R E V I E W

Drug and Alcohol Review (May 2011), 30, 255–263

DOI: 10.1111/j.1465-3362.2011.00324.x

Recent trends in pharmaceutical drug use among frequent injecting

drug users, frequent methamphetamine users and frequent ecstasy
users in New Zealand, 2006–2009 dar_324 255..263

CHRIS WILKINS, PAUL SWEETSUR & RICHARD GRIFFITHS

SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand

Abstract
Aims. To examine the rates of pharmaceutical drug use, and level of prescription use and injection of pharmaceutical
drugs, by frequent injecting drug users (IDU), frequent methamphetamine users and frequent ecstasy users in New
Zealand for 2006–2009. Design and method. The paper draws on findings from the 2006, 2007, 2008 and 2009
Illicit Drug Monitoring System (IDMS). The IDMS interviews three groups of frequent illegal drug users (i.e. IDU,
methamphetamine users and ecstasy users) from the three main cities of New Zealand using purposive sampling and
‘snowballing’. Results. Pharmaceutical morphine rather than heroin was the principal opioid used by the IDU. Few
of the IDU or frequent methamphetamine users had prescriptions to use morphine. A lower proportion of the IDU
had a prescription to use morphine in 2009 compared to 2008. The injection of methadone by IDU and metham-
phetamine users was common. A higher proportion of the IDU had injected methadone in 2009 compared to
previous years. A higher proportion of the IDU had used oxycodone in 2009 compared to 2008 and prescription use
of oxycodone by IDU was very low. All three groups of frequent drug users were involved in the extra-medical use
of methylphenidate and benzodiazepines. Discussion and conclusion. Extra-medical use of pharmaceuticals
occurred among all three groups of frequent illegal drug users to varying degrees. Differences between the three
groups in the level and type of extra-medical pharmaceutical drug use suggest that different control strategies may
be effective for each group. [Wilkins C, Sweetsur P, Griffiths R. Recent trends in pharmaceutical drug use among
frequent injecting drug users, frequent methamphetamine users and frequent ecstasy users in New Zealand,
2006–2009. Drug Alcohol Rev 2011;30:255–263]

Key words: Pharmaceutical drug use, frequent injecting drug users, frequent methamphetamine users, frequent
ecstasy users, New Zealand.

increasing levels of prescribing by medical professionals

Introduction
There is growing awareness worldwide of the issue of
extra-medical use of pharmaceuticals [1]. A number of
factors have contributed to the problem in the past few
decades including: the marketing of pharmaceuticals to
medical professionals by the pharmaceutical industry;
marketing campaigns by pharmaceutical companies
raising awareness of disorders and the drugs available to
treat them; the involvement of the pharmaceutical
industry in academic research into the efficacy of phar-
maceutical products; the introduction of new pharma-
ceutical medications with the potential for abuse;
and in particular psychiatrists; and greater private
access to pharmaceutical drugs via the Internet [2–4].
Much attention has been given to the extra-medical use
of pharmaceutical opioids in a number of countries in
recent years, with particular concern about the leakage
of diverted pharmaceutical opioids to injecting illegal
drug users [5]. Less is known about the extra-medical
use of pharmaceuticals by other groups of illegal drug
users, such as stimulant users and so called party drug
users.
In New Zealand, pharmaceutical opioids illicitly
diverted from the medical system have been known to

Chris Wilkins PhD, Senior Researcher, Drugs Team Leader, Paul Sweetsur MSc (Hons), Statistician, Richard Griffiths PhD, Researcher.
Correspondence to Dr Chris Wilkins, SHORE and Whariki Research Centre, School of Public Health, P O Box 6137,Wellesley St, Auckland, New
Zealand. Tel: +64 9 366 6136; Fax: +64 9 366 5149; E-mail: c.wilkins@massey.ac.nz

Received 8 April 2010; accepted for publication 9 April 2011.

