tag:theconversation.com,2011:/au/topics/methamphetamines-1070/articlesMethamphetamines – The Conversation2024-03-15T12:09:55Ztag:theconversation.com,2011:article/2256382024-03-15T12:09:55Z2024-03-15T12:09:55ZHow meth became an epidemic in America, and what’s happening now that it’s faded from the headlines<figure><img src="https://images.theconversation.com/files/582056/original/file-20240314-20-ipf1yd.jpg?ixlib=rb-1.1.0&rect=163%2C92%2C4570%2C3009&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Police detectives sort through evidence after raiding a suspected meth lab. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/UrbanMeth/62442edc986247c08ccfff109e7b07e0/photo?Query=meth%20AND%20rural&mediaType=photo&sortBy=creationdatetime:desc&dateRange=Anytime&totalCount=7&currentItemNo=6">AP Photo/Jeff Roberson</a></span></figcaption></figure><p><em>Rural America has long suffered from an <a href="https://theconversation.com/when-hes-not-on-drugs-hes-a-good-person-one-communitys-story-of-meth-use-and-domestic-violence-176069">epidemic of methamphetamine use</a>, which accounts for <a href="https://news.illinois.edu/view/6367/548454463">thousands of drug overdoses and deaths every year</a>.</em></p>
<p><em>William Garriott, an anthropologist at Drake University, explored meth’s impact on communities and everyday life in the U.S. in his 2011 book “<a href="https://nyupress.org/9780814732403/policing-methamphetamine/">Policing Methamphetamine: Narcopolitics in Rural America</a>.” Since then, the problem has only gotten worse.</em></p>
<p><em>The rural news site <a href="https://dailyyonder.com">the Daily Yonder</a> spoke with Garriott about what has been driving the <a href="https://www.nih.gov/news-events/nih-research-matters/trends-us-methamphetamine-use-associated-deaths">surge in meth use in recent decades</a> and what prompted him to focus on meth in his work. The Conversation has collaborated with The Daily Yonder to share the interview with you.</em></p>
<p><strong>How’d you get interested in methamphetamine as an academic subject?</strong></p>
<p>When I started my Ph.D in anthropology in 2003, I knew I wanted to focus on the Appalachian region of the United States. At the time, I was curious about religious life in the region and its contribution to the growth of Pentecostalism and evangelicalism around the world.</p>
<p>But I had also just taken a course with medical anthropologist Arthur Kleinman. He says that we should seek to understand “<a href="https://tannerlectures.utah.edu/_resources/documents/a-to-z/k/Kleinman99.pdf">what’s at stake</a>” or “<a href="https://global.oup.com/academic/product/what-really-matters-9780195331325?cc=us&lang=en&">what really matters</a>” for people in their everyday lives.</p>
<p>And what really mattered to people in places like eastern Kentucky at the time was drugs. We now know we were at the beginning of the opioid epidemic. OxyContin was already taking a toll on local communities, and there was little national concern because it was seen as an isolated regional problem (the derogatory term “hillbilly heroin” was <a href="https://www.theguardian.com/world/2001/jun/25/usa.julianborger">getting thrown around a lot</a> at the time).</p>
<p>When I started my dissertation research, methamphetamine had become the primary concern, both regionally and nationally. When the <a href="https://www.justice.gov/archive/ll/highlights.htm#%22%22">Patriot Act</a> was reauthorized in 2005, the only significant addition was anti-meth legislation called the <a href="https://www.deadiversion.usdoj.gov/meth/cma2005.html">Combat Meth Epidemic Act</a>.</p>
<p><strong>In what sense was the meth surge of the ’90s and early 2000s a rural phenomenon?</strong></p>
<p>Lots of ways. The internet gave people access to meth recipes, and meth cooks tended to be located in rural areas. It was easier to hide and access key ingredients like <a href="https://www.justice.gov/archive/ndic/pubs13/13853/product.htm">anhydrous ammonia</a>. In fact, the number of meth labs grew so quickly that huge swaths of the rural U.S. were labeled <a href="https://www.jstor.org/stable/10.5816/anthropologynow.5.1.0027">High Intensity Drug Trafficking Areas</a> – something that had only been applied to cities like New York and Los Angeles before.</p>
<p>The rural economy was also changing. Jobs weren’t paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs – something <a href="https://nyupress.org/9780814732403/policing-methamphetamine/">I saw</a> in the poultry industry in West Virginia, journalist <a href="https://www.bloomsbury.com/us/methland-9781608192076/">Nick Reding</a> found in the pork industry in Iowa, and anthropologist <a href="https://www.upress.umn.edu/book-division/books/the-alchemy-of-meth">Jason Pine</a> found in general in Missouri. Eventually some folks just left these jobs to work in the meth economy full time.</p>
<p>I think it’s also important to mention how meth was being portrayed in national media as the drug of choice for <a href="https://pubmed.ncbi.nlm.nih.gov/29733233/">poor white people</a>. From there, it doesn’t take much to connect it to rural communities, given how those communities are often thought of as predominantly white and poor in the public imagination.</p>
<p>Anti-meth programs like the <a href="https://montanameth.org/">Montana Meth Project</a> and <a href="https://www.oregonlive.com/pacific-northwest-news/2004/12/the_faces_of_meth.html">Faces of Meth</a> played a big part in this. They were very visual campaigns that focused on the damage meth does to the body. All of the people they pictured appeared to be white. They had sores, scars and sunken eyes. They also were often missing teeth. All of that invokes a lot of stereotypes. Sociologists Travis Linnemann and Tyler Wall have a great <a href="https://journals.sagepub.com/doi/10.1177/1362480612468934">journal article on this</a>.</p>
<p>With all of that said, it is important to keep in mind that meth is just as much an urban and suburban problem as a rural one, particularly now. Sociologist <a href="https://www.rutgersuniversitypress.org/women-on-ice/9780813554594/">Miriam Boeri</a> has made this point really clearly. Also, something to keep in mind about Faces of Meth: It was created by a jail deputy in Oregon who used mugshots of people booked into the county jail. The jail is in Portland, so the folks featured probably weren’t living in rural communities at the time.</p>
<p><strong>Your book was called “Policing Methamphetamine.” I’m curious – what made you zero in on that element of meth culture, its policing?</strong></p>
<p>When I began my research, I thought my focus would be on the treatment experiences of people who use methamphetamine. But what I quickly found was that those experiences couldn’t be understood outside of the criminal justice system. Many people only got treatment after an arrest, and often as a condition of probation. One officer told me that people came up to him on the street and asked to be taken to jail so they could stop using drugs. Community members also often channeled their concerns into calls for increased enforcement.</p>
<p>In retrospect, none of this should have been surprising. U.S. drug policy has long focused on <a href="https://www.britannica.com/topic/war-on-drugs">enforcement</a>. This puts police and the criminal justice system on the front lines whenever and wherever a new drug problem emerges. There is no exception to this dynamic for rural communities. What’s more, the justice system is likely to be the most visible and well-resourced state institution in the community (which is not to say it is sufficiently resourced).</p>
<p><strong>What are the questions you still have about meth in American life?</strong></p>
<p>Today, the most pressing question from my perspective is how meth and opioids are converging. One of the more unfortunate developments is that people have started <a href="https://www.health.state.mn.us/communities/opioids/basics/intravenous.html">injecting meth</a>. There is also the broad contamination of the drug supply with fentanyl.</p>
<p>All of this creates additional public health challenges, particularly in rural communities.</p>
<p>Something else I’m thinking about a lot is what happens when drugs like meth stop making headlines and get replaced by the next drug scourge. Today, people are much more likely to <a href="https://www.texastribune.org/2023/06/19/texas-fentanyl-drugs/">talk about fentanyl than meth</a>. This is understandable given the overdose risks, as well as the way news media works. But what are the consequences of this for the communities where meth is still a major concern?</p>
<p>Bigger picture, I’m thinking about meth in the broader context of U.S. drug policy. My next book is about marijuana legalization and justice reform. It’s been interesting because the conversation around cannabis is so different from the conversation around meth. One of the big questions I have is if the kinds of reforms that are following cannabis legalization will do anything to change the conversation around the broader punitive approach to drugs. <a href="https://www.opb.org/article/2024/03/04/oregon-drug-misdemeanor-new-convictions-arrests/">The debate happening right now in Oregon over Measure 110</a> is something I’m watching very closely. It’s a major test case for whether or not a different, less punitive approach to drugs is possible.</p>
<p><em><a href="https://dailyyonder.com">The Daily Yonder</a> provides news, commentary and analysis about and for rural America. The interview accompanies a five-part series on its <a href="https://open.spotify.com/show/41tCRxV4af8cl7CuJi6NsN?si=868e20efc47142e4">Rural Remix podcast</a>.</em></p><img src="https://counter.theconversation.com/content/225638/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Will Garriott received funding for his meth research from the National Science Foundation. His current work on marijuana legalization and cannabis policy reform has been funded by the Wenner Gren Foundation, Drake University, and the Center for the Humanities at Drake University.
</span></em></p>An anthropologist who wrote a book exploring meth’s impact on rural communities explains what drove the epidemic and how it’s changed.William Garriott, Professor of Law, Politics, and Society, Drake UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760692023-02-14T14:03:56Z2023-02-14T14:03:56Z‘When he’s not on drugs, he’s a good person’ – one community’s story of meth use and domestic violence<figure><img src="https://images.theconversation.com/files/497679/original/file-20221128-19-dvr0iq.jpg?ixlib=rb-1.1.0&rect=100%2C0%2C4674%2C3178&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Meth, control and violence have shaped, but not defined, the lives of women like Misty.</span> <span class="attribution"><span class="source">Photo by Jared Ragland</span></span></figcaption></figure><p>One night, after five days of smoking meth, Misty* heard a voice. </p>
<blockquote>
<p>It just said ‘BOOM! Get up’ and I got up and was like, ‘where’s my son?’ and I run to the bathroom and my little girl’s standing at the sink and I could see the water running and coming down the hallway and he was already blue at the bottom of the tub. So I grabbed him up and was like, I mean, panic – I couldn’t do nothing but sing ‘Amazing Grace.’ It’s the only thing I knew to do.</p>
</blockquote>
<p>Misty’s son, one of her five children, survived – he was saved by a neighbour who worked for the ambulance service in their Alabama community.</p>
<p>At first glance, Misty’s story is a cautionary tale against drug use, not unlike those portrayed in campaigns like the <a href="https://facesofmeth.us/">Faces of Meth</a> and the <a href="https://www.methproject.org/">Meth Project</a> in the US. Media depictions of people who use meth often show reductive, one-dimensional perspectives that demonise people as little more than monsters, criminals and addicts.</p>
<p>While the damaging effects of methamphetamine use are too often true and indeed tragic, as researchers we wanted to understand the greater nuance and complexities of those who used meth. We were particularly interested in the motivations for meth use and the notable gendered differences associated with it, and how those differences can contribute to harm and to gender inequality.</p>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
<hr>
<p>Misty was one of the 52 people we interviewed over 18 months in the south-eastern US state of Alabama. We developed close relationships with a dozen of them, and ultimately published our findings in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1745-9125.12295">the journal Criminology</a>. Central to our research was the role of images, particularly documentary-style photographs made with and by our participants. This was instrumental in helping us connect with them. It was a shared experience that allowed us all to be more comfortable with each other, and made it easier for them to share their stories. The collaborative process of making photographs with participants, showing them our photographs, and having them share theirs with us meant that the photos became intimately connected to data collection. </p>
<h2>An epidemic of meth use</h2>
<p>Rural America is suffering from an epidemic of meth use, accounting for thousands of <a href="https://pubmed.ncbi.nlm.nih.gov/34550301/">drug overdoses every year</a>. Almost 80% of people who use meth in these areas say they have used within the past month. Many of these people are women. Their stories are not just stories of addiction, but of motherhood, resilience and navigating abuse from their partners, much of which was closely linked to meth use.</p>
<p>We heard stories about how meth’s supposed sexual benefits exacerbated domestic abuse and <a href="https://journals.sagepub.com/doi/10.1177/1077801209347452">coercive control</a>. Men used violence and control to dictate when, where and with whom their romantic partners used meth, fearing the women would be unfaithful to them. Many sought to isolate, intimidate, manipulate, exploit and degrade their partners so that they could more easily control them. </p>
<p>Although men and women shared some similar motives for using meth, such as boosted energy and experiencing the high, there was significant divergence in how they spoke about the association between sex and meth. </p>
<p>As Chico, one of the male participants, explained:</p>
<blockquote>
<p>It’s about sex, sex, sex! It’s a sex drug, plain and simple … Anybody does it and says it don’t make them horny, they lying. … That’s what it’s designed for, to trick your brain to release more dopamine than it normally would and it floods it. That’s your pleasure to your brain. That’s what methamphetamine’s for. You should try it!</p>
</blockquote>
<figure class="align-center ">
<img alt="Black and white overhead view of a man's hands lighting a broken glass meth pipe. His arms are tattooed, and his bare feet are visible on the floor." src="https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494125/original/file-20221108-26-1933lr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chico lights up a broken meth pipe to smoke: ‘It’s about sex, sex, sex! It’s a sex drug, plain and simple.’</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<p>But the women we spoke to were less likely than men to say that meth increased their desire for sex. Even among those who said that sex was enhanced while on meth, none said this was their primary motivation for using. In fact, several said that meth diminished their desire for sex and inhibited some men from being able to perform. When we mentioned that the women seldom discussed the benefits of meth for sex, some men rejected these accounts. They countered by saying that women were not being forthcoming because they did not want others to think of them as being promiscuous.</p>
<p>It is probably no surprise that men and women talk about the sexual benefits of meth use differently. Social expectations that women be modest about their sexuality persist among all segments of society, but are especially prevalent in the American South. What was particularly interesting is how men’s stories about meth being a “sex drug” affected how they interacted with women, specifically their romantic partners. </p>
<figure class="align-center ">
<img alt="Michelle, a woman with long wavy hair wearing a tank top, stands in front of an open garage. Jennifer, who is mostly out of frame, holds out a cigarette towards Michelle." src="https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494128/original/file-20221108-18-ntqita.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Michelle and her sister Jennifer argued over whether meth increased their sex drives. ‘It turns me into a nympho,’ Michelle said. ‘Your sexual encounters are so much better on ice. You go for hours.’ Jennifer offered a different experience: ‘If I am high on meth, I don’t want to do anything.’ Jennifer said that a boyfriend had regularly coerced her into engaging in sexual activity that she did not like.</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<h2>Coercive control</h2>
<p>For the men who saw meth as primarily a sex drug, coercive control took various forms. Some women spoke of domestic abuse from their partners, ranging from threats to physical and sexual assaults. Several women said that their partners did not like them interacting with other men. Others spoke of how they tried to avoid falling victim to violence by carefully self-monitoring their behaviour:</p>
<blockquote>
<p>I have to be careful of the way I speak to men because they can take the tiniest smile or look the wrong way. </p>
</blockquote>
<p>Persistently being on guard so as to not upset or anger their partners was emotionally taxing for the women. Such guarded behaviour denied them the freedom to comfortably be themselves and highlighted how far men’s control extended. Indeed, women watched how they spoke and with whom they interacted even when the men were not with them. </p>
<p>Other men exerted control by insisting that their partners use meth with them. As one woman explained:</p>
<blockquote>
<p>I was afraid of getting beat up. It was more of the fear of, if I didn’t do what he says then something bad gonna happen to me or something to the kids … It was like he did not want to do it without me doing it … it was not an option for him. I had to do it when he did, if I didn’t it could get bad.</p>
</blockquote>
<p>It was common for the men to try to dictate the amount and frequency with which women used meth. The men believed that by policing meth use they could better protect their women from succumbing to the harmful effects of it, including mitigating the chances that women would be unfaithful. For other men, this meant encouraging their partners to use more meth to facilitate dependence, both on the drug and on their partners to supply it. </p>
<figure class="align-center ">
<img alt="Close up black and white photo of a young woman with a black eye." src="https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509203/original/file-20230209-18-bqi8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women often spoke of domestic abuse from their partners, ranging from threats to physical and sexual assaults. When asked how she received this black eye, Elle said that a partner was upset that she used drugs with another man.</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<h2>Misty: meth, control and motherhood</h2>
<p>Misty was introduced to meth by a boyfriend of her sister, who was dealing drugs. He decided he wouldn’t let Misty’s sister have any meth unless Misty also agreed to use. Misty assumed he did this in the hope she would have sex with him, and his coercion worked. Misty believed she could take a hit and be done. Instead, she found herself smoking for five days straight until she finally crashed, leading to the incident where her son nearly drowned.</p>
<p>When we met up with her early in the project, she was married to JC. He would frequently go on binges and disappear from home for days, sometimes weeks, at a time. JC eventually told us that he began using meth to cope with trauma from childhood, when he was sexually abused by a family friend. </p>
<blockquote>
<p>[Meth] blocks my memories and emotions out so I feel no pain, I feel no fear. I don’t think about it, it blocks it out.</p>
</blockquote>
<figure class="align-center ">
<img alt="Black and white photo of Misty, with an open mouth and smiling, kissing JC. Her bite marks can be seen on his neck." src="https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494130/original/file-20221108-20-re37m6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Despite what she describes as controlling and abusive behaviour, Misty considered herself a ‘ride or die’ wife to JC. They are pictured reuniting during JC’s jail work release job. He was serving a sentence following a domestic violence conviction.</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<p>It was clear that meth played a role in the instability of Misty and JC’s life together. She worried about him – wondering where he was and calling jails to look for him. But according to Misty’s account, he was abusive and controlling to her. He also used meth as a means of coercive control, not allowing Misty to get high with him: “It’s harder for me to not do it then it is for her, she’s good at not doing it.”</p>
<p>On one occasion, JC was in jail, we texted Misty to ask how they were doing. Her reply was heartbreaking – she told us that JC had assaulted her. But this was still not enough for her to leave him. In fact, she said she violated restraining orders to visit JC in jail – an act that could have led to her own arrest. Misty viewed herself as a “ride or die” wife, often excusing and forgiving JC’s controlling and abusive behaviour. </p>
<blockquote>
<p>I know when he’s not high and when he’s not on drugs, he’s a good person. And if I can get that person out and get him off drugs, we’d have the best marriage ever.</p>
</blockquote>
<p>It was ultimately Misty’s role as a mother that helped her leave JC and give up meth completely. The impetus came when she saw that JC’s abuse was clearly affecting her youngest son, Michael. </p>
<blockquote>
<p>What made me really, really leave JC – well, my son looked me in my face and told me: ‘One thing that’s gonna kill you is you gonna die by JC’s hands.’ I had to get out. He saved me. He’s my little hero.</p>
</blockquote>
<p>Misty now has a steady boyfriend, a full-time job, her own home and an improved relationship with her children. </p>
<h2>Alice</h2>
<p>Alice also began using meth due to pressure from a man – her then-boyfriend, Ryan. When we met, Alice was 21 and using meth daily. In our first interactions she was detached, quiet and reserved, often staying in a back room of the trailer to minimise interactions with us or anyone else who might come into the home. Eventually, she came to trust us and shared her plans for the future. More than anything, Alice wanted to regain custody of her daughter. </p>
<p>Alice married young and had a daughter soon after graduating high school. Her marriage was short-lived – she said her husband had been unfaithful, leaving her for someone she considered a good friend. For much of Alice’s life, men had not played stable, caring roles. She believed that her father cared more about her brother than he did about her. Her romantic relationships throughout high school were abusive and characterised by infidelity. </p>
<p>She was sexually assaulted by a friend of the family, but said her mother did not believe her when she spoke about it. After her divorce, Alice was left struggling with feelings of abandonment. To combat this struggle, she began looking for excitement, and she found it in a new relationship with Ryan.</p>
<figure class="align-center ">
<img alt="Black and white photo of Alice, a young woman with dark hair, sitting on a bed inside a trailer, with a sheet hanging over the window." src="https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506799/original/file-20230127-3249-lgo9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alice, sitting on the bed she shared with Chico. She said she would sometimes wake in the middle of the night with a needle in her arm, not knowing who had put it there.</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<p>Ryan had a youthful, dangerous charisma. He was a regular user of spice (synthetic cannabinoids) and meth. Although she resisted using for a while, Ryan was persistent and manipulative. Several months into their relationship, he made Alice an offer. He would quit meth but with a symbolic gesture: his last time would be her first time. The plan was that after they used together, they would break the pipe together, and then neither use again. But as Alice said: “We never broke that pipe.”</p>
<p>Their meth use steadily increased. Alice betrayed family members so often they no longer let her stay with them, or even come into their house. She and Ryan ended up staying with Chico at his mobile home. Nearly twice their age, Chico had used, manufactured and sold meth for more than two decades. His trap house – where drugs are sold – was known across the county. It was at Chico’s that Alice’s meth use led to her being ostracised by her family and losing custody of her daughter. </p>
<figure class="align-left ">
<img alt="Dark photo of a woman's silhouette" src="https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1340&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1340&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497779/original/file-20221128-14-nq66tz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1340&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alice’s self-portrait reflecting how she felt after being demeaned by Ryan.</span>
<span class="attribution"><span class="source">Jared Ragland</span></span>
</figcaption>
</figure>
<p>She and Ryan were out on their own, describing themselves as a modern-day Bonnie and Clyde. But once Ryan was arrested for passing counterfeit money, Alice had nowhere to go except Chico’s. </p>
<p>Chico and Alice’s relationship was complicated. Whereas Ryan tried to control her drug use by not letting her use on her own and controlling how much she used, Chico pushed drugs on to her. She began using with needles and her meth use increased substantially. She believes that Chico would shoot her up while she was sleeping to get her further addicted and to coerce sex from her. </p>
<p>After Ryan’s release from jail, he and Alice made a go at staying free from meth. They found a trailer to share with another couple and their newborn baby. But the allure of meth was too strong, and they both began using again. One night while using, Ryan demanded to know what happened between Alice and Chico. She sent us a selfie she made during their argument. The picture featured a dark, featureless silhouette. </p>
<blockquote>
<p>This is at the hotel when Ryan had brought up all the Chico stuff, everything came out, because he finally wanted to know everything. I told him that I didn’t want to tell him because I knew he was going to really blow things out of proportion, and when he gets mad he’s got a mouth on him and doesn’t care who hears it and we were at a hotel. He started using a bunch of colourful names and not so nice things. … In the picture I am in the dark, where I felt like I belonged.</p>
</blockquote>
<p>Ryan struggled with the fact that Alice had shared a needle with Chico. To him it was a bond that she should have had with him, not Chico. Eventually, Ryan and Alice split up. After bouncing between several homes and relationships – a common occurrence for those who chronically use meth – Alice eventually found a place to stay that provided her with the stability she needed to get a job and begin the process of regaining custody of her daughter. Alice is now over three years free of meth. More importantly, she has a steady job, a place of her own and full custody of her daughter. </p>
<p>“The only thing that really bothers me is when I think about what it felt like to get high, and I miss it,” Alice told us. “And then I’m like, no, it’s not worth it. It took me a long time to get back to being who I am, and I’m a mom.”</p>
<figure class="align-center ">
<img alt="Black and white photo of a young woman smiling down at a girl, who she is holding in her arms on a couch" src="https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497683/original/file-20221128-24-rtgg30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alice, reunited with her daughter.</span>
<span class="attribution"><span class="source">Photo by Jared Ragland</span></span>
</figcaption>
</figure>
<p>The stories and narratives we tell do more than simply relay the past. They can also shape behaviour and relationships. Whether it is narratives of coercion and control like those attributed to Chico and JC, or of redemption and recovery experienced by Misty and Alice, these stories reflect powerful cultural expectations and gender norms, and guide behaviour like drug use and abuse.</p>
