Looking at recent news headlines, you’d be forgiven for thinking Australia was being overrun with methamphetamine, with reports of skyrocketing use. The focus is largely on crystal meth, also known as ice, which tends to be purer and more harmful than other forms of methamphetamine such as speed powder and “base”.
The political response has also been substantial. A Victorian Parliamentary Inquiry recently delivered a 900-page report on the problem. And the Labor party vowed to crack down on ice with stronger penalties if it wins the state election in November.
But while ice use in Australia is an important problem that needs to be addressed, we shouldn’t panic. The triennial National Drug Strategy Household Survey shows that any methamphetamine use has been stable at around 2% of the Australian population from 2007 to 2013.
This survey also shows that methamphetamine users are increasingly favouring ice as their main form of the drug: 50% in 2013 compared to 22% in 2010. So we’re seeing methamphetamine users shifting to ice rather than an uptake of ice use by non-users.
Among Australians who inject drugs, ice use remained stable over 2012-13, at around 55%. And among Australian ecstasy users, ice use fell from 29% to 23%.
But despite ice use staying stable or declining, there is evidence of greater harms, including increased methamphetamine-related ambulance call-outs and presentations for treatment.
These apparently contradictory trends are probably best explained by the increased purity of methamphetamine available in Australia, combined with stable prices. Essentially, people already using the drug now purchase much more actual methamphetamine for any given purchase size.
Scare campaigns won’t solve the problem
Typical responses to combat drug-related harms include population-wide social marketing campaigns, such as the Victorian government’s new What are you doing on ice? campaign.
The TV ads, posters and website show occasional users quickly becoming hooked; however, as noted in the Victorian Parliamentary Inquiry, this is not the experience for most people who use the drug.
And with only 2% of the population actively using any form of methamphetamine, the problem doesn’t warrant population-wide approaches.
Not only are such campaigns costly and resource-intensive, experience from the United States suggests they’re unlikely to work. In fact, US campaigns such as the Montana Meth Project and Faces of Meth may even be counterproductive by decreasing the perceived dangers of drug use and increasing acceptability of methamphetamine.
The depictions of methamphetamine users in these campaigns rarely accord with the experience of most people. Instead, such images better reflect other health and social problems US users face, such as homelessness, poor access to health care, serious mental health issues and use of other drugs, such as crack cocaine.
Indeed, this stark stigmatisation of methamphetamine users may actually prevent people who use the drug from seeking professional support when needed. Rather than population-wide scare campaigns, we need a considered response that targets those who are at risk of harm.
Targeted responses
A number of barriers prevent methamphetamine users from engaging with counselling, detoxification and rehabilitation services – and staying with them. Users may be unaware of the treatment options available, they may lack the motivation to engage with services or feel that they don’t need them.
On the treatment front, there is no approved pharmaceutical substitute therapy for treating dependence or withdrawal, like with methadone and Suboxone for heroin, and treatments tend to be one-size-fits-all.
So, what approaches are needed?
A number of strategies would be beneficial, starting with targeted education programs and more accessible treatment. Harm-reduction education programs should be established within current service systems and their delivery should ideally involve peer educators, with a focus on potency and toxicity.
Key populations that are more likely to use the drug, such as men who have sex with men, should be the focus of specific, tailored treatment initiatives and education. The Victorian AIDS Council is already leading the way with one-on-one and group-based counselling, and dissemination of information and harm-reduction techniques.
Methamphetamine is commonly smoked through a pipe and isn’t normally thought of as a disease risk. But blood-borne viruses such as HIV and hepatitis C can be transmitted via cracked lips. To reduce this risk, sterile smoking paraphernalia should be distributed through existing services, such as needle and syringe programs, and possibly even vending machines in high-use areas.
Finally, research has shown that some health-care workers, such as GPs, lack knowledge about methamphetamine use and how to adequately address the needs of methamphetamine users. Education of frontline workers is essential and is already occurring in some parts of Victoria.
Rather than perpetuating stigma and stereotypes, we need to focus on evidence-based initiatives that engage and treat methamphetamine users and address the harms of problematic drug use.