tag:theconversation.com,2011:/id/topics/crystal-meth-10161/articlesCrystal meth – The Conversation2024-02-29T05:22:58Ztag:theconversation.com,2011:article/2246202024-02-29T05:22:58Z2024-02-29T05:22:58ZMeth use is declining in Australia – but the public still sees it as the most worrying drug<figure><img src="https://images.theconversation.com/files/578820/original/file-20240229-28-o17b54.jpg?ixlib=rb-1.1.0&rect=8%2C4%2C2986%2C1989&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/silhouette-sad-teenage-girl-looking-out-370131206">Max kegfire/Shutterstock</a></span></figcaption></figure><p>Methamphetamine, also known as ice or meth, is the drug Australians most associate with a drug problem and the drug they’re most concerned about, according to the latest <a href="https://pp.aihw.gov.au/reports/alcohol/perceptions-alcohol-drugs">National Drug Strategy Household Survey</a>. </p>
<p>Yet the survey, released today, shows recent use of methamphetamine has been declining. It’s at its lowest in more than a decade, with <a href="https://pp.aihw.gov.au/reports/illicit-use-of-drugs/meth-amphetamine-ndshs">1% of Australians</a> using methamphetamine in the past 12 months.</p>
<p>So why are Australians still worried about this drug, and why does it matter?</p>
<p>There’s a global trend in viewing drug use as a health rather than criminal justice issue. The Australian Capital Territory <a href="https://www.act.gov.au/our-canberra/latest-news/2023/october/drug-law-reform-changes-commence">recently decriminalised</a> methamphetamine and a range of other illicit drugs for personal use. Other states are <a href="https://adf.org.au/insights/decriminalisation-australia/">considering whether to take this step</a>, which means the public’s opinion is increasingly important. </p>
<p>Let’s take a look at the reasons why some drugs are viewed more negatively than others (such as alcohol and cannabis). We know it’s not always to do with <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">the level of harm they cause</a>. </p>
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Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<h2>How do we develop attitudes about drugs?</h2>
<p>Messages conveyed by news media and government advertising affect public beliefs and attitudes about many important social and health issues <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13622">including alcohol and other drugs</a>.</p>
<p>Media reports about drug use tend to focus on the negative aspects of illicit drugs rather than presenting it as a health or social issue. People who use methamphetamine are <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2019.1679089">framed as criminal, deviant or dangerous</a>. A review of articles in print media found stories about methamphetamine were <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13622">disproportionately focused</a> on crime or justice-related topics.</p>
<p>Methamphetamine use, especially the use of the crystal form (ice), has been called a “<a href="https://time.com/4737800/meth-australia-ice-crystal-methamphetamine-methylamphetamine/">crisis</a>” and an “<a href="https://www.smh.com.au/national/nsw/ice-epidemic-amount-of-illegal-stimulants-seized-in-nsw-more-than-doubles-in-a-year-20211019-p5917s.html">epidemic</a>”.</p>
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<img alt="A person reading a newspaper on a bench." src="https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578508/original/file-20240228-21-raiir5.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">
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<span class="caption">Media coverage affects public attitudes to drugs.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-sitting-on-bench-reading-newspaper-_Zua2hyvTBk">Roman Kraft/Unsplash</a></span>
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<p>Interaction with <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2017.1397602">people who have experience of drug use</a> has been shown to decrease stigmatising attitudes, but with such a low rate of use, most Australians wouldn’t know anyone who uses methamphetamine. </p>
<p>As a result, many Australians hold misconceptions about methamphetamine and its effects. A <a href="https://www.jmir.org/2021/8/e29026">survey of 2,108 Australians</a> found more than half (57.4%) thought methamphetamine was the most popular illicit drug in Australia and one-quarter (25.5%) believed most teenagers had used methamphetamine.</p>
<p>But <a href="https://pp.aihw.gov.au/reports/illicit-use-of-drugs/illicit-drug-use">methamphetamine use is low</a> compared with other drugs such as cannabis (11.5%), cocaine (4.5%) and ecstasy (2.1%). The most commonly used drugs among young people are alcohol, cannabis and cocaine. </p>
<p>Methampehtamine use has <a href="https://cracksintheice.org.au/how-does-ice-work">short-term effects including</a> increasing heart rate and body temperature, disrupting sleep, and making you feel alert or agitated. Long-term use of methamphetamine <a href="https://onlinelibrary.wiley.com/doi/10.1080/09595230801923702">can lead to</a> heart or lung problems, exhaustion and dependence. But most people who try methamphetamine <a href="https://pp.aihw.gov.au/reports/illicit-use-of-drugs/meth-amphetamine-ndshs">don’t go on to use it regularly</a>. </p>
<p>The <a href="https://pp.aihw.gov.au/reports/illicit-use-of-drugs/meth-amphetamine-ndshs">National Drug Strategy Household Survey</a> also found Australians in poorer areas were more likely to have used crystal methamphetamine, while those in wealthier areas were more likely to use its powdered form, or speed.</p>
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Read more:
<a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">How does ice use affect families and what can they do?</a>
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<h2>Why do attitudes to illicit drugs need to change?</h2>
<p>Negative attitudes lead to stigma, isolation and unfair treatment of people who use drugs, and their friends and family. </p>
<p>Stigma toward people who use crystal methamphetamine <a href="https://www.sciencedirect.com/science/article/pii/S0955395920303200?via%3Dihub#bib0014">is common in Australia</a>, with one in three people who use crystal methamphetamine reporting they have felt discriminated against by other people (for example, community members or health workers) because of their drug use. </p>
<p>Stigma leads to psychological distress for people who use drugs and has been linked with <a href="https://journals.sagepub.com/doi/10.1177/1468017308101818">low self-worth and shame</a>. We know <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-020-00288-0">stigma is a barrier</a> to help-seeking and treatment. This can make the problem worse because people who need help aren’t able to get it, and continue to use drugs. According to one participant in a study by <a href="https://cracksintheice.org.au/">Cracks in the Ice</a>: </p>
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<p>There’s this big stigma around drug use, especially with crystal methamphetamine. Because of that, you tend to hide a lot of what you’re going through.</p>
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<p>Reducing stigma is important as often <a href="https://adf.org.au/reducing-risk/aod-mental-health/prevention-early-intervention/">the sooner someone gets help</a>, the better the outcome is and the <a href="https://espace.curtin.edu.au/handle/20.500.11937/55464">better for the community</a> (for example, less absences from work, less crime, and fewer visits to health care). The harms and costs of drug use are higher for people dependent on drugs.</p>
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<img alt="One person holds another person's hand across a table." src="https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578823/original/file-20240229-30-w6923r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&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">Stigma affects the degree to which people will seek support.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/person-in-black-long-sleeve-shirt-holding-white-ceramic-mug-xM4wUnvbCKk">Priscilla Du Preez/Unsplash</a></span>
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<h2>So, what can we do to change people’s attitudes?</h2>
<p>We know accurate information improves knowledge and understanding, and can lead to more empathetic attitudes. </p>
<p>A number of free evidence-based resources are available for all Australians, such as the <a href="https://cracksintheice.org.au/">Cracks in the Ice toolkit</a>. When <a href="https://www.jmir.org/2021/8/e29026">it was evaluated</a>, people who visited the website knew more about crystal methamphetamine and held less negative or stigmatising attitudes towards people who use it. </p>
<p>The media also have an important role to play by not sensationalising drug use. Guidelines such as those from <a href="https://mindframe.org.au/">Mindframe</a> set out advice for accurate and non-stigmatising reporting on suicide, mental health and alcohol and other drugs.</p>
<p>These include Mindframe guidelines specifically developed for <a href="https://mindframe.org.au/alcohol-other-drugs/communicating-about-alcohol-other-drugs/crystal-methamphetamine-in-the-media">methamphetamine reporting</a>. Using Mindframe guidelines has been shown to be <a href="https://pubmed.ncbi.nlm.nih.gov/19261565/">effective in improving media reporting</a>.</p>
<p>Similarly, <a href="https://www.aodmediawatch.com.au/">AOD Media Watch</a> highlights examples of good and stigmatising reporting in the media. </p>
<p>Language is <a href="https://adf.org.au/talking-about-drugs/power-words/">really important in reducing stigma</a>. If we talk about drugs openly, focusing on health and wellbeing rather than crime, it provides better support for people to make informed decisions and improves access to help when people need it. This in turn helps reduce the problems associated with methamphetamine and other drugs.</p>
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<p><em>For free and confidential advice about alcohol and other drugs, call the National Alcohol and Other Drug Hotline on 1800 250 015.</em></p><img src="https://counter.theconversation.com/content/224620/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steph Kershaw receives funding from The Australian Government Department of Health and Aged Care and is affiliated with the Cracks in the Ice online toolkit.</span></em></p><p class="fine-print"><em><span>Cath Chapman is Director of Research Development and Strategy at The Matilda Centre, The Universoty of Sydney. She receives funding from the National Health and Medical Research Council, the Australian Government, Paul Ramsay Foundation and other research organisations. She is affiliated with Cracks in the Ice, Positive Choices and OurFutures and is Chair, The Mental Health Services Learning Network (TheMHS).</span></em></p><p class="fine-print"><em><span>Maree Teesson is Chair of Australia's Mental Health Think Tank which is funded by the BHP Foundation. She is Director of The Matilda Centre, The University of Sydney. She receives funding from the National Health and Medical Research Council, Medical Research Future Fund, the Australian Government, BHP Foundation, Paul Ramsay Foundation and other research organisations. She is co-director and co-founder of OurFutures Institute a not-for-profit company established to distribute evidence resources to education organisations.</span></em></p><p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, National Health and Medical Research Council and other public funding bodies for alcohol and other drug research. She is a Board member of drug checking organisation The Loop Australia. She is CEO at Hello Sunday Morning, which receives funding from the Australian Government.</span></em></p>Negative attitudes lead to stigma, which sees people who use drugs isolated and marginalised.Steph Kershaw, Research Fellow, Matilda Centre for Research in Mental Health and Substance Use, University of SydneyCath Chapman, Professor, Matilda Centre for Research in Mental Health and Substance Use, University of SydneyMaree Teesson, Professor & Director of The Matilda Centre. Chair, Australia's Mental Health Think Tank, University of SydneyNicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1926352022-10-24T00:43:53Z2022-10-24T00:43:53ZDoes methamphetamine use cause Parkinson’s? And what do pizza boxes have to do with it?<figure><img src="https://images.theconversation.com/files/490818/original/file-20221020-21-vvr4vd.jpg?ixlib=rb-1.1.0&rect=66%2C12%2C3881%2C3005&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/sxQz2VfoFBE">Christian Erfurt/Unsplash</a></span></figcaption></figure><p>The South Australian government is planning to roll out a new <a href="https://www.abc.net.au/news/2022-10-17/new-research-links-meth-use-to-parkinsons-disease/101540584">mass media campaign</a> about the impact of using <a href="https://theconversation.com/explainer-methamphetamine-use-and-addiction-in-australia-13280">methamphetamine</a>, including crystal methamphetamine or “ice” and powdered methamphetamine or “speed”.</p>
<p>The campaign includes warning messages on pizza boxes – presumably because young people are the group most likely to try methamphetamine and they also eat lots of pizza.</p>
<p>It’s based on <a href="https://www.unisa.edu.au/media-centre/Releases/2022/dont-let-meth-take-hold-campaign-to-highlight-life-long-impacts-of-minimal-use/">research</a> from a few years ago that <a href="https://people.unisa.edu.au/Gabrielle.Todd#Current-research">links</a> illicit use of methamphetamine and Parkinson’s disease.</p>