© 2011 Australasian Professional Society on Alcohol and other Drugs

256 C.Wilkins et al.
be a central source of opioids for injecting drug users
for many decades [6–9]. The regular supply of heroin
into New Zealand was substantially disrupted in the
late 1970s by the arrest of ‘Mr Asia’, the New Zealand
head of an international heroin trafficking syndicate
[6,7]. New Zealand’s geographical isolation, small
population and effective border control meant the
international supply of heroin never fully recovered
[6,7]. Three sources of opioids emerged in the subse-
quent decades to replace the international supply of
heroin to New Zealand: (1) pharmaceutical morphine
diverted from the medical system; (2) ‘homebake’
heroin or morphine manufactured in makeshift labora-
tories from codeine base; and, (3) opium extracted on a
seasonal basis from locally grown opium poppies [6–8].
Since the early 2000s, there has been an increase in
the use of methamphetamine and ecstasy in New
Zealand [10–12]. Frequent users of methamphetamine
and ecstasy in New Zealand have been found to have
different demographic profiles as well as different drug
use patterns from the traditional frequent injecting
drug users. This raises the question of whether these
new drug using groups also have different preferences
for pharmaceutical drugs than injecting drug users.
The current understanding of the extent of the extra-
medical use of pharmaceutical drugs in New Zealand is
fragmented and incomplete [13]. A serious limitation of
many of the existing official data sources is the inability
to distinguish between the sanctioned and extra-
medical use of pharmaceutical drugs [13]. Measuring
the level of extra-medical use of pharmaceuticals is in
itself challenging as extra-medical use can occur during
the process of procurement (i.e. pharmaceutical drugs
are obtained through deception, fraud or outright
theft), during the process of administration (i.e. phar-
maceutical drugs intended for oral use are injected,
such as with methadone) or even after pharmaceuticals
have been legitimately obtained (i.e. sanctioned recipi-
ents of pharmaceuticals sell, trade or give away their
pharmaceuticals to others who go on to use them in
extra medical ways) [13–15]. Having a prescription to
use a pharmaceutical drug in the recipient’s own name
is one measure of legitimate use, albeit incomplete
given the subsequent opportunities for extra-medical
administration and sharing and sale.
The aim of this paper is to examine the rate of phar-
maceutical drug use by frequent injecting drug users,
frequent methamphetamine users and frequent ecstasy
users in New Zealand for the years 2006–2009. Two
measures of extra-medical use of pharmaceuticals are
presented in the paper for these groups: (1) use without
a prescription in the recipients own name; and, (2)
injection of a pharmaceutical drug intended for oral use
only. The paper also presents frequent illegal drug
users’ perceptions of the availability and use of different
© 2011 Australasian Professional Society on Alcohol and other Drugs
pharmaceutical opioids in New Zealand for the years
2008–2009.
Method
The paper presents data from the 2006, 2007, 2008
and 2009 Illicit Drug Monitoring System (IDMS).The
IDMS interviews approximately 300 frequent illegal
drug users (i.e. 100 frequent methamphetamine users,
100 frequent injecting drug users and 100 frequent
ecstasy users) each year from the three main urban
centres of New Zealand (i.e. Auckland, Wellington and
Christchurch) using purposive sampling and ‘snowball-
ing’ [16,17]. Three separate street-level recruitment
campaigns are undertaken in each site using promo-
tional material specifically designed to target each fre-
quent drug user group. Respondents are screened for
eligibility for the drug type they contact the interviewer
about. An individual can only be interviewed for one of
the three frequent drug user groups in a given wave (i.e.
the groups are mutually exclusive). Participants are
required to be 16 years or older, have used the drug
type of interest or injected a drug approximately
monthly or more often in the past six months, and have
resided in the site location for the past 12 months.
Eligible participants are administered a structured face-
to-face interview at a public venue of their choosing.
Measures
Demographics
The frequent drug users were asked about their age,
primary ethnicity, employment status, marital status
and highest educational qualification.
Drug use
The frequent drug users were asked whether they had
used a range of drug types in the previous six months.
Those who had used a drug were asked if they had
injected it in the past six months. In 2008 and 2009,
additional pharmaceutical drug types were added to the
list of drugs asked about and those frequent drug users
who reported using a pharmaceutical drug type in the
past six months were asked if they had a ‘prescription
for the drug in their own name’.
Opioid trends
In the 2008 and 2009 IDMS the frequent drug users
were asked if they had any knowledge of four types of
opioids (i.e. ‘street/illicit morphine’, ‘street/illicit
methadone’, ‘homebake morphine/heroin’ and
‘heroin’). Those with knowledge of an opioid type were

