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drug use WHO TOOK THE SURVEY? Typical UK respondents

69.7% 30.3% 82.7% are male

Welcome to the biggest study of drug use of all time: the Mixmag / Guardian Drugs Survey, conducted by Global Drug Survey. The new partnership with the Guardian newspaper not only meant that we broke all records for participation, but helped build a truly global reach. Over 15,500 people filled it in, from Brazil to Birmingham, Phoenix to Finland The massive response also changed the demographic slightly: while previous surveys have been dominated by regular clubbers, this year a much wider spread of people took part. Because of this, we’ve split some of the figures (for things like drugs taken in the last year) to compare the results for respondents who have been clubbing in the past month with the wider picture. A huge number of respondents from the United States (3,300) this year also

means we also have a raft of figures comparing drug use in the UK and the US. Unless stated otherwise, the figures given here refer to the 7,700 people from the UK who filled in the survey. Over the next few pages we’ve picked out some of the more startling trends and the most relevant figures, but you can see more online at Mixmag.net/ drugssurvey2012, where the full results will be published along with detailed explanations of what we like to call ‘the science bit’.

are female

are heterosexual

68.4%

drugs ever tried by uk respondents

76.2% 45.1% say they don’t need drugs for a good night out

think drugs ‘can make a bad night out good’

Average age is 28 years and 4 months The most common age is 21

78.2% 39.5% 23.8%

are working are (or are also) studying are unemployed

Drugs used in the last 12 months (uS respondents)

Drugs used in the last 12 months (uk regular clubbers)

Alcohol

99.2%

95.2

95.5%

98%

Cannabis

91.1%

68.2%

69.3%

69%

75%

53.7%

26.5%

77%

64.9%

46.3%

19.4%

67%

69%

39.2%

19.3%

57%

Cocaine

69.4%

41.8%

19.8%

54%

Ketamine

47.8%

24.5%

5.5%

40%

Nitrous oxide

49.6%

27.2%

10%

43%

Mephedrone

42.7%

19.5%

2%

30%

37%

18.1%

19%

22%

Mushrooms

53.1%

13.9%

21%

13.9%

Caffeine tablets

47.3%

13.4%

9%

13.4%

Poppers

56.9%

13.1%

3%

13.1%

Speed

52.9%

11.8%

10%

8%

LSD

39.6%

10.5%

18%

16%

2CB

16.7%

7.4%

3%

12%

Amphetamine (paste)

25.3%

4.8%

2%

7%

13%

4.7%

3%

5%

Methoxetamine

4.9%

4.2%

1.5%

6%

DMT

7.7%

3.4%

6%

5%

14.2%

3.3%

14%

5%

Benzo Fury

3.2%

2.4%

<.5%

3%

MDAI

4.1%

2.2%

.5%

3%

Opium

12.5%

1.9%

4%

2%

Methylone

6.9%

1.4%

2.5%

2%

Crack

8.3%

1.1%

1%

1%

2CI

9.4%

3.7%

3.9%

6%

GBL

7.7%

1.6%

1%

2.5%

GHB

3.8%

1.5%

<.5%

2%

Heroin

7%

1.1%

2.5%

1%

Ritalin

6.5%

1.9%

10%

3%

Methamphetamine

3.8%

.8%

2.1%

1%

Solvents

7.9%

.4%

<0.01%

.5%

Steroids

1.3%

.5%

<.5%

.5%

MDMA MDMA powder MDMA pills

Benzos (valium etc)

Viagra

Synthetic cannabis

of respondents agree or strongly agree with the statement ‘drugs can make a good night out better’

Drugs used in the last 12 months (uk respondents)

91.1% of UK respondents have tried cannabis, 75% some form of MDMA. More (69.4%) had tried cocaine than legal ‘drugs’ such as caffeine tablets, poppers and nitrous oxide. Nearly half of UK respondents had tried ket, and 42% mephedrone. Cannabis is the most used illegal drug of the last year among UK and US respondents, with MDMA in second place and cocaine in third. In the US, MDMA is well behind cannabis – now effectively

decriminalised in some states (26.5% compared to 69.3% for weed). Fewer US respondents were regular clubbers, and the picture of drug use there is quite different, with hallucinogens (shrooms, LSD) far more prevalent than in the UK, and club drugs like ketamine and meph nowhere near UK levels. Synthetic cannabis and Ritalin use are much higher in the US, while crack and meth are at similar low level either side of the pond.