<p>The researchers looked at <a href="https://pubmed.ncbi.nlm.nih.gov/26923520/">changes</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/29082542/">parts of the brain</a> after methamphetamine use and say they look similar to those in Parkinson’s patients.</p>
<p>But what does the research really tell us about the link? And will pizza box messages prevent these types of harm? </p>
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Read more:
<a href="https://theconversation.com/what-is-methamphetamine-or-crystal-meth-140956">What is methamphetamine or 'crystal meth'?</a>
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<h2>Is there a link between methamphetamine use and Parkinson’s?</h2>
<p>Parkinson’s disease is a brain disease that progressively gets worse and has no cure. The key feature is deterioration of neurons that manage the amount of dopamine in a part of the brain, called the <a href="https://www.ncbi.nlm.nih.gov/books/NBK536995/">substantia nigra</a>. Symptoms start to show when <a href="https://pubmed.ncbi.nlm.nih.gov/1933245/">about 50% of the neurons</a> have been damaged. </p>
<p>This part of the brain is responsible for controlling movement as well as the production of the neurotransmitter <a href="https://www.webmd.com/mental-health/what-is-dopamine">dopamine</a>. </p>
<p>Dopamine is the feel good neurochemical and part of the reward pathway in the brain. Every time we do something pleasant – like eating, sex, listening to music – our brain releases a little bit of dopamine to make us feel good and remind us to do it again. Dopamine is also needed for lots of other functions including <a href="https://www.cell.com/trends/cognitive-sciences/fulltext/S1364-6613(19)30013-0#:%7E:text=Dopamine%20enables%20successful%20cognitive%20control,complementary%20roles%20in%20cognitive%20control.">thinking</a> and <a href="https://elifesciences.org/articles/61591">moving</a>.</p>
<p>Methamphetamine triggers the release of much larger amounts of dopamine than most other activities, which is where its intense pleasurable effects come from. But over time, with regular methamphetamine use, the brain’s receptors become less sensitive. <a href="https://adf.org.au/insights/understanding-aod-dependence/">Tolerance</a> results. Then the effects of the drug are not as strong, or you need to use more to get the same effect.</p>
<p>We already know regular methamphetamine use causes changes in brain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011179/">structure</a> (what the brain looks like) and <a href="https://www.nature.com/articles/npp2011276">function</a> (how the brain works). And that those changes are similar to those seen in Parkinson’s patients.</p>
<p>But as far as we know, unlike Parkinson’s Disease, the changes after using methamphetamine are temporary and in most cases the brain resets itself back to normal functioning once use stops or becomes less frequent.</p>
<h2>Is the link a causal one?</h2>
<p>A number of animal and human studies have shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582059/">a link</a> between people who have a history of methamphetamine use and the later development of Parkinson’s disease in older age.</p>
<p>Studies have shown that people in treatment for methamphetamine problems are up to <a href="https://pubmed.ncbi.nlm.nih.gov/21794992/">two</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/25479916/">three</a> times more likely to develop Parkinson’s disease.</p>
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<img alt="Person looks out of their apartment window" src="https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490817/original/file-20221020-11-xx0xn9.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">We still don’t know whether methamphetamine causes Parkinson’s.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/zBBlSdn6fVA">Max Harlynking/Unsplash</a></span>
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<p>However, it’s hard to work out whether one causes the other because the numbers of people with both methamphetamine use and Parkinson’s disease are very small.</p>
<p>The estimate of methamphetamine use is around <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">1.3%</a> of Australians), and the number of people who develop Parkinson’s disease (<a href="https://www.parkinson.org/understanding-parkinsons/statistics">around 0.1% worldwide</a>) is relatively small. </p>
<p>The large majority of people who use methamphetamine generally use only <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">a handful of times a year </a> and for a short period in their lifetimes. So even if there is an increased risk of developing Parkinson’s disease, the population risk is quite small.</p>
<p>Studies like those from the <a href="https://pubmed.ncbi.nlm.nih.gov/29082542/">UniSA researchers</a>, that take a snapshot in time and look at the correlation of two events, aren’t able to tell us whether <a href="https://www.jmp.com/en_au/statistics-knowledge-portal/what-is-correlation/correlation-vs-causation.html">one thing causes another</a>, only that they are related in some way.</p>
<p>So we don’t know whether methamphetamine <em>causes</em> Parkinson’s disease.</p>
<p>To really work out whether methamphetamine use causes Parkinson’s disease a <a href="https://en.wikipedia.org/wiki/Longitudinal_study">longitudinal study</a> is needed. A longitudinal study would track people from say childhood to older age and measure their brain structure and function over time to see whether there is higher rate of Parkinson’s disease among people who have used methamphetamine compared to those who haven’t.</p>
<h2>Other potential explanations</h2>
<p>It’s possible that short term brain changes from using methamphetamine have some longer term impact that make someone more vulnerable to developing a range of disorders later in life, including Parkinson’s disease.</p>
<p>But there may also be other explanations for the link.</p>
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Read more:
<a href="https://theconversation.com/why-do-many-people-with-parkinsons-disease-develop-an-addiction-we-built-a-virtual-casino-to-find-out-126019">Why do many people with Parkinson's disease develop an addiction? We built a virtual casino to find out</a>
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<p>For example, people who use methamphetamine regularly are more likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841129/">poor nutrition</a> (because the drug reduces feelings of hunger), more likely to have <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2021.658205/full">experienced trauma</a>, and are at higher risk of <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-3-14">physical injury</a>. These factors might affect the brain in ways that make the development of Parkinson’s disease more likely.</p>
<p><a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/parkinsons-disease/the-genetic-link-to-parkinsons-disease#:%7E:text=About%2015%20percent%20of%20people,SNCA%20gene%20(see%20below).">Genetics</a> plays a major role in Parkinson’s disease and also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506170/">has some role</a> in the development of drug problems. So there might be a common genetic link.</p>
<p>It’s also worth noting that other drugs, <a href="https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-13-190">including alcohol</a> and a range of common prescription drugs like medicines for treating psychotic disorders, depression, high blood pressure and epilepsy, also <a href="https://www.tandfonline.com/doi/full/10.1517/14740338.2013.787065">increase the risk</a> of Parkinson’s disease.</p>
<h2>And the pizza boxes?</h2>
<p>We know mass media campaigns for issues that affect a relatively small number of people are <a href="https://pubmed.ncbi.nlm.nih.gov/26338836/">not very effective</a>. Targeted campaigns for people at risk of developing problems <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248563/">tend to work better</a>.</p>
<figure class="align-center ">
<img alt="Peperoni pizza" src="https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490819/original/file-20221020-14-u1u4hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pizza-box messaging is unlikely to work.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/SU1LFoeEUkk">Alan Hardman/Unsplash</a></span>
</figcaption>
</figure>
<p>Drug use is one of the issues for which public campaigns are largely ineffective. In fact, they can actually increase problems by creating stigma. This makes people <a href="https://theconversation.com/is-there-really-such-a-thing-as-an-addictive-personality-184137">less likely</a> to seek help for their drug problems.</p>
<p>So the pizza box idea is unlikely to have much impact at all. </p>
<p>Money wasted on these types of campaigns would be much better spent on evidence-based interventions. These include addressing the social problems that increase the risk of using methamphetamine such as poverty and childhood trauma, effective <a href="https://www.sydney.edu.au/matilda-centre/news-and-events/2022/02/04/our-futures.html">drug education programs</a> at school, harm reduction programs and <a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">treatment</a>.</p>
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Read more:
<a href="https://theconversation.com/parkinsons-disease-bad-dreams-could-be-an-early-warning-sign-new-study-184495">Parkinson’s disease: bad dreams could be an early warning sign – new study</a>
</strong>
</em>
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<p><em>If you are worried about your own or someone else’s drug use you can call the National Alcohol and other Drug Hotline on 1800 250 015 for advice, counselling or help finding a treatment provider.</em></p><img src="https://counter.theconversation.com/content/192635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Steven Bothwell 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>If governments want to tackle drug use, targeting those at most risk is a better strategy than mass campaigns.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversitySteven Bothwell, Consultant and Adjunct Associate Lecturer, University of NewcastleLicensed 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>
</figcaption>
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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>
</figure>
<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/1406062020-06-15T14:14:55Z2020-06-15T14:14:55ZCrystal meth: Europe could now see a surge in supply and use<figure><img src="https://images.theconversation.com/files/341513/original/file-20200612-153812-1hvh1e4.jpg?ixlib=rb-1.1.0&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/background-macro-shot-blue-crystals-salt-1175586049">SeventyFour</a></span></figcaption></figure><p>For many people in Europe, the closest they will have got to methamphetamine will be the TV series <a href="https://www.washingtonpost.com/news/wonk/wp/2013/08/15/heres-what-breaking-bad-gets-right-and-wrong-about-the-meth-business/">Breaking Bad</a>. But that could be about to change, as a result of developments in the international supply chain for cocaine and a new potential alliance between Mexican drug cartels and illegal European laboratories. </p>
<p>Other members of the amphetamine family have been used in Europe for years. A number are used in medicine, such as <a href="https://bnf.nice.org.uk/drug/methylphenidate-hydrochloride.html">methylphenidate</a> in the treatment of attention deficit hyperactivity disorder (ADHD); while <a href="https://www.talktofrank.com/drug/speed">“speed” or d-amphetamine</a> has had a steady following among recreational drug users. </p>
<p><a href="https://www.talktofrank.com/drug/methamphetamine">Methamphetamine</a> is more potent than speed, produces more intense effects, has a longer duration of action, and is more likely to be inhaled or injected. Also known as meth, crystal or ice, regular use is <a href="https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-misuse">more likely</a> to damage users’ brains or affect their mental health. Illicit production of methamphetamine also has a high <a href="https://www.politico.eu/article/brabant-dutch-drug-labs-blight-the-landscape/">environmental cost</a> from things like chemical waste. </p>
<p>So far, meth use in Europe has been quite <a href="https://www.emcdda.europa.eu/data/stats2019/gps">limited</a>. In England and Wales, for instance, only 15,000 people <a href="https://www.gov.uk/government/statistics/drug-misuse-findings-from-the-2018-to-2019-csew">reported using</a> the drug in 2018-19. This includes some <a href="https://www.vice.com/en_uk/article/n7jdd8/uk-british-dont-use-meth">notable pockets of use</a>, but other drugs are more available, more embedded in leisure and lifestyle, and don’t have the same <a href="https://journals.sagepub.com/doi/10.1177/1741659012443234">negative</a> media <a href="https://www.mirror.co.uk/news/world-news/faces-crystal-meth-shocking-before-7260592">representation</a>. In contrast, 976,000 people reported using cocaine, and around half a million used ecstasy. </p>
<p><strong>Methamphetamine use around the world</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=312&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=312&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=312&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=392&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=392&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341515/original/file-20200612-153849-1ftr6bp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=392&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://wdr.unodc.org/wdr2019/prelaunch/WDR19_Booklet_4_STIMULANTS.pdf">Methamphetmine UNODC</a></span>