asked about its current availability, change in availabil-
ity and change in the number of people using it, and
were read a set of scale answers for each question.
Analysis
To ensure consistent comparisons between years we
applied fixed weights to the four annual IDMS samples
based on the average distribution of the total sample by
location and average distribution of the total sample by
the three frequent drug user groups for 2006–2008.
The rate of drug use in the previous six months in 2009
was compared to the rate of drug use in 2008, 2007 and
2006 using logistic regression. We fitted year as a cat-
egorical variable to predict use of a given drug in the
previous six months. Statistically significant differences
are noted at the bottom of each table and discussed in
the text. We compared perceptions of current availabil-
ity, change in availability and change in the number of
users between the four opioid drug types for 2009. To
do this for current availability, the categories ‘very easy’
and ‘easy’ were combined into one easy category and
the ‘difficult’ and ‘very difficult’ categories were com-
bined into one difficult category. The new combined
‘easy’ and combined ‘difficult’ categories were then
compared between each of the four opioid drug types.
For ‘change in availability’, the ‘more difficult’ category
was compared to a combination of the ‘easier’, ‘stable’
and ‘fluctuates’ categories. For ‘change in use’, the ‘less’
category was compared to a combination of the ‘same’
and ‘more’ categories. Chi-square analysis was used to
test for these differences. If the overall chi-square test
was statistically significant at the alpha = 0.05 level,
chi-square tests between each pair-wise combination of
the four opioid drug types were conducted. The six
p-values obtained from the pair-wise tests between the
opioid drug types were adjusted for multiple compari-
sons by using the Bonferroni-Holm step-down method.
We also compared the current availability, change in
availability and change in use categories for each opioid
between 2008 to 2009.These tests were also completed
using Chi-square analysis. Rates of drug use and demo-
graphic variables were produced with 95% confidence
intervals except in cases where the ‘yes’ or ‘no’ results
were very high or very low and consequently there
insufficient numbers (e.g. only 1% of frequent ecstasy
users used methadone in the previous six months).
Results
Demographics
In 2009, 63% of the frequent injecting drug users were
male, their average age was 38 years old, 77% were
European, 79% were unemployed and 31% had no
Pharmaceutical drug use by frequent illegal drug users 257
educational qualifications (Table 1). Seventy-seven
percent of the frequent methamphetamine users were
male, their average age was 30 years old, 28% were
Maori, 37% were employed and 30% had no educa-
tional qualifications. Seventy percent of the frequent
ecstasy users were male, their average age was 23 years
old, 86% were European, 54% were students and 97%
had an educational qualification. In 2009, the frequent
injecting drug users were more likely than the frequent
methamphetamine users to be female (37% vs. 23%,
P = 0.0260), older (38 years vs. 30 years, P < 0.0001)
and to be unemployed or on a sickness benefit (79% vs.
51%, P = 0.0003) (Table 1). The frequent ecstasy users
were more likely than the frequent methamphetamine
users to be younger (23 years vs. 30 years, P < 0.0001),
European (86% vs. 68%, P = 0.0024), to be students
(54% vs. 12%, P = 0.0003) and to have an educational
qualification (97% vs. 70%, P < 0.0001). The frequent
injecting drug users were older in 2009 compared to
2006 (38 years vs. 32 years, P < 0.0001). The frequent
ecstasy users were more likely to be of Maori ethnicity
in 2009 compared to 2006 (11% vs. 3%, P = 0.0294).
Drug use
The drug types most commonly used by the frequent
injecting drug users in the previous six months in 2009
were tobacco (88%), methadone (73%), cannabis
(72%), morphine (62%), alcohol (60%) and metham-
phetamine (50%). High proportions of the frequent
injecting drug users had used pharmaceutical drugs
such as methadone, morphine, benzodiazepines and
methylphenidate (Ritalin) over the four years of survey-
ing (Table 2). Only approximately one-fifth of the fre-
quent injecting drug users had used heroin during these
years. A higher proportion of frequent injecting drug
users had used oxycodone in 2009 compared to 2008
(18% vs. 9%, P = 0.0341). A higher proportion of the
frequent injecting drug users who had used methadone
had injected it in 2009 compared to 2006 (80% vs.
65%, P = 0.048) and in 2009 compared to 2007 (80%
vs. 63%, P = 0.0221). Nearly all those frequent inject-
ing drug users who had used methylphenidate over the
previous four years had injected it (i.e. 89% in 2006,
94% in 2007, 98% in 2008 and 98% in 2009). In 2009,
high proportions of the frequent injecting drug users
reported having ‘prescriptions in their own names’ for
anti-depressants (95% of those who had used them in
the previous six months) and methadone (67%). Some
of the frequent injecting drug users had prescriptions
for codeine (41%) and benzodiazepines (41%) in 2009.
Very few injecting drug users had prescriptions for oxy-
codone (0%), methylphenidate (2%), and morphine
(6%) in 2009. A lower proportion of injecting drug
© 2011 Australasian Professional Society on Alcohol and other Drugs
 258
C.Wilkins et al.