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Ecstasy MDMA is the most popular illegal drug among UK respondents who have been clubbing in thepast month; 77% had used it in the past year. More regular clubbers among UK respondents took MDMA powder in the past year than took ecstasy pills Taken in last year

67% 57%

MDMA Quality

Powder

28%

Pills

of respondents believe the purity of ecstasy pills has gone up in the past 12 months

Buying pills

26%

usually buy one or two pills at a time

40%

45% of respondents believe the purity of ecstasy pills has gone down

usually buy six to nine pills

29%

usually buy 10 or more pills at a time

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18% of respondents believe the purity of MDMA powder has gone up in the last 12 months

22% 22% of respondents believe the purity of MDMA powder has gone down

Cannabis/synthetic cannabis

54% of regular UK clubbers have taken cocaine in the past 12 months.Most users take a gram in one session; 10 per cent usually take 2g or more. The most common amount paid for a gram is £50

Cannabis was the most popular illegal drug overall in both the UK (68.2% of respondents had used it in the past year) and the US

40%

UK: Types of cannabis used in the past year

of cocaine users don’t know how many lines they usually get from a gram...

73%

of respondents who take ecstasy have been offered higher priced pills with the promise of better quality – usually at £10.

78% 81% thought they were better.

MDMA powder 18%

Cocaine

In the US, the average price of a pill was $14, and the most common price paid was $10

bought them...

usually buy three to five pills

5%

The average price of a normal pill is £2.50, the most common price is £4/5, but the percentage of people usually paying £10 for a pill has risen to 28%

The average price for a gram of MDMA was £38; the most common price paid was £40 75% of users take one gram or less in a session; the average number of doses per gram is 7.8

40% say that they get between 10 and 20.

● 98% of cocaine

● 1.5% of

have smoked cocaine

30%

people who have taken cocaine injected it ● 3% rubbed it on their gums

have swallowed cocaine

Cocaine quality believe the quality has gone up

5%

52% of cocaine users believe the quality of cocaine has gone down in the past 12 months

In the last three years over 200 synthetic cannabinoids have appeared, of varying chemical structure. Usually these are sprayed on non-psychoactive herbal mixtures and sold as smoking blends or incense – there’s a wide variation between batches with variable branding, composition and potency.

MYSTERY POWDER

users snort it ● 1% smoke it ●.5% swallow it

31%

Grass 50.9% Skunk 75.5% Resin 34.7%

3.3% of UK respondents had used synthetic cannabis in the past year, up from 2.2% the previous year. 14% of US respondents had used synthetic cannabis in the past year

39% of respondents who have taken cocaine have been offered ‘higher quality’ cocaine at a higher price (most commonly about £60 per gram, but in 25% of cases £80 or more)

64% 76% bought it...

thought it was better

14.6% of respondents have snorted or ingested a ‘mystery powder’ Blame it on the ever increasing amount of legal highs, cynicism about media coverage of drugs like mephedrone, or just that people are more blasé about drugs than ever, but almost 15% of respondents had taken a mystery white powder in the past year without knowing what it was or what it was originally sold as. Two thirds had been given it by someone they trusted; 80% were intoxicated when they did it. The most common place to snort a mystery powder was at a party (32%), followed by a club (25%), or at home (25%)

users compared the effects with natural cannabis: Ability to function after use 6.84% Addictiveness 3% Munchies 6.87% Effects on memory 4.63% Negative effects when high 2.8% Paranoia 3.89% Value for money 6.73% Consistency of product 6.38% Natural cannabis

93%

of people said they would choose natural cannabis over synthetics

of users had to seek medical attention after using synthetic cannabis. The most common complaint was panic and anxiety, followed by paranoia, breathing difficulties, sweating, chest pain, seeing things, agitation, hearing things and aggression

Back-door banquet 3.5%

1.75%

3.5%

2%

of respondents have taken MDMA powder rectally

have taken cocaine rectally

have taken amphetamine rectally

have taken mephedrone rectally

● 20% cocaine ● 18% mephedrone ● 13% ketamine ● 10% ‘research

23% said it did nothing for them, 12% reported that it made them feel sick and 65% said it had positive effects. The younger you are, the more likely you are to have taken a mystery powder.