</figcaption>
</figure>
<p>This is very different to the <a href="https://www.drugabuse.gov/drug-topics/methamphetamine/methamphetamine-trends-statistics">US</a> and also Asia. In east and south-east Asia, for instance, the meth trade is now <a href="https://www.unodc.org/documents/scientific/ATS/2020_ESEA_Regonal_Synthetic_Drug_Report_web.pdf">estimated to be</a> worth around US$61 billion (£48 billion) a year, <a href="https://www.reuters.com/article/us-southeastasia-crime/asia-pacific-meth-drug-trade-worth-up-to-61-billion-un-says-idUSKCN1UD0BO">having quadrupled</a> in five years to become the world’s biggest market. The supply has increased on the back of intense manufacturing in the region, which has improved quality and driven down prices. </p>
<h2>Signs of change</h2>
<p>The gamechanger for Europe could be coming via the cocaine market. <a href="https://www.washingtonpost.com/world/the_americas/coronavirus-coca-crash-bolivia-colombia-peru-latin-america/2020/06/09/8c7da42c-a11f-11ea-be06-af5514ee0385_story.html?mc_cid=5b630ec8fa&mc_eid=%5BUNIQID%5D&utm_campaign=5b630ec8fa-SENSEMAKER_MEMBERS_10_06_20&utm_medium=email&utm_source=Tortoise%20Members">Some reports</a> suggest that the price of coca, the raw ingredient of cocaine, is falling. You might think this would lead to heightened demand, but it could actually threaten future supplies as South American coca farmers switch to alternative crops to put food on the table. </p>
<p>This gap in the market could play into the hands of manufacturers of methamphetamine looking to expand into Europe. Historically, meth production in Europe has been quite localised, serving small domestic markets or exporting to more profitable regions like Asia-Pacific and the Middle East. Now, however, there is <a href="https://www.emcdda.europa.eu/publications/joint-publications/eu-drug-markets-report-2019_en">intelligence that</a> organised crime groups from Mexico might be beginning to take an interest in Europe, potentially sharing manufacturing expertise and supply chains for raw materials. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341522/original/file-20200612-153849-1f5f4gu.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">Breaking borders?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-cooking-meth-538605031">Nomad_Soul</a></span>
</figcaption>
</figure>
<p>A <a href="https://www.telegraaf.nl/nieuws/401784231/mexicanen-aangehouden-bij-vondst-drugslab-in-herwijnen">number of reports</a> from the Netherlands also suggest that well-established laboratories which had been manufacturing large quantities of MDMA (ecstasy) are now <a href="https://www.vice.com/en_uk/article/3azzvj/dutch-and-mexican-gangs-are-teaming-up-to-sell-high-end-meth-to-asia">switching to meth production</a>. One mobile meth laboratory was even found in a boat moored <a href="https://www.theguardian.com/world/2019/may/13/netherlands-police-raid-cargo-ship-crystal-meth-lab-moerdijk">at Rotterdam</a> docks. <a href="https://www.emcdda.europa.eu/">According to</a> the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), reports of police seizures of methamphetamine have also recently increased in Europe.</p>
<h2>Substitution</h2>
<p>Due to the coronavirus, we know that a <a href="https://www.bbc.co.uk/news/business-52557191">European recession</a> is unfolding. It threatens record levels of unemployment, with knock-on effects on consumer spending and people’s choice of leisure activities. Particularly at a time like this, value for money in the drugs market is just as important as with the legitimate economy. This is where methamphetamine may have an advantage over cocaine: its effects last significantly longer, and falling prices and high purity from more European production may make it seriously competitive. </p>
<p>There are several historical examples of how consumers replace one drug with another. When consumers substitute because of government attempts to clamp down on a specific drug, criminologists sometimes call it the <a href="https://www.vox.com/xpress/2014/8/30/6083923/drug-war-on-drugo">“balloon” or “hydra” effect</a>. </p>
<p>One of the reasons for the recent explosion in meth use in Asia, for example, was authorities <a href="https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/14714/655_Drivers_and_Enablers_of_Serious_Organised_Crime_in_Southeast_Asia.pdf?sequence=1">attempting to</a> suppress heroin use and poppy cultivation in the region. This merely increased manufacturing of synthetic drugs like methamphetamine. Not only that, heroin use continued as supply re-routed from Afghanistan to Myanmar. </p>
<p>Shortages of drugs or the arrival of new synthetic drugs have both prompted consumers to substitute one variety for another. And if there is a big rise in methamphetamine use in Europe, drug services in many countries won’t be prepared. </p>
<p>Forseeing what will happen in the drug market is certainly not an exact science. Specialists <a href="https://www.bbc.co.uk/news/magazine-23453028">have predicted</a> a rise in meth use in the UK before and been proven wrong. But this time, along with changes in the global supply chain, we have a pandemic that provides fertile conditions for a stimulant like meth because many people are doing less than usual.</p>
<p>Finally, a thought on how to prepare for this possible surge. In their response to coronavirus, most governments have shown they are willing to “follow the science” to protect the public’s health. As citizens and voters, we can ask them to extend this logic to drugs policy. </p>
<p>The past few decades’ drug policies of control and criminalisation have been costly and have seemingly <a href="https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-and-social-care-committee/news/drugs-policy-report-published-19-20/">failed</a> to achieve their intended objectives. Taking control of production and supply of drugs might seem far-fetched, but there are great potential rewards for thinking outside of the box in this area – both in relation to methamphetamine and other recreational drugs. The pandemic has shown that when there is the incentive and willingness to act, no policies are off the table.</p><img src="https://counter.theconversation.com/content/140606/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research.</span></em></p><p class="fine-print"><em><span>Ian Hamilton 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>Methamphetamine use has increased dramatically in Asia in the past five years, overtaking even the US. Now cartels spy an opportunities in Europe.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1106962019-02-07T19:07:53Z2019-02-07T19:07:53ZIn debates about drug use, fun is important<figure><img src="https://images.theconversation.com/files/257659/original/file-20190207-174857-19hll8p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">"Just say no" messages are ignored because young people want to have fun.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/IB5bld_weak">Marvin Meyer</a></span></figcaption></figure><p>Millions of Australians use, or have used, <a href="https://campaigns.health.gov.au/drughelp/drug-trends-and-statistics">illicit substances</a> at some point in their life, while millions more are regular users of legal drugs such as <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2014-15%7EMain%20Features%7EAlcohol%20consumption%7E25">alcohol</a>, <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc%7Esmoking-rates">tobacco</a> or <a href="https://www.abc.net.au/triplej/programs/hack/misuse-of-pharmaceuticals-on-the-rise/9271046">sleeping pills</a>. </p>
<p>While some people become heavy users of alcohol or other drugs as a way of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.02902.x">coping</a> with past trauma or mental illness, this is not the story for millions of others. Young (and older) people use drugs and alcohol for fun, enjoyment and socialisation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
</strong>
</em>
</p>
<hr>
<p>NSW Greens MP Cate Faehrmann <a href="https://www.smh.com.au/national/i-m-coming-out-about-drugs-it-s-time-get-real-about-pill-testing-20190120-p50shc.html">summed it up well</a> when she explained why she had used MDMA (ecstacy) in her 20s (and since):</p>
<blockquote>
<p>We knew there were risks but we were prepared to take them because having a good time was our priority … The ‘Just Say No’ message was around then too. We ignored it. Some things never change.</p>
</blockquote>
<p>“Fun” or “having a good time” as a reason for drug use is often dismissed as trivial or inconsequential. Why would people risk their health or life for simple fun? </p>
<p>Let’s look at the evidence for why people use three different types of drugs: <a href="https://www.racgp.org.au/download/documents/AFP/2010/August/201008frei_partydrugs.pdf">party drugs</a>, such as MDMA (ecstasy), cocaine or crystal methamphetamine (ice/crystal meth); marijuana; and alcohol.</p>
<h2>Party drugs</h2>
<p>The party drug category includes a range of drugs commonly used for dance parties, particularly MDMA (ecstasy), cocaine or gamma hydroxybutyrate (GHB), as well as crystal methamphetamine (ice). </p>
<p>In <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/13676260600983668?needAccess=true">studies</a> exploring motivation for party drug use, fun and pleasure are central. Users describe party drugs as giving them energy to dance and socialise, reducing inhibition and enhancing feelings of <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/13676260600983668?needAccess=true">connection to others</a>. </p>
<p>For some, party drugs also <a href="http://sigmaresearch.org.uk/projects/item/project59">intensify sexual experience</a>. </p>
<p>In these studies, party drug users’ descriptions of fun often relate to the quality of social relationships – drugs are fun because they allow for intense and disinhibited experiences with friends and lovers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-young-people-gain-from-drug-use-18878">What do young people gain from drug use?</a>
</strong>
</em>
</p>
<hr>
<p>Some studies have suggested that party drug use can lead to <a href="https://theconversation.com/what-do-young-people-gain-from-drug-use-18878">social benefits</a> that carry through into other areas of life, including building friendship networks and social connections through which people derive support. </p>
<p>Fun, in this sense, is not just about hedonism, but about the experience of belonging and developing social bonds. </p>
<h2>Marijuana</h2>
<p>Marijuana is the <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/cannabis">most commonly used</a> illicit drug in Australia, with 35% of the nation trying it at least once.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.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">One in three Australians have used marijuana.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/UoXLndT32Hg">Thought Catalog</a></span>
</figcaption>
</figure>
<p>There are many studies examining reasons why people use marijuana. For some, it is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696937/">coping</a> and managing stress or difficult emotions. However, most people <a href="https://www-sciencedirect-com.ez.library.latrobe.edu.au/science/article/pii/S030646030600298X">tend to use marijuana</a> for fun, enjoyment, or relaxation in a social setting. </p>
<p>In the 1950s, sociologist <a href="https://www.jstor.org/stable/2771989?seq=1#page_scan_tab_contents">Howard Becker</a> described the ritual of smoking marijuana as a process in which people formed social ties and established a sense of group identity as they learned how to derive pleasure from the act of smoking marijuana.</p>
<p>For young people, marijuana use can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847659/">symbolise independence</a> and a sense of freedom – a change in their social status. </p>
<h2>Alcohol</h2>
<p>Understanding what motivates people to drink alcohol is a complex task, given that unlike illicit drugs, alcohol is integrated into mainstream <a href="http://cw.routledge.com/textbooks/anthropologyofstuff/alcohol_home.html">rituals and routines</a> of modern life. We drink together to mark success, to celebrate marriages, to commiserate loss. Bars, pubs and restaurants are the focal points of most adults’ social lives. </p>
<p>The <a href="https://theconversation.com/how-alcohol-makes-you-friendlier-but-only-to-certain-people-41730">physical effects of alcohol</a> – relaxation and disinhibition – are part of the pleasure associated with alcohol. But this can be hard to disentangle from the pleasure of participation in <a href="https://www.jstor.org/stable/4189107?seq=1#page_scan_tab_contents">social rituals</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zSKsSrXXj7E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens when we take the first, second and fifth drink.</span></figcaption>
</figure>
<p>As with other drugs, studies which ask people why they drink cite <a href="https://www.sciencedirect.com/science/article/pii/S0376871610000992">social reasons</a> – fun, enjoyment and disinhibition – as common motivations for drinking. </p>
<h2>Why is this relevant?</h2>
<p>Emphasising the social nature of drug use should not detract from the recognition that drug and alcohol use can devastate the lives of some individuals. </p>
<p>There is also a valid argument that the legitimised social status of alcohol allows us to <a href="https://theconversation.com/social-acceptance-of-alcohol-allows-us-to-ignore-its-harms-10045">ignore its health risks</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
</strong>
</em>
</p>
<hr>