<p>It is through analysing these stories that we can understand the complexities and nuanced natures of marginalised people and communities.</p>
<p><em>*All names have been changed.</em></p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
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<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Photographing the lives of women meth users in rural America.Heith Copes, Professor, Department of Criminal Justice, University of Alabama at BirminghamFiona Brookman, Professor of Criminology, University of South WalesJared Ragland, Assistant Professor, Photography, Utah State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849262022-06-19T12:50:48Z2022-06-19T12:50:48ZDecriminalizing hard drugs in B.C. follows decades of public health advocacy<figure><img src="https://images.theconversation.com/files/469560/original/file-20220617-14205-7slb7v.JPG?ixlib=rb-1.1.0&rect=0%2C467%2C5439%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">B.C. Minister of Mental Health and Addictions Sheila Malcolmson holds a copy of exemption documents that enable British Columbia to decriminalize possession of small amounts of 'hard' drugs for personal use. B.C.’s bold experiment will be closely watched as a comparator with other progressive jurisdictions.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalizing-hard-drugs-in-b-c--follows-decades-of-public-health-advocacy" width="100%" height="400"></iframe>
<p><a href="https://globalnews.ca/news/8882290/bc-overdose-crisis-decriminalize-possession/?utm_source=NewsletterNational&utm_medium=Email&utm_campaign=2022">British Columbia has become</a> the first province to be granted an exemption under the <a href="https://laws-lois.justice.gc.ca/eng/acts/c-38.8/">Controlled Drugs and Substances Act</a> to remove criminal penalties for possession of opioids, cocaine, methamphetamine and MDMA for personal use. </p>
<p>This means that police will no longer arrest, charge or seize drugs from adults found with 2.5 grams or less of these substances. Instead, people with drugs will be offered information on available health and social services and assistance with referrals to access treatment if they choose.</p>
<p>B.C.’s bold experiment to decriminalize “hard” drugs will be closely watched as a comparator with other progressive jurisdictions, such as <a href="https://www.pbs.org/newshour/politics/oregon-1st-state-to-decriminalize-possession-of-hard-drugs">Oregon</a> and <a href="https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it">Portugal</a>. Decriminalization in these places has been implemented differently, reflecting the distinctive circumstances and priorities that influence drug policy in different global contexts.</p>
<p>As a sociologist who has been studying drug policy development in Canada for nearly 30 years, it is plainly evident to me that decision-making is a political process that does not rest on facts alone. <a href="https://doi.org/10.1017/S0829320100006566">Drug policy</a> reflects <a href="https://doi.org/10.1080/0959523021000023270">ideological commitments</a> that are influenced by, and in turn influence, prevailing public understandings and opinions about drugs. <a href="https://doi.org/10.1080/09595230500404145">Exposure to the facts</a> — which are also contested — and <a href="https://doi.org/10.1016/S0955-3959(01)00085-8">constructive dialogue about social norms and values</a> is needed to facilitate more meaningful debate. </p>
<figure class="align-center ">
<img alt="Cropped image of a group of people, one of whom is holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advocates gather in Victoria to mark the anniversary of the declaration of a public health emergency in opioid-related overdoses in British Columbia on April 14.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Decriminalizing drug use is the <a href="https://www.oupcanada.com/catalog/9780199007882.html">realization of 50 years of policy discussions</a> advocating for removal of all penalties for small amounts of drugs. The called-for public health perspective is just beginning to materialize, despite extensive evidence that <a href="https://cannabiscoalition.ca/info/HarmReductionHeadway_Resistance_IJDPX2008.pdf">the war on drugs has failed</a>. The research evidence instead supports the view that prohibition of substance use has been ineffective, costly, inhumane and harmful to the user and society.</p>
<h2>Why so little progress for so long?</h2>
<p>Canada has long pursued half-measures by adopting a hybrid model recognizing public health considerations within a legal framework that enforces prohibition. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947221/pdf/canmedaj01573-0103.pdf">LeDain Commission of Inquiry</a> in 1972 proposed a gradual withdrawal from criminal penalties for illicit drug possession, phasing out incarceration in favour of medical treatment. </p>
<p>The LeDain report foreshadowed the emergence of drug policy with the goal of <a href="https://ontario.cmha.ca/harm-reduction/">harm reduction</a> and the need for more attention to the principles that underlie drug policy debates. What is meant by “harm” has been contentious when determining the proper role of law when the police and politicians define harm in ways that justify continued prohibition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman at a podium in front of a row of flags, and two other women at opposite sides of stage, in front of background with the words 'A pathway to hope'" src="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Minister of Mental Health and Addictions Sheila Malcolmson discusses details about the province’s application for decriminalization at the provincial legislature in Victoria on Nov. 1, 2021, as provincial health officer Dr. Bonnie Henry and chief coroner Lisa Lapointe look on.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Ten years after the LeDain report, the enactment of the <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/">Charter of Rights and Freedoms</a> provided legal tools that complement more scientific evidence-based arguments for drug policy reform. The success of <a href="https://doi.org/10.1017/S0829320100006566">legal challenges on Charter grounds</a>, however, has been largely limited to striking down the most egregious policing practices and penalties for drug crimes.</p>
<p>Sweeping changes in the law might well have been expected with the launch of <a href="https://www.csc-scc.gc.ca/research/forum/e133/133a_e.pdf">Canada’s Drug Strategy</a> in 1987. The language change was monumental: it covered the full spectrum of non-medical drug use, including legal drugs like alcohol, prescription drugs and even solvents; and it signalled an intent to set out in a new direction that dramatically departed from the war-on-drugs approach. </p>
<p>The implementation of the strategy, however, was much less so. Police continued to command the lion’s share of funding, despite the promise of pursuing a “more balanced” and coherent public health approach to substance use. </p>
<p>Thirty-five years later, the situation has changed little. In 2018, after decades of debate, but little action indicating actual commitment to reform, <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis was legalized in Canada</a>, transforming its users from pariahs to responsible consumers. Users of more dangerous drugs continue to be treated differently, primarily because such use elicits more concern for crime control than protecting health. </p>
<h2>Lessons from other jurisdictions</h2>
<p>In Oregon, the lack of full commitment to a public health approach explains the <a href="https://abcnews.go.com/Health/wireStory/oregon-decriminalized-drugs-2020-hows-83846382">“mixed results.”</a> U.S.-style decriminalization there has been adopted as a social justice remedy to mitigate the impact of policing on marginalized communities.</p>
<p>In 2020, Oregon voters approved a <a href="https://www.oregonlegislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf">ballot measure to decriminalize hard drugs</a> as a way to keep addicts out of prison and get them into treatment. Possession of controlled substances is now a “violation” carrying a maximum US$100 fine. The fine is waived if the offender calls a hotline for assessment, which may lead to them receiving treatment. </p>
<p>However, after the first year, just one per cent had used the hotline, and nearly half did not show up to court, prompting criticism that the system is too lenient.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black wall with colourful handprints and names on it" src="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some of the handprints of people recovering from drug addiction are seen on a wall in the parking lot of an addiction recovery centre in McMinnville, Ore., on Dec. 9, 2021.</span>
<span class="attribution"><span class="source">(AP Photo/Andrew Selsky)</span></span>
</figcaption>
</figure>
<p>Portugal’s adoption of decriminalization measures has been <a href="https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight">implemented more successfully</a>, in part because its social safety net is far more comprehensive and better integrated with the criminal justice system. </p>
<p>Portugal’s approach is both more vigorous and nuanced, recognizing that most drug use is “low risk” and requires no intervention. The vast majority of cases referred by the police are deemed non-problematic and the charges are suspended. Those who have a pattern of repeated violations may be issued fines or offered counselling appointments. Substance use dependence and abuse in high-risk cases more often triggers a referral for non-mandatory treatment. </p>
<p>Portugal’s adoption of a graduated system of intervention demonstrates a view that is consistent with coherent harm reduction policy development. Drug use is treated as a health issue. And the proof is in the pudding. Since these measures were enacted in 2001, drug-related deaths and rates of drug use have remained below the European Union average. The rates of HIV infection from injection drug use, and incarceration for committing drug offences, have also been dramatically reduced. </p>
<p>Canada’s adoption of a public health perspective on substance use is hampered by its failure to address the inconsistencies inherent in its hybridized approach. Enacting harm reduction within a prohibition framework perversely criminalizes people recognized as needing help.</p>
<p>B.C.’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs. Much can be learned from other places in deciding the path forward, and the world is waiting for new lessons to be learned.</p><img src="https://counter.theconversation.com/content/184926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Hathaway does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>British Columbia’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs.Andrew Hathaway, Professor, Department of Sociology and Anthropology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671002021-09-16T12:11:03Z2021-09-16T12:11:03ZOxyContin created the opioid crisis, but stigma and prohibition have fueled it<figure><img src="https://images.theconversation.com/files/421389/original/file-20210915-17-1lvjamv.jpg?ixlib=rb-1.1.0&rect=6%2C12%2C997%2C597&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People around the world mourned loved ones on International Overdose Awareness Day on Aug. 31, 2021.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/edmontonians-pose-wooden-crosses-with-roses-on-news-photo/1234986137?adppopup=true"> NurPhoto/Getty Images</a></span></figcaption></figure><p>The <a href="https://theconversation.com/how-the-purdue-opioid-settlement-could-help-the-public-understand-the-roots-of-the-drug-crisis-166701">highly contentious</a> <a href="https://www.npr.org/2021/09/01/1031053251/sackler-family-immunity-purdue-pharma-oxcyontin-opioid-epidemic">Purdue Pharma settlement</a> announced Sept. 1, 2021, comes at a pivotal time for the U.S. overdose crisis: 2020 was the worst year on record, with over <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">93,000 Americans</a> losing their lives to fatal drug overdose. The drug overdose epidemic, now more than two decades long, has claimed the lives of <a href="https://www.cdc.gov/opioids/data/index.html">more than 840,000</a> people since 1999. Current estimates suggest that some <a href="https://www.rand.org/content/dam/rand/pubs/research_reports/RR3100/RR3140/RAND_RR3140.pdf">2.3 million people</a> in the U.S. use heroin and <a href="https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis">1.7 million people</a> use pharmaceutical opioids without a prescription. </p>
<p>Since 2016, I’ve <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">studied the overdose crisis</a> with an eye to understanding its roots as well as its ramifications. As a <a href="https://www.holycross.edu/academics/programs/sociology-and-anthropology/faculty/emily_b_campbell">sociologist</a>, I came to this area of research in my own quest for meaning, as each year brought more funerals of former classmates and friends. What I found was an increasingly dangerous drug environment for people who use drugs, often exacerbated by policies not founded in research and by attitudes that harm those affected.</p>
<h2>How prohibition fuels dangerous markets</h2>
<p>Research shows that <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">the illicit drug market adapts</a> to both demand and drug enforcement efforts. </p>
<p>The first consequence of increased demand is that drugs become <a href="https://doi.org/10.1016/j.drugpo.2007.11.016">cheaper over time</a>. For example, the price of heroin and cocaine have been falling for decades. Political economists explain that demand, coupled with globalization, increases efficiency and competition. The result is that there are more drugs on the illicit market, which in turn lowers prices. </p>
<p>Second, as a response to drug prohibition, <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">drugs become more potent</a>. A stronger product in a smaller package is easier to transport and harder to detect. The American overdose crisis has become <a href="https://doi.org/10.1016/j.drugpo.2017.05.050">a case study</a> in the devastating interplay of demand and prohibition. </p>
<p>OxyContin was released in 1996 and <a href="https://doi.org/10.2105/AJPH.2007.131714">mass-marketed as a revolutionary intervention</a> in the medical treatment of pain. Purdue Pharma, its maker, <a href="https://www.nytimes.com/2007/05/10/business/11drug-web.html?smid=url-share">knowingly downplayed</a> its addictive potential. As an opioid and central nervous depressant, <a href="https://doi.org/10.1300/J069v23n04_01">OxyContin has effects</a> similar to those of morphine or heroin. Not surprisingly, studies show that prescription patterns of opioids from 1999 to 2008 were <a href="https://pubmed.ncbi.nlm.nih.gov/22048730/">directly linked to a surge in overdose deaths</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pill bottle and pills of OxyContin prescription-only pain medication" src="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420692/original/file-20210913-27-4nizsn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Oxycontin prescription-only pills were aggressively promoted to primary care physicians as a safe and effective pain control method for patients.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/oxycontin-pills-oxycodone-hydrochloride-prescription-only-news-photo/563590877?adppopup=true">Lawrence K. Ho/Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<p>As concern over opioid overdose grew, doctors’ prescribing practices <a href="https://doi.org/10.1007/s11013-016-9496-5">came under scrutiny</a>. In 2010, Purdue Pharma replaced the original OxyContin with an <a href="https://doi.org/10.1001/jamapsychiatry.2014.3043">“abuse deterrent” formulation</a> that was more difficult to crush and inhale. As a result, many people who were addicted to OxyContin turned to heroin, which was <a href="https://doi.org/10.1162/rest_a_00755">cheaper and easier to get</a>. This spurred a surge in heroin-related fatal overdoses, which is often termed the <a href="https://doi.org/10.1016/j.drugpo.2019.01.010">second wave of the overdose crisis</a>.</p>
<p>The growing market for heroin paved the way for the <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">introduction of fentanyl</a> into the illicit U.S. drug market. Fentanyl, a drug used in medical settings for severe pain, is <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">50 times more potent than heroin</a>. From the standpoint of efficiency for shipping and trafficking, fentanyl is easier to transport and sell than heroin. Fentanyl’s entry into the illicit drug market, in particular in combination with heroin, <a href="https://doi.org/10.1016/j.drugpo.2017.06.010">led to a doubling and tripling </a>of overdose deaths around 2012 to 2013. </p>
<p><a href="https://journals.lww.com/co-psychiatry/fulltext/2021/07000/the_rise_of_illicit_fentanyls,_stimulants_and_the.4.aspx">Since then, fentanyl</a> <a href="https://doi.org/10.1016/j.drugpo.2021.103353">has contaminated</a> the U.S. illicit drug supply: It is often found in not just heroin but cocaine, MDMA – commonly known as Ecstasy – methamphetamine and counterfeit prescription pills. The result is that most people <a href="https://doi.org/10.1016/j.drugpo.2019.07.008">do not know the potency or contents</a> of what they are using. </p>
<p>As the overdose crisis evolves, <a href="https://doi.org/10.1007/s40615-021-01007-6">communities of color</a> in particular have experienced a surge in fatal overdoses – deaths that are often preventable. And most recently, COVID-19 supply chain disruptions led people to use whatever was available, causing <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306256">a surge in overdoses</a> from drug mixing. </p>
<h2>Barriers to treatment</h2>
<p>Too often, people who use drugs are bombarded with messages that are not supported by research and that deepen the harm. </p>
<p>Public health officials and community leaders urge people to seek treatment and highlight that recovery is within reach. Yet, roughly 70% of people who seek treatment are <a href="https://www.rcorp-ta.org/sites/default/files/2020-06/Improving-Access-to-Evidence-Based-Medical-Treatment-for-OUD_FINAL.pdf">unable to access it</a>. <a href="https://doi.org/10.1080/10826084.2017.1363238">Barriers to treatment</a> include health care costs, lack of available treatment options and social stigma. Research also demonstrates that some people are not ready for treatment or <a href="https://doi.org/10.1080/10826084.2017.1310247">do not want to be sober</a>.</p>
<p>Sobriety is touted as the ultimate goal for people who use drugs. Yet research shows that addiction is a <a href="https://doi.org/10.1038/s41386-020-00950-y">recurring brain disease</a>, and relapse is highly likely. Most people who use drugs do so in a <a href="https://www.ucpress.edu/book/9780520293472/hurt">sporadic way</a> that features bouts of controlled and uncontrolled use as well as sobriety. It is also well documented that fear of arrest and shame encourages people to hide their drug use in ways that <a href="https://doi.org/10.1080/10826084.2020.1790008">increase their risk</a> of a fatal overdose. This is because when people use alone, there is no one there to call 911 or perform CPR should an overdose occur. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding up phone with image of brother and son who died after taking fentanyl-laced drugs" src="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420698/original/file-20210913-23-1llv382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Laurie Restivo’s brother, David Restivo, 47 (left on phone image), died from fentanyl-laced heroin, and her son, Jason Fisher Jr., 25 (right), died from fentanyl-laced cocaine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fentanyl-overdose-restivo-johnson-laurie-restivo-displays-a-news-photo/1315873058?adppopup=true">Reading Eagle/MediaNews Group via Getty Images</a></span>
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<p>In terms of effective treatment, <a href="https://doi.org/10.1176/appi.ps.201300256">medically assisted treatments</a> are considered the gold standard for opioid use disorder, yet they are still <a href="https://doi.org/10.1111/jrh.12328">underutilized</a>. <a href="https://doi.org/10.1001/jama.2021.1741">Buprenorphine</a> is an opioid with a “ceiling effect,” meaning it does not intoxicate like morphine or heroin but instead satiates an opioid craving. Buprenorphine assists people in transitioning away from uncontrolled use and mitigates physical cravings. People who are prescribed it are often able to work, attend therapy and regain enjoyment of day-to-day life. </p>
<p>Nonetheless, buprenorphine’s availability <a href="https://doi.org/10.1002/pds.4984">varies widely by state</a>, and people of color are <a href="https://doi.org/10.1377/hlthaff.2020.02261">persistently underprescribed</a> this lifesaving medication. Methadone has been used as a treatment for opioid use disorder since the 1950s, yet it is persistently <a href="https://doi.org/10.1007/s11606-018-4801-3">hard to access</a> long term. Researchers point to the <a href="https://doi.org/10.1080/08897077.2019.1640833">ongoing role of stigma</a> in the underuse of both of these medications. </p>
<h2>Better paths forward</h2>
<p>Public health officials, harm reduction activists and concerned citizens across the U.S. are working to secure <a href="https://doi.org/10.1097/01.NPR.0000534948.52123.fb">safer injection sites</a> where people can use drugs in the presence of medical staff. Such sites facilitate the prevention of fatal overdose by assuring an adequate and timely medical response and open a pathway for further health care and addiction-related treatment. In response to the pandemic’s strains on inpatient care facilities, <a href="https://doi.org/10.1016/j.jsat.2021.108552">take-home methadone</a> availability was expanded in new ways – a change that some treatment experts <a href="https://doi.org/10.1016/j.jsat.2020.108246">hope will be permanent</a>. </p>
<p>For people who use drugs, the <a href="https://doi.org/10.1016/j.jhealeco.2019.01.001">potency and contents of their drugs are often unknown</a>. <a href="https://doi.org/10.1016/j.drugpo.2018.10.001">Drug-checking programs</a> allow people to inspect the <a href="https://doi.org/10.1016/j.drugpo.2018.09.009">contents of their drugs for fentanyl</a> at home with a simple test strip. Such programs have recently gained traction with <a href="https://www.cdc.gov/media/releases/2021/p0407-Fentanyl-Test-Strips.html">federal support</a>. States also continue to expand <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049966/">access to naloxone</a>, an overdose reversal nasal spray that is simple to administer. People who use drugs or have loved ones who use drugs are encouraged to receive training on how to administer naloxone and to carry the nasal spray on them. </p>
<p>Those who argue for a <a href="https://doi.org/10.1503/cmaj.201618">safer supply</a> and <a href="https://doi.org/10.1016/j.socscimed.2021.113986">decriminalization of drugs</a> point to success abroad. <a href="https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1263/RAND_WR1263.pdf">Heroin-assisted treatment</a> is shown to be effective in keeping people away from an unpredictable drug market, thus lowering the risk of overdose. Germany’s use of <a href="https://doi.org/10.1111/j.1360-0443.2008.02185.x">heroin-assisted treatment</a> improved patients’ physical and mental health while dramatically reducing illicit drug use. In the early 2000s, <a href="https://doi.org/10.1177/2050324516683640">Portugal decriminalized</a> all drugs in response to consistently having the highest fatal overdose rates in Western Europe. With diversion of funds away from prohibition to education and treatment, Portugal saw a drop in overall drug use and now boasts among the lowest fatal overdose rates in Western Europe.</p>
<p>Americans are the world’s <a href="https://doi.org/10.1111/add.14234">largest consumers</a> of drugs and consistently have among the highest rates of opioid and cocaine dependence globally. In <a href="https://gc-cuny.academia.edu/EmilyCampbell?from_navbar=true">my own research</a>, I’ve found that people often describe drug use as a battle between sobriety and death. But the heartbreaking surge in accidental, fatal overdose deaths tells a much more complex story. Ignoring the evidence will surely cost many more lives.</p>
<p><em>If you or someone you care about has a substance use disorder and wants help, you can call SAMHSA’s National Helpline: 1-800-662-HELP (4357). Immediate emotional support is available from the National Suicide Prevention Hotline 800-273-8255.</em> </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167100/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily B. Campbell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>False narratives about drug addiction and policies that are not supported by research are deepening the overdose epidemic in the US.Emily B. Campbell, Visiting Assistant Professor of Sociology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637562021-07-06T22:03:48Z2021-07-06T22:03:48ZFish hooked on meth – the consequences of freshwater pollution<figure><img src="https://images.theconversation.com/files/409852/original/file-20210706-13-d05bln.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2650%2C1662&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/underwater-photo-brown-trout-salmo-trutta-102700592">Kletr/Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html">269 million people worldwide</a> use drugs each year. Often forgotten in this story is a problem of basic biology. What goes in must come out. Sewers are inundated with drugs that are excreted from the body, along with the broken down chemical components that have similar effects to the drugs themselves.</p>
<p>Sewage treatment plants don’t filter these things out – they were never designed for it. A lot of sewage also finds its way into <a href="https://www.theguardian.com/environment/2020/jul/01/water-firms-raw-sewage-england-rivers">rivers and coastal waters untreated</a>. Once in the environment, drugs and their byproducts can affect wildlife. In <a href="https://journals.biologists.com/jeb/article-lookup/doi/10.1242/jeb.242145">a recent study</a> published in the Journal of Experimental Biology, researchers in the Czech Republic investigated how methamphetamine – a stimulant with <a href="https://www.unodc.org/wdr2017/press/WDR17_Fact_sheet.pdf">a growing number of users</a> worldwide – might be affecting wild brown trout.</p>
<p>They examined whether concentrations of methamphetamine and one of its byproducts, amphetamine, which were estimated from other studies that have measured illicit drug concentrations in waterways, could be detected in the brains of brown trout. They also looked at whether these concentrations were enough to cause the animals to become addicted. </p>
<figure class="align-center ">
<img alt="White methamphetamine crystals on a black background with a glass meth pipe." src="https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409868/original/file-20210706-27-y359uz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recreational methamphetamine users often smoke crystal meth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-pile-methamphetamine-crystals-blue-glass-1314852365">AMF Photography/Shutterstock</a></span>
</figcaption>
</figure>
<p>The trout were exposed to the drug in large tanks over eight weeks and then put into withdrawal, going “cold turkey” in drug-free tanks for ten days. During that time, the researchers tested the fish’s preference for fresh water or water containing methamphetamine and compared this with the responses of fish that had never been exposed to the drug. </p>
<p>Their findings were intriguing. The methamphetamine-exposed fish preferred the water containing the drug, while no such preference was shown for the untreated fish. The researchers also found that during their withdrawal period, the methamphetamine-exposed trout moved less. The researchers interpreted this as a sign of anxiety or stress – typical signs of drug withdrawal in humans. </p>
<p>The brain chemistry of the exposed fish differed from the unexposed, too, with several detected changes in brain chemicals that correspond to what is seen in cases of human addiction. Even after the behavioural effects had waned after ten days of withdrawal, these markers in the brain were still present. This suggests that methamphetamine exposure could have long-lasting effects, similar to what is seen in people.</p>
<h2>How drugs affect ecosystems and fish biology</h2>
<p>Why should we care if trout are becoming addicted to drugs? There are several reasons.</p>