Synthetic

2.5%

What did people think it was?

chemical’ ● 6% legal high ● 16% don’t know ● 17% speed / MDMA/ methoxetamine / caffeine / chalk / BZP

5.47% 2.62% 3.79% 4.26% 4.8% 4.75% 4.76% 5.92%

DR WINSTOCK “Rectal use of drugs is not that uncommon in medicine, and can be used for the administration of pain killers and anticonvulsant drugs, among other things. Your rectum has a mucosal lining (like the inside of your mouth) and a very good blood supply. Drugs administered rectally can thus be absorbed

directly into your bloodstream. Drugs taken rectally avoid what is called ‘first pass metabolism’ (breakdown by your gut and liver), meaning that for some drugs you can end up getting higher concentrations in your bloodstream. Avoiding your stomach can also reduce nausea. Depending on the drug, the effect may come on quicker and might be stronger and last longer, so best always to reduce your dose if you have never used the drugs anally before. As always, there are risks. If applied regularly to the anus and rectum, drugs can cause irritation, soreness and ulcers. There is also a risk of spreading infection between the hands, mouth and the rectum. Some drugs (like cocaine) that are applied to the anus specifically for their numbing effect to facilitate anal sex can also lead to initially unnoticed trauma.”


Mephedrone

KETAMINE

24.5% of UK respondents reported taking ketamine in the past year. This rose to 40% for regular clubbers. The US figure was 5.5%

Mephedrone use among all respondents in the past year has fallen from 51% to 19.5%. Even among regular clubbers it was down to 30%

£20

is the usual price paid for a gram of mephedrone

70% 20% of users snort it

of users swallow it

49%

We asked users of mephedrone, MDMA and cocaine which of the following effects they had experienced, moderately or severely: mephedrone

cocaine

MDMA 4% 8% 1% 23% 14% 9% 10% 5% 3% 12% 4% 6% 41% 21% 32% 11% 2% 20% 24% 9% 23% 26% 7% 23% 17% 10% 7% 12% 6% 6% 11% 3% 9% 10% 2% 5% 36% 11% 33% 52% 22% 58%

Aggression Agitation Chest pain Numb fingers Depression Hallucinations Memory loss Overheating Paranoia

of users think the purity of mephedrone has gone down in the past year Of all the UK respondents to the drug survey: 45% think banning mephedrone was the wrong thing to do 23% think it was the right thing to do 32% are unsure

Severe headache Severe nausea Severe tremors Extreme sweating Teeth grinding

With the highest scores for things like extreme agitation, headaches, tremors and nausea and feeling depressed after use, it seems that the downsides of mephedrone are starting to affect its former popularity.

Most people take half a gram per session

50% 10% 5% take 1g or more per session

take 5g or more per session

have taken mephedrone for seven days in a row

70% 25% 1/3

had used more than 1g in a session

had used more than five grams

have taken it for 48hrs or more

50% 25% 20% had taken it with alcohol

with taken it with ketamine

had taken it with with MDMA

18% 40% of ketamine users reported abdominal pain or discomfort in association with its use

said this had lasted for hours. The frequency of doses and the use of alcohol seem to make it worse

Prescription drugs

the drugs meter: compare your use to others

We asked respondents in the UK and the US if they had used any of the following prescription drugs in the past year:

Global Drug Survey, the team behind this year’s survey, have created a free app for people who drink or take drugs and want to know how their use measures up

Viagra 6.3% Ritalin 3% Antidepressants 11.9% as benzos Sleeping tablets such 22.4% eg Temazepam as zopiclone/ Sleeping tablets such 7.2% zolpidem Opioid painkillers 24.6% Other painkillers 9.2%

4.1% 18.8% 19.6% 21.6% 11.5% 34.7% 9.9% uk

Methoxetamine respondents 4.9% of said they had

taken methoxetamine (aka mKet, roflcopter), the vast majority of them in the past year of respondents who’d taken ketamine in the past year reported having taken methoxetamine as well

14%

Reasons for taking methoxetamine

73%

said it was easier to get hold of

20%

were curious or said it was sold as ketamine

20%

said it’s better value for money

18%

thought it was less damaging to liver / kidneys

A slightly higher percentage of users of methoxetamine (14.4%) than ketamine (14.2%) would like to use less of each drug. There is no evidence that methoxetamine is any less harmful than ketamine.