Table 1. Demographic profile of frequent drug user groups, 2006–2009

Frequent injecting drug users Frequent methamphetamine users Frequent ecstasy users

(95% Confidence 2006 2007 2008 2009 2006 2007 2008 2009 2006 2007 2008 2009
Interval) (n = 93) (n = 109) (n = 132) (n = 99) (n = 114) (n = 110) (n = 137) (n = 105) (n = 111) (n = 105) (n = 135) (n = 111)

Male (%) 55 63 73 63 71 75 75 77 64 69 62 70
(49,65) (53,72) (65,80) (53,72) 62,79) (67,83) (66,81) (68,84) (55,73) (60,77) (54,70) (61,78)

© 2011 Australasian Professional Society on Alcohol and other Drugs

Mean age (years) 32 36 37 38* 30 31 30 30 23 23 23 23
(30,34) (34,38) (35,39) (36,40) (29,32) (29,33) (28,32) (28,31) (22,24) (22,24) (22,24) (22,23)
European (%) 79 82 70 77 71 67 68 68 96 90 87 86
(69,86) (73,88) (62,78) (68,84) (62,79) (58,76) (59,75) (59,77) (90,98) (83,94) (80,91) (78,91)
Maori (%) 19 16 25 20 22 25 28 28 3 5 8 11*
(12,28) (10,25) (19,34) (14,29) (16,31) (18,34) (21,36) (20,37) (1,8) (2,11) (4,13) (6,18)
Unemployed (%) 68 76 81 79 64 63 51 51 6 17 6 6
(58,77) (68,84) (74,88) (70,87) (54,73) (53,72) (42,60) (42,61) (2,11) (10,25) (2,11) (2,10)
Employed (%) 29 23 15 19 23 31 43 37 49 27 31 40
(20,39) (15,31) (9,22) (11,28) (15,31) (22,40) (34,51) (27,46) (40,59) (19,36) (22,39) (31,50)
Student (%) 3 1 4 2 14 7 6 12 44 55 63 54
(0,7) (0,3) (1,8) (0,5) (7,20) (2,12) (2,10) (6,18) (35,54) (46,65) (55,72) (44,63)
Educational 64 58 64 69 63 67 74 70 97 93 96 97
qualification (%) (53,73) (48,67) (55,73) (59,77) (54,72) (57,75) (65,81) (60,78) (92,99) (86,97) (90,98) (91,99)
Single marital status 39 45 49 47 57 40 57 47 50 66 53 56
(%) (29,49) (36,55) (40,57) (37,57) (48,66) (31,50) (49,65) (38,57) (41,60) (57,75) (45,62) (46,65)