<p>If the trout are “enjoying” the drugs, as they appear to be in the recent study, they may be inclined to hang around pipes where effluent is discharged. We know that fish can <a href="https://www.sciencedirect.com/science/article/pii/S0301008221000071">behave</a> similarly to what is seen in humans suffering from addiction, not only from this trial, but from several studies on different fish species. One of the hallmarks of drug addiction is a loss of interest in other activities – even those that are usually highly motivated, such as eating or reproducing. It’s possible that the fish might start to change their natural behaviour, causing problems with their feeding, breeding and, ultimately, their survival. They may, for instance, be less likely to evade predators.</p>
<p>Exposure to drugs not only affects the fish themselves, but their offspring. In fish, addiction can be inherited over <a href="https://www.sciencedirect.com/science/article/pii/S0166445X14000265">several generations</a>. This could have long-lasting implications for ecosystems, even if the problem was fixed now.</p>
<p>This is not the first study to find illicit drugs in wildlife. In 2019, scientists in the UK reported <a href="https://www.sciencedirect.com/science/article/pii/S0160412019307160">cocaine</a> in freshwater shrimp in all 15 rivers they sampled. Interestingly, they detected illicit drugs more often than some common pharmaceuticals. </p>
<p>But the wider effects of those drugs remain largely unknown. There have, however, been comprehensive studies into the effects of pharmaceuticals in rivers. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/five-ways-fish-are-more-like-humans-than-you-realise-157929">Five ways fish are more like humans than you realise</a>
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</em>
</p>
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<h2>Pharmaceutical pollution</h2>
<p>Medicines do not fully break down in our bodies either and arrive at wastewater treatment plants in faeces and urine. Most are discharged with wastewater effluent, but some enter rivers by seeping from landfills or farm fields where human sewage is used as fertiliser. Wildlife living in rivers and coastal waters where effluent is discharged are exposed to cocktails of medicines, from painkillers to antidepressants.</p>
<p>Caged fish downstream of some water treatment plants changed sex from male to female <a href="https://www.tandfonline.com/doi/abs/10.1080/02757549408038554">within a few weeks</a> due to exposure to hormone-disrupting chemicals found in contraceptive pills. Recent studies have shown that antidepressants can cause a wide range of behavioural changes in aquatic organisms from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0045653517302370?via%3Dihub">aggression</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0166445X10002122">attraction to light</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/23413353/">increasing boldness</a>.</p>
<p>Drug addiction is a global health concern that can devastate communities, and tackling its environmental consequences will be expensive. One study has estimated it would cost <a href="https://www.nature.com/articles/485441a">over US$50 billion</a> (£36 billion) to upgrade wastewater treatment plants in England and Wales so that they can remove these chemicals. </p>
<figure class="align-center ">
<img alt="Water flowing out of a concrete grate into a river." src="https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=251&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=251&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409876/original/file-20210706-19-175dya5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=251&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drugs can’t be filtered from sewage without significant upgrades to existing infrastructure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/processed-cleaned-sewage-flowing-out-water-1860614533">Marekuliasz/Shutterstock</a></span>
</figcaption>
</figure>
<p>It might seem obvious that prescribed and illegal drugs designed to change behaviour in humans also change the behaviour of wildlife. But this problem is potentially far more widespread and complex. We don’t even know if synthetic chemicals in everyday household products, such as cosmetics, clothes and cleaning agents, can affect the behaviour of people and other species. An international group of scientists has urged <a href="https://pubs.acs.org/doi/10.1021/acs.est.0c06493">companies and regulating bodies</a> to check their toxic effect on behaviour as part of risk assessments of new chemicals. </p>
<p>We must get to grips with the amount of pharmaceuticals in our waterways. The world is some way from fixing the problems of addiction and illicit drug use. But, at the very least, more should be done to improve filtration in sewage treatment plants, and to force water companies to take more responsibility for ensuring effluent doesn’t affect wildlife.</p><img src="https://counter.theconversation.com/content/163756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Parker receives funding from NC3Rs (UK), Ministry of Defence (UK), Alzheimer's Research UK, Foundation for Liver Research (UK), European Commission (INTERREG). </span></em></p><p class="fine-print"><em><span>Alex Ford receives funding from the Natural Environment Research Council (NERC) and the EU Interreg program (REDPOL & Horti-BlueC)</span></em></p>Chemicals in drugs can be excreted unchanged, infiltrating waterways via sewage and effluent.Matt Parker, Senior Lecturer in Neuroscience and Psychopharmacology, University of PortsmouthAlex Ford, Professor of Biology, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1409562020-06-24T14:33:04Z2020-06-24T14:33:04ZWhat is methamphetamine or ‘crystal meth’?<figure><img src="https://images.theconversation.com/files/343737/original/file-20200624-133013-1chiizs.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C582&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Inside an illicit meth lab.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/view-inside-clandestine-methamphetamine-lab-1493320838">Darwin Brandis/Shutterstock</a></span></figcaption></figure><p>Ever been in love? You’ll know the rush. That’s chemistry at work. Our brain produces molecules such as <a href="http://www.chm.bris.ac.uk/motm/pea/peah.htm">2-phenylethylamine</a>, the mood enhancer also found in chocolate. But eating chocolate <a href="https://theconversation.com/love-is-it-just-a-fleeting-high-fuelled-by-brain-chemicals-129201">won’t make you fall in love</a> – enzymes in your liver break it down before it gets to the brain. Chemistry does explain why certain drugs produce similar mood-enhancing effects and also why <a href="https://theconversation.com/crystal-meth-europe-could-now-see-a-surge-in-supply-and-use-140606">they can become a problem</a>.</p>
<p>With a structure closely related to phenylethylamine, pure crystalline methamphetamine was first made in 1919 and its cousin, amphetamine, in 1887. Smith, Kline and French marketed a nasal inhaler containing amphetamine (“Benzedrine”) for nasal congestion in 1932; people soon found that it rapidly released stimulating neurotransmitter molecules <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413312/pdf/20080617s00018p1679.pdf">such as dopamine</a>. Within a short while, people were extracting it from the wadding in inhalers for its “high”, becoming known as “bennies”. Methamphetamine was also found to be a stimulant. Users felt sharper, stronger and more energetic. </p>
<p>Unlike cocaine, morphine (easily converted into heroin) and <a href="https://theconversation.com/khat-on-a-hot-tin-roof-but-its-no-meow-meow-15817">khat</a>, which are plant-derived, methamphetamine is a synthetic drug. Similar molecules <a href="https://www.sciencedirect.com/science/article/pii/S0731708513004378">have been found</a> in one or two plants, but there’s no evidence that they actually contain amphetamine or methamphetamine. While the plant-based drugs are widely smuggled across borders, methamphetamine can be made locally with cookbook recipes from the internet, using chemicals that can be bought on the high street or the internet.</p>
<p>Amphetamine and methamphetamine have a slightly different structure to the naturally occurring phenylethylamine (PEA), so they resist the liver enzyme that decomposes amines, such as phenylethylamine, in food. The body hasn’t yet developed enzymes to break down amphetamines, which have only been around for about 100 years.</p>
<h2>Use … and addiction</h2>
<p><a href="https://defenceindepth.co/2017/08/11/amphetamines-and-the-second-world-war-stimulating-interest-in-drugs-and-warfare/">During the second world war</a>, methamphetamine, in particular, was used by both the Allied and the Axis powers - the Germans, Japanese, Americans and British - by watchkeepers on ships and bomber crews <a href="https://masterbombercraig.wordpress.com/avro-lancaster-bomber/lancaster-crews/wakey-wakey-pills/">to keep alert</a> on long night missions. In Germany, amphetamine was known as Pervitin (it is still called that in the Czech Republic). </p>
<p>Civilians used amphetamines, too. Author Graham Greene <a href="https://slate.com/culture/2013/04/auden-sartre-graham-greene-ayn-rand-they-loved-amphetamines.html">used Benzedrine</a> in 1938 to complete his novel <a href="https://www.penguin.co.uk/books/103/1033517/the-confidential-agent/9780099286196.html">The Confidential Agent</a> in six weeks; Jack Kerouac <a href="https://choice.npr.org/index.html?origin=https://www.npr.org/templates/story/story.php?storyId=11709924">was said to have</a> produced <a href="https://www.penguinrandomhouse.com/books/540750/on-the-road-by-jack-kerouac/9780142437254/readers-guide/">On the Road</a> in one three-week frenzy of typing in April 1951. Benzedrine <a href="https://academic.oup.com/qjmed/article/98/6/387/1548168">helped former British prime minister</a> Anthony Eden get through the Suez crisis in 1956, though it may not have improved his decision-making. </p>
<p>Because of the energy rush they give, sportsmen also used amphetamines long before they turned to steroids, and they were banned from the Olympics in 1967. <a href="https://www.bbc.co.uk/programmes/p02xgs8b">Tom Simpson</a>, the first British cyclist to crack Europe (and wear the Yellow Jersey), and a BBC Sports Personality of the Year, long before media celebrities, died from a combination of heat, alcohol and methamphetamine on the 1967 Tour de France. However, their use continues, with the drug being cited in a number of doping scandals.</p>
<p>The first big amphetamine abuse occurred just after WWII in Japan. After 1951, they became prescription drugs in the US, widely prescribed as pick-me-ups, known as “pep pills”. Long-distance lorry drivers and students both used amphetamines to help stay awake and concentrate. A side-effect of amphetamines is appetite loss, so post-war they were also widely used <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482033/">as prescription drugs to fight obesity</a>. </p>
<p>Because of its “go-faster” characteristics, methamphetamine started to be known as “speed” in the early 1960s. The Summer of Love in the Haight-Ashbury region of San Francisco in 1967 was fuelled by marijuana and psychedelics, such as LSD, but the next year things went badly wrong with an epidemic of intravenous methamphetamine injection; “peace and love” was replaced with the motto “speed kills”. </p>
<p>By the 1980s, someone in the Far East found out how to create large crystals of methamphetamine hydrochloride known as “crystal meth”, which did not have to be injected. Since then it has spread from Hawaii to the West Coast of America. In Thailand, it’s called <em>Ya ba</em> (“madness drug”). Although <a href="https://edition.cnn.com/2018/05/01/health/fentanyl-opioid-overdose-study/index.html">opioids</a> are the <a href="https://www.cdc.gov/drugoverdose/images/data/OpioidDeathsByTypeUS.PNG">biggest cause of drug death</a> in the US, methamphetamine is <a href="https://science.sciencemag.org/content/361/6408/eaau1184">a particular problem</a> in its western and south-western states. In some ways it has <a href="https://medcraveonline.com/MOJAMT/MOJAMT-05-00092.pdf">become a forgotten epidemic</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343740/original/file-20200624-133008-1cdcz0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Meth crystals.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-pile-methamphetamine-crystals-blue-glass-1314852365">xxxxx</a></span>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343735/original/file-20200624-133002-1vwkhog.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Opioid deaths in the US. But meth use is still a big problem.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/drugoverdose/images/data/OpioidDeathsByTypeUS.PNG">CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta GA: US Dept of Health and Human Services, CDC, 2018.</a></span>
</figcaption>
</figure>
<p>A powerful stimulant, crystal meth <a href="https://www.researchgate.net/publication/297617655_Irreversible_brain_damage_caused_by_methamphetamine">has been linked with</a> brain damage.</p>
<h2>Two mirror-image forms</h2>
<p>Methamphetamine molecules can exist <a href="https://www.youtube.com/watch?v=RBtgAz70_JY">in two mirror-image forms</a>, which interact differently with the receptors in the human body.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/RBtgAz70_JY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>The stimulant we call speed is d-methamphetamine; the other, l-methamphetamine, contains the same atoms connected in the same sequence, just arranged differently in space, and has absolutely no stimulant properties. It is simply a decongestant, found in American Vicks (not the British version). Olympic regulations, however, just forbid the use of “methamphetamine”. They do not distinguish between these two forms. Nor did the testing procedures used at the 2002 Winter Olympics, <a href="http://www.chm.bris.ac.uk/motm/methamphetamine/methh.htm">when Alain Baxter lost a medal</a> for using an American Vicks.</p>
<p>Until now, methamphetamine – or crystal meth – <a href="https://theconversation.com/why-meth-hasnt-broken-bad-in-the-uk-18708">has not really appeared in the UK drug market</a>. Many will only be familiar with it from its use in the US series, Breaking Bad. But some fear that is about to change. Partly <a href="https://www.vice.com/en_uk/article/n7jdd8/uk-british-dont-use-meth">because</a> of its cost, a plethora of alternatives, lack of availability of chemicals to make it, as well as a poor image, methamphetamine has not been fashionable in the UK for many years but it would be unwise to assume that this will continue.</p><img src="https://counter.theconversation.com/content/140956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Cotton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A history of the drug crystal meth.Simon Cotton, Senior Lecturer in Chemistry, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1295932020-02-10T13:57:42Z2020-02-10T13:57:42ZA Nazi drug’s US resurgence: How meth is making a disturbing reappearance<figure><img src="https://images.theconversation.com/files/313198/original/file-20200203-41516-vfhkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A drug addict smoking crystal meth on Skid Row in downtown Los Angeles.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/APTOPIX-Homeless-Crisis-on-the-Coast-Photo-Gallery/854421aedac84655854ae18e015b0021/62/0">AP photo/Jae C. Hong</a></span></figcaption></figure><p>Although I am teaching a course at Indiana University this semester on the opioid epidemic, I can’t get meth out of my mind.</p>
<p>A colleague of mine was recently carjacked. He was forced to drive at extreme speed throughout the city and escaped with his life only by intentionally crashing his car. My colleague told me he believes his gun-wielding assailant was suffering an acute psychosis related to methamphetamine use. </p>
<p>Opioids may get most of the media attention these days, but meth has hardly gone away. <a href="https://www.npr.org/sections/health-shots/2019/07/29/745061185/seizures-of-methamphetamine-are-surging-in-the-u-s">Law enforcement seizures</a> of meth are surging in the U.S., up 142% between 2017 and 2018. <a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-scope-methamphetamine-misuse-in-united-states">Overdose deaths</a> in 2017 were seven times higher than in 2007. </p>
<p>Just what is meth? Why is it such a grave threat to health? And why does its terrible specter seem to loom larger and larger?</p>
<h2>The health effects of meth</h2>
<p>Methamphetamine, a powerful stimulant of the central nervous system, has some <a href="https://books.google.com/books/about/Blitzed.html?id=YN2pDAAAQBAJ">legitimate medical uses</a>, such as the treatment of attention deficit hyperactivity disorder. But it is widely trafficked and purchased for recreational consumption, often as crystal meth (think of the award-winning television drama “<a href="https://www.npr.org/2019/10/11/769312766/breaking-bad-creator-vince-gilligan-reflects-on-meth-and-morals">Breaking Bad</a>”).</p>
<p><a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/how-methamphetamine-misused">Recreational meth users</a> smoke, snort, ingest or inject the drug. Smoking and injection seem to give the greatest rush, but the effect doesn’t last as long. <a href="https://methoide.fcm.arizona.edu/infocenter/index.cfm?stid=166">Users often report</a> euphoria, increased alertness and reduced appetite; chronic users may experience paranoia, delusions and unpredictable mood swings. Addicts may exhibit a “<a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/how-methamphetamine-misused">binge and crash</a>” pattern, and many try to maintain the rush with continuous consumption. </p>
<p>Chances of addiction are high, and symptoms from withdrawal can linger for months. Treatment is complicated, particularly because many meth users are often also using cocaine, heroin or alcohol. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313199/original/file-20200203-41485-1ka9xnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Law enforcement seizures of meth are on the rise.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/California-Meth-Seizure/f79539f304ff4189af2fffec407a1e68/5/0">US Customs & Border Protection via AP</a></span>
</figcaption>
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<p>Meth is directly <a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-misuse">toxic</a> to the brain; developmental delays are common in meth babies. In adults, it’s associated with an <a href="https://doi.org/10.1016/j.drugalcdep.2018.02.032">increased risk for Parkinson’s disease</a>. Addicts age at an accelerated pace, and commonly acquire “<a href="https://www.mouthhealthy.org/en/az-topics/m/meth-mouth">meth mouth</a>” – tooth loss, tooth decay and tooth blackening.</p>
<p><a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-misuse">Those who overdose</a> may develop psychosis or abnormal heart rhythms. Unlike opioid overdoses, which can quickly be resolved if the drug naloxone is available, meth overdoses have no “reversal” agent. <a href="https://medlineplus.gov/ency/article/007480.htm">Instead</a>, the meth is suctioned from the stomach. Anti-psychotics can help with psychosis, and anti-hypertensive drugs can reduce acutely elevated blood pressure. </p>
<h2>Meth’s dark history</h2>
<p>During World War II, meth played a sinister role in the Nazi war machine. </p>
<p>The military, along with German civilians, used a <a href="https://books.google.com/books/about/Blitzed.html?id=YN2pDAAAQBAJ">commercial form</a> of the drug – made in Berlin and marketed under the trade name <a href="https://www.spiegel.de/international/germany/crystal-meth-origins-link-back-to-nazi-germany-and-world-war-ii-a-901755.html">Pervitin</a> – to stay awake, alert and energized. With Pervitin, factory workers and homemakers alike found they could work longer and harder. Troops called it “tank chocolate” or “pilot’s salt.” Pervitin fueled the Nazis during their “<a href="https://www.spiegel.de/international/the-nazi-death-machine-hitler-s-drugged-soldiers-a-354606.html">blitzkrieg</a>” invasion of France in 1940. </p>
<p><a href="https://books.google.com/books?id=YN2pDAAAQBAJ&q=everyone+cheerful#v=snippet&q=everyone%20cheerful&f=false%22%22">Wrote one German commander</a> about Pervitin: “Everyone fresh and cheerful, excellent discipline.” Later his assessment became less rosy: “After taking four tablets, double vision and seeing colors.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313200/original/file-20200203-41554-nww6s9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A box of meth from a 2018 Minneapolis drug bust. Law enforcement seized a total of 171 pounds with an estimated street value of $7.75 million.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Meth-Deaths/8d6651c49058456291cdcd7fd8a5fa62/38/0">Cannon River Drug & Violent Task Force via AP</a></span>
</figcaption>
</figure>
<p>The toll meth took on the Germans was <a href="https://books.google.com/books/about/Blitzed.html?id=YN2pDAAAQBAJ">immense</a>. It provoked war crimes, stoked psychosis and triggered suicide. As the war progressed, <a href="https://books.google.com/books/about/Hitler.html?id=v3bWAAAAMAAJ">Adolf Hitler</a> received ever-increasing doses of the drug. </p>
<p>No one should be surprised. After all, the German name Pervitin is related to the word pervert (“ill-turned”). It means corrupted or distorted. Meth, as the Nazis discovered, distorts our nature and turns us away from what we are meant to be.</p>
<p>Now, 75 years after the war, and still without an <a href="https://www.pbs.org/wgbh/pages/frontline/meth/faqs/">effective</a> drug therapy, a meaningful response to methamphetamines requires three things. We in the U.S. must recognize the true scope of the problem. We must make sure meth users have access to counseling and behavioral therapy. Most of all, our society needs to help individuals and families discover healthier ways to find meaning in life. </p>
<p>[ <em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/129593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s widespread attention on the dangers of opioid addiction, but use of damaging crystal meth continues in the U.S., with police seizures rising.Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/882482018-01-22T19:07:02Z2018-01-22T19:07:02ZIce psychosis: what is it, and why do only some users get it?<figure><img src="https://images.theconversation.com/files/201268/original/file-20180109-83550-10dw76k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It doesn't matter if you're male, female, young or old, the major risk factor for ice induced psychosis is how much you use it and how addicted you are.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>There is growing concern about crystal methamphetamine (ice) use in Australia and internationally, in part because of the psychological effects of the drug. Although most people who use ice do not experience psychological problems, <a href="http://journals.lww.com/co-psychiatry/Abstract/2016/07000/Psychosis_induced_by_amphetamines.3.aspx">about one in three people</a> who use it regularly report experiencing psychosis in their lifetime. </p>
<p>Research also suggests that up to <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0745-5">30%</a> of people who experience ice psychosis go on to develop a long-term psychotic illness such as schizophrenia or bipolar disorder. <a href="http://journals.sagepub.com/doi/abs/10.1177/0004867417748750">Our new study</a> aimed to find out why some ice users are more likely to experience psychosis than others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ice-causes-death-in-many-ways-overdose-is-just-one-of-them-81752">Ice causes death in many ways, overdose is just one of them</a>
</strong>
</em>
</p>
<hr>
<h2>So what is ice psychosis?</h2>
<p>Psychosis refers to a range of mental health symptoms, including suspiciousness and paranoia, hallucinations, and unusual or agitated behaviour. Individuals often lose touch with reality, and may not have an understanding of what is happening to them. This can be very distressing for the individual and for their family and friends, and may result in the person having to go to hospital. </p>
<p>Psychosis can occur as part of many different mental health disorders, or be triggered by a range of drugs. Amphetamine-type stimulant drugs, such as ice, are particularly known to potentially trigger psychosis. In the 1970s, amphetamines administered in <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490932">experimental situations</a> were shown to cause psychotic symptoms in healthy people who had never used the drug before. </p>
<p>In Australia, ice is the drug that most commonly results in <a href="https://www.researchgate.net/publication/276065432_The_role_of_methamphetamines_in_psychosis-related_ambulance_presentations">ambulance attendances</a> for psychosis symptoms. And <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12426/full">hospital admissions</a> for ice psychosis have increased steeply in the past ten years. </p>
<p>These patterns of increasing harms have paralleled the increase in the purity of ice and <a href="https://www.mja.com.au/journal/2016/204/4/estimating-number-regular-and-dependent-methamphetamine-users-australia-2002">increasing dependence</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-ice-and-speed-the-drugs-that-kept-soldiers-awake-and-a-president-young-61002">Weekly Dose: ice and speed, the drugs that kept soldiers awake and a president young</a>
</strong>
</em>
</p>
<hr>
<h2>What did the study find?</h2>
<p>We know the majority of people who use ice don’t experience psychosis. So we <a href="http://journals.sagepub.com/doi/abs/10.1177/0004867417748750">looked at 20 existing studies</a> examining more than 5,000 regular ice users to try to find out what factors made someone more at risk of psychosis. </p>
<p>We found the frequency and amount of methamphetamine use, and the severity of dependence, were the factors most commonly associated with the risk of psychosis. Unfortunately, the design of the studies, and the different ways in which they measured the frequency and amount of methamphetamine use, mean we can’t estimate exactly how much an increase in use will result in an increase in risk. </p>
<p>Other risk factors included a family history of a psychotic disorder, and current use of other drugs, including cannabis and alcohol. While <a href="http://www.sciencedirect.com/science/article/pii/S0376871614009697">one study</a> found a link between a history of traumatic experiences in childhood and the experience of ice psychosis, more research needs to be done. </p>
<p>Just as important were factors that were <em>not</em> associated with ice psychosis – for example, age, gender, income or employment status. Interestingly, the way in which people used methamphetamine – by smoking versus injecting, for instance – did not appear to affect the likelihood of psychosis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-methamphetamine-use-and-addiction-in-australia-13280">Explainer: methamphetamine use and addiction in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>Better treatment would make the difference</h2>
<p>It’s important to remember almost all of the research on this topic has been cross-sectional. This means measurements of psychotic symptoms and measurements of risk factors have occurred at the same time – so we don’t know which causes the other, only that they’re related. </p>
<p>The best way to study risk factors for ice psychosis would be to follow people from before they start using the drug, to when they develop the problem. But this sort of study is very difficult to conduct when it comes to drug use. Differences in the way researchers measure psychosis, or measure methamphetamine use, also affect how we understand the relationship between the two. </p>
<p>Taken together, the main finding of our study was that people who used the drug more often and were more dependent on it were more likely to experience psychosis. While this might appear obvious, it does help healthcare workers and treatment services identify people who might be at greatest risk. </p>
<p>Similarly, for people who aren’t ready to stop using the drug, changing the frequency or pattern of their use might help them avoid developing psychosis. </p>
<p>More broadly, the key message from our research is better treatment of ice use would translate to a reduction in harms from the drug. The challenge remains making sure effective treatment is available when people are ready and willing to access it.</p><img src="https://counter.theconversation.com/content/88248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shalini Arunogiri receives funding from the National Health & Medical Research Council (NHMRC), and has received fellowships from the Royal Australian & New Zealand College of Psychiatrists (RANZCP) and the Windermere Foundation.