<p>However, understanding the social nature of drug use reveals why fun-seeking is so compelling. When people <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/02614369100390131?needAccess=true">describe fun</a>, they are often talking about an experience of social connection and belonging. Fun is not insignificant in human lives.</p>
<p>Understanding this might help to make sense of why “just say no” messages are so often ignored.</p><img src="https://counter.theconversation.com/content/110696/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Power receives research funding from the Australian Department of Health, The Victorian Department of Health and Human Services and the Australian Research Council.</span></em></p>People who use party drugs say it gives them energy to dance and socialise, reduces their inhibitions and enhances their feelings of connection to others.Jennifer Power, Senior Research Fellow at the Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1070872018-12-06T22:35:10Z2018-12-06T22:35:10ZGay men who use crystal meth need integrated care<figure><img src="https://images.theconversation.com/files/249061/original/file-20181205-186082-1x9rh0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The growing trend of sexualised injection meth use — colloquially referred to as 'slamming' — is a growing public health concern due to the dual risk of transmission of HIV and other blood-borne viruses via both injection and sexual transmission. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The use of cheap and potent crystal methamphetamine (meth) is reaching a “<a href="https://www.thestar.com/news/canada/2018/10/28/inexpensive-crystal-meth-eclipsing-opioids-on-the-prairies.html">crisis point in Canada</a>” and <a href="https://journals.sagepub.com/doi/abs/10.1177/1057567717730104">globally,</a> replacing opioids as the drug of choice in some areas. </p>
<p>In media and policy conversations about this drug, one important population is often missed out: Gay, bisexual and other men who have sex with men (herein, referred to as gay and queer men).</p>
<p>Used alone or in combination with other substances, the sexualized use of meth is a practice often referred to as “chemsex” or “party n’ play.” It is <a href="https://doi.org/10.1177/0956462416642125">one of the key drivers of high and rising HIV rates</a> and other sexually transmitted infections. And meth use can lead to many other negative health outcomes, including depression, anxiety and suicide.</p>
<p>Unfortunately, there are limited options available for gay and queer men who want to quit or reduce their meth consumption. Most sexual health-care services do not offer specialized substance use services. Similarly, conventional substance use services do not consider how a patient’s sexuality or sexual behaviour may relate to their drug use patterns. </p>
<p>My research team at the <a href="http://www.bccsu.ca/">British Columbia Centre on Substance Use</a> recently published a systematic review offering compelling evidence that <a href="https://doi.org/10.1016/j.drugalcdep.2018.09.023">integrating sexual health services and substance use care for gay and queer men who use meth can work</a>. </p>
<p>We found that most of the effective strategies to integrate services rely on various counselling techniques — including those that centre around an individual’s internal motivations to change their substance use behaviour.</p>
<h2>‘Slamming’ and risky sex</h2>
<p>Meth use can result in a variety of negative health and psychosocial outcomes, including drug-induced psychosis, depression, suicide, anxiety and a tendency toward anti-social behaviour. </p>
<p>What makes this even more concerning is that as the illicit drug supply becomes increasingly contaminated with synthetic opioids such as fentanyl, there are more cases of overdose being reported by those using non-opioid-based substances, including meth.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249081/original/file-20181205-186058-77khaq.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">Seized crystal meth is shown at a news conference at the RCMP headquarters in Surrey, B.C. in April 2018.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Jonathan Hayward)</span></span>
</figcaption>
</figure>
<p>While meth use is harmful to one’s health generally, using meth during sex can further compound the harms. Research indicates that <a href="https://sti.bmj.com/content/93/3/203">meth is often used by gay and queer men as a means to reduce anxiety and increase disinhibition, pleasure and sociability</a>. Gay and queer men who use meth often report engaging in sex practices that they would not otherwise choose, including having anal sex with multiple partners without condoms. </p>
<p>Some also report that the use of meth and other substances during sex can lead to situations in which they experienced sexual violence.</p>
<h2>London and Vancouver blaze the trail</h2>
<p>There are a few exceptional initiatives in major urban centres — for example the <a href="http://dean.st/">56 Dean Street Clinic in London</a> — that have been trying to address the harms associated with the sexualized use of substances. </p>
<p>In Canada, the Vancouver-based <a href="https://checkhimout.ca/">Health Initiative for Men</a> recently launched a <a href="https://whenthepartyisover.ca/">specialized service and information campaign</a> for those who use meth. The initiative now offers counselling specifically for those who use meth. It is also launching new harm reduction services for those who use substances, including a <a href="https://www.bccsu.ca/wp-content/uploads/2017/12/Drug-Checking-Evidence-Review-Report.pdf">drug checking service</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1036690666254942209"}"></div></p>
<p>Despite the positive findings from our review that show the value of integrating sexual health and substance use care, it is important to emphasize that effective treatment strategies for those who would like to reduce or stop their meth use remain elusive. </p>
<p>Unlike for opioid use disorder, there are no effective pharmaceuticals that one can take. Even psychosocial interventions such as counselling demonstrate moderate to limited efficacy, particularly for those who use meth regularly or heavily.</p>
<h2>Loneliness at the root</h2>
<p>Some researchers are looking towards new and innovative approaches to treating meth use. For example, the recent <a href="https://theconversation.com/ca/topics/marijuana-legalization-canada-2018-48796">legalization of recreational cannabis in Canada</a> may have important implications for those who wish to reduce or taper their meth use. </p>
<p>In our ongoing research, many of the young gay and queer men who report using meth have told us that they have reduced their meth use by using cannabis. </p>
<p>Nevertheless, cannabis is unlikely to be helpful for all gay and queer men who use meth, as we are also seeing that some of those using cannabis continue to report a variety of mental health problems, including anxiety, feeling paranoid and a tendency to isolate themselves.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249080/original/file-20181205-186073-13itgl6.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">For gay and queer men who use meth, complex motivations are often rooted in experiences of loneliness or violence.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The harms associated with meth use among gay and queer men are unlikely to be addressed via psychosocial interventions alone. While many countries like Canada have made profound advances in terms of improving human rights for LGBTQ people, we continue to see severe inequities with regards to social, mental and physical health outcomes compared to heterosexual and cisgender counterparts. </p>
<p>For gay and queer men who use meth, the motivations are complex and often rooted in experiences of <a href="https://slate.com/human-interest/2017/03/gay-loneliness-is-real-but-toxic-gay-cultures-isnt-the-problem.html">loneliness</a>, violence and other forms of trauma resulting from the social conditions of their lives, rather than the individual choices they make.</p><img src="https://counter.theconversation.com/content/107087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rod Knight holds funding from the Canadian Institutes of Health Research and is supported by a Scholar Award from the Michael Smith Foundation for Health Research.</span></em></p>The sexualized use of crystal meth by gay men is one of the key drivers of rising HIV rates and has many negative mental health consequences. Integrated sexual and substance use care is vital.Rod Knight, Assistant Professor of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1048692018-10-17T12:39:37Z2018-10-17T12:39:37ZA closer look at how crystal meth attacks gums and teeth<figure><img src="https://images.theconversation.com/files/240994/original/file-20181017-41122-cjg4ih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tik users' teeth are often damaged by their habit. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Crystal methamphetamine is the most widely used synthetic drug in the world, according to the <a href="https://www.unodc.org/drugs/en/get-the-facts/methamphetamine.html">United Nations Office on Drugs and Crime</a>. It’s an extremely addictive stimulant that dramatically affects the <a href="https://www.ncbi.nlm.nih.gov/pubmed/22251899">central nervous system</a>.</p>
<p>The drug is widely used in South Africa, with particular hotspots in the Western Cape province where it is referred to as “tik” due to the “ticking” sound it produces when smoked. Cape Town appears to be the tik capital of South Africa; about 98% of methamphetamine patients seen across the country come from this city. Tik is used as a recreational stimulant and can be swallowed, snorted, injected or smoked. In its smoked form it is often referred to as ice, crystal, crank and glass. Smoking is the most dangerous way of consuming the drug, as it provides quicker access to the brain and bloodstream.</p>
<p>People who use the drug experience feelings of wakefulness, energy, a sense of well-being, and euphoria. But crystal methamphetamine abuse has <a href="https://www.ncbi.nlm.nih.gov/pubmed/22251899">devastating effects</a>: it can cause lung disorders, kidney damage, hyperthermia, stroke and cardiac arrest. But, one of the least researched areas is the extensive tooth decay and gum disease that it causes. </p>
<p>A team at the <a href="https://www.uwc.ac.za/Faculties/DNT/Pages/ContactUs.aspx">Tygerberg Oral Health Centre</a> at the University of the Western Cape’s faculty of dentistry <a href="https://www.ncbi.nlm.nih.gov/pubmed/25952435">traced</a> how tik affects users’ teeth and gums. Tik causes serious mouth and teeth problems commonly known as “meth mouth” – that presents as extensive tooth decay and gum disease. Once the damage begins, it is virtually impossible to stop and in many cases leads to multiple tooth extractions. Based on our findings we recommend early diagnosis to prevent the rapid and extensive deterioration.</p>
<p>Education is also key – not only within communities and for the users, but also the education of other health care workers (nurses, social workers and medical practitioners) so they can recognise the oral and dental signs of methamphetamine use.</p>
<h2>The effects</h2>
<p>My colleagues and I at the Tygerberg Oral Health Centre noticed an increase in the number of young adult patients presenting with multiple badly decayed teeth. We saw an unusual pattern of tooth decay. These patients presented with cavities on the smooth surfaces of the teeth, leading eventually to total destruction of the tooth. </p>
<p>One of the side effects of tik is hyposalivation (causing a dry mouth). This lack of saliva has serious consequences. The ducts of the salivary glands produce saliva that is the primary defence in fighting bad bacteria in the mouth, buffering acids and protecting the teeth. The enzymes in saliva keep the mouth moist and in a state of homeostasis; that is, a pH balance with just the right amount of acid in the mouth.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/241012/original/file-20181017-41135-18yfe9g.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">Meth mouth is one of the devastating effects of abusing tik.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
</figcaption>
</figure>
<p>In mechanisms still being studied and debated, the use of tik affects the actions of the salivary glands and inhibits the secretion of saliva, causing a dry mouth. One theory is that the drug causes a narrowing of the blood vessels in salivary glands, decreasing the flow of saliva. Others argue that the use of the drug affects those parts of the brain that control the salivary glands.</p>
<p>But the consequences of a dry mouth go even further. To counteract the very dry mouth, tik users consume vast amounts of sugary, fizzy drinks. With no or very little protective saliva in the mouth, this creates the perfect acidic conditions for rapid wear and tooth decay by weakening the teeth’s surface enamel.</p>
<p>To exacerbate matters, tik users often grind their teeth because of drug-induced hyperactivity, anxiety and nervousness. This causes accelerated tooth wear. Furthermore, they lose interest in basic personal and dental hygiene. A tik “high” can last for days; users don’t bother brushing their teeth for extended periods causing plaque to accumulate and the bacteria to continue metabolising sugars into acids. The acidic environment often leads to erosion and when mouth pH drops below critical levels, tooth decay is the result.</p>
<h2>What we found</h2>