US

We asked respondents if they had ever used these prescription drugs to get high: Ritalin Opioid painkillers Other painkillers Zopiclone

57.8% 28.2% 42% 15.8%

47% 56% 45% 28% uk

40%

40% happiness We asked all respondents to estimae their happiness, using the Australian Personal Wellbeing Index, one of the few scientific ways to quantify personal happiness on a scale of 1–10. The average score for everyone who filled in the drug survey was 70.8 – about the same as the average Australian.

US

of respondents who had taken prescription sleeping pills had used them to enhance their mood

We asked if you were interested in knowing how your use of drugs or alcohol compared to other people’s. About 80% said you were. Then we asked you how you thought your use of drugs compared to other people. The results were amazing. Just under 20% of people who were judged as alcohol dependent using AUDIT (a screening tool developed by the World Health Organisation) thought their drinking was average or less than average compared to other drinkers. Just over 15% of people who smoked cannabis 20 or more days per month thought their use of cannabis was average or less than average compared to others (when in fact they were in the top 30% of all cannabis smokers in our UK sample) Over 50% of people using 1/2gm (about 5 pills) or more of MDMA a month thought they were average or below average users (when in fact they were in the top 25% of all MDMA users in our UK sample). Over 50% of people using 4gm or more of coke per month thought they were average or below average (when in fact they were in the top 20% of all UK users) Our participants probably compared themselves to their mates. If you do lots of drugs and your mates do lots of drugs it probably seems like everyone is doing lots of drugs. If all your mates drink a lot then lots of drinking might seem normal. Global Drug Survey

developed the Drugs Meter app after talking to people who use drugs and realising that most wanted to avoid harm, have fun and look after themselves and those they care for. Global Drug Survey also wanted to give something back to people who take the time to share their drug use data with us. Drugs Meter is designed to allow people to think about their use and compare themselves to others. It provides people with immediate, objective feedback on their use of nine different drugs. Drugs Meter is not funded by any government. It does not tell a person what to do; it does not say that their use of a drug is safe. Your data is completely confidential. Global Drug Survey wants Drugs Meter to be a safe place where people can think about their use of drugs. So if you are not sure if you have an alcohol problem, or you want to know if your use of coke is high or low compared to others like you, check Drugs Meter out and join the community. Available as a webbased or smartphone app, Drugs Meter is free from www.drugsmeter.com


WORRies ABOUT YOUR MATES DRUG USE We asked what your biggest worries were, when it came to your mates’ drug use. Both in the UK and US, the amount and frequency of use was your biggest worry, followed by the impact on your friends’ health UK Biggest worries are Amount/ Frequency of use Impact upon health Behaving like an idiot/ putting themselves or others at risk Damage to relationships Money worries/ police worries

79% 75% 58% 54% 28%

US Biggest worries are Amount/ Frequency of use Impact upon health Behaving like an idiot/ putting themselves or others at risk Damage to relationships Money worries/ police worries

Buying Drugs online and legal highs

24%

of repondents had ever bought drugs from the internet

9.8%

20%

78% 72% 65% 58% 40%

had bought drugs from the internet in the last12 months

had ever bought ‘research chemicals’or legal highs

We also asked which substances you most worried about your mates taking. The world’s most widely used and available intoxicant, alcohol coming out on top, in both the US and UK, by a long strech. Drug that causeD YOU most worry (UK) Alcohol Cocaine Ketamine Cannabis Mephedrone MDMA Heroin Tobacco

40% 15% 11% 11% 7% 6% 2.4% 2%

Drugs that causeD you most worry (US) Alcohol Cocaine Methamphetamine Cannabis Benzodiazepines MDMA Heroin Tobacco