Shalini is also the Chair of the Faculty of Addiction Psychiatry at the Royal Australian & New Zealand College of Psychiatrists (RANZCP). </span></em></p>A new study has looked at why some ice users suffer psychosis and others don’t.Shalini Arunogiri, Addiction Psychiatrist, Lecturer, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/731252017-02-17T03:13:07Z2017-02-17T03:13:07ZAustralia emerges as a leader in the global darknet drugs trade<figure><img src="https://images.theconversation.com/files/157249/original/image-20170217-21853-1xtnn0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australians are increasingly using darknet marketplaces to buy and sell illicit drugs.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Australia is a leading country in the <a href="https://theconversation.com/explainer-what-is-the-dark-web-46070">darknet</a> drugs trade, with more online drug vendors per capita than any other nation except the Netherlands, according to research presented at this week’s <a href="https://www.eventbrite.com.au/e/vaada-conference-2017-complexity-collaboration-consumers-and-care-tickets-27298320010">Victorian Alcohol and Drug Association Conference.</a></p>
<p>Australians are increasingly using eBay-style darknet marketplaces or <a href="http://journals.sagepub.com/doi/abs/10.1177/1748895813505234">cryptomarkets</a> to buy and sell illicit drugs. </p>
<p>Australian cryptomarket vendors sell a wide variety of illicit drugs, and are disproportionately represented in global terms for sales of ecstasy, opioids and, particularly, methamphetamine. More than a quarter of the world’s darknet methamphetamine trade (27.1%) is facilitated by Australian cryptomarket dealers.</p>
<h2>Market composition and price</h2>
<p>The composition of the Australian darknet drugs trade mirrors some aspects of the conventional illicit drugs trade. For example, cannabis was the most popularly traded drug by domestic cryptomarket vendors, accounting for 25% of all recorded transactions. This was followed by prescription drugs (20%), ecstasy (16%), psychedelics such as magic mushrooms and LSD (12%), methamphetamine (12%) and cocaine (8%). Opioids such as heroin accounted for only 3% of all transactions undertaken by Australian cryptomarket vendors. </p>
<p>Our analysis also focused on the price of illicit drugs that are sold on the darknet. Here we found large disparities between the prices of illicit drugs sold by foreign-based cryptomarket vendors and those located in Australia. For example, average prices for ecstasy sold by Australian vendors were more than six times the price of those sold by their foreign counterparts. Methamphetamine and cocaine were approximately three times more expensive when purchased from an Australian cryptomarket vendor. Only cannabis was priced similarly, with prices from Australian and foreign vendors largely comparable. </p>
<p>These findings indicate that the prices of Australian darknet drugs are much more closely correlated to local street prices than they are to those sold by foreign vendors. Only methamphetamine was significantly cheaper when purchased from an Australian cryptomarket vendor compared to a local street dealer, with prices approximately 45% lower when sourced online. </p>
<p>Explaining why methamphetamine is so much cheaper when sourced via a local cryptomarket vendor as opposed to a street dealer will require further research. However, given recent law enforcement crackdowns on the methamphetamine trade, and the involvement of violent organised crime groups in methamphetamine distribution, it is possible that people selling methamphetamine find it less risky and costly to sell these drugs anonymously online rather than via conventional means. </p>
<h2>Law enforcement and border protection</h2>
<p>The relatively high prices charged by local cryptomarket vendors are likely to be interpreted as signs of success by Australian border protection agencies. They are evidence that while foreign vendors are typically prepared to send illicit drugs to Australia, many local consumers are averse to the risks this entails. The perception that drugs may be intercepted entering the country therefore contributes to the high prices that local consumers pay for illicit drugs. </p>
<p>The flip side to this argument is that local cryptomarket vendors – and the organised crime groups that supply them – benefit from the protectionism that is unwittingly afforded by Australian law enforcement. By deterring the importation of cheaper foreign drugs, local law enforcement are effectively insulating Australian drug suppliers from foreign competition, thereby boosting their profits and helping to maintain their illegal businesses. </p>
<h2>Where to from here?</h2>
<p>Despite the growth in darknet drug trading in Australia, there are important reasons to remain optimistic regarding its overall impact on both drug consumers and broader society. </p>
<p>Darknet drug consumers typically report access to <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12470/full">higher quality illicit drugs online</a> compared to those available from conventional sources. They have greater knowledge regarding the composition of illicit drugs and are able to <a href="http://www.sciencedirect.com/science/article/pii/S0955395915003503">access information</a> regarding safer forms of drug use. They also report <a href="http://www.sciencedirect.com/science/article/pii/S0955395916301323">fewer instances of threats and violence</a> when compared to sourcing drugs via conventional means.</p>
<p>Darknet drug trading also reduces the potential for systemic <a href="http://www.palgrave.com/gp/book/9781137399045">violence between rival drug retailers</a> through the maintenance of online anonymity and physical separation from drug retailing sites.<br>
Unfortunately, cryptomarkets are unable to resolve the worst, <a href="https://www.nytimes.com/2016/12/13/world/americas/mexico-drug-war-violence-donald-trump-wall.html?_r=0">intractable systemic drug violence in source countries such as Mexico</a>. In the absence of a legal market for these drugs, this violence will continue unabated, much as it has since the beginning of the war on drugs. </p>
<p>However, the “silver linings” associated with the darknet drugs trade suggest that for every additional drug deal done online instead of on the street, further progress is being made in reducing the harms associated with illicit drugs.</p><img src="https://counter.theconversation.com/content/73125/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Martin receives funding from the National Health and Medical Research Council and the Australian Institute of Criminology. He is a member of the Alcohol and Other Drugs Media Watch.</span></em></p>Despite the growth in darknet drug trading in Australia, there are important reasons why it is less harmful than street drug dealing.James Martin, Senior Lecturer in Criminology, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727232017-02-15T20:49:53Z2017-02-15T20:49:53ZFull response from Mark McGowan on methamphetamine use in Western Australia<p>In relation to <a href="http://theconversation.com/factcheck-its-true-western-australia-has-the-highest-rate-of-methamphetamine-use-in-the-country-72506">this FactCheck</a> on the rates of methamphetamine use in Western Australia, The Conversation requested sources and comment from West Australian Labor leader Mark McGowan.</p>
<p>In response, a spokesperson for Mark McGowan said (questions from The Conversation in bold):</p>
<p><strong>When Mark McGowan used the term “we”, was he was referring to Western Australia?</strong> </p>
<blockquote>
<p>Yes.</p>
</blockquote>
<p><strong>Could you please provide a source, or sources, to support the assertion that Western Australia (if that is confirmed as the reference point) has the worst rate of methamphetamine usage in the country?</strong></p>
<blockquote>
<p>Sources:</p>
<p><a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">National Drug Strategy Household Survey</a> detailed report 2013 (the 2016 report is not out yet - so this is the latest). Quote from Page 11 of the report ‘Meth/amphetamine use was higher in Western Australia (3.8%) than any other jurisdiction.’ </p>
<p>Also media citing WA Police Commissioner in November 2016 (PerthNow report) - ‘[Police Commissioner] Karl O'Callaghan said our findings reflected the fact WA continued to have the highest meth use per capita in Australia.’</p>
<p>Liberal National Government also acknowledges that WA has the highest rate (WA Government “<a href="https://www.mediastatements.wa.gov.au/MediaDocuments/WA%20Meth%20Strategy%202016.pdf">Western Australian Meth Strategy</a>”) Page 7.</p>
</blockquote>
<p><strong>Could you confirm that when Mr McGowan used the term “worst”, he was indicating the highest rates?</strong></p>
<blockquote>
<p>Yes.</p>
</blockquote>
<p><strong>Is there any other comment you’d like us to include?</strong></p>
<blockquote>
<p>A McGowan Labor Government will implement a State-wide, coordinated and targeted Methamphetamine Action Plan (MAP) focussed on three key areas to reduce demand, reduce harm and reduce supply. This is the most comprehensive plan to tackle methamphetamine use ever released in WA. </p>
<p>WA Labor will work with experts and stakeholders on early targeted prevention, better treatment services and effective withdrawal services. The MAP will build on what is currently seen as best practice, providing education, training, rehabilitation, coordination and research. There will be more focus on breaking the cycle of drug related crime in our community by ensuring that there is a focus on rehabilitation in prisons with a specialised treatment and withdrawal services. </p>
<p>WA Labor also announced that meth traffickers will face a maximum life sentence in prison in a plan to cut the supply in WA.</p>
<p>The flow on effects of methamphetamine use are devastating and will not be solved by prosecution alone. We need to ensure that equal emphasis is given to reducing both the demand and the harm caused by methamphetamines.</p>
</blockquote><img src="https://counter.theconversation.com/content/72723/count.gif" alt="The Conversation" width="1" height="1" />
West Australian Labor leader Mark McGowan’s responded to The Conversation’s request for sources and comment regarding our FactCheck on methamphetamine usage rates in Western Australia.Madeleine De Gabriele, Deputy Editor: Energy + EnvironmentLucinda Beaman, FactCheck EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725062017-02-14T05:38:41Z2017-02-14T05:38:41ZFactCheck: it’s true – Western Australia has the nation’s highest rate of methamphetamine use<blockquote>
<p>We have the worst rate of methamphetamine usage in the country. – <strong>West Australian Labor leader Mark McGowan, <a href="https://thewest.com.au/politics/state-election-2017/crime-spike-gave-labor-weapon-hurt-liberals-ng-b88371752z">quoted</a> in The West Australian, February 6, 2017.</strong></p>
</blockquote>
<p>The illicit drug methamphetamine, commonly known as “speed”, “crystal meth” and “ice”, continues to <a href="http://www.abc.net.au/news/2017-01-25/adelaides-methamphetamine-use-climbs-sewage-analysis-shows/8210188">make</a> <a href="http://www.smh.com.au/entertainment/tv-and-radio/tom-carroll-on-his-recovery-from-addiction-and-taking-part-in-the-new-abc-doco-ice-wars-20170202-gu4n35.html">headlines</a> in Australia as communities grapple with its <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">destructive effects</a>. </p>
<p>In a <a href="https://thewest.com.au/politics/state-election-2017/crime-spike-gave-labor-weapon-hurt-liberals-ng-b88371752z">news report</a> outlining the Liberal and Labor party’s strategies for tackling drug-related crime in Western Australia, state Labor leader Mark McGowan was quoted as saying “we have the worst rate of methamphetamine usage in the country”.</p>
<p>Is that right?</p>
<h2>Checking the source</h2>
<p>When asked for sources to support his statement, a spokesperson for Mark McGowan referred The Conversation to the <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 National Drug Strategy Household Survey</a>, particularly page 11 of the report, which says:</p>
<blockquote>
<p>Meth/amphetamine use was higher in Western Australia (3.8%) than any other jurisdiction. </p>
</blockquote>
<p>The spokesperson also referred The Conversation to the state government’s <a href="https://www.mediastatements.wa.gov.au/MediaDocuments/WA%20Meth%20Strategy%202016.pdf">Western Australian Meth Strategy 2016</a> report, which states on page seven that meth use in Western Australia is higher than the national average.</p>
<p>And the spokesperson cited Western Australia’s Police Commissioner Karl O'Callaghan, who was <a href="http://www.perthnow.com.au/news/western-australia/wa-speaks-meth-drug-issue-voted-states-top-crime-problem/news-story/8274d9ef179070d27a93818c0c39b1eb">reported</a> as saying the state continues to have the highest methamphetamine use per capita in Australia. </p>
<p>You can read the full response from McGowan’s office <a href="http://theconversation.com/full-response-from-mark-mcgowan-72723">here</a>.</p>
<h2>Does Western Australia have the highest rate of methamphetamine use?</h2>
<p>Yes. The latest available Australian data, published in the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">2013 National Drug Strategy Household Survey</a>, show that 3.8% of the West Australian population had used methamphetamine in the 12 months prior to the survey. That’s nearly double the Australian average of 2.1%.</p>
<p>This isn’t a recent phenomenon. The rate of methamphetamine use in Western Australia has been higher than the rest of the nation since at least the 1990s.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=754&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=754&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=754&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=948&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=948&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=948&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=685&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=685&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=685&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The rate of methamphetamine use across Australia has been declining since 1998 – including in Western Australia. But over that time, the rate of use in the state has remained consistently higher than the Australian average.</p>
<p>The rate of use of many other drugs, including binge drinking, cannabis and pharmaceuticals for non-medical purposes, is also <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/ch7/">higher in Western Australia</a> than the Australian average. </p>
<h2>How do we know?</h2>
<p>The data in the charts above come from the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">National Drug Strategy Household Survey</a>. It’s a reliable data set that’s been collected every three years since the 1990s.</p>
<p>It’s the only population level data we have that shows drug use trends. That means it collects data from the general population, including people who don’t use drugs at all, not just among specific groups of people who use drugs.</p>
<p>It’s not perfect; no dataset is. The survey has been criticised because it’s likely to underestimate drug use. But it is likely to underestimate usage of all drug types in all locations and relatively consistently over time, so it can give us a good sense of trends over time and differences between states.</p>
<p>All the other reliable data available is collected among people in <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2014-15/aodts-nmds/">treatment</a>, people in the <a href="http://aic.gov.au/about_aic/research_programs/nmp/duma.html">justice system</a>, or populations of people who <a href="https://ndarc.med.unsw.edu.au/project/illicit-drug-reporting-system-idrs-d1">regularly use</a> drugs. The rates of use among these groups is much higher than the general population, so the data doesn’t reflect drug use in the general community.</p>
<p>The <a href="http://www.aihw.gov.au/2016-national-drug-strategy-household-survey/">2016 National Drug Strategy Household Survey</a> is due to be released shortly. In general, drug use shows relatively small increases and decreases over time (typically less than half to one percentage point change between years), so it’s unlikely that the 2016 data will buck the long term trend too much.</p>
<h2>People are using more potent forms of methamphetamine</h2>
<p>Although the rate of methamphetamine use across Australia has stabilised at <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2.1%</a> of the population between 2010 and 2013, we have seen a major shift in the <em>type</em> of methamphetamine people are using. Western Australia has seen the <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549643">same shift</a> as the rest of the country.</p>
<p>In 2010, most people who used methamphetamine preferred to use the less potent powder form, known as “speed”. But by 2013 around half the people surveyed preferred to use the stronger crystal form, known as “ice”. Speed and ice have the same chemical makeup, but ice is a lot stronger.</p>
<p><strong>Changes in methamphetamine use among Australian users aged 14 or older, 2007 to 2013</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This shows the main forms of methamphetamine used by recent users (meaning within the last 12 months) aged 14 or older, 2007 to 2013.</span>
<span class="attribution"><a class="source" href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/ch5/#t5_4">Australian Institute of Health and Welfare, 2013 National Drug Strategy Household Survey</a></span>
</figcaption>
</figure>
<p>The majority of people who use methamphetamine use a small amount, very occasionally, for a short period in their life, and never experience any major problems with it. Around 70% of people who used a methamphetamine in the last year used it <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">fewer than 12 times</a>, and many of those used it only once or twice.</p>
<p>But for the small percentage who do experience problems, it is a drug that can cause significant <a href="https://theconversation.com/crystal-meth-harms-on-the-rise-in-australia-18190">harm</a>.</p>
<p>Even though there hasn’t been a significant increase in the number of people using methamphetamine, the shift to the stronger form means that the risks – which include <a href="https://www.mja.com.au/journal/2016/204/4/estimating-number-regular-and-dependent-methamphetamine-users-australia-2002-2014">drug dependence</a>, <a href="https://ndarc.med.unsw.edu.au/news/methamphetamine-deaths-increase-across-australia-and-ice-use-jumps-52-cent-among-people-who">overdose</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">aggression</a> and <a href="https://www.promises.com/articles/abused-drugs/meth-causes-psychosis-study-finds/">mental health</a> problems – are amplified. As a result, we have seen a big increase in people who use methamphetamine regularly coming to <a href="https://www.mja.com.au/journal/2007/186/7/hospital-separations-cannabis-and-methamphetamine-related-psychotic-episodes?inline=true">hospital</a>, needing an <a href="http://apo.org.au/node/56610">ambulance</a>, seeking <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2014-15/clients/age-profile/">drug treatment</a> and being <a href="http://www.abc.net.au/news/2015-05-15/drug-data-shows-ice-arrests-nearly-double-in-five-years/6471024">arrested</a>.</p>
<h2>Verdict</h2>
<p>Mark McGowan’s statement is correct. Western Australia has the highest rate of methamphetamine use in Australia – and has since records of the use of this drug began. Western Australia has a higher rate of other drug use as well. <strong>– Nicole Lee</strong></p>
<hr>
<h2>Review</h2>
<p>This is appears to be a fair representation of the available population data. As the author notes, no data set is perfect. When you look at groups of people who regularly use drugs, the jurisdictional trends differ from general population trends.</p>
<p>In addition we’d note the heading would more accurately read “It’s true – Western Australia has the nation’s highest rate of methamphetamine use according to available population data”. <strong>– Courtney Breen and Amanda Roxburgh</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/72506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant to public, private and not for profit services to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research. She is a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. Nicole was interviewed for the program.</span></em></p><p class="fine-print"><em><span>Amanda Roxburgh receives funding from the federal government.</span></em></p><p class="fine-print"><em><span>Courtney Breen receives funding from the federal government. </span></em></p>West Australian Labor leader Mark McGowan said his state has the “worst rate of methamphetamine usage in the country”. We asked the experts to check the evidence.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727192017-02-13T19:09:24Z2017-02-13T19:09:24Z‘Ice Wars’ message is overblown and unhelpful<figure><img src="https://images.theconversation.com/files/156503/original/image-20170213-23342-10nqphj.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ice Wars invokes fear and stigma - both of which are very unhelpful in battling drug dependence.</span> <span class="attribution"><a class="source" href="https://tv.press.abc.net.au/ice-wars-coming-to-abc-on-february-7">Screen Shot/ABC website</a></span></figcaption></figure><p>Without doubt, crystal methamphetamine, or ice, is capable of causing immense harm. That’s true for many drugs, including alcohol. But when facts are distorted to create fear and stigma it helps no one. Not the people who use ice. Not their families. Not the health professionals supporting them. Not the police who enforce drug law.</p>
<p><a href="http://iview.abc.net.au/programs/ice-wars/DO1501H001S00">Ice Wars</a>, airing over the next few weeks on ABC, shows the dark side of crystal methamphetamine use. It shows the great, but difficult work that police, mental health and substance use treatment professionals do every day. </p>
<p>It carefully explains some of the commonly misunderstood effects of the drug. It shows the breadth of the ice problem across police, treatment services and individuals. And it shows how people are suffering and the compassionate response that is possible from health workers and police.</p>
<h2>There’s no ‘ice epidemic’</h2>
<p>Most of what is reported in this four-part documentary is not incorrect, but it lacks nuance and context. It makes entertaining television, but it contains the type of sensational language that can create community fears leading to the stigmatisation of people who use drugs and knee jerk responses from policy makers.</p>
<p>We are not “under siege”, or “at war” with ice. There is <a href="http://www.abc.net.au/radionational/programs/allinthemind/why-no-australian-ice-epidemic-counselling-treatment/7235576">no ice epidemic</a>. Ice is not “tearing apart the fabric of our community”.</p>
<p>Crystal methamphetamine, commonly known as “ice”, is one form of methamphetamine. The other main form is a powder, commonly known as “speed”. They are the same chemical, but ice is more pure and therefore much stronger. </p>
<p>We have seen a consistent <em>decrease</em> over the last 15 years in the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">percentage of the population</a> using methamphetamine, but a large proportion of the group who previously used speed are now using ice. From our <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">best available data</a>, 2.1% of Australians over 14 years have used methamphetamine in the last year and about half of those prefer ice over speed.</p>
<p>It’s <em>close</em> to the truth that 1.3 million people have <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/"><em>tried</em></a> crystal methamphetamine – the figure is probably more like 850,000. It sounds like a lot of people, but it’s around 5% of the population over 14 years old. </p>
<p>The vast majority of these people have tried the drug not more than a handful of times and <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">are not regular users</a>. Around 1% of the Australian population have used ice in the past year. Around <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/tables/">three quarters of that 1%</a> have used not more than 12 times in the past year. That means only 0.25% of the population use more than once a month.</p>