*Statistically significant difference between 2009 and 2006 result at the P < 0.05 level.
 Table 2. Selected drug types used by frequent illegal drug users in the past six months (pharmaceutical drug types highlighted), 2006–2009
Frequent injecting drug users Frequent methamphetamine users Frequent ecstasy users

2006 2007 2008 2009 2006 2007 2008 2009 2006 2007 2008 2009
Use in past Use in past Use in past Use in past Use in past Use in past Use in past Use in past Use in past Use in past Use in past Use in past
six months six months six months six months six months six months six months six months six months six months six months six months
Drug type (%) (n = 93) (%) (n = 109) (%) (n = 132) (%) (n = 99) (%) (n = 114) (%) (n = 110) (%) (n = 137) (%) (n = 105) (%) (n = 111) (%) (n = 105) (%) (n = 135) (%) (n = 111)

Opioids
Methadone 74 71 73 73 16 27 22 21 2 3 2 1
(64,82) (62,79) (65,80) (64,81) (10,24) (20,37) (16,30) (14,30)
Morphine NA NA 54 62 NA NA 16 25 NA NA 6 6
(45,62) (52,71) (11,24) (17,34) (3,12) (3,13)
‘Homebake’ NA NA 18 24 NA NA 5 9 NA NA 1 1
heroin/ (12,25) (16,33) (3,11) (5,16)
morphine
Codeine NA NA 27 26 NA NA 21 16 NA NA 24 21
(20,35) (18,35) (15,29) (10,24) (18,32) (15,30)
Oxycodone NA NA 9 18* NA NA 3 5 NA NA 2 4
(5,15) (12,27) (1,8) (2,11)
Heroin 25 11 21 19 8 6 6 10 0 0 1 3
(17,35) (6,17) (15,29) (12,28) (4,15) (3,12) (3,12) (6,17)
Opium poppies NA NA 10 4 NA NA 5 3 NA NA 4 2
(6,17) (1,10) (2,10) (1,9)
Stimulants
Methylphenidate 43 46 37 40 21 26 23 22 13 15 19 19
(Ritalin) (33,53) (37,56) (29,46) (31,50) (15,30) (18,36) (17,31) (15,31) (8,21) (9,23) (13,26) (13,27)
Methamphetamine 40 44 47 50 100 97 100 100 21 23 13 13
(31,50) (35,53) (39,56) (40,60) (15,30) (16,32) (8,20) (8,20)
Ecstasy (MDMA) 30 22 18 13 50 51 47 41 100 100 100 100
(21,40) (15,31) (12,26) (7,21) (40,59) (42,61) (39,56) (32,51)
Cocaine 4 1 8 1 11 8 11 7 9 5 18 9
(6,18) (4,15) (6,17) (4,14) (5,15) (2,12) (13,26) (5,15)
Other drugs
Benzodiazepines 57 54 37 46 25 33 26 25 13 10 10 12
(47,67) (45,63) (29,45) (36,56) (18,34) (25,43) (19,34) (18,34) (8,20) (6,18) (6,16) (7,20)
Anti-depressants 8 9 19 18 5 14 14 12 3 5 7 6
(SSRIs) (4,16) (5,16) (13,27) (11,27) (2,11) (9,22) (9,21) (7,20) (1,9) (2,11) (4,13) (3,13)
Ketamine 5 6 1 7 6 13 8 10 10 11 9 20*
(3,13) (8,21) (4,14) (6,18) (6,17) (6,18) (5,15) (14,29)

*Statistically significant difference between 2009 and 2008 result at the P < 0.05 level.
Confidence intervals were not produced for rates of drug use that were extremely high or extremely low due to low numbers in either the ‘yes’ or ‘no’ category.
Pharmaceutical drug use by frequent illegal drug users
259

© 2011 Australasian Professional Society on Alcohol and other Drugs

260 C.Wilkins et al.

Table 3. Perceptions of availability and use of the four different opioid categories by combined frequent illegal drug users, 2009