<p>The research team recruited a sample of over 300 Cape Town patients between the ages of 21 and 29 years, making their study one of the largest of its kind. The study confirmed the harmful effects of tik use on oral health, as well as highlighted the impediments to treatment. Methamphetamine users are not easy patients to treat as they are often paranoid and unpredictable. </p>
<p>Users usually seek dental care for pain. But by that stage, most of the teeth are already badly decayed and need extraction or several sessions to repair. But, once the pain is gone, most patients don’t attend repeat appointments.</p>
<p>Dental disease is a distinct comorbidity in tik users and requires the development of comprehensive treatment plans that address both its abuse and the oral and dental health problems.</p>
<p>Dentists should be trained to identify users presenting in their clinics, as should other health care workers (nurses, doctors, community health workers) and addiction specialists who need to be aware of oral health problems among tik users. Combating the public health problem and social nightmare of tik abuse requires buy-in from government, industry and society. And perhaps seeing images of a “meth mouth” might go some way in putting anyone off drug use for life.</p><img src="https://counter.theconversation.com/content/104869/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sudeshni Naidoo 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>Extensive decay and gum disease are overlooked and under-researched effects of crystal methamphetamine.Sudeshni Naidoo, Emeritus Professor, Faculty of Dentistry, University of the Western CapeLicensed 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/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/579772016-08-28T20:08:02Z2016-08-28T20:08:02ZHow big a problem is ice use among Indigenous Australians?<figure><img src="https://images.theconversation.com/files/128258/original/image-20160627-28373-1r0h8gs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There has been particular concern about methamphetamine use among Aboriginal and Torres Strait Islander Australians.</span> <span class="attribution"><a class="source" href="http://www.flickr.com">Matthew/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>While rates of methamphetamine use in Australia have remained fairly stable at 2.1% over the past ten years, there has been a <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">shift</a> among people who use the lower-grade powdered form of methamphetamine (speed) to using the higher-grade crystal form (ice) in recent times.</p>
<p>Ice is much stronger than speed and has the potential to cause greater problems.</p>
<p>Purity and availability have increased, while the price of both speed and ice has decreased. The number of people using <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">weekly or more</a> has grown, which is an <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723192">indication of dependence</a>.</p>
<p>As a result, Australia has seen significant increases in ambulance call-outs, hospital visits, people seeking treatment and police arrests <a href="http://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">related to methamphetamine use</a>.</p>
<p>There has been <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">particular concern</a> about increases in methamphetamine use among Aboriginal and Torres Strait Islander people. So what do we know about ice in these communities? And what are the effective responses? </p>
<h2>Rates of use</h2>
<p>Across Australia, around 2.3% of Aboriginal and Torres Strait Islander people 15 years and over report using methamphetamines in the <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument">past year</a>. This is similar to the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">general population</a> rate of 2.1%.</p>
<p>Methamphetamine use in remote Aboriginal communities appears to be very limited. Only <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument">0.8%</a> of the remote area population uses methamphetamine. Like the general population, the greater percentage of users are in the cities.</p>
<p>However, there are concerns this may be <a href="http://www.mja.com.au/journal/2015/203/1/recent-warnings-rise-crystal-methamphetamine-ice-use-rural-and-remote-indigenous">changing</a>. <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">Remote areas</a>, which are largely populated by Aboriginal communities, showed an increase in recent use of methamphetamine between 2010 and 2013.</p>
<h2>Seeking help</h2>
<p>The data is limited, but the rate of Aboriginal people seeking treatment for methamphetamine-related problems seems to be following the same upward trend as other people who use. <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">Service providers</a> report the use of ice in particular has increased among young Aboriginal people.</p>
<p>Although there is no widely available medicine to treat methamphetamine dependence, psychological treatment is effective. <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/%24File/Patient%20Pathways%20National%20Project.pdf">One study</a> found people who use methamphetamine have the best treatment outcomes of all alcohol and other drug users.</p>
<p>Cognitive behaviour therapy (<a href="http://www.aacbt.org">CBT</a>), motivational interviewing (<a href="http://www.motivationalinterview.net/clinical/whatismi.html">MI</a>) and acceptance and commitment therapy (<a href="http://contextualscience.org/act">ACT</a>) are both effective, as is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">residential rehabilitation</a>. As little as <a href="http://www.ncbi.nlm.nih.gov/pubmed/15733250">two sessions</a> of CBT and MI increases abstinence, even among heavily dependent users. </p>
<p>The evidence is limited for mutual support groups, such as 12-Step (Alcoholics and Narcotics Anonymous) and SMART Recovery (Self-Management and Recovery Training). But this type of post-treatment support may increase the chances of <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/%24File/Patient%20Pathways%20National%20Project.pdf">maintaining abstinence</a>. Peer worker or telephone contact are other options, but there is little methamphetamine-specific research.</p>
<p>The overall <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">relapse</a> rate after treatment, however, is high and there are few ongoing supports after treatment.</p>
<p>Although Aboriginal and Torres Strait Islander people access these interventions through both mainstream and Aboriginal-specific services, <a href="http://www.publish.csiro.au/?act=view_file&file_id=PY14126.pdf">little is known</a> about their outcomes. </p>
<h2>Prison diversion programs</h2>
<p>There are a number of mechanisms through which people who use drugs can access treatment via the justice system. </p>
<p>Drug courts, for instance, divert illicit drug users from the prison system into treatment. These operate in most states and have been found to be <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">effective</a>.</p>
<p>Aboriginal people are heavily over-represented in the justice system, but participation rates in drug court programs <a href="http://www.aic.gov.au/media_library/conferences/2006-drugdiversion/keynoteking.pdf">varies</a>. Where drug courts have taken a collaborative approach to design and implementation, working closely with Aboriginal and other organisations, participation rates are <a href="http://www.aic.gov.au/media_library/conferences/2006-drugdiversion/keynoteking.pdf">higher</a>. </p>
<h2>Improving access to treatment and support</h2>
<p>It is generally agreed responses to alcohol and other drug use in Aboriginal and Torres Strait Islander communities should be community owned and driven. </p>
<p>The Mallee District Aboriginal Services (MDAS) in Victoria, for example, has conducted <a href="http://www.onemda.unimelb.edu.au/sites/default/files/docs/Onemda%20Ice%20Report-WEB.pdf">research</a> to advocate for service improvement. MDAS developed a <a href="http://www.youtube.com/watch?v=EG-f3HQRhwo">short film</a> where Aboriginal people discuss how they have reduced their own ice use and ice use in their families. </p>
<p>This work highlights the vital role of families in helping people to give up using ice and avoid relapse. The <a href="http://www.lowitja.org.au/family-wellbeing-program-empowerment-research">Family Wellbeing Program</a> has been shown to empower Aboriginal individuals and families to take greater control of their lives. This may involve re-engaging in education and employment, addressing challenges such as family conflict and advocating for community services and support. </p>
<p>MDAS is partnering with La Trobe University to evaluate whether the program is a useful add-on to alcohol and drug treatment in supporting individuals and families who are affected by ice use.</p>
<p>The Victorian government has <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">made some progress</a> in improving treatment and support. It has piloted an <a href="http://www.healthinfonet.ecu.edu.au/key-resources/programs-projects?pid=2587">18-month program</a> to link mainstream specialist services with Aboriginal services. The aim is to build the capacity of both sectors to respond specifically to Aboriginal people and their families who are affected by the use of methamphetamine. The pilot is under evaluation.</p>
<p>But there is plenty of room for improvement. Both the Aboriginal and generalist drug and alcohol workforce have identified a need to be <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">better skilled</a> in responding to the needs of Aboriginal people who use methamphetamine.</p>
<p>Culturally appropriate harm-reduction strategies are critical for people who continue to use methamphetamine. Indigenous people in the United States, for example, have successfully used <a href="http://www.tandfonline.com/doi/abs/10.1080/02791072.2011.629140#.V0KzB2Y3nbE">culturally targeted education</a> and social marketing, plus individual and family treatment, to reduce methamphetamine-related incidents and arrests.</p>
<p>Finally, we need better data and project evaulations to create an <a href="http://www.publish.csiro.au/?act=view_file&file_id=PY14126.pdf">accurate picture of methamphetamine use</a> among Aboriginal Australians and develop more effective responses.</p><img src="https://counter.theconversation.com/content/57977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant to health services to support best practice implementation of methamphetamine and other drug treatment and is the President of the Australian Association for Cognitive and Behaviour Therapy. She has previously been awarded grants by the NHMRC and Australian Government for research into methamphetamine treatment options. Nicole is leading the team evaluating the Aboriginal Metropolitan Ice Partnership Program.</span></em></p><p class="fine-print"><em><span>Sarah J MacLean receives funding from the Australian Research Council. She has received funding in the past from the University of Melbourne to investigate methamphetamine use in Aboriginal communities, and is currently funded by La Trobe University to undertake pilot research into the effectiveness of a family wellbeing intervention as an adjunct to alcohol and drug treatment for methamphetamine users. </span></em></p>Around 2.3% of Aboriginal and Torres Strait Islander Australians 15 years and over report using speed or amphetamine in the past year. This is similar to the general population.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversitySarah J MacLean, Senior lecturer, La Trobe UniversityLicensed 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">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</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/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/517232015-12-06T05:31:37Z2015-12-06T05:31:37ZIce report marks a welcome shift in thinking towards prevention and treatment<figure><img src="https://images.theconversation.com/files/104521/original/image-20151206-29716-1jgt2ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Methamphetamine comes in several forms – crystal, or ice, is by far the strongest.</span> <span class="attribution"><span class="source">AAP/NSW Police</span></span></figcaption></figure><p>The federal government on Sunday released the <a href="https://www.dpmc.gov.au/sites/default/files/publications/national_ice_taskforce_final_report.pdf">final report</a> of, and its <a href="http://health.gov.au/internet/main/publishing.nsf/content/ice">response to</a>, the <a href="https://www.dpmc.gov.au/taskforces/national-ice-taskforce">taskforce</a> established in response to growing community concern around crystal methamphetamine, or ice. The government has announced a significant funding injection of nearly A$300 million over four years – mostly reportedly new funding – for improved treatment services and community awareness.</p>
<p>The report and the government’s response to it mark a shift in focus towards support for better health responses. Will it be effective?</p>
<h2>Methamphetamine use in Australia</h2>
<p>Methamphetamine comes in several forms – mainly powder (“speed”), paste (“base”) and crystal (“ice”). They are all the same drug but vary in potency, purity and strength. Ice is by far the strongest.</p>
<p>Australia has one of the highest rates of methamphetamine use in the world. However, the rate of use has declined over the past 15 years and currently sits at around <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">2% of the population</a>.</p>
<p>What has <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">changed</a> in the past few years is the rise in the preference for ice. Around half of regular methamphetamine users prefer ice. There has also been an increase in people using weekly (which is associated with dependence), increased purity and a decrease in price. </p>