<p>Yes, there is an increased risk of <a href="http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1555603">psychosis</a> among people who use methamphetamine, but 75% of people who use it regularly never have any type of psychotic experience. Yes, there is an increased risk of agitation, aggression and violence among people who use methamphetamine, but 75% of people who use it regularly never become <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">aggressive</a> while using it.</p>
<p>Clearly ice is capable of causing significant harm to the person using it and to others, and significant distress to their families and friends. It’s a drug that when it is bad, it can be very bad.</p>
<p>But we already know the best, most <a href="http://www.drugpolicy.org/docUploads/ndny_costeff.pdf">cost effective</a> way to reduce drug use in the community is to reduce demand through effective treatment. Interventions as brief as <a href="https://www.ncbi.nlm.nih.gov/pubmed/15733250">two sessions</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/18368613">counselling</a> and longer term <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">rehabilitation</a> are all effective, and people who use methamphetamine do <a href="http://journals.sagepub.com/doi/abs/10.1177/0004867415625815">as well, or better, in treatment</a> than people who use other drugs.</p>
<h2>Fear and stigma help no-one</h2>
<p>There is one significant thing we have learned from hundreds of sessions of community education, thousands of hours of worker training and many sessions of treatment with people who use ice and their families: it is counterproductive and distressing for people who are affected when the media makes exaggerated negative claims, showing only the ugly side of drug use.</p>
<p>One of the greatest harms to people who use drugs is the fear and stigma generated by exaggerated images, out of context “facts”, and name calling - “monsters”, “junkies”, “addicts”, “zombies”. We see it every day - fear drives good people to lock their doors and close their hearts. Families and individuals become isolated as a result, and communities outcast those who need to be pulled closer.</p>
<p>Our research has found it takes on average five years for someone to <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17570971211225145">access treatment</a> after they first experience problems with methamphetamine. We know the earlier someone gets treatment, the better the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12778840">outcomes</a>. Continued stigmatisation of people who use ice and their families only serves to prolong the time to treatment by making it less likely those who need help will <a href="http://www.psychologicalscience.org/publications/mental-illness-stigma.html#.WJ0_vxA3kgA">ask for it</a>.</p>
<p>Fear and stigma also make it hard for families to have an <a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">open discussion</a> about drugs, which is crucial in prevention efforts. <a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">Talking early</a> and openly about drugs in an age-appropriate way is one of the best protective factors for kids.</p>
<p><a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">Fear messages don’t work</a> on young people, and they don’t work on the people at highest risk of using. They just make those who would probably never try the drug more determined not to. Sometimes these approaches can even <a href="https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753">increase</a> young people’s interest in using. Kids see the world differently from adults. When we use scare tactics on kids, if it doesn’t fall within their sphere of experience they switch off.</p>
<p>Fear drives poor policy, policy that focuses on “crackdowns”, “zero tolerance” and scare campaigns. None of these things is effective. We know what reduces drug related harms in the community is a focus on support, on keeping people alive and on access to treatment.</p>
<p>So watch Ice Wars with interest. But question, reflect, look for the good news. Remember it’s not the whole story. And know the people who use methamphetamine and their families are, first and foremost, people. Compassion and a clear head is going to solve this problem. Not fear and stigma.</p>
<hr>
<p><em>Annie Bleeker from the Alcohol and Drug Foundation co-authored this article.</em></p><img src="https://counter.theconversation.com/content/72719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant to public, private and not for profit services to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research. She is a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. Nicole was interviewed for the program. </span></em></p>Without doubt, crystal methamphetamine, like many drugs (including alcohol) is capable of causing immense harm. But when facts are distorted to create fear and stigma it helps no one.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/695332016-11-29T02:25:50Z2016-11-29T02:25:50ZFlakka is a dangerous drug, but it doesn’t turn you into a zombie<figure><img src="https://images.theconversation.com/files/147974/original/image-20161129-17065-1anzxsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">"Bath salts," or synthetic street drugs with amphetamines. Via DEA.</span> <span class="attribution"><span class="source">DEA</span></span></figcaption></figure><p>Stories of horrific crimes resulting from drug use have been propagated by the media for <a href="https://www.washingtonpost.com/news/the-watch/wp/2014/06/19/drug-war-coverage-is-still-filtered-through-race/?utm_term=.5e81f0acdee3">over a century</a>. Such stories began with <a href="http://www.cnn.com/2011/HEALTH/07/22/social.history.cocaine/">cocaine in 1914</a> and were followed by <a href="http://www.theatlantic.com/magazine/archive/1994/08/reefer-madness/303476/">“reefer madness” </a> stories in the 1930s and reports of <a href="http://www.rawstory.com/2016/02/meet-the-psychiatrists-who-are-bringing-lsd-back-to-the-medical-mainstream/">“LSD murders”</a> in the 1960s. Our latest drug said to be associated with murderous stories is a “bath salt” called Flakka, which some media have even called a “<a href="http://www.rollingstone.com/culture/news/florida-zombie-drug-flakka-everything-you-need-to-know-w435074">zombie drug</a>.” </p>
<p>It’s gained this moniker by being associated with bizarre and violent behavior of some drug users. </p>
<p>In August, 19-year-old Austin Harrouff attacked and killed a couple in their Florida home, and he was found <a href="http://www.palmbeachpost.com/news/crime--law/update-sheriff-office-austin-harrouff-remains-critical-condition/uDeXCSRXxXnP4RVR51ErIN/">biting</a> the face and abdomen of one of his victims. The attacker’s parents reported he had displayed strange behavior for months prior to the incident and that he possibly suffered from undiagnosed schizophrenia. <a href="http://www.rollingstone.com/culture/news/florida-zombie-drug-flakka-everything-you-need-to-know-w435074">Authorities</a>, however, believed Harouff was likely high on the new street drug called Flakka, as use had previously been <a href="http://www.nbcnews.com/news/us-news/devils-drug-flakka-driving-florida-insane-n471531">attributed</a> to widespread incidents of <a href="http://www.abc2news.com/news/health/mens-health/flakka-synthetic-drug-behind-increasingly-bizarre-crimes">strange</a> and sometimes violent behavior.</p>
<p>On Nov. 23, however, <a href="http://www.cbsnews.com/news/florida-face-biting-attack-austin-harrouff-drug-test-results/">media coverage</a> of Harouff’s toxicology tests revealed that Flakka was not detected in Harrouff’s system. Thus, this “cannibal” incident did not involve the drug, as was widely believed.</p>
<p>Regardless, Flakka is a new and potentially dangerous synthetic drug. Flakka is a street name for alpha-PVP – a very potent synthetic cathinone drug. Synthetic cathinones are a new variety of amphetamine-like street drugs, which are commonly referred to as “bath salts.”</p>
<p>Flakka is a very potent and inexpensive stimulant. In fact, it appears to be more potent than methamphetamine, and it is believed to have higher <a href="http://www.newsweek.com/flakka-more-addictive-meth-study-suggests-330746">addictive</a> potential. Flakka use has been <a href="https://www.ncbi.nlm.nih.gov/pubmed/27185821">found</a> to be associated with paranoia, delusions and hallucinations (which may be somewhat dependent on frequent and/or extensive use). Within 16 months (2014-2015) in <a href="http://www.cbsnews.com/news/after-ravaging-florida-street-drug-flakka-disappears/">Fort Lauderdale</a> and its suburbs alone, 63 supposed Flakka users died from acute intoxication, accidents, suicides and homicides. </p>
<p>Flakka is particularly infamous for being tied to rashes of bizarre behavior in <a href="http://www.abc2news.com/news/health/mens-health/flakka-synthetic-drug-behind-increasingly-bizarre-crimes">Florida</a> and recently in <a href="http://www.news.com.au/lifestyle/health/health-problems/hallucinations-seizures-aggression-flakka-hits-the-gold-coast/news-story/c38e2ee8d7efb3c6ba975b34c72f80eb">Australia</a>.</p>
<p>“Bath salts” such as Flakka quickly became extremely stigmatized drugs in response to media coverage of users supposedly turning into zombies or cannibals. As someone who studies drug use epidemiology, I think it is very important to separate truth from myth when it comes to drugs.</p>
<h2>Cannibals and zombies high on ‘bath salts’?</h2>
<p>The zombie/cannibal label phenomenon began in Miami on May 26, 2012 when Rudy Eugene – naked and thought to be high on “bath salts” – <a href="http://www.dailymail.co.uk/news/article-2152519/Rudy-Eugene-Last-words-Miami-cannibal-girlfriend-attack-Ronald-Poppo.html">chewed the face and eyeball off of a homeless man</a>. The attacker was killed by police, and the homeless man was left disfigured and blind. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147792/original/image-20161128-22742-1jonnie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doctors for a man whose face and eyeball were eaten by Rudy Eugene.</span>
<span class="attribution"><span class="source">Alan Diaz/AP</span></span>
</figcaption>
</figure>
<p>However, <a href="http://www.cbsnews.com/news/rudy-eugenes-toxicology-report-experts-speculate-on-what-caused-face-chewing-attack/">toxicology</a> tests later confirmed that “bath salts” were not present in the attacker’s system.</p>
<p>Still, the zombie/cannibal pop culture phenomenon had begun and would continue.</p>
<p>Prevalence of self-reported “bath salt” use among high school seniors remained relatively stable at about <a href="http://www.newsweek.com/one-percent-teens-use-bath-salts-survey-says-354485">1 percent</a> over the last few years; however, between 2012 and 2016, perceived <a href="http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2015.pdf">harmfulness</a> of trying “bath salts” nearly doubled – from 33 percent to 58 percent. This is likely a result of the zombie/cannibal label, as perception of harm often leads to less use.</p>
<p>The belief that Flakka or other “bath salt” use can turn you into a zombie or cannibal appears to have been a somewhat effective deterrent against use. However, what a lot of young people don’t know is that they have been using Flakka or other “bath salts,” or both, without knowing it, as these drugs are common adulterants, in “Molly” – the newest street name for ecstasy/MDMA.</p>
<p>Last year I collected hair samples from dozens of nightclub and dance festival attendees in New York City to be tested for <a href="https://theconversation.com/legal-highs-a-look-at-the-growing-use-of-synthetic-drugs-38404">new psychoactive substances</a>. Many attendees <a href="http://www.businessinsider.com/mdma-ecstasy-contaminated-with-bath-salts-2016-2">joked</a> that they would never use “bath salts” as “they are not zombies or cannibals.” </p>
<p>But what my colleagues and I actually <a href="http://www.drugandalcoholdependence.com/article/S0376-8716(16)00057-0/abstract">found</a> was that among self-reported ecstasy users who denied “bath salt” use (after being provided a list of dozens of compounds in this class), four out of 10 actually tested positive for one of more of these compounds.</p>
<p>So a lot of drug users are actually using Flakka and/or other “bath salts” unknowingly or unintentionally, thinking it’s Molly. (And no, these people didn’t turn into cannibals or zombies.)</p>
<h2>Let’s try to get the facts straight</h2>
<p>While information based on falsehoods can help deter people from (intentionally) using potentially dangerous drugs such as Flakka, legitimate and truthful information is needed not only to deter use, but also to prevent those who reject abstinence from experiencing harm.</p>
<p>Sometimes scary information works to deter drug use. But “scary” should be based on truthful information about potentially harmful drugs. If we continue to exaggerate adverse effects, then this can work against our prevention efforts in two ways. </p>
<p>First, potential users – especially experienced drug users – may disregard our warnings. Second, exaggerating dangerous effects usually leads to increased stigma toward those who use or happen to be dependent on the drug. This usually leads only to further ostracization and a lower likelihood of seeking treatment.</p>
<p>Drug-induced cannibalism now appears to be a hot media topic. This is understandable as much of the public is now obsessed with zombie TV shows. But we need to ensure that we remain cautious about news we hear, and responsible for news we share.</p><img src="https://counter.theconversation.com/content/69533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Palamar receives funding from the National Institute on Drug Abuse. </span></em></p>Flakka was believed to be behind two cannibalistic attacks in Florida that left one man blind and a married couple dead. It wasn’t so. Here’s why we need facts, not myths, about dangerous drugs.Joseph Palamar, Associate Professor of Population Health, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/411862016-09-11T20:09:17Z2016-09-11T20:09:17ZHow does ice use affect families and what can they do?<figure><img src="https://images.theconversation.com/files/137130/original/image-20160909-13345-w0v9ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">US TV-style 'interventions' aren't the answer. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-210886186/stock-photo-teenager-problems-teenage-girl-cries-while-her-mother-looks-at-her-on-the-background.html?src=5UtKCi4Tk9jhy81jHfcEMw-1-15">Kamira/Shutterstock</a></span></figcaption></figure><p>Some of the <a href="https://www.youtube.com/watch?v=aVA3Pj6gBGk">greatest impacts</a> of drug use are on families, but families sometimes feel in a position of little control when it comes to responding. Often they receive mixed messages about what they should do.</p>
<p>Ice or crystal meth, the strongest form of methamphetamine, has arguably the biggest impact on families of all drugs. It increases the <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">risks</a> of psychosis, violence and impulsivity and decreases emotional control. This can create a volatile and chaotic environment for people living with a person with an ice problem.</p>
<p>So, what can families really do?</p>
<h2>The good news</h2>
<p>The good news is fewer teenagers and young people are drinking and <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">trying drugs</a> than in the past. Those who are drinking and taking drugs do so less often than in previous years. Most young people who are offered drugs don’t try them.</p>
<p>Drug <em>use</em> does not necessarily mean drug <em>dependence</em>. So parents shouldn’t panic if they discover their son or daughter has tried drugs. Most people who use drugs do so very occasionally, for a short period and then stop.</p>
<p>Most people who use drugs don’t need treatment. Specialist treatment in a drug and alcohol centre is designed for people who are experiencing moderate to severe harms, such as addiction or dependence (which is the clinical term). </p>
<p>For crystal meth, more than <a href="http://www.sciencedirect.com/science/article/pii/S0376871606001475">weekly use</a> is associated with dependence. Around 15% of people who have used methamphetamine in the last year use once a week. A further 15% use more than once a month but less than once a week. These groups are at higher risk of other harms such as overdose. </p>
<p>That means 70% of people who use methamphetamine do so irregularly and won’t be dependent or experiencing the harms of long-term use.</p>
<h2>Prevention is better than cure</h2>
<p>The best protection for kids is prevention. Children are strongly influenced by their <a href="http://dera.ioe.ac.uk/6903/1/rdsolr0507.pdf">parents’ attitudes</a> – sometimes more so than by their peers. Parents influence when and how their kids use drugs and alcohol through timing, supervision, modelling, attitudes and communication.</p>
<h3>Timing</h3>
<p>There’s a popular myth that introducing kids to small amounts of alcohol early has a protective effect. The argument is that they can learn to drink safely when supervised by parents. </p>
<p>But there’s no evidence that early sips of alcohol are protective, and lots of evidence that delayed drinking reduces risk. </p>
<p>Early supply of alcohol from years 7 to 9 is the single biggest <a href="http://connections.edu.au/publicationhighlight/parents-who-supply-sips-alcohol-early-adolescence-prospective-study-risk">predictor</a> of drinking in year 10. </p>
<p>So delay the introduction of alcohol as long as possible.</p>
<h3>Supervision</h3>
<p>Parents who establish clear and understandable rules and then supervise their children to ensure those rules are followed tend to have children <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084357/">with lower rates of alcohol and drug use</a>.</p>
<p>Low parental supervision is associated with <a href="http://www.sciencedirect.com/science/article/pii/S0890856709634092">earlier</a> drinking and drug use.</p>
<h3>Modelling</h3>
<p>Parents have an important influence on whether kids drink and use drugs through their own <a href="http://scholar.google.com.au/scholar_url?url=https://www.researchgate.net/profile/Judy_Andrews2/publication/14839250_The_Influence_of_Parent_Sibling_and_Peer_Modeling_and_Attitudes_on_Adolescent_Use_of_Alcohol/links/55c1280908aed621de154156.pdf&hl=en&sa=X&scisig=AAGBfm118HWb8-pU_V2x8wRUmrno4bCoTA&nossl=1&oi=scholarr&ved=0ahUKEwir1ZyyvO_OAhUEJJQKHbAUDPcQgAMIHCgAMAA">behaviour</a>. Not getting drunk or using drugs in front of your kids – or not reaching for a medicine for every minor ailment – are the kinds of strategies parents can use to reduce early exposure to alcohol and other drugs.</p>
<p>Kids who learn effective coping and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518980/">social skills</a> and good emotion regulation are also less likely to use drugs. These skills are typically learnt through parental modelling.</p>
<h3>Attitudes</h3>
<p>Clear and early communication of values and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16228115">attitudes</a> to drugs heavily influences children’s attitudes to drug use and the likelihood they will try drugs.</p>
<p>Talk to pre-school kids about safe use of medicines when they are sick. Talk to them about the effects of smoking and alcohol in primary school, especially if you notice smoking and drinking in movies or on TV. Communicate family rules about drinking and drugs in high school, including drinking and driving.</p>
<p>Make not using alcohol and other drugs “normal”. Only a small proportion of teenagers drink and a very small proportion try drugs. Those who do generally drink or take drugs only very occasionally. If teenagers think everyone is doing it, they are more likely to do it themselves.</p>
<h3>Communication</h3>
<p>Keep an open dialogue with young people about alcohol and drugs. Particularly talk to high school students about what is happening in their year level. </p>
<p>Young people are more likely to discuss difficult issues, including drugs and alcohol, when they believe their parents will not be reactive. Using the <a href="http://friendlyschools.com.au/cyberstrong/5-teaching-and-learning/5.4">LATE Model</a> has been shown to increase help-seeking: <strong>l</strong>isten, <strong>a</strong>cknowledge issues, <strong>t</strong>alk about options, and then end with <strong>e</strong>ncouragement.</p>
<h2>What about when there is a problem?</h2>
<p>When someone in the family has a problem with alcohol or other drugs, family members cope in a number of ways, with both positive and negative impacts on the family. <a href="http://opus.bath.ac.uk/21589/1/paper4jo.pdf">Some</a> will tolerate substance use and its impact; some will attempt to change the drug use; and some will withdraw by reducing interaction.</p>
<p>There’s no right or wrong way of responding. But when family members have vastly different coping styles or change the way they cope in unpredictable ways, conflict in the family can result. Agree on boundaries and responses, and stick to these as much as possible.</p>
<p>It can help family members to get support from a family therapist who specialises in alcohol or other drug problems in the family, or from one of the many support groups available. These include <a href="http://sharc.org.au/program/family-drug-help/support-group">Family Drug Help</a> and <a href="http://www.fds.org.au/meetings-and-events/family-support-meetings">Family Drug Support</a>.</p>
<h2>What works?</h2>
<p>Families can encourage the person who uses drugs to seek help from a number of <a href="http://theconversation.com/you-dont-have-to-go-off-the-grid-to-get-treatment-for-drug-dependence-50075">sources</a> if they’re ready. When families are involved in an effective way, the person using drugs is <a href="https://www.researchgate.net/publication/8228917_Family-based_therapies_for_adolescent_alcohol_and_drug_use_Research_contributions_and_future_research_needs">more likely to engage</a> in treatment and outcomes are better.</p>
<p>If the person isn’t ready to seek treatment, talk to a family specialist who can explore options for encouraging someone into treatment.</p>
<h2>What doesn’t work</h2>
<h3>Fat camp</h3>
<p>American TV-style “family interventions” or Southpark “fat camp”-style interventions aren’t generally effective.</p>
<p>The premise behind them is that the person using is in “denial” about their drug use and how it affects others. They are designed to force the person to see those connections. However, confrontation is rarely helpful and it’s often distressing for all involved.</p>
<p><a href="http://www.researchgate.net/publication/14475502_A_Comparison_of_the_Johnson_Intervention_with_Four_Other_Methods_of_Referral_to_Outpatient_Treatment">Research</a> suggests those who enter treatment as a result of a family intervention are less likely to stay in treatment and more likely to relapse.</p>
<h3>Forced treatment</h3>
<p>Last year, Tasmanian MP Jacqui Lambie <a href="http://www.news.com.au/national/politics/senator-jacqui-lambie-reveals-her-son-is-addicted-to-the-drug-ice/news-story/d6804a56adc30cf7d7a8e680c44c2641">voiced</a> many families’ frustration, proposing forced treatment for people who use ice. Lambie eventually admitted, though, that this type of strategy would not have helped her son.</p>
<p>Her assessment was correct. There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/26790691">no evidence</a> that forcing people into treatment has any long-term benefits in reducing drug use. In some cases it can actually backfire, making it less likely a person will seek treatment in future.</p>
<p>While forced treatment is an <a href="https://www2.health.vic.gov.au/alcohol-and-drugs/aod-policy-research-legislation/aod-legislation/severe-substance-treatment-act-ssdta">option</a> in some states in Australia, there are many more palatable options available for people who use ice and their families if treatment is required.</p>
<hr>
<p><em>The <a href="http://abc.net.au/4corners">Four Corners</a> report <a href="http://www.abc.net.au/4corners/stories/2016/09/08/4535254.htm">Rehab Inc, The high price parents pay to get their kids off ice</a> goes to air on Monday, September 12, at 8.30pm on ABC television & iView.</em></p><img src="https://counter.theconversation.com/content/41186/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee provides alcohol and other drug policy development and training to schools and other workplaces as a private consultant. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross consults to 360edge which provides alcohol and other drug policy development and training to schools and other workplaces and conducts evaluations of drug treatment programs.