Street/illicit Street/illicit ‘Homebake’ morphine/

morphine methadone heroin Heroin

2008 2009 2008 2009 2008 2009 2008 2009

Current availability
of opioids (%)
Number with (n = 110) (n = 108) (n = 86) (n = 78) (n = 27) (n = 45) (n = 38) (n = 40)
knowledge
Very easy [4] 40% 50% 32% 30% 19% 6% 20% 27%
Easy [3] 52% 40% 55% 47% 30% 43% 23% 22%
Difficult [2] 7% 9% 12% 21% 44% 43% 27% 22%
Very difficult [1] 1% 1% 1% 2% 7% 8% 30% 29%
Change in availability
of opioids (%)
Number with (n = 110) (n = 109) (n = 85) (n = 75) (n = 26) (n = 45) (n = 37) (n = 40)
knowledge
Easier [3] 13% 16% 7% 13% 11% 4% 17% 7%
Stable [2] 62% 60% 74% 67% 38% 46% 62% 55%
Fluctuates [2] 14% 7% 8% 5% 9% 9% 7% 7%
More difficult [1] 11% 17% 11% 14% 42% 41% 14% 30%
Number of people
using opioids (%)
Number with (n = 109) (n = 108) (n = 82) (n = 77) (n = 26) (n = 46) (n = 32) (n = 41)
knowledge
More [3] 22% 18% 31% 25% 32% 15% 22% 7%
Same [2] 59% 62% 65% 60% 46% 53% 45% 59%
Less [1] 19% 19% 4% 15%* 22% 31% 33% 34%

*Statistically significant difference between 2009 and 2008 result at the P < 0.05 level.

users had a prescription to use morphine in 2009 com-
pared to 2008 (6% vs. 19%, P = 0.0362).
The drug types most commonly used by the frequent
methamphetamine users in the past six months in 2009
were methamphetamine (100%), cannabis (85%),
tobacco (84%), alcohol (83%), crystal methamphet-
amine (53%) and ecstasy (41%). Substantial minorities
of the frequent methamphetamine users reported using
benzodiazepines, methylphenidate, morphine and
methadone over the past four years of surveying
(Table 2). Most of the frequent methamphetamine
users who had used methadone had injected it (i.e. 70%
in 2006, 58% in 2007, 65% in 2008, 78% in 2009) and
about half who had used methylphenidate had also
injected it (i.e. 55% in 2006, 62% in 2007, 56% in
2008, 54% in 2009). High proportions of the frequent
methamphetamine users reported having prescriptions
for anti-depressants (85% of those who had used them
in the previous six months) and methadone (74%), but
low proportions of frequent methamphetamine users
had prescriptions for oxycodone (0%), methylpheni-
date (8%) and morphine (8%) in 2009. Only some of
the frequent methamphetamine users had prescriptions
for codeine (42%) and benzodiazepines (34%) in 2009.
The drug types most commonly used by the frequent
ecstasy users in the past six months in 2009 were
© 2011 Australasian Professional Society on Alcohol and other Drugs
ecstasy (100%), alcohol (95%), cannabis (89%),
tobacco (68%) and LSD (47%). Very low proportions
of the frequent ecstasy users reported using methadone
and morphine over the four years of surveying
(Table 2). Substantial minorities of the frequent ecstasy
users had used methylphenidate and ketamine in recent
years. A higher proportion of the frequent ecstasy users
had used ketamine in 2009 compared to 2006 (20% vs.
10%, P = 0.0334) and in 2009 compared to 2008 (20%
vs. 9%, P = 0.0142). Low proportions of the frequent
ecstasy users had prescriptions for benzodiazepines
(13% of those who had used them in the previous six
months) and methylphenidate (0%) in 2009.
Current trends in availability and use of illicit opioids
High numbers of the frequent drug users reported they
had knowledge of ‘street/illicit morphine’ trends while
more modest numbers had knowledge of ‘heroin’ and
‘homebake’ morphine trends (Table 3). In 2009, 50% of
those with knowledge of street/illicit morphine
described the currently availability of street morphine as
‘very easy’ with a further 40% describing the availability
of street morphine as ‘easy’. In contrast, 29% of those
who had knowledge of heroin described the current
availability of heroin as ‘very difficult’ and a further 22%

