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Is there an ice epidemic in A ustralia?

2015; Wiley; Volume: 24; Issue: 4 Linguagem: Inglês

10.1111/inm.12155

1447-0349

Kim Usher, Alan Clough, Cindy Woods, Jan Robertson,

HIV, Drug Use, Sexual Risk

Since the mid-2000s ‘ice’ (crystal methamphetamine) has received significant attention by the Australian media who appear responsible for naming the ‘ice’ problem as an epidemic (Fife-Yeomans et al. 2006). Media reports related to ‘ice’ continue to occur regularly on television and in the press with emphasis on issues such as ease of access to the drug, reduced costs (Lee 2015), the impact on emergency services (Fulde & Forster 2015), and police services, particularly homicides, motor vehicle accidents and aggressive and violent crimes (Buttler 2014; Conifer & Greene 2015). Sensational headlines such as: ‘crystal meth menace’; ‘tide of evil’; ‘deadly ice scourge’ and ‘the icy grip of creeping death’, have contributed to alarming perceptions of the size of the problem. Earlier this year the Premier of the state of Victoria stated, based on the 2013 National Drug Strategy Household Survey, that there were 80 000 ice users in his jurisdiction. However, based on the same information, the total number of crystal methamphetamine users is said to be more likely closer to 40 000 (Australian Broadcasting Corporation 2015). The Prime Minister of Australia recently announced the formation of a task force to coordinate a national response to the ‘drug epidemic way beyond anything we have seen before’ (Conifer & Greene 2015). Given the potential seriousness of this problem (Law Reform, Drugs and Crime Prevention Committee 2014), to question whether the media and politicians, including our ‘leader’, are using the terms ‘ice’ and ‘epidemic’ in a precise manner would seem pedantic. However, the question needs to be addressed, beginning with the recognition that crystalline methamphetamine represents a much purer form of methamphetamine, with more severe consequences for both users and service providers (Australian Institute of Health and Welfare 2014). The rapid spread of the use of the terms ‘ice’ warrants investigation. Epidemiological models of drug use highlight contagious processes, that is, the way in which other users influence the uptake and use of drugs. Economic models emphasize market factors of supply and demand (Gruenewald et al. 2013). Rapid expansion of use can be influenced by availability of the drug and social influences. Criteria for identification of an epidemic includes: high case rates; exponential growth of cases, or contagious dynamics exhibited by case growth (Gruenewald et al. 2013). So what is happening in Australia? Multiple forms of methamphetamine have been widely available in Australia since the 1990s. The highly potent crystal methamphetamine form of the drug, known as ‘ice’ because of its colourless form, became available in the early 2000s (McKetin & McLaren 2004), with related harms evident since the mid-2000s (Fulde & Wodak 2007). Between 2000 and 2006, surveys in three Australian cities demonstrated a significant increase in smoking of crystal methamphetamine (Kinner & Degenhardt 2008). Users of this purer form of methamphetamine report more frequent methamphetamine use and higher levels of dependence (Australian Institute of Health and Welfare 2014; Kinner & Degenhardt 2008). The number of people in Australia using methamphetamines weekly has grown from 9.3% in 2010 to 15.5% in 2013 (Australian Institute of Health and Welfare 2014). While there was not a significant increase in methamphetamine use overall from 2010 to 2013, there was a change in use from other forms to smoking of crystal meth. Daily or weekly ‘ice’ use has doubled from 12.4% in 2010 to 25% in 2013 (Australian Institute of Health and Welfare 2014). In addition, emergency service call-outs and presentations to hospitals where methamphetamines were the principal drug of concern have increased extensively, as have arrests for methamphetamine-related crime (Lee 2015). The number and weight of seizures of amphetamine-type stimulants (excluding MDMA), both nationally and at the Australian border, are currently at their highest recorded levels, as are the number of detected clandestine laboratories set up for the manufacture of these drugs (Australian Crime Commission 2015). Risk factors, identified in a review of international literature, for uptake of methamphetamines by youth, include a history of: risk-taking behaviour; psychiatric disorder; family history of crime and drug or alcohol use (Russell et al. 2008). Of the general population of Australia, people in remote and very remote areas (4.4%) are twice as likely to have used methamphetamines as people living in major urban settings (2.1%) (Australian Institute of Health and Welfare 2014). This is consistent with the increase of clandestine manufacturing laboratories in more remote locations in order to avoid detection by neighbours and/or law enforcement agencies (McKetin 2008). There is growing concern regarding the use of methamphetamines in the Australian Indigenous population, although currently clear evidence of the extent of the issue is lacking. Of further concern is the emergence of methamphetamine use, including ice, in remote Aboriginal communities. These communities are disadvantaged by distance, poverty, overcrowded housing, poor employment opportunities and limited access to services. Many of these locations have alcohol restrictions and high rates of cannabis use, along with well-established networks to supply these illicit substances (Delahunty & Putt 2006; Robertson-McMahon & Dowie 2008). In these settings the term ‘ice’ has been used by community members to describe a range of amphetamine-type stimulants, which may include powder or pill forms (Clough et al. 2015). Methamphetamine use is strongly associated with psychiatric disorders ranging from auditory hallucinations, paranoia, depression, self-harm, suicidal ideation and psychosis (Australian Drug Foundation 2014; McKetin et al. 2005). Disturbingly, methamphetamine-induced psychosis can be transient or may persist despite abstinence, particularly with young age of uptake, heavy use, schizoid disorder or pre-existing neurological disorders such as learning disorders (Vearrier et al. 2012). Indigenous Australian people are hospitalized for mental health conditions at twice the rate of non-Indigenous people and suicide rates are also at nearly twice that of the non-Indigenous population (Australian Institute of Health and Welfare 2015). While remote community strengths include connectedness, social contagion is a recognized phenomena with relation to suicide in these settings (Hanssens 2011). Furthermore, in remote locations in northern Australia a high burden of psychosis has been reported, associated with substance misuse and intellectual disability (Hunter et al. 2012). Psychosis is often associated with aggressive and violent behaviour, requiring intensive management by front-line service providers in the domains of health and law-enforcement. With mental health and drug and alcohol staff usually providing fly-in fly-out services only, local management of violent psychosis in remote settings is extremely challenging, posing safety risks for the patient, police, health staff, and community members. The management of a highly agitated patient may require acute sedation and highly expensive aeromedical transfer to appropriate psychiatric care (Le Cong et al. 2015). The implications of a growth in uptake of ice in these settings are severe in terms of community harm and limited resources. While there is a need for more cautious/accurate use of the terms ‘ice’ and ‘epidemic’, particularly by media and politicians, there is no doubt that the use of crystal methamphetamine is increasing and is highly problematic across the domains of health and law enforcement. While there are many calls for a greater investment in treatment services where methamphetamine use is established, there is also a need to identify high risk populations relatively free of the issue. Although use of methamphetamines has remained stable at 2% of the Australian population from 2010 to 2013, media sensationalism may be shaping public perceptions and anxieties about the scope and magnitude of the problem (Fitzgerald 2015). Does the use of crystal methamphetamine qualify as ‘epidemic'? Epidemic or not, further understanding of the market forces of supply and demand and the contagious process of social influence within the diversity of geographical contexts (urban, regional, rural, remote) may assist with targeted efforts for primary prevention initiatives where methamphetamine misuse is emerging and secondary prevention initiatives to reduce the uptake of harmful methods of use. Communities do not need to bear the brunt of policy decisions driven by media pressure and public opinion. There is a need for timely information gathering to inform cost-effective, evidence-based strategies suited to the maturity of the methamphetamine scourge within dissimilar contexts.