She is affiliated with Family Drug Help@SHARC by her position on the advisory committee. She conducts a private practice in which she sees family and individuals with problems associated with substance use.</span></em></p>Ice increases the risks of psychosis, violence and impulsivity, and decreases emotional control. So what can families really do?Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityPaula Ross, Sessional psychology lecturer, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/647532016-09-08T20:04:35Z2016-09-08T20:04:35ZEx-ice users lecturing school kids isn’t the answer to preventing drug use<figure><img src="https://images.theconversation.com/files/136990/original/image-20160908-25279-1up6cua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Programs like the Meth Project are unlikely to have any significant impact on drug use.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-193838348/stock-photo-woman-slumped-on-sofa-with-drug-paraphernalia-in-foreground.html?src=fdo1X81kzDyRj6h8BGl82A-1-32">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Australia is following the lead of the United States and sending ex-ice users into schools in the hope they can have an impact on kids’ attitudes towards drug use and prevent use. </p>
<p>The <a href="http://australianantiicecampaign.org.au/">Australian Anti Ice Campaign</a> has recently rolled out a program based on the Montana <a href="http://www.news.com.au/lifestyle/real-life/news-life/the-meth-project-exice-addicts-teaching-kids-of-seven-how-to-dodge-drugs/news-story/505ecb6082da56aa9370d2c883e97cff">Meth Project</a>. Former users show confronting images of some of the negative effects of ice use and share personal stories of suicide attempts, mental health problems and deaths from ice.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zd712j3kavE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One of the many Montana Meth Project advertisements.</span></figcaption>
</figure>
<p>But, although well-intentioned, there’s little evidence this type of program is effective. It may even serve to normalise, and therefore <a href="http://www.ncbi.nlm.nih.gov/pubmed/12380855">increase</a>, drug use.</p>
<p>So what works in school-based drug education and how should schools implement drug policy?</p>
<h2>What works for school drug ed?</h2>
<p>According to the United Nations Office on Drugs and Crime (<a href="https://www.unodc.org/documents/prevention/UNODC_2013_2015_international_standards_on_drug_use_prevention_E.pdf">UNODC</a>), programs are more likely to be effective if they:</p>
<ul>
<li>use interactive methods</li>
<li>are delivered by trained facilitators</li>
<li>are delivered through a series of structured sessions, often with refreshers</li>
<li>normalise the non-use of alcohol and other drugs</li>
<li>impact perceptions of risk associated with substance use</li>
<li>provide opportunities to practise and learn personal and social skills.</li>
</ul>
<p>Programs are more likely to be ineffective if they:</p>
<ul>
<li>use non-interactive methods like lecturing</li>
<li>are information-only, particularly if they are based on fear</li>
<li>are based on unstructured chat sessions</li>
<li>focus only on building self-esteem and emotional education</li>
<li>address only ethical or moral decision-making or values</li>
<li>use ex-drug users as testimonials</li>
<li>use police officers to deliver the program.</li>
</ul>
<p>Australia’s broader drug policy is based on “harm minimisation”. This acknowledges it’s impossible to eliminate drugs from society and that most people will use drugs only occasionally and for a short period in their lives. So reducing harms associated with drug use is the priority.</p>
<p>The Australian government’s <a href="http://apo.org.au/resource/principles-school-drug-education">Principles for School Drug Education</a> state that drug-education outcomes should contribute to the overall goal of minimising drug-related harm.</p>
<p>In Australia, school programs that adopt a <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00420.x/abstract">harm-minimisation</a> goal have been shown to prevent and reduce alcohol and other drug use.</p>
<h2>Who should drug ed programs target and how?</h2>
<h3><em>Universal programs</em></h3>
<p>Universal school-based alcohol and other drug-education programs are delivered to all students, regardless of level of risk. They have the advantage of reaching large audiences at relatively low costs. </p>
<p>Many of the available universal programs are ineffective at best. Some have even been shown to increase risk of <a href="nceta.flinders.edu.au/download_file/-/view/834">alcohol</a> or <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00420.x/abstract">other drug</a> use.</p>
<p>Most school-based programs have had very little evaluation, but among those that have been evaluated with Australian students, <a href="https://www.climateschools.com.au/">Climate Schools</a> has the best <a href="http://hej.sagepub.com/content/early/2016/01/27/0017896915612227.abstract">evidence</a>. A number of other <a href="https://positivechoices.org.au/resources/recommended-programs/">evidence-based</a> universal programs are available.</p>
<h3><em>Selective programs</em></h3>
<p>Selective programs are designed for adolescents and young people who are at greater risk for developing substance-use problems.</p>
<p>They often show bigger impacts on drug use than universal programs, but are often not used in schools because of practical limitations and risk of stigmatisation.</p>
<p>Only one selective program has been evaluated in Australia. “<a href="http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12558/full">Preventure</a>” has been shown to reduce drinking and problematic drinking among high-risk youth.</p>
<h3><em>Online programs</em></h3>
<p>Some 87% of all households and 97% of households with 15- to 17-year-olds in Australia have <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0">access</a> to the internet. Most children also have internet access at <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features60Jun+2011">school</a>. This makes online programs increasingly important for alcohol and other drug education, and a number do appear to be <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00517.x/full">effective</a>.</p>
<p>The online programs <a href="http://www.ncbi.nlm.nih.gov/pubmed/17114331">Consider This</a> and <a href="https://www.climateschools.com.au/">Climate Schools</a> have the most evidence for reducing alcohol and drug use.</p>
<h2>What should schools do?</h2>
<p>Based on what we know about programs that are and aren’t effective, programs like the Meth Project are unlikely to have any significant impact on drug use. But they may increase acceptability of drug use among students.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=427&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=427&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136988/original/image-20160908-25237-1v38imk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=427&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fear-based programs are more likely to be ineffective.</span>
<span class="attribution"><a class="source" href="https://montanameth.org/">Screenshot of montanameth.org</a></span>
</figcaption>
</figure>
<p>An <a href="http://link.springer.com/article/10.1007/s11121-008-0098-5">evaluation</a> of the US program, on which the Australian program is based, showed no evidence of positive outcomes. It found an increase in the acceptability of methamphetamine and a decrease in the perceived danger of using drugs among school students exposed to the program.</p>
<p>Schools should ensure their school drug policy is comprehensive and includes only elements we know to be effective, meaning they have been shown to reduce alcohol and other drug use.</p>
<p>In December 2015, the Commonwealth government launched the <a href="http://www.positivechoices.org.au">Positive Choices</a> portal as part of the government’s drug and alcohol prevention strategy for schools. This provides evidence-based drug prevention resources for teachers, students and parents to support positive choices about drug and alcohol education for young people.</p><img src="https://counter.theconversation.com/content/64753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee provides alcohol and other drug policy development and training to schools and other workplaces as a private consultant. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Nicola Newton currently holds a research fellowship from the Society for Mental Health Research and her research into drug prevention has been funded from the Australian Government Department of Health and the National Health and Medical Research Council. She is co-director of Climate Schools Pty Ltd. </span></em></p>Australia is following the lead of the United States and sending ex-ice users into schools in the hope they can impact kids’ attitudes towards drug use and prevent use.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityProfessor Nicola Newton, Senior Research Fellow, National Drug and Alcohol Research Centre; Director, Prevention Stream, NHMRC Centre for Research Excellence in Mental Health and Substance Use, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/610022016-07-06T05:11:24Z2016-07-06T05:11:24ZWeekly Dose: ice and speed, the drugs that kept soldiers awake and a president young<figure><img src="https://images.theconversation.com/files/129495/original/image-20160706-814-1jt1j3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ice is more readily smoked than other methamphetamines, but can also be injected.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Ice is a slang name for crystal methamphetamine – a stimulant drug that is swallowed, smoked or injected. Ice is also called shabu, tina, T, crystal and meth. </p>
<p>It is usually made overseas – from the ingredients pseudoephedrine, iodine and hypophosphorous acid – and imported illegally into Australia. But because the ingredients <a href="http://www.smh.com.au/nsw/price-of-ice-plummets-in-sydney-as-legal-ingredients-flood-australia-20150606-ghi61b.html#ixzz4BGMRUQhZ">can be legally imported</a>, ice can also be made here in large quantities. </p>
<p>Ice has been around for years, but a powdered form of methamphetamine called <a href="http://www.health.nsw.gov.au/crystallinemethamphetamine/Publications/background-paper.pdf">speed was more commonly used</a> in Australia up until about 2010, when ice became more available. Speed and ice are chemically the same drug but instead of a powder, ice is produced in a crystal form that is stronger than speed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129488/original/image-20160706-807-jz6ezp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
<h2>How it works</h2>
<p>Because ice is more likely to be smoked than other types of methamphetamines, it enters the bloodstream quickly, which means the effect is <a href="https://www.mja.com.au/journal/2016/204/4/ice-crystal-methamphetamine-concerns-and-responses">faster and stronger</a> than if it were swallowed or snorted. Injecting ice works as quickly as smoking it.</p>
<p>Ice travels to the brain, <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-modpsy-toc%7Edrugtreat-pubs-modpsy-2%7Edrugtreat-pubs-modpsy-2-3%7Edrugtreat-pubs-modpsy-2-3-pamp">activating the reward</a> (dopamine) pathway. This is the centre of the brain involved in motivation, euphoria and compulsion. </p>
<p>Ice causes increased amounts of the chemical dopamine to be released, and for long-term users, it becomes difficult to feel pleasure when not intoxicated by ice. This is because the usual pleasurable activities, such as eating chocolate, do not release the same flood of dopamine as ice does.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=901&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=901&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=901&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1132&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1132&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129499/original/image-20160706-804-xqvae4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1132&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When ice is smoked, it enters the bloodstream quickly.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There are also physical effects on the body: heart rate, blood pressure and body temperature all increase and appetite decreases.</p>
<p>One of the reasons people experience problems with ice is <a href="http://www.health.nsw.gov.au/crystallinemethamphetamine/Publications/background-paper.pdf">because it is more potent</a> than in the past. Tests of drugs seized by police show it increasing in purity – which means there is a higher concentration of methamphetamine in the product. In early 2011, 50% of drugs captured had a purity of 10% or less. By July to September 2014, average purity was 75% to 80%. </p>
<h2>What it’s used for</h2>
<p>Ice is used as a stimulant. It will keep people awake; make them feel more energetic as well as capable and confident. </p>
<p>A prescription drug – methamphetamine hydrochloride (brand name Desoxyn) – is sometimes used in the United States to treat attention deficit hyperactivity disorder (ADHD) and obesity that is resistant to other treatments. </p>
<p>However, Desoxyn’s manufacturer provides <a href="http://www.rxlist.com/desoxyn-drug.htm">several warnings</a> about the health and dependency risks of using the drug.</p>
<h2>Side effects</h2>
<p>Common <a href="https://www.mja.com.au/system/files/issues/204_04/10.5694mja15.01253.pdf">problematic effects</a> of ice use include insomnia, weight loss, dental problems related to jaw clenching and teeth grinding, dehydration, mental health problems, injuries, infections (related to injecting and also risky sex) and heart palpitations.</p>
<p>People typically experience a “crash” when coming down from ice where they feel physically and emotionally drained. More serious health problems include heart attacks, high blood pressure and stroke. Those dependent on the drug often go back to using it even though they want to stop.</p>
<h2>How it was developed</h2>
<p>Romanian chemist Lazar Edeleanu <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377281/">created amphetamine sulphate</a> in 1887 from a Chinese plant called ma-huang, also known as ephedra. </p>
<p>In routine commercial drug development, methamphetamine was developed from amphetamine <a href="http://www.drugfreeworld.org/drugfacts/crystalmeth/history-of-methamphetamine.html">in Japan in 1919</a> to relieve fatigue. It was widely used in World War II to keep troops awake as well as to treat asthma (because it dilated the bronchial tubes in the lungs) and narcolepsy. </p>
<p>Methampetamine, as opposed to amphetamine, was a crystalline powder that was soluble in water and could be more easily injected than amphetamine sulphate.</p>
<p>Civilians started using methamphetamine during the 1940s, both legally and illegally. It was prescribed as a diet aid, for depression and to treat heroin addiction <a href="http://healthvermont.gov/adap/meth/brief_history.aspx">in San Francisco</a> clinics. </p>
<p>Methamphetamine was used to keep people awake for partying, driving long distances and studying for exams. Considered harmless, methamphetamine was readily available from doctors during the 1960s.</p>
<h2>Interesting history</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=766&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=766&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=766&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=962&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=962&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129496/original/image-20160706-789-qkh7x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=962&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">US President John F. Kennedy received regular methamphetamine injections to keep him young.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/5/5e/John_F._Kennedy,_White_House_photo_portrait,_looking_up.jpg">White House Press Office (WHPO)/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>United States President John F. Kennedy received regular injections of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377281/">methamphetamine to help maintain his youthful vigour</a>, as <a href="http://jfk.hood.edu/Collection/White%20Materials/White%20Assassination%20Clippings%20Folders/Miscellaneous%20Folders/Miscellaneous%20II/Misc%20II-219.pdf">did other music</a> and film stars. </p>
<p>It has also been rumoured, though not confirmed, that writer Jack Kerouac wrote his famous novel <a href="https://www.thefix.com/content/beat-poets-speed5123">On The Road in a two-week drug-fuelled</a> frenzy. He was taking Benzedrine, a form of amphetamines popular at the time. </p>
<p>Amphetamine psychosis was recognised in medical literature in 1958. British <a href="http://www.abebooks.com/Amphetamine-Psychosis-P.H-Connell-Oxford-University/10230341413/bd">psychiatrist Phillip Connell found</a> that, given enough of the drug, anyone would develop paranoid symptoms including hearing sinister voices coming from toilet bowls and spies watching every move. </p>
<p>Connell found paranoia and psychotic symptoms built up over time as a person continued to take the drug and then went away when they stopped taking it.</p>
<h2>Who uses it</h2>
<p><a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554227">Methamphetamine use has declined</a> in Australia from 3.2% of the population in 2004 to 2.1% in 2013, and has stayed relatively steady at around 2% since. This works out to be <a href="https://www.mja.com.au/journal/2016/204/4/estimating-number-regular-and-dependent-methamphetamine-users-australia-2002-2014">268,000 regular users</a> across Australia in 2016; half of these are estimated to be dependent on the drug. </p>
<p>Like most drugs, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554227">people who use methamphetamines</a> are generally younger (under 40 years of age) and more often men than women. Use of ice is more common in rural and remote communities and among some groups, especially Aboriginal and Torres Strait Islander people, as well as the gay, lesbian, transgender and transsexual communities. </p>
<p>Methamphetamine is also popular among some in the gay community for <a href="http://www.abc.net.au/news/2016-04-14/the-rise-of-chemsex/7326744">chemsex parties</a> – group drug and sex parties that last several days.</p>
<p>Waste water analysis has been used to identify population level methamphetamine use. This is a scientific method that measures the concentration of a drug in the water going into council treatment plants. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129498/original/image-20160706-786-1vofokl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Writer Jack Kerouac is rumoured to have pumped out On The Road in two weeks in a drug-fuelled frenzy.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>A <a href="https://www.mja.com.au/journal/2016/204/4/trends-methamphetamine-residues-wastewater-metropolitan-and-regional-cities-south">study of two cities in Queensland</a> found a significant increase of methamphetamine in waste water samples between 2009 and 2015. The water analysis findings are consistent with increases in the purity of methamphetamine seized by police and arrests for methamphetamine use and supply during that period.</p>
<h2>How much it costs</h2>
<p>The price of ice varies from place to place and according to the quantity sold. The Australian Crime Commission reports <a href="https://theconversation.com/ice-in-australia-overseas-crime-gangs-not-bikies-are-the-threat-39313">wholesale prices</a> are between A$90,000 to A$325,000 per kilogram.</p>
<p>The United Nations Office on Drugs and Crime reported the average street price per gram of methamphetamine was between US$500 (A$678) in Australia to US$80 (A$108) in China. People using ice <a href="https://www.buzzfeed.com/allanclarke/dubbo-struggling-to-break-free-from-ice?utm_term=.ld9YlwKqW4#.bn9M2o4p93">have reported</a> a gram costs A$300 in rural New South Wales. </p>
<p>Ice is usually bought as a point (about a tenth of a gram) for around A$40. A point is enough for one person for a single occasion; perhaps lasting a couple of days depending on the purity of the drug and the tolerance of the person using it.</p><img src="https://counter.theconversation.com/content/61002/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from the NHMRC, the Australian Research Council, The Rural Industries Research and Development Corporation and the Ian Potter Foundation for the research projects she has been involved with. Julaine works for Lyndon, a not for profit drug and alcohol treatment service in rural NSW</span></em></p>Ice is a slang name for crystal methamphetamine – a stimulant drug that is swallowed, smoked or injected. It works by activating the reward pathways in the brain, producing feelings of alertness.Julaine Allan, Senior Research Fellow, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/604512016-06-28T03:00:44Z2016-06-28T03:00:44ZHow the desire for masculinity might drive some disadvantaged young men to substance abuse<figure><img src="https://images.theconversation.com/files/128423/original/image-20160628-28366-w9wb1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young men with problem drug-use have high rates of mental health problems and backgrounds of contact with child protection.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Males <a href="http://www.ysas.org.au/sites/default/files/SYNC_2013_Statewide%20Results_FINAL_0414.pdf">make up two-thirds</a> of people accessing alcohol and other drug services; 75% of them have been involved in the justice system.</p>
<p>Those with problem drug use also <a href="http://www.sciencedirect.com/science/article/pii/S0190740916301931">have high rates</a> of mental health problems and backgrounds of contact with child protection. They <a href="http://www.ysas.org.au/sites/default/files/SYNC_2013_Statewide%20Results_FINAL_0414.pdf">have much lower levels</a> of educational attainment and employment than their peers. </p>
<p>While poverty or childhood trauma certainly don’t <em>cause</em> substance abuse, they do play a part. But awareness of other social and environmental factors, such as society’s perpetuation of masculinity, are critical to understanding the interconnections between trauma, disadvantage and substance abuse in young men.</p>
<h2>The ‘wrong crowd’</h2>
<p>I interviewed 35 young males between the ages of 14 and 25 accessing drug treatment services in Victoria. The usual drugs of concern are cannabis, methamphetamine and alcohol. </p>
<p>When asked about what they wanted for their future, the men’s answers were remarkably similar: they wanted a home, job and wife. Traditional ideas of being a provider pervaded their narratives.</p>
<p>Achieving this kind of masculinity is difficult for these young men. Primarily because it necessitates education and employment. Only 9% of those in my study completed school, with most (66%) leaving by the end of year nine. </p>
<p>At a time when <a href="http://www.education.vic.gov.au/Documents/about/department/brochuremarch.pdf">87% of Victorian males</a> are completing their final year of school, lack of formal education is a considerable barrier to employment. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/128428/original/image-20160628-8002-1pt6vxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Traditional ideas of being a provider and having a family pervaded young men’s narratives.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>When I asked how they transitioned from school to unemployment, many spoke about falling in with “the wrong crowd”. The description of this group as being wrong showed they felt a deviation from their idea of what young men ought to be doing. </p>
<p>Gerald was acutely aware of the steps to this conception of manhood he had not taken:</p>
<blockquote>
<p>I can’t help but compare myself to some of my other friends. Like my other mate, he’s got a trade, he’s paying off a house, he’s got a girlfriend - he’s living the dream pretty much … and I’ve got nothing, and it’s my fault – I am not making excuses. It’s just hard to not feel like an idiot.</p>
</blockquote>
<p>At a time in their lives when they were realising there was no place for them in the labour force, the “wrong crowd” offered another variety of masculinity and a place where they felt belonging. Chris described the appeal:</p>
<blockquote>
<p>Whether it’s drugs, or fighting, or graffiti, or knives, it’s all just cultures – subcultures. Wherever somebody feels that they fit in, or feel comfortable with that group of people, then they want to do what those people are doing. </p>
</blockquote>
<p>Another boy, Pailin, was struggling at school with a poor grasp of English which was not his native tongue. He described his pathway into the wrong crowd as a process of learning to be assertive:</p>
<blockquote>
<p>I got picked on because I couldn’t speak properly … It kind of changed me a little bit, because I had to stand up for myself. I wasn’t an aggressive kid or anything you know… But what happened to me… made me more aggressive because I had to stand up for myself… I needed to become one of those cool kids who smoked at school at that’s what I kind of turned into. </p>
</blockquote>
<p>Among the wrong crowd, rather than being a worker and provider, men are celebrated for rebellion of these things. From minor delinquency, such as skipping school, through to drug use and violence; the more these young men defied mainstream norms, the more masculine they were perceived to be. </p>
<h2>Men are tough</h2>
<p>According to my interviews, a <a href="http://jmm.sagepub.com/content/8/1/44.abstract">key implicit rule</a> in the wrong crowd is to never show any vulnerability: men are tough. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/128432/original/image-20160628-28391-1xrv4rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even those who did not initially like drugs learned they were able to anaesthetise their emotions by getting stoned.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Similarly, <a href="https://books.google.com.au/books?id=DcMmAAAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false">a seminal study of street-based crack dealers in East Harlem</a> found the excessive displays of confrontation among men were performances of power from a group who, beyond their housing estates, had no power in the world.</p>
<p>The machismo perpetuated in these subcultures appeared to prevent the men I interviewed from being able to work through their past trauma in ways that didn’t harm them socially. </p>
<p>The middle classes often defer to therapy – formally or informally – but these men did not have spaces where talking, crying and expressing vulnerable emotions would be greeted with compassion. So these were unsurprisingly expressed in other ways. </p>
<p>As Brandon explained:</p>
<blockquote>
<p>I get depressed all the time. I get upset over nothing… and then it goes to anger and I blackout and whatever happens, happens … I’ve smashed a lot of things, a few people.</p>
</blockquote>
<p>This was similar to Mick:</p>
<blockquote>
<p>I’d go to a pub or whatever, pick on someone, wait until they’d fight me. I’d get smashed – I didn’t care; I loved it. I loved being hurt so much ‘cause it relieved all of the tension out of me.</p>
</blockquote>
<p>Another common practice of the “wrong crowd” was drug use. Even those who did not initially like drugs learned they were able to anaesthetise their emotions by getting stoned. </p>
<p>Getting out of problem drug use was hard. Criminal records, illiteracy, little formal education and lack of housing or family supports created and exacerbated barriers to entering expected young-adulthood. These barriers seemed insurmountable; in turn, drug use increased. </p>
<p>This cycle is replicated in studies of youth homelessness where it is established that the longer and earlier a person is homeless, <a href="http://jos.sagepub.com/content/early/2011/11/04/1440783311422458.abstract">the less likely</a> they are <a href="http://search.informit.com.au/documentSummary;dn=546983225278750;res=IELAPA">to escape homelessness</a>.</p>
<p>Understanding these pathways is integral to any prevention or intervention initiatives.</p><img src="https://counter.theconversation.com/content/60451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Daley received funding from the Foundation for Alcohol Research and Education (FARE) and in-kind support from the Youth Support + Advocacy Service (YSAS). </span></em></p>Awareness of social factors, such as society’s perpetuation of masculinity, are critical to understanding the interconnections between trauma, disadvantage and substance abuse in young men.Kathryn Daley, Lecturer, School of Global, Urban and Social Studies, RMIT University, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/608152016-06-20T13:17:42Z2016-06-20T13:17:42ZSmoking may protect against Parkinson’s disease – but it’s more likely to kill you<figure><img src="https://images.theconversation.com/files/126516/original/image-20160614-22395-1piolp9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Smoking therapy – not recommended.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=ipfa6b16xyle410vz0j&searchterm=smoking%20cigarette&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=426850741">Notto Yeez/Shutterstock.com</a></span></figcaption></figure><p>There is a little art gallery in my high street which is run by a lovely lady who unfortunately suffers from Parkinson’s disease. Deep inside her brain, nerve cells are dying. This results in a steep decline in the neurotransmitter dopamine. As a smoker you may be familiar with dopamine as its release by nicotine causes a strong feeling of reward. Other drugs such as methamphetamine, made famous as crystal meth in the TV series <a href="http://www.imdb.com/title/tt0903747/">Breaking Bad</a>, also trigger an increase in this neurotransmitter.</p>
<p>My art friend, and an estimated <a href="http://www.parkinsons.org.uk/content/facts-journalists">127,000</a> other people in the UK, have low levels of dopamine which cause the well known debilitating movement defects of Parkinson’s, such as muscle twitching and slowness of movement (<a href="http://www.parkinsons.org.uk/content/what-parkinsons">bradykinesia</a>). The late Muhammad Ali – himself a Parkinson’s sufferer – helped to raise awareness for these life-changing conditions.</p>
<p>Strikingly, <a href="http://www.ncbi.nlm.nih.gov/pubmed/15331239">half of all smokers</a> are protected from Parkinson’s disease after taking into account their reduced life expectancy. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/9921857">protection increases</a> with the number of cigarette packs consumed per year. Studies with <a href="http://www.ncbi.nlm.nih.gov/pubmed/11865136">identical twins</a> have borne out this “dose-response” relationship and suggested that the protective effect has nothing to do with differences in genes or environment.</p>
<p>A similar protective effect does not extend to crystal meth, as this drug kills the dopamine producing neurons thereby <a href="http://www.ncbi.nlm.nih.gov/pubmed/23600399">promoting Parkinson’s disease</a>.</p>
<h2>A daily puff?</h2>
<p>Nicotine has been shown to relieve the symptoms of Parkinson’s disease, to reduce the significant side effects of its treatment and to protect dopamine neurons from dying. Since nicotine stimulates the release of dopamine, it can partly compensate for the low levels of the neurotransmitter in the substantia nigra of the brains of people with Parkinson’s – a part of the brain responsible for movement and reward. Nicotine also decreases the involuntary muscle movements known as dyskinesia which are caused by the treatment of the disorder with the <a href="http://www.ncbi.nlm.nih.gov/pubmed/26093062">dopamine precursor L-dopa</a>. (As an artist, my friend finds dyskinesia particularly frustrating.) </p>
<p>Also, nicotine protects damaged neurons from death by increasing the amounts of survival proteins and by blocking inflammation of the affected brain area. Based on this evidence, Ali may have benefited from a daily cigarette – although it would not have provided a cure.</p>
<p>In more than 95% of Parkinson’s patients, large amounts of inactive alpha-synuclein protein accumulate inside the <a href="http://www.ncbi.nlm.nih.gov/pubmed/26250687">dying brain cells</a>. These deposits are known as Lewy bodies. Alpha-synuclein exists in two forms: an active form, which is involved in the release of dopamine, and an inactive form that can form Lewy bodies. Nicotine may prevent cell death by increasing the amount of active alpha-synuclein as it encourages neurons to release dopamine. This would block the formation of Lewy bodies thereby keeping nerve cells alive. </p>
<h2>Should you buy nicotine patches?</h2>
<p>Small scale clinical trials testing <a href="http://www.ncbi.nlm.nih.gov/pubmed/14687854">nicotine patches</a> have failed, so far, to provide conclusive evidence of improvements in cognitive and motor function. Unlike smoking, a patch results in the constant release of nicotine that could deactivate nicotine receptors in the brain. It is well known that the continuous presence of an activator such as nicotine switches off its receptor which in turn causes changes in <a href="http://www.ncbi.nlm.nih.gov/pubmed/26806304">other receptors in the same cell</a>.</p>
<p>Cigarette smoke also contains thousands of chemicals and it could well be that nicotine needs some of them to do its protective work. One of them, a naptho-quinone, protects against neuronal cell death and may help nicotine to <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=castagnoli+k+2004">prevent Parkinson’s disease</a>. </p>
<p>While your brain may stay active, the rest of your body is unlikely to approve of a smoking therapy against Parkinson’s disease as cigarette smoke harms most organs, causing about <a href="http://ash.org.uk/files/documents/ASH_107.pdf">96,000 premature deaths</a> a year in the UK. </p>
<p>My artist friend incorporated the disease in her art which may be a very good way to deal with the situation until we reach a better understanding of the therapeutic benefits of cigarette smoke and, in particular, nicotine.</p><img src="https://counter.theconversation.com/content/60815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Caspari does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Smoking causes 96,000 premature deaths a year in the UK. The fact that it protects against Parkinson’s disease is not a reason to take up the habit.Thomas Caspari, Reader in Cancer Biology, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/554972016-03-06T21:55:03Z2016-03-06T21:55:03ZAddress other life problems to get at-risk young people off methamphetamines<p>While the level of methamphetamine use (including ice) has remained stable in population studies of young people at 2%, <a href="https://www.mja.com.au/journal/2016/204/04">new research</a> has found use of methamphetamines has increased significantly in young people already at risk of other drug- and alcohol-related dependence and harm.</p>
<p>“Tough on drugs” approaches to getting young people off methamphetamine and ice don’t work, and temporary rehabilitative measures don’t last. The problems affecting the rest of these youths’ lives have to be addressed long-term if we’re to have any hope of keeping them away from methamphetamines for good.</p>
<h2>Meth use on the rise among already at-risk youth</h2>
<p>Our study was based on 865 adolescents, aged 14–18 years, admitted to a drug and alcohol rehabilitation program in NSW and the ACT. The number of young people in this program reporting methamphetamine use doubled from 2009 to 2014.</p>
<p>Young people admitted for treatment not only report the drugs they use, but also the drug that is of greatest concern to them at the time. Methamphetamines were the only drug to show a significant upward trend over time, from 10% in 2009 to almost 50% in 2014. </p>
<p>Some 64% also reported they currently used alcohol, 85% cannabis and 73% tobacco in 2014.</p>
<p>Those reporting methamphetamine use were more likely to have unstable living arrangements and more police contact.</p>
<p>This may mean these young people are already in precarious positions in their lives which leads them into problematic methamphetamine use. The reverse may also be true.</p>
<p>Population surveys show no rise in young people’s use of methamphetamines. The best sources of adolescent drug and alcohol use in Australia are the <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school11">Australian Secondary Students’ Alcohol and Drug Survey</a> and the <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">National Drug Strategy Household Survey</a> which includes 12- to 19-year-olds.</p>