said the availability of heroin was ‘difficult’.There was a
statistically significant difference in the reported current
availability of the different opioids in 2009 (c2 = 40.03,
d.f. = 3, P < 0.0001). Street/illicit morphine was consid-
ered to be currently more easily available than street/
illicit methadone (90% vs. 77%, P = 0.0440), heroin
(90% vs. 49%, P < 0.0001) and ‘homebake’ heroin
(90% vs. 49%, P < 0.0001). Street/illicit methadone was
also currently more available than heroin (77% vs. 49%,
P = 0.0072) and ‘homebake’ heroin (77% vs. 49%,
P = 0.0072). There was also a statistically significant
difference in the reported change in availability of the
different opioids in the past six months in 2009
(c2 = 15.46, d.f. = 3, P = 0.0015). A higher proportion
of knowledgeable respondents thought ‘homebake’
heroin had become ‘more difficult’ to obtain compared
to street/illicit morphine (41% vs. 17%, P = 0.0060) and
methadone (41% vs. 14%, P = 0.0054). A higher pro-
portion of those with knowledge of street methadone
trends thought ‘less’ people were using street methadone
in 2009 compared to 2008 (15% vs. 4%, P = 0.0227).
Discussion
This paper has examined the rate of pharmaceutical
drug use, levels of prescription use and levels of injec-
tion of pharmaceutical drugs by frequent injecting drug
users, frequent methamphetamine users and frequent
ecstasy users in New Zealand for the years 2006–2009.
An important contribution of our paper is to provide an
indication of the types of pharmaceutical drugs likely to
be used in an extra-medical manner by the newly
emerging groups of frequent drug users in New
Zealand (i.e. frequent methamphetamine users and fre-
quent ecstasy users).
High proportions of the frequent injecting drug users
had a prescription to use methadone but a high pro-
portion had also injected methadone. The injection of
methadone is associated with increased health prob-
lems due to the difficulties of injecting methadone in a
highly diluted form [18]. There are many benefits from
having injecting drug users enrolled in methadone
maintenance programmes and these benefits have been
found to increase with the length of time the patient is
on the programme [18]. These findings suggests that
the focus in these circumstances should be on keeping
patients in methadone programmes rather than taking a
punitive approach to continued injection of methadone
[18]. It has been suggested that an open and empathetic
relationship between the patient and clinician, as well as
the provision of harm minimisation information con-
cerning safe injection, can work toward reducing the
underlying reasons for continued injection of metha-
done and also reduce the immediate health risks of such
behaviour [18].
Pharmaceutical drug use by frequent illegal drug users 261
We found the injecting drug users had high levels of
use of pharmaceutical morphine rather than interna-
tionally sourced heroin, supporting the understanding
of the weakness of the heroin market in New Zealand.
A similar situation is found in the Northern Territory
and Tasmania, which like New Zealand are geographi-
cally isolated and have smaller populations compared
to the larger states of Australia [19]. Oxycodone
appears to be emerging as an opioid of abuse in New
Zealand and this appears to be directly related to its
wider use following the granting of a government
subsidy [14]. The frequent injecting drug users also
had high levels of use and injection of methylpheni-
date. Methylphenidate is largely used to treat
Attention-Deficit Hyperactivity Disorder (ADHD) in
children and the number of prescriptions for meth-
ylphenidate in New Zealand has increased consider-
ably over the past few decades in response to the
increase in the diagnoses of ADHD [6]. Methylpheni-
date has similar effects to amphetamine among adult
users and there have been anecdotal reports in New
Zealand of drug users using methylphenidate as a
substitute for methamphetamine in areas where meth-
amphetamine is less available [13]. Parents of children
receiving methylphenidate and the children them-
selves have been reported to sell or trade methylpheni-
date to drug seekers in New Zealand [13]. A survey of
students in the United States found 23% of those
receiving prescription stimulants for ADHD (such as
methylphenidate) reported being approached to sell,
give, or trade their prescription drugs [20].
The frequent methamphetamine users had also
used methadone and morphine in an extra-medical
manner, as well as methylphenidate and benzodiaz-
epines. The frequent ecstasy users had low levels of
use of morphine, methadone and ‘homebake’ mor-
