10 years of ecstasy and other party drug use in Australia: What have we done and what is there left to do?

Paul Dillon

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, 2052 NSW, Australia. Phone no: +61 – 2 9398 9333 Fax no: +61 – 2 9399 7143

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History of Ecstasy

It is difficult to say when ecstasy first came to Australia, but it seemed to be brought in by a religious group called the ‘Orange People’ in the late 1970s, early 1980s. The first media reports of ecstasy use in Australia were in the mid-1980s. In the late 1980s and the early 1990s use was low, as were problems with use and in fact, in the 1988-1991 national Drug Household Surveys, only 1-2% of the population had ever tried the drug. Interestingly, in 1995 9% of 14-29 year old females had tried the drug. In 1998, it leapt even higher: 5% of the population had tried ecstasy.

When it comes to the law, it is very complex. In 1985, it was made illegal in the USA under emergency action and placed by the DEA into Schedule One. As Australia is known to do, it quickly followed America’s lead and changed its laws also.

Ecstasy deaths

In terms of ecstasy related deaths, we do not have any central collection of drug overdoses in Australia and it has made it very difficult over the past few years, particularly with the increase in heroin deaths that we have had, so it is very difficult to determine. Between 1995 and 1997, there were at least twelve deaths. At least six involved PMA (paramethoxyamphetamine), either alone or in conjunction with MDMA. Most of these were in Adelaide. There has been a lot of media hype around the fact that Adelaide has the highest rate of ecstasy related deaths per capita in the world. This batch of deadly PMA ecstasy was gradually released over a two-year period.

Unlike some other countries, Australia has no published information on national or State hospital admissions so little is known about how many people are going into hospital following an ecstasy overdose. Ecstasy related deaths are rare compared with the likely frequency of its use. If you compare it to heroin, for example, 2% of the Australian population has tried heroin and there were six hundred deaths in 1997. 5% percent of the population have tried ecstasy and there were four deaths in 1997 – from all stimulant deaths (not just ecstasy).

However, ecstasy deaths are unpredictable. No one really knows why some of these deaths have occurred. Some of the likely reasons that have been put forward are either genetic differences or concurrent use of other drugs. In 1995, interestingly the week after the UK experienced the Leah Betts phenomenon, we had a very similar death. A young fifteen-year old school girl, Anna Wood, died as a result of taking an ecstasy tablet. This generated incredible media coverage. In fact, it almost destroyed the harm reduction movement in Australia and as a result has hindered harm reduction messages getting through to current and potential users of the drug. In fact, the national household survey figures before and after, and any figures around the time of her death, show quite a dramatic increase almost straight after her death. Ecstasy was a drug that no one knew very much about prior to Anna’s death and in a very short period of time people knew where you could get it, how much it would cost, and that the purity was high. It was a major advertising campaign for the drug.

Ecstasy deaths continue to be rare but they do happen and this is one of the biggest problems we face. People do not believe that people are dying as a result of taking ecstasy. Admittedly it is very few, but there are other harms associated with ecstasy. Users are regularly seen by emergency departments across the country.

There was a recent study conducted at a Sydney inner city hospital which was getting all the drug related overdoses. It found that 30% percent of all illicit drug overdoses were ecstasy related. Deaths do continue to go unreported: there are at least five or six a year that never make the media. This normally happens if the death occurs some time after using the drug, so that individuals do not actually die on the dance floor but die on the Thursday or the Friday of the following week. The other one is if the family do not wish to highlight the cause of death and, of course, that always makes it really, really difficult for the media to get any really juicy comments.

The most recent high profile death was at a Sydney nightclub. A twenty-two year old man died from MDMA overdose. In fact, his toxicity levels were twice as high as a normal MDMA overdose would be. GHB (gamma-hydroxybutyrate) was also implicated but if you do not actually withdraw blood from a person who has used GHB within four hours it is impossible to actually tell whether that person has used GHB or not. The headlines that surrounded this death included ‘Death on the dance floor’ and ‘Designer poison’, but there was not the same amazing amount of media uproar as with the Anna Wood case. One of the key reasons for this is that the parents refused to become involved in the media circus. We could actually step in as health authorities, as people who have some knowledge in the area and give accurate information about the drugs, and surprise, surprise, the media were not particularly interested in good credible accurate information, which they found very difficult to make sensational headlines out of. If they had had parents crying on the front page of the paper, they could have done something with it but as a result the emotive angle of the story could not be generated.

The Epidemiology of Ecstasy in Australia

What is known about ecstasy in Australia? There were three Australian studies conducted in the early 1990s, all with very different approaches. The first one in 1990 looked at one hundred users. They appeared to be using for special events, maybe a major dance party or an occasional big night out. Ecstasy use appeared to be self-limiting, with many users discontinuing use after a very short period of time.

The next study was conducted in 1992 and was an ethnographical study of a social network of psycho-stimulants, not just ecstasy use in Perth. This looked more at the rituals around ecstasy use and found very few problems, although for the very first time injecting of ecstasy was noted. In 1993, another survey was conducted, this time in Melbourne. These were three very different areas of Australia. This study demonstrated that ecstasy use was opportunistic: if people got it they used it, if they did not, they did not really mind. The health effects they were reporting were relatively minor apart from those who were heavy users, and even they were only reporting things such as depression and headaches. The evidence concluded that ecstasy seemed to be controlled by its relatively high cost, its social sections and other more common drug use, so these people were interested in other drugs because they were more widely available.