<p>These surveys show that alcohol, cannabis and tobacco were the most commonly currently and recently used drugs among adolescents. These surveys also show use of methamphetamine among adolescents has remained very low (around 2%) and stable over the last few years.</p>
<p>However, some adolescents may be missed in these surveys due to school suspension or expulsion, homelessness, or being in custody – the very young people our study includes.</p>
<h2>Addressing harm</h2>
<p>Our data from young people admitted to treatment show clearly that methamphetamine use is on the rise in this group, but other data provide no evidence for an “epidemic” among young people.</p>
<p>Early intervention and treatment for young people, including residential treatment programs, is what is needed, not more arrests by police. The program in the recent study was run as a therapeutic community which involves residents living in a drug-free setting for up to three months to address <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2010.00169.x/abstract">underlying causes</a> of addictive behaviour. </p>
<p>The program aims to build young people’s skills to manage their lives effectively addressing employment, training, relationship building, mood management, and teaches relapse prevention skills. </p>
<p>There have been some <a href="http://www.ncbi.nlm.nih.gov/pubmed/19819085">robust studies</a> focused on the outcomes of residential treatment for young people, which have found <a href="http://www.tandfonline.com/doi/abs/10.1080/0886571X.2013.819273#.VtUMevl94dU">positive effects</a> in the first 12 months after treatment. </p>
<p>However, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19819085">one study</a> found positive effects on substance use and psychological functioning were not maintained longer-term. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19819085">Continuing support</a> after treatment is critical to prevent the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17207126">erosion of short term</a> program effects and includes ongoing counselling, employment assistance and interventions with families. The current study findings suggest stable and affordable housing is also crucial.</p>
<p>If we want to make a difference in the longer term, we need to address the broader context of these young people’s lives, not just their drug use. </p>
<p>There is also a clear imperative not to forget the harms of other drugs commonly used by young people, such as cannabis, tobacco, as well as alcohol, in the hysteria generated about ice.</p>
<hr>
<p><em>Mr Mark Ferry, Chief Operating Officer at the Ted Noffs Foundation and Ms Anna Bethmont, former Master of Public Health student at UNSW Australia contributed to the study in the MJA.</em></p><img src="https://counter.theconversation.com/content/55497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Nathan receives funding from the Australian Research Council's Linkage Projects funding scheme (project number LP140100429) and the Ted Noffs Foundation as a partner organisation. Ted Noffs Foundation are a signatory to the Australian Research Council Funding Contract. </span></em></p><p class="fine-print"><em><span>Andrew Hayen receives funding from the Australian Research Council's Linkage Projects funding scheme (project number LP140100429) and the Ted Noffs Foundation as a partner organisation. Ted Noffs Foundation are a signatory to the Australian Research Council Funding Contract.</span></em></p><p class="fine-print"><em><span>Patrick Rawstorne receives funding from the Australian Research Council's Linkage Projects funding scheme (project number LP140100429). </span></em></p><p class="fine-print"><em><span>Ranmalie Jayasinha does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Use of methamphetamines has increased significantly in young people already at risk of other drug and alcohol related dependence and harm.Sally Nathan, Senior Lecturer, UNSW SydneyAndrew Hayen, Associate Professor of Biostatistics, UNSW SydneyPatrick Rawstorne, Senior Lecturer in International Health, UNSW SydneyRanmalie Jayasinha, Research Associate, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/500752015-11-12T19:20:32Z2015-11-12T19:20:32ZYou don’t have to go off the grid to get treatment for drug dependence<figure><img src="https://images.theconversation.com/files/101652/original/image-20151112-9374-zpl23l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evidence-based drug treatments are relatively successful at reducing use and improving quality of life.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-329595416/stock-photo-mature-woman-discussing-problems-with-counselor.html?src=pp-same_model-329595437-9CTx2p4rAJ1fyYCwfk1MMA-2&ws=1">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>Every other week stories appear online and in the media about alternative “treatments” for drug dependence. <a href="http://www.smh.com.au/world/rock-im-a-drug-addict-and-other-cracking-rehab-admissions-in-kyrgyzstan-20151031-gkepee.html?skin=text-only">Rock therapy</a> in Kyrgyzstan and <a href="http://www.sbs.com.au/news/dateline/story/last-resort-rehab">vomit therapy</a> in Thailand are two recent examples. </p>
<p>Long <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">waiting lists</a> for drug treatment in Australia and a perception that drug treatments are ineffective may be driving people to seek solutions elsewhere. But these untested interventions are expensive at best and potentially dangerous at worst. </p>
<p>So what treatments <em>do</em> work for ice and other drug users?</p>
<h2>Not all drug users need treatment</h2>
<p>Different drugs have different dependence thresholds. For most drugs, infrequent, short-term users make up the larger group of people. They eventually stop without experiencing any significant problems.</p>
<p>For <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723192">methamphetamine</a> (which includes ice and speed), using more than weekly is associated with dependence. Around <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">15% of people</a> who used methamphetamine in the past year fall into this category. </p>
<p>For <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2001.9657379.x/abstract">cannabis</a>, around 20% of people who have used in the past year are likely to be dependent. Around 4% of <a href="http://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.097.pdf">drinkers</a> are dependent. </p>
<p>This means that 85% of methamphetamine users, 80% of cannabis users and 96% of drinkers are probably not dependent and are unlikely to need treatment. </p>
<p>Those who are not dependent are still at risk of unwanted side effects and overdose. Harm-minimisation strategies are designed to keep this group, and the community, as safe as possible while they continue to use. Measures include police random breath testing, drug checking (testing the content of drugs) and needle and syringe programs.</p>
<p>Methamphetamine users also commonly experience mental health problems such as transient psychosis (25%) or symptoms of depression (80%). </p>
<p>This group may not be willing, or need, to access drug treatment but may seek help for their mental health symptoms through their GP or other health service. Addressing mental health symptoms can encourage users to <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17570971211225145">seek help</a> for their drug use earlier.</p>
<h2>What works for those who need treatment?</h2>
<p>The goal of treatment for alcohol or other drug dependence is to reduce use and to improve quality of life. According to the National Institute of Drug Abuse (NIDA) in the United States, people who enter and remain in treatment reduce their use of alcohol or other drugs, are less involved in criminal activity and have better general functioning. </p>
<p>There are also <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">cost savings</a> to the community through better health and reduced crime.</p>
<p>For those people who use alcohol or other drugs and need treatment there are a number of effective options. The <a href="http://psychology.org.au/Assets/Files/Evidence-Based-Psychological-Interventions.pdf">Australian Psychological Society</a> has undertaken a review of psychological interventions for mental health conditions and found that <a href="http://www.aacbt.org/viewStory/WHAT+IS+CBT%3F">cognitive behaviour therapy</a> (CBT) has the best evidence for its effectiveness. </p>
<p>NIDA endorses a number of <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies">treatments</a> as effective. Most fit within the group of behavioural and cognitive therapies.</p>
<p>For dependent heroin users and cigarette smokers, and to some extent dependent drinkers, <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies">drug therapies</a> are also effective. But for other drugs, medical treatments are generally limited to medicines to relieve symptoms of withdrawal or use such as mental health symptoms.</p>
<p>Drug dependence is a chronic health condition and relapse is likely along the road to recovery. The <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">overall relapse rate</a> is around 50% after one year. This is similar to relapse rates after treatment for other chronic health conditions, such as diabetes, hypertension and asthma. It is also similar to other mental health conditions such as <a href="http://www.australianprescriber.com/magazine/30/2/44/6">psychosis</a>, which has a reoccurrence rate of 70%, and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2169519/">depression</a> (50%).</p>
<p>The <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">Patient Pathways</a> study in Australia found that one year after treatment, about 40% of dependent users in treatment were abstinent, ranging from 60% (methamphetamine) to 28% (alcohol). However, continuous abstinence was harder to achieve, with only around 30% of people remaining abstinent for an entire year. </p>
<p>But not everyone who goes through drug treatment aims to be abstinent from drugs. Around 55% of people in treatment succeeded in making significant changes to their use.</p>
<p>A <a href="http://www.odysseyhouse.com.au/uploads/70255/ufiles/ATOS_11_year_bulletin_FINAL.pdf">follow-up of heroin users</a> who entered treatment found substantial reductions in heroin and other drug use, crime and injecting-related health problems. Reductions were still evident after two years and maintained after 11 years.</p>
<h2>When is treatment most effective?</h2>
<p>The idea that drug users need to hit “rock bottom” before recovery is possible is not supported by evidence. Many people make significant changes to their use well before they reach crisis point.</p>
<p><a href="http://pubs.niaaa.nih.gov/publications/arh23-2/086-92.pdf">Motivation</a> is important in the success of drug treatment, but part of the core skills expected of alcohol and other drug treatment professionals is the ability to increase motivation for engaging in treatment and reducing drug use. </p>
<p>In <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">a study</a> of an intervention for methamphetamine users, which included a motivational component, more than a third of people entering the study were not interested in changing their drug use. But their outcomes were similar to those who were motivated at the beginning of treatment and both groups showed increased abstinence.</p>
<p>Mandated treatment programs, such as court diversion or <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">drug court</a> programs, also show that people who are ordered to treatment through the justice system do well once they get there.</p>
<h2>What treatments are available in Australia?</h2>
<p>Specialist alcohol and other drug treatment services vary between states. </p>
<p>Publicly funded services are run by government and non-government organisations. These services are generally free or low cost to the consumer. They offer a range of options including outpatient counselling, group programs, rehabilitation day programs (typically six to 12 weeks), inpatient rehabilitation programs of typically between two and 12 months, and inpatient and outpatient detoxification. </p>
<p>The different treatment options show similar outcomes.</p>
<p>In the public sector, most people needing drug treatment choose <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551454">outpatient counselling</a>, which is the <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">least expensive</a> option. </p>
<p>Although self-help groups are considered peer support rather than treatment services per se, programs such as <a href="http://smartrecoveryaustralia.com.au/">SMART Recovery</a> and a range of 12-Step programs are widely available. These are usually run by consumers and peers at low or no cost.</p>
<p>Private services are also available in all states, both through hospitals – usually offering inpatient detoxification, inpatient stays of typically up to three months that include individual and group attendance – and private individuals, such as psychologists, psychiatrists and addiction medicine specialists. These services vary in cost, some of which may be claimable through Medicare and/or private insurance.</p>
<p>In Australia, government-funded services are expected to meet minimum standards of accreditation for health providers, and some states require minimum qualifications for practitioners. Private providers, such as hospitals, psychologists, nurses and medical professionals, may be required to meet certain professional standards for registration and accreditation. </p>
<p>However, many providers that offer drug and alcohol treatment, such as “counsellors” and “psychotherapists”, are unregulated. There are also no specific minimum requirements for establishing a private drug rehabilitation program. </p>
<p>Some use frameworks that are not consistent with the evidence. Very few have been independently evaluated. If considering treatment, it is important to check into any potential program to ensure it meets best practice standards.</p>
<p>Evidence-based treatments for drug use problems are available in Australia at low or no cost to consumers, but waiting lists can be long. Public investment in these treatment options for drug users is essential if we’re serious about improving access to and outcomes of treatment. </p>
<p>Innovation is important, but new and untested treatment programs should be subjected to well-conducted evaluation of outcomes to ensure they’re not only doing good but are also doing no harm.</p><img src="https://counter.theconversation.com/content/50075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a private consultant to health services and is the President and Board Chair of the Australian Association for Cognitive and Behaviour Therapy</span></em></p>Many untested drug therapies are expensive at best and potentially dangerous at worst. So what treatments do work for ice and other drug users?Nicole Lee, Associate Professor at the National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/482462015-10-15T19:17:31Z2015-10-15T19:17:31ZIf we’re serious about tackling ice, we need to try something new<figure><img src="https://images.theconversation.com/files/98495/original/image-20151015-27945-1racvky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Policymakers should consider other solutions, such as prison diversion programs. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-193975568/stock-photo-man-slumped-on-sofa-with-drug-paraphernalia-in-foreground.html?src=qKzJQ31tSERFqi00eE97_w-1-2">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Methamphetamine use has been a major health problem in Australia for more than a decade, particularly since the heroin supply was severely restricted. Better availability and higher purity of “ice” have <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">increased the level of harm</a> to users, leading to calls for new thinking and action. </p>
<p>New <a href="https://ministers.employment.gov.au/abetz/government-building-code-now-requires-drug-and-alcohol-testing-policies-construction-sites">national rules requiring</a> drug and alcohol tests on construction sites, and expanded roadside drug testing in several states, offer the potential to identify ice users while they are still functioning members of society. </p>
<p>But the challenge is to intervene before they hit crisis point. </p>
<p>Australia’s experience of methamphetamine is relatively recent, while countries such as the United States have been dealing with it for decades. We should therefore look abroad to evidence-based initiatives that have – and haven’t – worked. </p>
<p>Unfortunately, treatment programs are not the only answer. While they may be important for some ice users, overall, two <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12709/abstract">decades of research shows</a> that: </p>
<blockquote>
<p>Despite an urgent need, there are currently no widely accepted psychological or pharmacological treatments for methamphetamine dependence.</p>
</blockquote>
<p>We need to look to other, more controversial solutions, such as prison diversion programs. The Hawaii Opportunity Probation with Enforcement, or HOPE, is one such program and it has achieved substantial reductions in drug use. </p>
<p>HOPE is a sentencing option for substance-using offenders, which mandates sobriety from drugs as an alternative to usual probation. Similar models have been effective for <a href="http://www.wvmphp.org/PHP.PhaseI.How_are_Addicted_Phys_treated.pdf">addicted doctors</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/23153129">drunk drivers</a>. The <a href="http://www.rand.org/health/projects/24-7.html">24/7 Sobriety Program</a> is now in place in more than 30 US states and has resulted in reductions in drink driving and domestic violence.</p>
<p>The HOPE program operates like this: people at a high risk of recidivism are screened for eligibility. If successful, they’re allocated a colour. They must call the HOPE hotline each morning and if their particular colour is stated, they must attend their probation office before 2pm that day for a drug test. </p>
<p>During the first two months of the program, they’re randomly tested once a week. Good behaviour through compliance and negative drug tests will mean they’re able to receive a new colour, which is associated with less regular testing. </p>
<p>If the participant returns a positive drug test or fails to appear for testing, a warrant to appear in court is immediately issued and they’re brought before the judge within 72 hours. </p>
<p>If the person has violated the HOPE conditions – if they haven’t maintained their abstinence – there are swift sanctions such as an immediate sentence for a short jail stay. This is usually several days, with credit given for time served. </p>
<p>If a person consistently demonstrates they cannot abstain from drugs, then treatment is mandated. However, participants in the HOPE program can also ask to attend treatment if trying to abstain by themselves is proving too difficult. </p>
<p>The court-based community supervision strategy for probationers began as a pilot program in October 2004 and has expanded to more than 1,500 participants. The <a href="http://www.nij.gov/topics/corrections/community/drug-offenders/pages/hawaii-hope.aspx">first evaluation</a> of HOPE found that completers were: </p>
<ul>
<li>72% less likely to use drugs</li>
<li>55% less likely to be arrested for a new crime</li>
<li>61% less likely to skip appointments with their supervisory officer</li>
<li>53% less likely to have their probation revoked.</li>
</ul>
<p>One of the more important findings is that most offenders were able to desist from drug use in the face of a credible sanction. This has important implications for treatment resource allocation, as fewer need to be treated, but the treatment programs used must be of a high quality and have demonstrated effectiveness. </p>
<p>Such a scheme could work in Australia, where some employees and road users are already being tested for ice and other drugs. </p>
<p>People failing tests more than once could be mandated to enter HOPE-style program, ensuring their drug use is addressed, rather than simply fining them and waiting for their situation to spiral downwards. </p>
<p>Initial pilots should be run to iron out problems and ensure resourcing is adequate. </p>
<p>Random drug testing and swift and certain justice might seem extreme, and could be argued to impinge on human rights. But most people have nothing to fear. The program is effective in getting people to stop using drugs <em>and</em> not filling our prisons or expending massive amounts of tax dollars building new ones. </p>
<p>We know ice is a major contributor to harm among users and to the community, and we need to respond proportionally. Doing so will require governments to think big, break down walls between departments and challenge short-term discussions focused on individualised budgets so that an evidence-based system with longevity can be built.</p>
<p><em><strong>Further reading: <a href="https://theconversation.com/swift-and-certain-sanctions-does-australia-have-room-for-hope-40158">Swift and certain sanctions: does Australia have room for HOPE?</a></strong></em></p>
<hr>
<p><em>Ashlee will be on hand for an Author Q&A between 3 and 4pm AEDT on Friday, October 16, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/48246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Queensland government and Australian Drug Foundation, travel and related costs from Australasian Drug Strategy Conference. He is affiliated with academic journal Addiction. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.</span></em></p><p class="fine-print"><em><span>Ashlee Curtis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The challenge is to intervene before users hit crisis point. A Hawaii-based program does just this and has achieved substantial reductions in drug use. A similar scheme could work in Australia.Peter Miller, Principal Research Fellow, Deakin UniversityAshlee Curtis, Research Fellow, School of Psychology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/461342015-08-21T02:01:02Z2015-08-21T02:01:02ZFactCheck: is ice more dangerous and addictive than any other illegal drug?<blockquote>
<p>Ice is the worst drug scourge Australia has faced. It is far more potent, far more dangerous, and far more addictive than any other illegal drug. – Prime Minister Tony Abbott, Liberal Party of Australia <a href="https://images.theconversation.com/files/208366/original/file-20180301-36680-1yeyv2u.png?ixlib=rb-1.1.0&q=45&auto=format">email</a> to subscribers, August 13, 2015.</p>
</blockquote>
<p>“Ice” is the crystalline form of methamphetamine. The other main forms of methamphetamine are “speed” (a powder) and “base” (a paste). They all have the same chemical structure but differ in <a href="https://www.burnet.edu.au/publications/3519_high_frequency_drug_purity_and_price_series_as_tools_for_explaining_drug_trends_and_harms_in_victoria_australia">potency and purity</a>, with ice typically three to four times stronger than speed but the purity of all forms depends on how it is made. </p>
<p>It is worth testing the prime minister’s comments, made as he announced new funding for the Australian Crime Commission to tackle ice, against the evidence. </p>
<h2>Is it the worst drug scourge Australia has faced?</h2>
<p>Mr Abbott’s office did not respond to requests for data to support his statement. </p>
<p>Terms like “worst” and “scourge” are subjective and not checkable, so it is not possible to test this part of the statement against a data set.</p>
<p>But we do know that ice is not the most widely used illicit drug and the percentage of the population using has not increased over at least the last decade. However, harms have increased substantially among people already using.</p>
<p>According to the latest <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">population statistics</a>, 2.1% of the population reported using methamphetamine in the 12 months prior to the survey, which was conducted in 2013. This includes people who have used once in a year and those who use every day. This statistic has remained stable for at least the last 10 years, so there does not appear to be a huge increase in new users. </p>
<p>As a comparison, just over 10% of the population report using cannabis in the last year, 4.7% pharmaceuticals (for non-medical purposes), 2.5% ecstasy (MDMA) and 2.1% cocaine.</p>
<p>The same data show that about half of methamphetamine users prefer ice over other forms. The proportion of users who use ice as their main form of methamphetamine has doubled since 2010 - from 22% of users to 50% of users. This suggests that regular users are switching from speed to ice. </p>
<p>In addition, these data show that existing users are using more frequently, with a larger percentage of users reporting using weekly or daily, but a lower quantity. As a result of these changes, we have seen an increase in <a href="https://theconversation.com/ice-epidemic-or-not-heavier-use-and-higher-purity-is-increasing-harms-40687">harms associated with methamphetamine use</a>.</p>
<h2>Is it far more dangerous?</h2>
<p>It is difficult to compare drugs in terms of severity. <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/">Fewer people</a> use ice than alcohol, tobacco, cannabis, ecstasy and pharmaceuticals for non-medical purposes; 2.1% of Australians are methamphetamine users (1% use ice), while 80% are alcohol users and 10% are cannabis users.</p>
<p>Alcohol is still the major drug-related reason for <a href="http://www.turningpoint.org.au/site/DefaultSite/filesystem/documents/Ambo%20Report%20-%20trends%20in%20alcohol%20and%20drug%20related%20ambulance%20attendances%202013-14%281%29.pdf">ambulance call-outs</a> and still results in the most <a href="https://theconversation.com/australias-daily-alcohol-toll-15-deaths-and-430-hospitalisations-29906">deaths and illnesses</a> every year compared to other drugs. However, the prime minister was not comparing ice to legal drugs like alcohol – he said it was more dangerous “than any other illegal drug”.</p>
<p>In Victoria, there are an average of 4.7 methaphetamine-related <a href="http://www.turningpoint.org.au/site/DefaultSite/filesystem/documents/Ambo%20Report%20-%20trends%20in%20alcohol%20and%20drug%20related%20ambulance%20attendances%202013-14%281%29.pdf">ambulance attendances</a> a day (3.4 of those for ice) and about 87% of those cases are transported to hospital. This is less than alcohol (34 attendances per day), benzodiazepines (8.3 attendances per day) and heroin (5.1 attendances per day). And it is similar to cannabis, with 4.4 attendances a day and around 86% transported to hospital.</p>
<p>Among illegal drugs, heroin and other opioids are typically involved in the most deaths, even though fewer people use them compared to other substances. Methamphetamine, including “ice”, has the second-highest <a href="http://www.racgp.org.au/afp/2013/july/illicit-drug-overdose/">death rate</a> among illegal drugs.</p>
<p>In Australia, according to the <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Cocaine%20and%20Methamphetamine%20related%20drug-induced%20deaths%20in%20Australia%2C%202011.pdf">latest accurate data</a>, there were 101 deaths involving methamphetamine with 20% of those attributed solely to methamphetamine (the rest involved a mix of drugs) compared to 617 deaths involving heroin. However, the trend seems to signal increasing deaths with methamphetamine, while heroin deaths are projected to remain stable.</p>
<p>One of the biggest harms from illicit drugs comes from the fact that they are illegal. Methamphetamine is manufactured using different methods and ingredients and vary widely in <a href="https://www.burnet.edu.au/publications/3519_high_frequency_drug_purity_and_price_series_as_tools_for_explaining_drug_trends_and_harms_in_victoria_australia">purity and potency</a> depending how it is made and who makes it.</p>
<h2>Is it far more addictive?</h2>
<p>The dependence potential of any drug depends on a number of factors, including the drug itself, the person who is using it and how it is used. It is difficult to get a precise measure of how “addictive” a drug is, but using methamphetamine three to four times a week or more is likely to be a sign of dependence.</p>
<p>Among people who have used any form of methamphetamine in the last year, around 15% used <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/">at least weekly</a>. This is higher among ice users with about 25% using weekly or more.</p>
<p>How does this compare to other drugs? In 2007, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960464-4/abstract">The Lancet</a> published a paper that compared the dependence potential of a range of drugs, including amphetamines. The paper concluded that heroin and cocaine among the illicit drugs, and tobacco, barbiturates, alcohol and benzodiazepines among the legally available drugs, are more likely to produce dependence than amphetamines.</p>
<h2>Verdict</h2>
<p>Methamphetamine is a drug that can cause substantial harms. Potency is difficult to compare between drugs, so it is not possible to confirm the accuracy of this statement. </p>
<p>However, it is an overstatement to say that ice is far more addictive and far more dangerous than other illicit drugs. </p>
<p>While we certainly need to address the harms associated with methamphetamine use, we should keep in mind that our most widely used drug – alcohol - still results in more harms to individuals and the community, and other illicit drugs are also associated with more harms.</p>
<hr>
<h2>Review</h2>
<p>This is overall a balanced and sensible article. However, I would be more reserved about the statement referring to the <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960464-4/abstract">paper</a> in The Lancet (2007). That paper, which focused on the harmfulness of drugs, was an exploration of expert opinion. There remains considerable division about the addictiveness of crystal methamphetamine, with many experts viewing it as top of the range for both harm and addictiveness. The basic science of it remains in dispute. – <strong>Michael Farrell</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” that doesn’t look quite right? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/46134/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee receives funding from a range of government and non-government organisations as a consultant to help services respond to ice users. She is Director of The LeeJenn Group consultancy and President of the Australian Association for Cognitive and Behaviour Therapy.</span></em></p><p class="fine-print"><em><span>Michael Farrell is and Director of the National Drug and Alcohol Research Centre (NDARC) at UNSW Australia. NDARC is funded by the Drugs Strategy Branch of the federal Department of Health.</span></em></p>Prime Minister Tony Abbott has said ice is far more potent, far more dangerous, and far more addictive than any other illegal drug. Is that supported by the data?Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/459462015-08-12T03:50:52Z2015-08-12T03:50:52ZForcing ice users into rehab won’t solve the problem – here’s what we need instead<p>Tasmanian Independent Senator Jackie Lambie <a href="http://www.news.com.au/national/politics/senator-jacqui-lambie-says-she-refuses-to-let-her-sons-ice-addiction-ruin-his-life/story-fns0jze1-1227477370843">this week revealed</a> her 21-year-old son’s problem with ice. She plans to introduce a private member’s bill to enable parents to force their drug-dependent children into treatment. Unused immigration detention centres, Lambie <a href="http://www.abc.net.au/news/2015-08-11/turn-detention-centres-into-ice-detos-units2c-says-senator-lam/6688696">suggests</a>, could be turned into detox facilities.</p>
<p>Assistant health minister <a href="http://www.theaustralian.com.au/national-affairs/jacqui-lambies-ice-rehab-proposal-to-await-taskforce-report/story-fn59niix-1227479375168">Fiona Nash said</a> the Coalition would wait for the National Ice Taskforce to release its final report later this year before deciding whether to support the proposal.</p>
<p>But Australia already has a number of effective options to divert dependent users from prison and into treatment. And there is no evidence to suggest mandatory treatment outside of the criminal justice system would work. Instead, we need to increase funding for treatment, including early intervention programs and “aftercare” services to reduce the rate of relapse.</p>
<h2>How big is the problem?</h2>
<p>Ice is the crystalline form of methamphetamine. Speed is the powder form of methamphetamine and base is a paste form of the drug. But they vary in potency, with ice being the <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">strongest</a>. It’s like comparing light beer and extra-strength rum: it’s all alcohol, but the latter is much stronger, so you don’t need as much to get the same effect. Or if you use the same amount, you’re more likely to be intoxicated and become dependent.</p>
<p><a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">Around 2%</a> of Australians use methamphetamine, with half of those preferring ice over speed or base. It’s hard to know how many people are dependent on methamphetamine but <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">around 15%</a> of those who took the drug in the past year used weekly, which is much more likely to cause dependence.</p>
<p>Long-term methamphetamine use can <a href="https://theconversation.com/ice-epidemic-or-not-heavier-use-and-higher-purity-is-increasing-harms-40687">significantly change</a> the structure and function of the brain, which takes a long time to recover. So, although the rate of dependence is relatively low, once users get hooked, it can be really hard to get off, and the relapse rate back to drug use is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">very high</a>: more than 70%. This can be very frustrating for users and the people close to them.</p>
<h2>Drug diversion programs</h2>
<p>Australia already has a number of types of mandated treatment. These all operate through the police and justice systems. The main aim is to reduce reoffending through reductions in drug use.</p>
<p>Police can refer people into treatment as an alternative to the justice system. All states have some kind of “police diversion” initiative, most commonly for cannabis. In South Australia, police are required to refer people who are arrested for simple possession of any drug to treatment as a first-line option instead of to the justice system. Police diversion to treatment has been <a href="http://www.aic.gov.au/media_library/publications/rpp/97/rpp097.pdf">shown to be effective</a> in reducing crime.</p>
<p>Drug courts are special courts where users who have committed non-violent crimes can opt for an intensive treatment program if they plead guilty. Similar to police diversion, courts divert users to treatment instead of the justice system. Drug courts operate in most states and have been <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">found to be effective</a>.</p>
<p>Police and court diversion all still have an element of choice: the main incentive to choose treatment is to avoid prison or criminal justice system. These programs have shown <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578041/">good results</a> and treatment mandated through the courts can be as effective as voluntary treatment when the practitioners are skilled and well-trained. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">Our study</a> of voluntary methamphetamine users showed that even when people were not very motivated for treatment they could still achieve good outcomes.</p>
<p>There is one compulsory treatment centre in Australia in New South Wales for drug users who repeatedly commit crimes. The program has <a href="http://www.bocsar.nsw.gov.au/Documents/l20.pdf">undergone evaluation</a> and shown good health outcomes for participants but we do not know what impact it has on reoffending.</p>
<p>We do not have any treatment facilities in Australia that make treatment compulsory for drug users without criminal charges. There is no evidence that compulsory treatment outside the criminal justice system is effective.</p>
<p>In some countries, including in East and Southeast Asia, people who are suspected of using drugs can be placed in <a href="http://www.sciencedirect.com/science/article/pii/S0955395914003351">compulsory drug treatment centres</a>, which are essentially prisons for drug users. They may not have committed any other crimes. </p>
<p>These facilities are <a href="http://www.ihra.net/files/2010/11/01/IHRA_BriefingNew_4.pdf">internationally opposed</a> on ethical and human rights grounds. They have been criticised for lack of both due judicial process and medical or health assessment prior to a person entering compulsory treatment.</p>
<h2>Why mandatory treatment isn’t the answer</h2>
<p>Drug use is complex and different things work for different people.