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50% 10% 2% 7% 3.5% 4.0% 8.0% 4%

Why DID RESPONDENTS buy research chemicals/ legal highs? Able to buy on line/ shop Other drugs unavailable Value for money Quality of other drugs was poor Think they are better than illegal drugs Thought they were not illegal Prefer effect to illegal drugs Think they are safer than illegal drugs I don’t know how to get illegal drugs Less likely to be detected by sniffer dogs Less easily detected by drug screens

4.4 3.9 3.7 3.4 2.7 2.5 2.2 2.1 1.9 1.6 1.4

1

2

3

4

5

6

7

Mean (1 no influence to 7 large influence)

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Methodology The founder of GDS Dr Adam R Winstock MD is a Consultant Addiction Psychiatrist and researcher based in London. The views presented here are entirely his own and have no relationship to those of his current employers or affiliate academic organisations. If you would like to contact Dr Winstock or the team behind the Drugs Survey email him on adam@globaldrugsurvey.com

Methods: strengths and limitations. On line surveys have both advantages and limitations when compared to more traditional approaches to asking people about their use of drugs, such as face-to-face researcher led interviews. As with any piece of epidemiological research when critically assessing the validity of the approach adopted, consideration needs to be given to both the questions asked (the research instrument), the method (on-line anonymous cross sectional surveys), the participants (who the respondents are), the recruitment strategy (how the participants were selected and how representative they are of the target population) and who is doing the asking (the research organisation). Such information can guide the reader in determining how useful the findings are. 1) The questions asked - the research instrument. The research instrument used by Global Drug Survey is a structured selfcomplete questionnaire, that following an initial drug use screen used in previous studies conducted by the group, tailors questions based on participant’s recent self reported drug use. The questions, designed by a group of academically trained researchers and clinicians offer a selection of fixed responses to each stem question. About 65% of the questions have been used in previous surveys conducted by the group to permit the monitoring of trends over time. Sections

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addressing specialist area of interest such as prescription drug use, GP consultations and those attempting to define a particular clinical entity such as urinary problems or abdominal pain associated with ketamine use have been developed in consultations with experts in that field. The questions and the responses to our surveys have been deemed robust enough to support the publication of research papers in high quality academic journals (see below). The current study was approved by the joint South London and Maudsley NHS and Institute of Psychiatry Ethics Committee. 2) The method: On-line anonymous cross sectional surveys. GDS conducts on-line anonymous self-complete surveys that tailor themselves automatically based on an individual’s responses to an initial drug use screen. Although limited by the self-nominating nature of the sample (see below), and fixed responses, the methodology adopted by GDS has a proven track record in being able to track drug trends over time and identify the use and harms associated with new drug classes such as the synthetic cathinones (mephedrone). Such methods although considerably cheaper and quicker than face to face research interviews do have their limitations, some specific to the method, others common to any approach enquiring about sensitive issues such as drug use. Common problems include recall bias (simply forgetting what you had done or taken) and response

bias (providing the answers you think the research team/survey want to hear). 3) The participants: Some of these limitations will be due to the on-line method of data collection. By definition those who respond are likely to be more ‘web-savvy’ and active online, and so may not be representative of the wider population (although they may be typical of younger people in general, who have higher rates of drug use, the area of focus of the study). Like other approaches assessing drug use in the general population such a randomly selected household surveys, on line approaches may exclude some populations with high than average levels of drug use, such as the homeless or those in prison. It is also true that those with less access to the web because of geography, or economic status may also be excluded. However with increasing access to the web, this limitation is becoming less significant. Issues of health literacy will also need to be taken into account. We estimate that reading of age of 15 years would be needed to participate fully in the most recent Global Drug Survey. We are working to improve our surveys, to increase access to lower literacy populations. Conversely the use of anonymous on-line approaches to assessing drug use may be considered to have some significant advantages over more traditional approaches. People may be reluctant to tell a complete stranger at their doorstep or over the phone what