phine use but sizable minorities were involved in the
extra-medical use of codeine, methylphenidate and
benzodiazepines. The differences in the extra-medical
use of pharmaceuticals between the frequent drug
user groups suggest that effective control strategies for
each group may differ. For example, regulations
restricting the non-prescription retail sale of codeine
products were tightening up in New Zealand in late
2010 (i.e. requiring codeine-based pain killers to be
sold by qualified pharmacists only and to be stored
behind the counter of pharmacies) and these moves
may be sufficient to discourage codeine use by fre-
quent ecstasy users who are largely occasional illegal
drug users [see 21]. Frequent methamphetamine
users in New Zealand appear to largely use meth-
ylphenidate as a substitute for methamphetamine in
circumstances where the availability of methamphet-
amine is difficult [13]. Consequently, steps to impose
greater controls over methylphenidate may be fairly
© 2011 Australasian Professional Society on Alcohol and other Drugs
262 C.Wilkins et al.
effective by making it more difficult to obtain relative
to methamphetamine. However, if tighter controls of
methylphenidate push more people back to using
methamphetamine this may not result in better out-
comes for users and their dependents.
Injecting drug users are likely to be the most difficult
to deter due to a combination of opioid dependency
and level of experience with pharmaceutical diversion
strategies. Efforts may be better focused on encourag-
ing injecting drug users to enter therapeutic relation-
ships where harm minimisation information can be
conveyed and underlying issues related to drug use
explored. It might also be worth exploring whether the
diversion of methadone was occurring because there
were real or perceived barriers to entering drug treat-
ment and receiving methadone as part of a legitimate
treatment programme.
We acknowledge a number of limitations to our
study. Firstly, our frequent drug user sample is a pur-
posive one and hence not representative of frequent
drug users in the site locations. Secondly, our sample is
limited to the three main urban centres of New
Zealand; frequent drug users in rural areas may have
different patterns of pharmaceutical drug use. Thirdly,
our one-off questions concerning whether a drug user
had a ‘prescription in their own name’ or had injected a
pharmaceutical in the previous six months were not
detailed enough to provide precise estimates of the
extent of extra-medical use. Those with a legitimate
prescription to use a pharmaceutical drug may still use
pharmaceuticals in an extra-medical manner and it is
not clear from our injection question how much of the
pharmaceutical drug was injected and hence used
extra-medically.
Our findings broadly support recommendations to
tighten the control of prescription drug use in New
Zealand [13]. Extra-medical use of pharmaceuticals
extended beyond injecting drug users to include fre-
quent methamphetamine users and even frequent
ecstasy users. Increasing control over pharmaceutical
drugs involves a delicate balance between reducing the
extra-medical use of pharmaceuticals while at the
same time not denying access to pharmaceuticals to
those with legitimate medical needs [13–15,22]. Also,
as noted in our discussion, there is a risk that tighter
restrictions of pharmaceuticals will drive some users
to obtain similar drugs from the illegal drugs market
or may drive them away from potentially helpful
therapeutic relationships. Policy changes which seek to
tighten the supply of pharmaceuticals need to con-
sider these unintended consequences. The differences
found in the patterns of pharmaceutical drug use
between the different frequent drug user groups
suggest that a ‘one size fits all’ response will not be
effective for all types of drug users.
© 2011 Australasian Professional Society on Alcohol and other Drugs
Acknowledgements
We would like to thank the anonymous referees for a
number of valuable comments and suggestions on our
paper. The IDMS is conducted as part of the New
Zealand National Drug Policy. We gratefully acknowl-
edge the support of a number of government agencies
including the New Zealand Police, New Zealand Min-
istry of Health and New Zealand Customs Service. We
would like to thank researchers at the National Drug
and Alcohol Research Centre (NDARC) for sharing
materials with us during the early development of the
IDMS. We also acknowledge the New Zealand Needle
Exchange who assisted us with the recruitment of fre-
quent drug users for the project.
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