But not everyone who uses drugs needs treatment. If someone is a danger to themselves or others as a result of their drug use, there may be an argument for forced treatment. The problem is that a person can be ordered to a treatment facility but they still have to want to take in the information once they are there. </p>
<p>Drug dependence is a chronic health condition and qualified medical and health practitioners are best placed to make recommendations about treatment options, in conjunction with the user. </p>
<p>There are a range of effective treatment options for methamphetamine dependence, including residential rehabilitation and cognitive behaviour therapy (a type of counselling), which, even in <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">small doses</a>, can have an impact.</p>
<p>But the relapse rate is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">high</a>. One study showed that after three years, people who had been through residential rehabilitation reported <a href="onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">similar levels</a> of use to those who had not had treatment: more than 70% were no longer abstinent. However, relapse rates are likely to be lower when people receive ongoing support. </p>
<p>Withdrawal on its own, either at home or in a treatment facility, is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">not considered effective</a> as a way to reduce drug use in the long term without further treatment.</p>
<p>In Australia, a large percentage of methamphetamine users use less than once a week and <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">are not likely to be dependent</a> but may experience problems with their use, such as mental health issues and other harms, that would benefit from early treatment.</p>
<p>There is a gap in funding for early intervention programs to help methamphetamine users before they become heavily dependent and also for <a href="https://www.linkedin.com/pulse/article/what-effects-drug-ice-nicole-lee-1">aftercare support services</a> to assist in relapse-prevention in the long recovery time post treatment. </p>
<p>Families and friends can be significantly affected by a person’s drug use and may need support themselves. Family support services can assist parents, partners and other family members and friends to understand how to respond and help methamphetamine users cut down, quit or get professional help. Family support services can help families and friends set boundaries, learn how to provide support and find effective treatment options. </p>
<p>In <a href="http://www.druginfo.adf.org.au/drug-facts/ice#effects">emergency situations</a>, if you or other family members feel threatened, call the police or if someone is showing symptoms of psychosis or overdose, call an ambulance.</p><img src="https://counter.theconversation.com/content/45946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee receives funding from a range of government and non-government organisations as a consutant to help services respond to ice users. She is Director of The LeeJenn Group consultancy and President of the Australian Association for Cognitive and Behaviour Therapy.</span></em></p>There is no evidence to suggest mandatory treatment outside of the criminal justice system would work. Instead, we need to increase funding for treatment programs, including early intervention.Nicole Lee, Associate Professor at the National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/427102015-06-28T20:02:18Z2015-06-28T20:02:18ZFocus on illicit drugs puts Australia’s drinking problem on ice<figure><img src="https://images.theconversation.com/files/86198/original/image-20150624-801-dy8d0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our current focus on the drug ice takes the spotlight away from the harms of excessive alcohol use, which is actually a bigger problem in Australia.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/fensterbme/4595195627/">Photographer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Recent discussions of Australia’s “<a href="http://www.adelaidenow.com.au/subscribe/news/1/index.html?sourceCode=AAWEB_WRE170_a&mode=premium&dest=http://www.adelaidenow.com.au/news/south-australia/ice-epidemic-gripping-australia-is-ruining-lives-and-destroying-families/story-fnpp66pk-1227355705459&memtype=anonymous">ice epidemic</a>” have culminated in a <a href="http://www.abc.net.au/news/2015-05-10/federal-government-launches-graphic-ice-ad-campaign/6457810">A$9 million</a> government-funded media campaign <a href="http://www.abc.net.au/news/2015-05-10/government-launches-ad-campaign-in-ice-battle/6456800">to raise community awareness</a> of the drug’s harms, particularly in rural areas. We do need to address the harms of illicit drugs, but, in doing so, we mustn’t overlook the greater social impact of excessive alcohol consumption. </p>
<p>A <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">number of commentators</a> have cautioned about the possible negative effects of <a href="https://independentaustralia.net/politics/politics-display/no-ice-epidemic--but-lots-of-political-fear-mongering,7578">government fear-mongering</a> on parents, families and communities. Experts have also highlighted the substantial evidence that drug education campaigns <a href="https://independentaustralia.net/politics/politics-display/no-ice-epidemic--but-lots-of-political-fear-mongering,7578">are, at best, ineffective</a> and, at worst, encourage experimentation. </p>
<p>But another – largely unremarked on – negative outcome of the strong focus on ice is that it takes the spotlight away from the harms of excessive alcohol use, which is actually a bigger problem in Australia. A reported 2.1% of Australians have used <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/ch5/#t5_4">some form of methamphetamine</a> in the last 12 months while 15.6% of people aged 12 or older have consumed <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/ch4/#t4_6">11 or more standard drinks</a> on a single drinking occasion in the same period. </p>
<h2>A polarised debate</h2>
<p>In what appears to have become a battle between those concerned about the different substances, we are increasingly seeing a debate polarised around which drug is worse, illustrated well by <a href="http://victorianalcoholanddrugassociationinc.cmail20.com/t/ViewEmail/j/8DC95E16EE7507EE/AD02CF30D6CC59A827D1E72AD0FD8334">this article</a> in the Herald Sun, arguing that ice is a bigger problem than alcohol:</p>
<blockquote>
<p>Yes, there are those who are addicted to alcohol and the consequences of that addiction can ruin lives. But when was the last time an alcoholic shot his girlfriend in the head in a fit of rage?</p>
</blockquote>
<p>The thing is, drunk people do kill their spouses, and they appear to do so in droves. Of the 1,565 solved homicides in Australia between 2000 and 2006, 729 (47%) were <a href="http://aic.gov.au/publications/current%20series/tandi/361-380/tandi372.html">classified as alcohol-related</a>. Both people had consumed alcohol in 60% of these cases, only the offender in 21%, and only the victim in 19%. Of the homicides involving an intimate partner relationship, between 2000 and 2006, 44% were related to alcohol.</p>
<p>In 2011 alone, there were <a href="http://www.fare.org.au/wp-content/uploads/2015/03/01-ALCOHOLS-IMPACT-ON-CHILDREN-AND-FAMILIES-web.pdf">29,684 police-reported incidents</a> of alcohol-related domestic violence in the four states and territories where this data is available (NSW, Victoria, WA and NT). When you add to that the other states, and the many cases of domestic violence that go unreported, the scale of the problem becomes enormous. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86204/original/image-20150624-827-tnspha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People who consume the same news have similar perceptions of risk even if they live in different areas.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/49093093@N02/4638656232/in/photolist-84UjTA-aFVwvH-sLyQX3-6QcFY-6iBan-aGHytD-dVvjh3-aBvstD-6t4JV6-oBn8N-4jNB1g-5TncTG-3tDrdx-8cQaeq-dQQsRY-4qQTkH-dzzVQe-AuPPH-8U4Nfe-bV4gj-ky2n4a-8pQZ6T-Pm13f-7nW6xt-5pe22p-aigW2k-33ymwS-29RDYm-rqSVYU-fmAaA2-4sfYJw-8xoTd3-cobm1b-3RM6Zk-mBBzQQ-f3BcR-4eTn9u-5KzEsL-MAjbH-5gYmEk-bCsChu-c8sKMu-8RAZk7-fH8p6c-nDr7-r5geXo-9fZT8a-4naTz-6cPpbt-nT1bht">Teresa Avellanosa/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>What’s more, data from the 2005 Personal Safety Survey <a href="http://www.fare.org.au/wp-content/uploads/2011/10/The-Range-and-Magnitude-of-Alcohols-Harm-to-Others.pdf">suggests that alcohol</a> contributes to 50.3% of all partner violence, and 73% of physical partner assaults.</p>
<p>So why do we think ice kills and alcohol doesn’t?</p>
<h2>The wrong shortcut</h2>
<p>The answer lies in a mental shortcut known as the <a href="http://www.sciencedirect.com/science/article/pii/0010028573900339">availability heuristic</a>, which helps us make decisions. It helps determine the likelihood of an event by how easily examples of that event come to mind. </p>
<p>The process works really well when we’re deciding what to wear in the morning (how many people can I remember seeing in the office this week in thongs?) but can lead to important biases in the way we make decisions. </p>
<p>Studies show media coverage has a significant impact on what we perceive as risky. Consider this example: a survey of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1539-6924.1994.tb00024.x/abstract">people living in France and Burkina Faso</a> conducted 20 years ago found they shared similar perceptions of the risks in their community – despite their fundamentally different geography, climates, environments and economies. The common factor was that both groups read magazines and newspapers originating in France. </p>
<p>The media have an enormous impact on how “available” a cause of death is in our minds, and may create a false sense of reality. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381061/">An analysis of the proportion of news coverage</a> of different causes of death in the United States, for instance, found tobacco-related deaths were under-represented (less than a quarter of the expected coverage) but illicit drug use deaths were over-represented (more than 17 times the expected coverage).</p>
<p>This positioning of illicit drugs – in this instance, ice – as a great and immediate risk to young people confuses parents and leads to the oft-heard lament “at least they are only drinking”.</p>
<p>The media have a role to play in creating – and correcting – the effects on communities, including politicians, of the availability heuristic. Perhaps we need to remind people that the reason ice-related homicides are on the front page of the newspaper is because they are rare; the reason alcohol-related homicides aren’t is because there are too many of them to report.</p><img src="https://counter.theconversation.com/content/42710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Jones holds an Australian Research Council Future Fellowship. She receives funding from the Australian Research Council, Healthway, FARE, Movember Foundation, WA Drug and Alcohol Office, and Medibank.</span></em></p>Alcohol-related violence is a much bigger problem in Australia than the harms of illicit drugs but we tend to overlook the former because the latter gets more headlines.Sandra Jones, Professor and Director of the Centre for Health and Social Research , Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/406312015-05-13T06:45:15Z2015-05-13T06:45:15ZAwareness campaigns need to target the real victims of ice<figure><img src="https://images.theconversation.com/files/81491/original/image-20150513-25052-m9o97p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Instead, we need to adopt a harm-minimisation approach. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-193975568/stock-photo-man-slumped-on-sofa-with-drug-paraphernalia-in-foreground.html?src=2rYBphv_c167L_RK3of-3g-1-4">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>This week the <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-nash015.htm">federal government launched</a> a television advertising campaign to warn young people and their families about the harms of using crystal methamphetamine, also known as “ice.” The first ad in the A$9 million campaign, depicting ice-fuelled violence in the home and a hospital emergency department, will run for four weeks on television and six weeks online. </p>
<p>The government also set aside <a href="http://www.budget.gov.au/2015-16/content/bp2/html/bp2_expense-14.htm">A$20 million in Tuesday’s budget</a> for ice awareness campaigns over the next two years. This comes as the Commonwealth government prepares its interim <a href="http://www.dpmc.gov.au/taskforces/national-ice-taskforce">National Ice Taskforce</a> report, which aims to develop a collaborative federal-state response to the drug.</p>
<p>But international evidence suggests such “awareness” campaigns are not the most appropriate way to address harmful methamphetamine use. In fact, fear-based approaches can increase stigma which possibly drives people away from, rather than towards, treatment.</p>
<h2>No methamphetamine epidemic</h2>
<p>Australian media outlets and politicians claim we’re facing a nationwide “ice <a href="http://www.abc.net.au/news/2015-05-05/governor-youthie/6446546">epidemic</a>”. But ice is just one – albeit typically very pure – form of methamphetamine and the most up-to-date <a href="http://www.ncbi.nlm.nih.gov/pubmed/25559677">research</a> estimates that the proportion of Australians who have used any type of methamphetamine (ice, “speed” powder) in the previous year has remained relatively stable for at least the last <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">decade</a>.</p>
<p>Nevertheless, the government and media’s continued use of hyperbolic language – in addition to a tendency to ignore and sometimes <a href="http://www.dailytelegraph.com.au/news/nsw/ice-scourge-needs-a-strong-response/story-fni0cx12-1227296149027">dismiss</a> public health experts’ advice on ice – has the potential to incite unnecessary fear and misinform the public about this supposed “<a href="http://www.governmentnews.com.au/2015/04/abbott-goes-cold-on-ice-menace/%22">menace</a>”. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GIh6Tb0O9sA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The government’s TV ad campaign started this week.</span></figcaption>
</figure>
<p>Victorian premier Daniel Andrews, for instance, <a href="http://www.abc.net.au/news/2015-03-05/victoria-unveils-455m-plan-to-tackle-ice-problem/6282258">recently claimed</a> 80,000 Victorians had used the “evil” drug ice in the previous year. ABC Fact Check subsequently <a href="http://www.abc.net.au/news/2015-04-07/ice-users-in-victoria/6346708">investigated</a> the accuracy of this figure and, based on the most recent National Drug Strategy Household <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">Survey</a> (NDSHS) and expert advice, concluded that the statement was not supported by data. </p>
<h2>Use and harm</h2>
<p>According to the NDSHS, in 2013 around 2% of the Australian population used any methamphetamine (speed powder, ice or “base”) in the previous 12 months. Only about 16% of these “recent” methamphetamine users reported using the drug once a week or more. </p>
<p>Regardless, using methamphetamine – particularly frequent and heavy use – <a href="http://www.ncbi.nlm.nih.gov/pubmed/18368606">is associated with</a> serious psychological, physical, social and financial harms.</p>
<p>The risk of experiencing such effects is likely to have increased due to the dramatic <a href="http://www.ncbi.nlm.nih.gov/pubmed/25220170">rise in purity</a> of methamphetamine in recent years. The average purity of speed powder and crystal methamphetamine seizures in Victoria increased from 12% to 37% and 21% to 64% respectively in the four years up to 2013. </p>
<p>It’s therefore crucial we that don’t undermine the experiences of individuals, families and communities impacted by the harmful use of the drug. </p>
<p>Rather, we need to accurately define the issue, including the nature and extent of methamphetamine use and related harms in rural and regional areas, to allow the development and implementation of cost-effective, evidence-based and timely responses. </p>
<h2>Awareness campaigns</h2>
<p>Numerous studies have indicated “what works” with regard to public awareness, education and prevention strategies which aim to reduce harms related to licit substances, such as <a href="http://www.tobaccoinaustralia.org.au/14-4-examining-effectiveness-of-public-education-c#x21.">tobacco use</a> and <a href="http://www.aic.gov.au/media_library/publications/tandi_pdf/tandi472.pdf">drink driving</a>. But there is little evidence that similar initiatives targeting illegal drugs are effective. </p>
<p>The limited available research suggests that the well-known, graphic <a href="http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.montanameth.org%2F&ei=H79JVfmZPOSgmwXBs4CIBA&usg=AFQjCNGsCkgtUZNS9CQJN-mXvwVZocT6zw&bvm=bv.92291466,d.dGY">Montana Meth Project</a> and <a href="http://www.facesofmeth.us/">Faces of Meth</a> advertising campaigns in the United States are costly, ineffective and possibly even counterproductive. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VsqVceV1bL0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Faces of Meth campaign.</span></figcaption>
</figure>
<p>The findings of one study suggest that the Montana Meth Project might actually increase acceptability and decrease perceptions of risk relating to using methamphetamine.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/20638737%20study">Another</a> noted that:</p>
<blockquote>
<p>“When accounting for a pre-existing downward trend in meth use… [the campaign’s] effects on meth use are statistically indistinguishable from zero.”</p>
</blockquote>
<p>Concerns about the efficacy of such initiatives are reflected in the HIV <a href="http://wsuengdoctors.pbworks.com/w/file/fetch/60398594/Fear%20apeals.pdf">literature</a>, which suggests that fear-based approaches can lead to stigma and poor health outcomes, such as from reduced treatment-seeking.</p>
<h2>Reducing the harms from meth use</h2>
<p>Many of the evidence-based suggestions put forward by leading experts are not – at least currently – politically palatable and are therefore unlikely to be implemented anytime soon. </p>
<p>Extensive international <a href="http://www.druginfo.adf.org.au/topics/supervised-injecting-facilities">research</a>, for example, shows safe-injecting facilities such as the one in Sydney’s Kings Cross can have enormous public health benefits. These include preventing blood-borne virus transmission, freeing-up health-care resources and improving drug treatment pathways. However, we are yet to see a comparable service implemented in any of Australia’s other drug use “hot spots.” </p>
<p>It is also unlikely that Australia will soon follow the lead of nations and jurisdictions that have decriminalised, legalised or “controlled” previously illicit substances. These include Portugal and the United States, with Ecuador’s government <a href="http://panampost.com/rebeca-morla/2015/04/14/ecuador-breaks-the-ice-on-drug-legalization-in-landmark-bill/">currently</a> debating the issue.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81496/original/image-20150513-20475-qit2e4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The average purity of speed powder and crystal methamphetamine seizures in Victoria increased in recent years.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-97440071/stock-photo-female-hand-retrieving-drug-packet-our-of-her-blue-jean-pocket-with-copy-space-on-black.html?src=pp-photo-755829-NeJk99chI1rL5pBu_mip7A-7&ws=1">Sylvie Bouchard/Shutterstock</a></span>
</figcaption>
</figure>
<p>As many have said before, drug policies in Australia need to ubiquitously incorporate the proven approach of harm-minimisation. </p>
<p>Although our <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/national-drug-strategic-framework-lp">National Drug Strategic Framework</a> is underpinned by this principle, failure to adopt evidence-based techniques that reduce drug-related harms, such as more safe-injecting facilities and <a href="https://ndarc.med.unsw.edu.au/resource/prison-based-syringe-exchange-review-international-research-and-program-development">prison-based needle exchanges</a>, indicates a discrepancy between policy and practice. </p>
<p>Because people will choose to engage in drug use (both licit and illicit) regardless of the policies and programs in place, we need to encourage them to do so as safely as possible. We also must continue to inform the public about options for managing drug-related consequences and appropriate and available means for professional support, such as telephone and internet counselling <a href="http://www.health.vic.gov.au/aod/directline.htm">DirectLine</a> and <a href="https://www.counsellingonline.org.au/">Counselling Online</a>. </p>
<p>Addressing barriers to drug treatment and ensuring that such services are adequately resourced is vital to meeting the needs of methamphetamine and other drug users at the “pointy end” of the spectrum. </p>
<p>But providing targeted and relevant harm reduction education and ensuring that support is available to individuals who aren’t yet ready – or who <a href="http://www.ncbi.nlm.nih.gov/pubmed/23867050">don’t see a need</a> – to use drug treatment is just as important for preventing the transition to more harmful use patterns.</p><img src="https://counter.theconversation.com/content/40631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brendan Quinn has worked on research projects funded by the National Health and Medical Research Council to study methamphetamine use and related issues.</span></em></p><p class="fine-print"><em><span>Paul Dietze has received funding from the National Health and Medical Research Council, the Australian Research Council, the Commonwealth Department of Health and Ageing and the National Drug Law Enforcement Research Fund to study methamphetamine use and harms.</span></em></p>International evidence suggests “awareness” campaigns are not the best way to address harmful methamphetamine use. Fear-based approaches can increase stigma and drive people from treatment.Brendan Quinn, Research Officer (drug and alcohol epidemiology), Burnet InstitutePaul Dietze, Head of Alcohol and other Drug Research, Centre for Population Health; Burnet Principal for Alcohol, other drugs and harm reduction, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.