<p>This created a perfect storm for significant problems.</p>
<p>While not an epidemic by any definition, the increase in ice use has resulted in a significant increase in problems and more users needing health services – including emergency departments, <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">ambulances</a> and specialist drug treatment services. This has created significant distress for users, their families, and health professionals.</p>
<h2>Prevention and treatment</h2>
<p>Prevention will always be a crucial part of the picture. The report recommended some new investment in prevention activities. This is largely through the Australian Drug Foundation’s <a href="http://goodsports.com.au/">Good Sports Program</a>.</p>
<p>But expanding treatment is of higher priority than prevention activities, given that new uptake of methamphetamine appears relatively limited.</p>
<p>Despite more than two decades of research, no <a href="http://www.leejenn.com.au/wp-content/uploads/2014-Lee-and-Jenner-ANCD-medication-for-ATS-research-paper.pdf">medicines</a> have strong evidence for their effectiveness in treating methamphetamine dependence. Only a handful show promise. This leaves a gap in treatment options.</p>
<p>However, there are effective psychological interventions. The taskforce recommended strengthening these. They include: </p>
<ul>
<li><p><a href="http://www.ncbi.nlm.nih.gov/pubmed/15733250">Two to four sessions</a> of two well established psychological therapies – <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front9-wk-toc%7Edrugtreat-pubs-front9-wk-secb%7Edrugtreat-pubs-front9-wk-secb-4%7Edrugtreat-pubs-front9-wk-secb-4-1">motivational interviewing</a> and <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> (CBT). This helps heavily dependent methamphetamine users cut down or stay off the drug and also reduces depression.</p></li>
<li><p>Twelve weeks of <a href="http://anzact.com/wp-content/uploads/2014/04/Smout-et-2010-RCT-ACT-Tx-methamphetamine.pdf">acceptance and commitment therapy</a>, a type of CBT combined with <a href="https://theconversation.com/au/topics/mindfulness">mindfulness</a>, a meditative technique to focus people on the present, is effective in reducing use. However, about 70% of people drop out before treatment is completed. </p></li>
<li><p>Short- and long-term <a href="http://www.ncbi.nlm.nih.gov/pubmed/22564065">residential rehabilitation</a> is also effective, but the dropout and relapse is high.</p></li>
</ul>
<p>Research also shows methamphetamine users have the most <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjC-8GH8MXJAhXCJKYKHX6XBu0QFgghMAA&url=https%3A%2F%2Fwww.health.gov.au%2Finternet%2Fmain%2Fpublishing.nsf%2FContent%2F699E0778E3450B0ACA257BF0001B7540%2F%24File%2FPatient%2520Pathways%2520National%2520Project%2520-%2520Final%2520report%2520September%25202014.docx&usg=AFQjCNEvaycJxE1cGyxIlLbaMVrliLJ0rA&sig2=7cPJoyWTxQZYMTyxipqiDg">successful</a> treatment outcomes of all drug users when they receive quality, evidence-based treatment.</p>
<p>Together, these results indicate that a number of treatment options are effective – and that longer treatment is not necessarily better.</p>
<p>Treatment experts generally recommend a <a href="http://www.druginfo.adf.org.au/fact-sheets/the-stepped-care-model-a-useful-intervention-strategy-web-fact-sheet">stepped care</a> model. Stepped care involves starting with the least intensive intervention that is likely to be effective and stepping up or down in intensity from there.</p>
<p>Most people who access methamphetamine treatment choose <a href="http://www.aihw.gov.au/publication-detail/?id=60129551120">outpatient counselling</a>, so it is important to ensure that programs are easily accessible and staff offering these services are well supported.</p>
<p>The taskforce report also recommended expanding online treatment options, and research into low-intensity methods.</p>
<p>There is a high risk of relapse after treatment. Stopping is one thing. Staying stopped over time is more difficult. Around <a href="http://www.ncbi.nlm.nih.gov/pubmed/22564065">80%</a> of people have relapsed one year after residential rehabilitation.</p>
<p>Well-funded post-treatment support – such as outreach, follow-up support and low-intensity intervention – is needed to help people stay off ice. The report’s recommendations are relatively limited in this area, but have highlighted the importance of service linkage with social, educational and vocational long-term supports. </p>
<h2>Targeting specific populations</h2>
<p>There is a dearth of services in regional areas, which will receive a much-needed boost.</p>
<p>The report also contained important recommendations about boosting services for Indigenous people, young people, and people in correctional facilities.</p>
<p>Families are particularly affected by methamphetamine use and often receive mixed messages about how they should respond. The report highlighted the struggle families face and its first recommendation is the development of information and resources to support families and communities. The government also announced funds to support this.</p>
<p>The report also highlights the need to address ice and other drug use in <a href="http://notatwork.com.au/wp-content/uploads/2015/07/Reducing-Harm-from-Drug-and-Alcohol-Use-in-the-Building-and-Construction-Industry.pdf">workplaces</a>.</p>
<p>The report recommends ensuring health workers are able to respond more effectively to methamphetamine. This includes updating existing guidelines, most of which are more than ten years old.</p>
<h2>So, what now?</h2>
<p>Ultimately, drug trends come and go. The switch among users from speed to ice, and the increase in problems as a consequence, has highlighted the gaps in Australia’s health system and its ability to respond quickly to unexpected changes in treatment presentations.</p>
<p>The proof of the pudding will be in the eating, especially as it looks as though the bulk of the funding will go through the Primary Health Networks tied to mental health delivery, rather than the specialist alcohol and drug treatment system. In the past, linking mental health and alcohol and drug treatment services has not been advantageous to the drug treatment sector. Good implementation is going to be key.</p>
<p>What Australia needs is a flexible, well-funded treatment system and an agile, confident workforce that can respond to any emerging trends in drug use as they arise.</p><img src="https://counter.theconversation.com/content/51723/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant to health services to support best practice implementation of methamphetamine and other drug treatment and is the President of the Australian Association for Cognitive and Behaviour Therapy. She has previously been awarded grants by the Australian Government for research into methamphetamine treatment options.</span></em></p>The ice taskforce’s report sends a clear message about the importance of focusing on drug use as a health issue. This signals an important shift in thinking.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityLicensed 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/462002015-08-18T20:33:14Z2015-08-18T20:33:14ZSickness or scourge, Australia’s ice problem can’t be summed up in soundbites<figure><img src="https://images.theconversation.com/files/92226/original/image-20150818-12386-r9fiy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These mixed messages reflect a longstanding tension in public policy and legal debates about drug use.</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-1-1">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Over the past week, we’ve seen two conflicting messages about the use of crystal methamphetamine, commonly known as “ice”.</p>
<p>On the one hand, Independent Tasmanian Senator Jacquie Lambie has <a href="http://www.themercury.com.au/news/opinion/talking-point-i-just-want-my-son-back/story-fnj4f64i-1227481025883">spoken about</a> her son’s struggle with ice addiction: “I refuse to watch, helpless, as ice seizes my child and turns him into a stranger,” she said. Lambie claims her son is no longer himself, and that she is dealing with the drug, and no longer a person. </p>
<p>Lambie has also called for “addicts” to undergo involuntary treatment for their addiction, a stance that has been criticised by <a href="https://theconversation.com/forcing-ice-users-into-rehab-wont-solve-the-problem-heres-what-we-need-instead-45946">some experts</a>.</p>
<p>In contrast, the federal government announced a new policy priority that would <a href="http://www.theaustralian.com.au/news/latest-news/govt-splurges-18m-for-new-ice-crackdown/story-fn3dxiwe-1227481632744">toughen punishments</a> for people on ice who attack health workers as well as a new “<a href="http://www.abc.net.au/news/2015-08-16/tony-abbott-announces-dob-in-a-dealer-hotline-fight-ice-epidemic/6700794">Dob in the Dealer</a>” campaign designed to reduce drug supply.</p>
<p>Herein lies the central policy dilemma. Are addicts sick and helpless victims with little control over their own behaviour, or brazen criminals who deserve to be punished accordingly? </p>
<p>These mixed messages reflect a longstanding <a href="http://www.tandfonline.com/doi/full/10.3109/16066359.2014.910511#.VdGOA87FHuQ">tension</a> in public policy and legal debates about drug use. How we respond to this dilemma depends in part on how we understand drug “addiction”. </p>
<h2>Ice addiction as a ‘brain disease’</h2>
<p>The view that “ice addicts” are hijacked by a drug that overwhelms their behaviour is supported by neuroscience research that suggests addiction is a “brain disease”. </p>
<p>The brain disease model of addiction is most prominently advocated by the United States <a href="http://www.drugabuse.gov/">National Institute on Drug Abuse</a> which funds around 85% of addiction research worldwide. According to the brain disease model, addiction is a chronic medical illness. This model commonly cites differences between the brains of addicts and non-addicts to explain the compulsive and involuntary nature of addiction.</p>
<p>Senator Lambie’s stance is consistent with the brain disease model of addiction, in that she understands drug use to be compulsive and involuntary. </p>
<p>But if ice addicts are hijacked by changes in their brain due to chronic ice use, should they be held responsible for their behaviour? Wouldn’t their addiction, on this view, make them less – not more – culpable? This is where some of the tensions in how politicians speak about drug use become most obvious. </p>
<h2>But ice users have some control</h2>
<p>Not everyone agrees addiction is a real condition, nor that it’s a brain disease. Critics come from a variety of sources, but commonly centre on different conceptualisations of “addiction”. </p>
<p>Libertarian critics see drug addiction as the hedonistic pursuit of pleasurable substances, no different than other pleasures we engage in, such as sex or food. For these critics, problems arise only when people who use drugs make poor choices, prioritising immediate desires over longer-term needs.</p>
<p>Others, including one of us, have argued that neuroscience research does not prove that drug addiction is a “brain disease”. At best, neuroscience shows that [some individuals](http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14) have developed changes in brain function and structure that make decisions not to use drugs such as ice more difficult.</p>
<p>The view that individuals are unable to control their drug use is inconsistent with other sorts of evidence. Even seemingly severely addicted people are able to control, reduce or stop their drug use following changes in their life, such as marriage or the birth of a child. In fact, if people didn’t maintain some control over their drug use, it’s hard to imagine how anyone would recover, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23653607">as the vast majority do</a>. </p>
<p>Drug use is also sensitive to changes in the cost of drugs in ways that are hard to reconcile with the view that people who use drugs are suffering from a disease that robs them of control over their behaviour.</p>
<p>Other scholars question the push to conceptualise certain behaviours as “pathological” or “<a href="http://www.palgrave.com/page/detail/habits-remaking-addiction-suzanne-fraser/?isb=9780230308107">compulsive</a>”, on the basis that it undermines an individual’s agency. For these <a href="http://www.researchgate.net/publication/228654303_Users_using_used_A_beginner's_guide_to_deconstructing_drugs_discourse">scholars</a>, models of addiction that portray individuals as “sick” and in need of state protection can be hugely damaging, creating and reinforcing the stigma often associated with drug use. It also does not account for the fact that people who use drugs are a <a href="http://www.ashgate.com/isbn/9781409408390">diverse group</a> with a range of experiences. </p>
<h2>The need for informed, rational policy</h2>
<p>Over the coming months the federal government’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MC15-009596-national-ice-taskforce">National Ice Taskforce</a> will develop a National Action Strategy to tackle the harms associated with ice. But so far the debates about policy priorities have been hampered by inconsistent messages about drug use, drug effects, drug addiction and the characteristics of people who use drugs. </p>
<p>Attributing ice addiction to a “brain disease” is not helpful to our understanding of ice use, and grossly distorts the scientific evidence. But while we’re sceptical of the “brain disease” account of addiction, the alternatives are multifaceted and complex. </p>