In 1997, the National Drug and Alcohol Research Centre conducted a major study of 329 existing users across three Australian States. Compared to the 1990 survey, there was quite a big gap. There had been the deaths and a whole pile of things happening in the media circuit. We really needed to know what was happening with ecstasy use in Australia at that time and it was quite a dramatic difference to what had been seen earlier. The users were now younger, they were more diverse, there were more females, and they used more and more often.

Price, purity and availability

With regard to price, purity and availability, ecstasy is expensive in Australia. It has remained pretty stable and it depends where it is bought. If you buy it in a nightclub you are taking more risks and it does cost more. For the past decade, it has cost between Australian $50 (approximately £20) and Australian $70 (approximately £28) but the average street price is about Australian $40 (approximately £ 16 )

In terms of purity, data for Australian MDMA, the average is around 34%, ranging from less than 1% to about 85%. If you look at most tablets they contain 70-85mg of MDMA. It is far less than the desirable dose of 120 milligrams. There appears to be much ecstasy flooding into Australia from different markets, no longer just the Netherlands and the UK. We are now getting it from Asia where there is increased production and also the US. In 1991, there were two seizures of the drug totalling 0.3 kilos - but in 1999 they had 100 seizures and got 89 kilos.

Responses

So what have the government done about it? Basically, the government have done very little. 1991 saw the first pamphlet on ecstasy released. In 1993, the New South Wales health department financed a booklet called "Rave Safe" and a video for ravers. That name has now been adopted by a whole range of different organisations because it did so well, and the term ‘Rave Safe’ has been used for a number of different projects around the country.

In 1997, an ecstasy education kit for dance party nightclub patrons and venue operators was launched called ‘Project E’. As far as I am aware, this is the only national ecstasy campaign that has ever been done in the world. It basically had two sections: it was an information kit for users, and on the inside there was a venue information guide for venue operators on how to make the venues safer.

In 1998, during our study of 329 ecstasy users we were asked so many questions about ecstasy, and what exactly people were putting into their bodies when they took it, that we wrote a booklet called ‘Ecstasy: Facts and Fiction’, which has been incredibly successful over the last few years.

Trends

Prevalence of use has doubled in the last few years, and we are seeing that those people who chose to use are using more and are using more often. Users are definitely getting younger. Injecting is becoming more wide spread amongst regular users. Poly-drug use is increasing as well as the range of drugs, with the introduction of substances such as Special K or ketamine and GHB.

The only Australian government campaign funded so far targeted the dance party or nightclub scene. However, the drug is actually going mainstream now and that also sets quite a few challenges. How do we actually target everybody? It is going to be very difficult. Prices are dropping, availability is on the increase and we are going to see younger people using. That is something else we have to start to think about.

Do we educate about ecstasy in high schools? In Australia this is not done and it is something to think about. Sensational media reporting has resulted in many young people completely disbelieving harm reduction messages. When you interview people, they believe it is adult propaganda. They do not think that there is any harm associated with the drug at all and that is potentially dangerous.

Is there any good news? In 1997, GHB entered the Australian and importantly the Sydney dance party scene; GHB, GBH, gamma hydroxidybutyrate, ‘grievous bodily harm’ or ‘liquid ecstasy’, made an impressive introduction with 200 non-fatal overdoses in two months. Some inner city hospitals were seeing 60 cases a week. The reason is that when used in conjunction with other drugs, particularly alcohol, it tends to depress the respiratory system so you end up going into respiratory distress. We thought this was a nightmare, but actually some very positive things happened as a result. There was first a community based approach to the problem.

This was mainly a gay problem. At the last Mardi Gras party there was a real problem. There were so many people dropping as a result of using GHB we had to do something. We got the community together and said, "Okay let’s actually have a dialogue about drug use", something that the gay community had never done before. As a result there was a whole series of things which came up around it and we had a campaign called ‘Party safe, party together’ which was extremely successful.

When GHB came up no one knew anything about it, but they knew where to come. They knew that there were people who could speak to the media. I made myself available and we actually got some good quality information in early on, instead of scare mongering stuff. We were able to say what we knew about the drug, the harms etc. I already write a weekly column for a gay magazine, but this has led to me being asked to write a weekly column for a national newspaper on harm reduction and drugs and also a national magazine as well. That is amazing and it also means that we can actually get some good quality information out of it too.

Finally, nightclubs and dance parties are utilising drug and alcohol services and information as a result of GHB and particularly a death that occurred at a nightclub in Sydney. The owner of the nightclub brought me in and asked, "What can we do here to make our nightclub even safer?" His club was probably the safest in Sydney anyway but he actually wanted to do more. The hope is that we will shame other nightclubs to actually look after their patrons better.

The future

Finally, what does the future hold? We need funding, not only to research the effects both short-term and long-term which users are interested in, but also to monitor the trends which are constantly changing. We really need to have some better information about combinations: what actually will happen if this drug and this drug are used together.

Relationships with the media need to be nurtured, so that when something does go wrong they will know where to go for good, accurate information, and so that the dissemination of credible warnings is possible, instead of ludicrous things that no one believes. Although the drug seems to be becoming more mainstream, we still need to work with nightclubs and the dance party scenes. Some of them have been terrific at getting some good information out. Finally, the community-based approach is a powerful tool and we should actually utilise the dance party scene as much as we can to get the good messages forward.