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drugs they have used recently, so that face-to-face studies may often result in under-reporting. By the time the results of most large national household surveys are released they are at least 12 months out of date. Our findings are 3 months old. Finally, because we attract groups with an interest in the use of drugs and alcohol we are able to access large numbers of people who are relevant to our area of study. In our most recent study, we collected 7700 UK responses in 4 weeks, making it almost 3 times larger than the sample of current drug users captured in the most recent British Crime Survey (where 10% of a representative sample of 27,000 people reported drug use in the last year). 4) Our recruitment (or sampling strategy): We work with credible media partners to attract a population who have an interest in the use of drugs and alcohol. Participants are not paid to participate. They are not approached or vetted in any way. Our participants self nominate themselves. Access comes through our media partners and increasingly through social media networks. But we are clear, our sample is not a random sample and cannot be said to be representative of the general population. It is hard, if not impossible to determine how similar our participants are to other people who came across the on-line survey and who did not choose to participate. Our participants almost certainly represent a group of people who have greater interest in and use of drugs and alcohol. However as previously stated given that use of these substances is the focus of the study, such a bias, can for some questions, (such as comparing the harms associated between heavy and light users of a drug) be of benefit. The fact the majority of our respondents were aged between 18-30 years demonstrates that the demographic of our participants matches the age profile of the largest group of drug users in the UK. Ultimately of course, the only people that this study, (like so many others) can definitively tell you about are those who have participated. As previously

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stated we accept that because of the non-random nature of the sample our findings cannot be considered to be reflective of patterns in the wider population. However unlike many selected non-random sampling methods, we do have very good data on our participants’ demographics, other lifestyle activities, their personality profile and overall wellbeing. This is important because the better you can describe your sample, the more of an idea you have of how they compare to the wider population. From a statistical perspective, errors consequent upon non-random sampling strategies are not easily corrected by poststratification (weighting) of responses, although by using complex statistical methods and by being able to define more accurately who your sample is some of this limitations can be minimised. However, even accepting the findings cannot be said to be representative of the wider population, they do still provide a useful snapshot of what drugs are being used and how they are impacting upon peoples’ lives. The findings can and do inform policy, health service development and most importantly those who drink, smoke and/or take drugs. As cited earlier our methods have their limitations but have been considered robust enough to lead to scientific publications* in high profile academic journals. Some of these publications are listed at the end of this document. 5) The research organisation: Global Drug Survey is an independent self-funded data mapping exchange hub founded by Dr Adam R Winstock, a Consultant Addiction Psychiatrist and researcher based in London. His role in GDS is totally independent of his employment within the NHS and his views expressed as part of GDS have nothing to do with his employers or his academic affiliate organisation (beyond the fact that ethics approval was obtained through his local research ethics committee). Adam has an extensive track record as a researcher and educator. His full CV can be found on the GDS website. Adam collaborates widely in the development of the survey

questions with a range of national and international experts. Many of these are also part of the GDS Expert Advisory Committee, which is made up of well-respected figures with experience in the fields of medicine, psychology, toxicology, epidemiology, statistics, and policy and health service development. GDS is totally independent and is not funded by any government to carry out its research. GDS determines the nature and scope of the questions. GDS provides only composite data reports to its media partners. Recent publication based on / informed by output from Global Drug Surveys Winstock AR, Cottrell; Urinary problems in ketamine users. In press British Journal of Urology International Winstock AR, Mitcheson L; Novel drugs and the approach to managing them in primary care. British Medical Journal February 2012 Winstock AR, Mitcheson L, Ramsey J, Marsden J; Mephedrone: use, subjective effects and health risks. Addiction Volume 106, Issue 11, pages 1991–1996, November 2011 *Winstock AR, Mitcheson L, De Luca P, Davey Z, Schiffano F; Mephedrone – new kid on the block’ Addiction 2011 Jan vol 105 (10) pp 1685-7 Winstock AR, Marsden J, Mitcheson L; What should be done about mephedrone British Medical Journal 2010;340:c1605 *Winstock AR, Mitcheson L Marsden J; Mephedrone, still available but twice the price. The Lancet, Volume 376, Issue 9752, Page 1537, 6 November 2010 * Directly based on data from GDS on-line methods

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MIXMAG'S DRUG SURVEY: THE RESULTS