<p>Policymakers and politicians must go beyond simplistic accounts of drug use and addiction, ideally in ways that exceed notions of addicts as either sick or criminal. The emphasis should instead be on <a href="https://theconversation.com/awareness-campaigns-need-to-target-the-real-victims-of-ice-40631">proven harm-reduction approaches</a>, including increased access and funding to treatment and other support programs that respect the dignity and humanity of people who use drugs.</p><img src="https://counter.theconversation.com/content/46200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Carter receives funding from the Australian Research Council and Monash University.</span></em></p><p class="fine-print"><em><span>Kate Seear receives funding from the Australian Institute of Criminology. </span></em></p><p class="fine-print"><em><span>Jarryd Bartle 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>Are addicts sick and helpless victims with little control over their own behaviour, or brazen criminals who deserve to be punished accordingly?Jarryd Bartle, Sessional Lecturer in Criminal Law, RMIT UniversityAdrian Carter, Senior Research Fellow, Monash UniversityKate Seear, Academic Director of Springvale Monash Legal Service & Senior Lecturer in Law, Monash 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/406872015-06-09T20:04:58Z2015-06-09T20:04:58ZIce epidemic or not, heavier use and higher purity is increasing harms<figure><img src="https://images.theconversation.com/files/79036/original/image-20150423-3121-kf85k6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Forms of methamphetamines that can be smoked or injected have greater risks.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/marcogomes/3261966912">Marco Gomes/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Much <a href="http://www.abc.net.au/7.30/content/2015/s4230206.htm">media attention</a> is being given to the rising toll of methamphetamine-related harm in Australia, fuelled by the increased availability and use of high purity crystalline methamphetamine (crystal meth or ice). </p>
<p>Unlike other forms of methamphetamine available in Australia (speed or base), ice (crystalline methamphetamine or crystal meth) can be smoked. This gives a rapid drug effect because it gets into both the bloodstream and the brain quite quickly. </p>
<p>Coupled with the already very high purity of the drug, this trend of smoking ice has been associated with a <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">marked increase</a> in methamphetamine-related health and social problems. </p>
<p><a href="https://ndarc.med.unsw.edu.au/resource/act-drug-trends-2014-findings-illicit-drug-reporting-system-idrs">Available data show</a> a trend toward people using the drug more frequently, with more people becoming dependent and needing treatment, ending up in hospital or dying from using methamphetamine.</p>
<h2>Laundry list of risks</h2>
<p>Methamphetamine-related harms arise from both the pharmacological effects of the drug and from the linked behavioural and lifestyle factors. Most of the serious harms occur with injecting and smoking the drug, which are also <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2002.00195.x/full">associated with</a> heavier use patterns and a higher likelihood of dependence.</p>
<p>Three serious harms related to the use of methamphetamine are the elevated risk of psychosis, violence, and cardiovascular problems. </p>
<p><strong>Psychosis</strong>: heavy methamphetamine use <a href="http://archpsyc.jamanetwork.com/article.aspx?articleID=1555603">increases the risk of psychotic symptoms</a> beyond <a href="http://journals.lww.com/addictiondisorders/Abstract/2010/12000/Methamphetamine_Psychosis_in_Australia,.2.aspx">any family history of psychosis risk</a>. These symptoms include hallucinations and paranoia, which are usually transient and subside when people stop taking the drug. </p>
<p>But the risk of symptoms is made worse by use of other substances, and other risk factors for psychosis such as family history, cannabis and alcohol use.</p>
<p><strong>Violence</strong>: three key factors underpin violent behaviour among people who use methamphetamine, including a personality predisposed to violence, contextual factors such as involvement in the illicit drug market, and the pharmacological effects of the drug itself. </p>
<p>In terms of pharmacological effects, chronic heavy methamphetamine use can change the brain chemistry involved in controlling emotions. And this can increase the risk of aggression, while being high can produce a fight-or-flight type response, leading to violent behaviour in threatening situations. </p>
<p><strong>Cardiovascular risks</strong>: methamphetamine increases heart rate and blood pressure, which increases the risk of stroke and heart attacks. The danger increases very significantly with age, but young people using the drug can also have a stroke and other cardiovascular problems that would not normally occur until later in life. </p>
<h2>The drug “lifestyle”</h2>
<p>Methamphetamine is also associated with a variety of other health and social concerns that usually result from a combination of the drug’s pharmacological effects and linked lifestyle factors. </p>
<p>Acute methamphetamine intoxication staves off sleep and reduces hunger, for instance, meaning sleep deprivation and poor nutrition are common among people who use the drug. Similarly, poor dental hygiene among users combines with the effects of methamphetamine to increase the risk of dental carries and gum disease (“meth mouth”). </p>
<p>These health effects are often compounded by the poverty and chaotic lifestyle that coincide with the development of dependence on the drug. </p>
<p>People who use methamphetamine, particularly people who are dependent on the drug, often also have pre-existing mental health conditions, including major depression, anxiety and conditions associated with psychotic symptoms, such as bipolar disorder and schizophrenia. </p>
<p>Heavy methamphetamine use can exacerbate or precipitate symptoms in people who are vulnerable to these mental health conditions.</p>
<p>The risk of dependence and other harms related to methamphetamine reflects a complex interplay of factors, including the vulnerability of the person who is using the drug, the qualities of the drug consumed, and the setting in which it’s used. A comprehensive response to the use of this drugs needs to target individuals and situations in which these harms are most likely to occur.</p><img src="https://counter.theconversation.com/content/40687/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca McKetin has received funding from the National Health and Medical Research Council, the Australian Research Council, the Australian Government, NSW Government and Beyond Blue.</span></em></p><p class="fine-print"><em><span>Michael Farrell receives funding from the Federal Core Funds as Director of NDARC. He also receives grant funding from the NHMRC and the ARC.</span></em></p>Much media attention is being given to the rising toll of methamphetamine-related harm in Australia, fuelled by the increased availability and use of high purity crystalline meth.Rebecca McKetin, Associate Professor, Australian National UniversityMichael Farrell, Professor and Director of the National Drug and Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/423522015-06-03T04:34:31Z2015-06-03T04:34:31ZTesting at work and nightclubs unlikely to reduce ice demand<p>The chairman of the Northern Territory’s parliamentary inquiry into crystal methamphetamine, Nathan Barrett MP, has <a href="http://www.abc.net.au/am/content/2015/s4242315.htm">advocated</a> for random drug testing of private and public sector workers as well as nightclub goers. Mr Barrett also noted a preference for civil penalties, such as fines, over criminal charges for users who test positive.</p>
<p>When asked by The Conversation to clarify what exactly he was calling for, Mr Barrett said by email:</p>
<blockquote>
<p>I would like to see hair follicle tests become the industry standard. It is able to provide clarity for a longer period of time on use of illicit substances… To be clear, I have doubt that punitive measures will ever effect addicts behaviour… If we can disrupt the market at the functional and recreational end, we can affect price and access at the dependent end of the spectrum. </p>
</blockquote>
<p>Mr Barrett added that he would like to see more discussion of mandating fines for marijuana use, but would not support the decriminalisation of ice.</p>
<p>In fact, it is unlikely that drug testing in workplaces and at nightclubs will have any discernible impact on rates of use.</p>
<p>However, decriminalisation of drug use is at least associated with the reduction of legal-related harms and possibly rates of use in the community.</p>
<h2>How does drug testing work?</h2>
<p>Roadside drug testing is the most common form of illicit drug testing but employees in high-risk workplaces, such as mining, transport and construction, also sometimes face random drug tests at work.</p>
<p>Roadside drug testing operates in a similar way to random breath testing for alcohol, but uses a <a href="http://www.druginfo.adf.org.au/fact-sheets/the-facts-about-roadside-drug-testing-web-fact-sheet">mouth swab</a> that collects saliva for analysis. Other common methods for random testing include hair analysis, blood tests and urine testing. Unlike random breath testing, samples from saliva, hair blood and urine generally need to be analysed by a laboratory.</p>
<p>One of the problems with drug testing as an indicator of use is the detection time. Methamphetamine, for example, can be detected in saliva and blood for up to 12 hours, in urine for up to five days after use and in the hair up to 90 days after use. </p>
<p>This means that users may return a positive test, depending on the type of test used, even when they have no drugs in their system or have not used for some time.</p>
<h2>Does random testing work?</h2>
<p>There has been virtually <a href="https://digital.library.adelaide.edu.au/dspace/handle/2440/82829">no examination</a> of the effect of roadside drug testing on crash outcomes, so it is difficult to say whether it has any long-term benefits.</p>
<p>Given its intrusive nature, our society generally considers workplace testing acceptable only in safety sensitive industries and positions as a harm-minimisation measure.</p>
<p>However, there is little <a href="http://www.ncbi.nlm.nih.gov/pubmed/24922614">evidence</a> that alcohol and drug testing in the workplace impacts on use, improves safety or reduces accident risk.</p>
<p>Drug treatment is an effective demand reduction strategy and is also cost effective <a href="http://www.globalcommissionondrugs.org/wp-content/themes/gcdp_v1/pdf/Global_Com_Alex_Wodak.pdf">compared</a> to supply reduction strategies such as “tough on drugs” style law enforcement.</p>
<p>There is little research into the effects of random (or otherwise) police drug testing or other similar activities, such as use of detection sniffer dogs, in nightclubs and party venues. </p>
<p>Anecdotal reports suggest that these activities may increase harms among party goers; for example, users may “preload” large amounts of a drug prior to entering a venue in anticipation of restricted ability to use during the night due to policing activity. Or they may ingest large amounts to divest themselves of possession of a drug when police appear at a venue. There is little research showing these activities are effective in reducing use. </p>
<h2>Are fines more effective than criminal charges for users who test positive?</h2>
<p>In Australia, we <a href="http://fbe.unimelb.edu.au/__data/assets/pdf_file/0007/784276/1130.pdf">know</a> there has been no discernible increase in marijuana use as a result of decriminalisation of cannabis.</p>
<p>In 2001, Portugal approved a new legal framework in which all drugs were decriminalised. Most drugs were still illegal but possession for personal use and drug use itself are considered administrative violations subject to a fine rather than criminal charges. Drug trafficking is still prosecuted as a criminal offence. </p>
<p>The evaluation of the new policy over a ten-year period <a href="http://www.cato.org/publications/white-paper/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies">shows</a> that decriminalisation has had no adverse effect on drug use rates, and in many categories Portugal’s rates are among the lowest in the EU. Indeed EU states with strict criminal sanctions for use and possession are <a href="http://www.cato.org/publications/white-paper/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies">more likely</a> to have high rates of use of illicit drugs.</p>
<p>Criminal sanctions appear to do little to deter drug use and in fact there is some evidence to suggest that decriminalisation may be associated with reduced drug use in the community.</p>
<p>Drug testing is an intrusive, time consuming and expensive exercise and there is little evidence that it reduces drug use over the long term, especially taking into account the very low prevalence of recent methamphetamine use in the community (currently <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/">estimated</a> to be around 2% of the general population over 14 years).</p>
<p>Other strategies, such as treatment, appear to be more effective in reducing the demand for drugs in the community, and may be more cost effective.</p><img src="https://counter.theconversation.com/content/42352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee receives research grants from the Federal Government related to methamphetamine treatment research.
