liver disease), suicide and accident comprised more than half of the deaths [10].

Treatment

Amphetamines

Data from the AIHW Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS NMDS) for amphetamines correspond to the Australian Standard Classification of Drugs of Concern (ASCDC) code for the general ‘amphetamines’ classification, in which methamphetamine is a sub-classification. Data on different forms of amphetamines, including methamphetamine, are not separately reported due to the nature of the classification structure used in this collection [15].

The AODTS showed that in 2016–17:

  • Amphetamines was a principal drug of concern in 26% of closed treatment episodes, the second most common principal drug of concern behind alcohol (Figure STIM4).
  • In more than half (53%) of episodes with a principal drug of concern of amphetamines, the client reported additional drugs of concern. These were most commonly cannabis (34%), nicotine (21%) and alcohol (20%) (Tables S2.77 and S2.78).
  • Client demographics:
    • More than two-thirds of clients receiving treatment for amphetamines as a principal drug of concern were male (63%) and about 1 in 7 clients were Indigenous (15%) (Table S2.79).
  • Referral to treatment:
    • The most common source of referral for treatment episodes with amphetamines as the principal drug of concern was self/family (42%), followed by health services (24%), and diversion (18%) (Table S2.80).
  • Treatment type:
    • The most common main treatment type for episodes with amphetamines as the principal drug of concern was counselling (38%), followed by assessment only (22%), and withdrawal management (11%) (Table S2.81).
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Ecstasy

  • Ecstasy was a principal drug of concern in fewer than 1% of episodes (1,342 of closed episodes), and an additional drug of concern in 2% (3,581) of closed episodes in 2016–17 (Table S2.76).
  • Client demographics:
    • Where ecstasy was a principal drug of concern, over 8 in 10 (84%) clients were male, and 3% were Indigenous (Table S2.79).
  • Referral to treatment:
    • In almost three-quarters (73%) of treatment episodes where ecstasy was the principal drug of concern, the client’s source of referral was from police and court diversion (Table S2.79).
  • Treatment type:
    • The most common main treatment type for episodes where ecstasy was the principal drug was information and education only (49%), followed by assessment only (22%), and counselling (18%) [15] (Table S2.80).

Cocaine

  • Cocaine was a principal drug of concern in fewer than 1% of episodes (776 of closed episodes), and an additional drug of concern in less than 1% of episodes (2,072) of closed episodes in 2016–17 (Table S2.76).
  • Client demographics:
    • Where cocaine was a principal drug of concern, 87% clients were male, and 7% were Indigenous (Table S2.79).
  • Referral to treatment:
    • Two in five (40%) of treatment episodes where cocaine was the principal drug of concern, the client’s source of referral was from self/family. Court diversion was the source of referral in 31% of treatment episodes for cocaine (Table S2.80).
  • Treatment type:
    • The most common main treatment type for episodes where cocaine was the principal drug was counselling (38%), followed by assessment only (24%) [15] (Table S2.81).

Policy context

Public perceptions and policy support

The NDSHS found that between 2013 and 2016, people’s perceptions of meth/amphetamine changed considerably. More people associated it with a drug problem (22% compared with 46%), thought it caused the most deaths (8.7% compared with 19%) and thought it was the drug of most concern to the community (16% compared with 40%) (Table S2.36, S2.37 and S2.71). It is possible that these self-report surveys underestimate the true extent of meth/amphetamine use, particularly in the context of the stigmas that exist around its consumption [5].

National Ice Action Strategy 2015

In April 2015, the Australian Government established a National Ice Taskforce, to provide advice on the development of a National Ice Action Strategy (NIAS).

The objectives of the NIAS are to ensure that:

  • families and communities have better access to information, support and tools to help them to respond to ice (methamphetamine);
  • prevention messages are targeted at high-risk populations and accurate information about ice is more accessible;
  • early intervention and treatment services are better tailored to respond to ice and meet the needs of the populations they serve;
  • law enforcement efforts are better targeted to disrupt the supply of ice; and
  • better evidence is available to drive responses to the effects of ice in our community [16].

Resources and further information

References

  1. Nielsen S & Gisev N (in press). Drug pharmacology and pharmacotherapy treatments. In Ritter, King and Lee (eds). Drug use in Australian society. Oxford University Press.
  2. Australian Criminal Intelligence Commission (ACIC) 2018. Illicit drug data report 2016–17. Canberra: ACIC. Viewed 21 September 2018.
  3. Peacock A, Gibbs D, Sutherland R, Uporova J, Karlsson A, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018. Australian Drug Trends 2018. Key findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
  4. Peacock A, Gibbs D, Karlsson A, Uporova J, Sutherland R, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L, & Farrell, M 2018. Australian Drug Trends 2018. Key findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
  5. Australian Institute of Health and Welfare (AIHW) 2017. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.
  6. Australian Crime Commission (ACC) 2009. Illicit drug data report 2007–08. Canberra: ACIC. Viewed 5 October 2018.
  7. Australian Crime Commission (ACC) 2015. The Australian methylamphetamine market: the national picture. Canberra: ACC. Viewed 24 November 2017.
  8. Patterson, E Sullivan, T, Ticehurst, A & Bricknell, S 2018. Drug use monitoring in Australia: 2015 and 2016 report on drug use among police detainees, Statistical Reports Number 4. Canberra: Australian Institute of Criminology. Viewed 20 April 2018.
  9. ACIC 2019. National wastewater drug monitoring program, report 6. Canberra: ACIC. Viewed 20 February 2019.
  10. Darke S, Kaye S & Duflou J 2017. Rates, characteristics and circumstances of methamphetamine-related death in Australia: a national 7-year study. Addiction 112: 2191-2201.
  11. NSW Ministry of Health 2017. A quick guide to drugs & alcohol, 3rd edn. Sydney: National Drug and Alcohol Research Centre.
  12. AIHW 2018a. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.
  13. ABS 2017. Causes of death, Australia, 2016. Cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.
  14. Roxburgh A, Dobbins T, Degenhardt L & Peacock A 2018. Opioid, Amphetamine, and Cocaine-Induced Deaths in Australia: August 2018. Sydney, National Drug and Alcohol Research Centre, University of New South Wales.
  15. AIHW 2018b. Alcohol and other drug treatment services in Australia 2016–17. Drug treatment services no. 31. Cat. no. HSE 207. Canberra: AIHW.
  16. Department of Health 2017. National ice action strategy. Canberra: DoH. Viewed 29 November 2017.