</span></em></p>It is unlikely that drug testing in workplaces and at nightclubs will have any discernible impact of rates of use.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/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>
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<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.tag:theconversation.com,2011:article/399922015-04-10T05:03:30Z2015-04-10T05:03:30ZPolitical fear-mongering just magnifies the harm ice can do<figure><img src="https://images.theconversation.com/files/77586/original/image-20150410-15265-1gmkrup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only a small proportion of Australians who use methamphetamines fall into a category of dependent users. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/14562127279">Thomas Hawk/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>There is no doubt methamphetamine can cause harm, and no doubt most who work in drug policy aim to help drug users. But when politicians hijack drug issues and overplay them for political purposes, that too can cause harm. </p>
<p>The rhetoric coming from some of our federal political leaders about ice is disturbing and needs to be balanced with sensible evidence-based discussion about both the dangers of methamphetamine and the dangers of responding to this problem from a position of fear.</p>
<p>As Flinders University researcher <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">Nicole Lee has made clear</a>, there is no “ice epidemic” in Australia. According to the range of surveys conducted nationally, population prevalence of ice has not gone up. In fact, <a href="http://www.parliament.vic.gov.au/images/stories/LRDCPC/Submissions/Submission_19_-_Burnet_Submission.pdf">most surveys show</a> it has gone down. </p>
<p>Ice is not our “nation’s addiction” as federal Justice Minister Michael Keenan <a href="http://www.smh.com.au/federal-politics/political-news/landmark-report-sparks-warning-over-australias-addiction-to-mindeating-ice-20150325-1m6hkv.html">claimed recently</a>. Only a small proportion of Australians who use methamphetamines fall into a category of dependent users. </p>
<p>This is not to discount the fact that those who use methamphetamine are using the drug more frequently. Or that the emergence of a drug market dynamic increases the risk of harm. </p>
<p>Methamphetamine is not a “mind-eating” drug, as our illustrious minister of rhetoric, Keenan, has pronounced. Any drug at high doses will cause nerve damage; however, methamphetamine is as toxic to the brain as a wide range of other substances. Alcohol is a <a href="http://www.smh.com.au/federal-politics/political-news/alcohol-a-bigger-problem-than-ice-says-jeff-kennett-20150409-1mgmrh.html">more worrying neurotoxin</a>, which is used far more widely and at more hazardous levels.</p>
<p>One of the greatest harms that our politicians and community leaders can commit is to create fear about drug users based on reports of what a drug can do to people. In recent news reports ice users have <a href="http://www.sbs.com.au/news/article/2015/03/25/ice-destroyed-my-life-recovering-ice-addict-and-former-dealer-speaks-out">been labelled</a> as “aggressive zombies” and a range of other fearful terms.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77587/original/image-20150410-15244-dids8q.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">Methamphetamine is as toxic to the brain as a wide range of other substances.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/sally_monster/10181430263">Sally Crossthwaite/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>What are the effects of fear?</h2>
<p>My concern about this kind of rhetoric is three-fold. First, labelling drug users in this way creates fear and makes it more difficult for families to have open and honest discussions about a drug when so much fear is attached to it. </p>
<p>One of the best protective factors for preventing harmful drug use is having a supportive and well-informed family environment. Fear-mongering makes it more difficult for parents to have open and honest conversations with their children. </p>
<p>Judging from the discussions parents and friends are having with me, people are afraid and they are aware that fear-mongering simply makes it worse for people managing drug use in their family. This is especially the case for people in rural and regional communities, where the stigma of a drug-using child can have substantial ripple effects for the entire family.</p>
<p>Second, fear is a terrible basis on which to drive drug law. We learnt a powerful lesson from the way United States lawmakers in the 1980s introduced excessive mandatory minimum sentences for crack cocaine offences. These sentences for crack possession were significantly harsher than sentences for possession of powder cocaine. </p>
<p>These laws were introduced in the erroneous belief that crack was more harmful than powder cocaine. The laws were repealed in 2010 and, 25 years later, the US prison system is still recovering from this dangerous example of drug laws made in an environment of fear.</p>
<p>Third, if a government goes over the top in its rhetoric about the harmfulness of drugs, it will be harder for the government to be taken seriously next time it faces a drug issue. Of particular concern is that every time a government makes an outlandish claim about the harmfulness of drugs in the absence of evidence, it reduces the capacity of future government campaigns to influence the public. </p>
<p>Many governments have learnt the hard way – through wasteful and expensive public information campaigns – that trying to shock the population with scary language and images does not resonate with the experience of drug users, rarely changes behaviour, nor improves family conversations about drugs.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=676&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=676&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=676&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=850&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=850&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77588/original/image-20150410-15216-1uo6nqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=850&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Responses to methamphetamine need to focus on frequent users.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/gazeronly/14255062625">torbakhopper/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>A recent Victorian <a href="http://www.ncbi.nlm.nih.gov/pubmed/25220170">drug market analysis</a> by Paul Dietze and colleagues at the Burnet Institute suggests that the price per pure gram of both ice and powder methamphetamine has dropped over the past few years. </p>
<p>The same research suggests also that the purity of methamphetamine fluctuates dramatically from around 10% to 80%, and that perhaps it is the fluctuations in the purity that may be causing the harmful effects among users. </p>
<p>The current evidence about the harmfulness of methamphetamine is not so much about ice, it’s about methamphetamine. It’s not about harm to the general community, it’s harm to a segment of the meth-using population who are using more frequently.</p>
<p>Mindful of this research, suitable responses should be focused on targeting existing methamphetamine users. Scare campaigns simply won’t work with this group, which leaves me wondering why the federal government is ramping up its rhetoric about ice.</p>
<p>Warnings of an “ice epidemic” carry their own harms. Our political and community leaders should be very wary of elevating fear. Although there are many unknowns in this difficult policy terrain, one thing we can be sure of is that elevating fear won’t help methamphetamine users.</p><img src="https://counter.theconversation.com/content/39992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Fitzgerald has previously received funding from the NHMRC, ARC, VIcHealth, the Australian National Council on Drugs (ANCD) and a range of Victorian and Australian government departments. He also has received funding from Stockland and City West Water. He was previously Acting CEO of VicHealth, and is a Board Director at Victoria's Northern Hospital where he chairs the Population Health and Primary Care Committee. </span></em></p>There is no doubt methamphetamine can cause harm. But when politicians hijack drug issues and overplay them for political purposes, that too can cause harm.John Fitzgerald, Associate Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/396972015-04-08T09:54:54Z2015-04-08T09:54:54ZAre we in the midst of an ice epidemic? A snapshot of meth use in Australia<figure><img src="https://images.theconversation.com/files/77320/original/image-20150408-18089-1g7leff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The number of people who use methamphetamine has not changed in at least the last ten years.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/purplemattfish/3192932120">Matthew/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Prime Minister Tony Abbott today launched a taskforce to tackle the growing problem of ice. “As a citizen and as a parent I am appalled at what is happening on our streets and in our homes,” he said, adding that the taskforce will canvass the problems and report back with a strategy by mid year. </p>
<p>But while Australia certainly has a problem with ice, it’s hardly an epidemic. Let’s consider the data on use and harms. But first, what is it? </p>
<p>Methamphetamine is a potent stimulant drug that comes in several forms: a powder, speed; a crystalline form, crystal meth or ice; and a base form, resulting from poor conversion of methamphetamine oil to crystalline form. </p>
<p>While the chemical composition of these three forms is the same, the potency varies, with ice the strongest.</p>
<p>Illicit methamphetamine use is relatively high around the world, but Southeast Asia in particular is a major hub for production. This impacts on Australia, which has one of the <a href="http://www.unodc.org/documents/ATS/ATS_Global_Assessment_2011.pdf">highest rates</a> of use in the world.</p>
<p>Yet, the prevalence of methamphetamine use in Australia has remained stable since 2001, at around 2% of the population. That is, the number of people who use methamphetamine has not changed in at least the last ten years.</p>
<p>However, there have been significant shifts recently in the way methamphetamine is used that have created significant issues for users and the community.</p>
<h2>Changing use</h2>
<p>First, the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/data-and-references/">number of methamphetamine users</a> who prefer ice over other types of methamphetamine has doubled, from 27% in 2007 and 22% in 2010, to 50% in 2013. The proportion of people using it at least weekly has grown, from 9.3% in 2010 to 15.5% in 2013. </p>
<p>There has also been a significant increase in smoking as the main route of administration, from around 20% of regular users to 40%.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25220170">Other data show</a> an increasing purity of ice, from an annual average of 21% in 2009, to 64% in 2013. The purity of traditionally lower-grade speed has also been increasing, from 12% to 37% between 2009 and 2013. </p>
<p>The price of both crystal and powder methamphetamine, based on purity, is now more similar than in previous years, making ice a more economical purchase for users.</p>
<h2>Growing harms</h2>
<p>There has been a corresponding increase in people seeking treatment at drug and alcohol clinics. The proportion of treatment “episodes” where methamphetamine was the principal drug of concern <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/data-and-references/">doubled</a> from 7% in 2009-10, to 14% in 2012-13.</p>
<p>There has been an <a href="http://www.turningpoint.org.au/site/DefaultSite/filesystem/documents/TP.ambocallout.fullreport.080514.pdf">88% increase</a> in ambulance call-outs in metropolitan Victoria and a 198% increase in call outs for methamphetamine-related incidents in some regional areas. People in regional areas are twice as likely to use methamphetamine as those in major cities (and are more likely to drink at risky levels and smoke cigarettes).</p>
<p>Hospital presentations for methamphetamine-related problems are the <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Australian%20Drug%20Trends%202001%20to%202013.pdf">second-highest</a> among the four major illicit drug types, with 182 “separations” per million people in 2010-11. </p>
<p>Finally, arrests for methamphetamine-related crimes have <a href="http://www.aic.gov.au/publications/current%20series/facts/1-20/2013.html">increased</a> by 30% between 2010-11 and 2011-12. And a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24389088">review</a> of more than 80,000 Queensland roadside drug-tests between 2007 and 2012 found methamphetamine to be present in 41% of positive results.</p>
<h2>Getting help</h2>
<p>Data we are currently analysing from the government’s <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/">National Drug Strategy Household Survey</a> suggest these changes are driven primarily by those who use more than once a month. This group is more likely experience harms from regular use, such as dependence, mental health problems and sleeping troubles, and would benefit from early treatment. </p>
<p>Irregular users are not at high risk of dependence but <a href="Economic%20analysis%20of%20methamphetamine%20prevention%20effects%20and%20employer%20costs">may experience</a> acute harms, such as overdose, and require harm-reduction strategies.</p>
<p>Both of these groups are, in some ways, hidden populations. They may not disclose their use of methamphetamine to their GP or other health professionals unless asked, and may not present to tertiary treatment services until their problems are severe. There is a <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17570971211225145?mobileUi=0&">time lag</a> of around five years between early methamphetamine-related problems and treatment.</p>
<p>While investment in policing and prevention is important, the bulk of the changes in use and the resulting harms are due to the small proportion who use more regularly and are at risk of dependence. </p>
<p>We know that for <a href="http://www.drugpolicy.org/docUploads/ndny_costeff.pdf">every dollar spent</a> on drug treatment we save A$7 to the community, compared with A$2 for stronger policing. We need to ensure that treatment is a significant part of the solution to the problems created by changes in methamphetamine use.</p><img src="https://counter.theconversation.com/content/39697/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee 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>Prime Minister Tony Abbott today launched a taskforce to tackle the growing problem of ice. But while Australia certainly has a problem with ice, it’s hardly an epidemic.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/393132015-03-29T23:15:06Z2015-03-29T23:15:06ZIce in Australia: overseas crime gangs, not bikies, are the threat<figure><img src="https://images.theconversation.com/files/76040/original/image-20150325-14488-173bjuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Methylamphetamine, in particular crystal meth or 'ice', has been the subject of much scrutiny in Australia in recent times.</span> <span class="attribution"><span class="source">AAP/David Crosling</span></span></figcaption></figure><p>The <a href="https://www.crimecommission.gov.au/publications/intelligence-products/unclassified-strategic-assessments/australian-methylamphetamine">Australian Crime Commission (ACC) report</a> into the methylamphetamine market in Australia makes for sombre reading. Released this week, it reveals that more drugs are coming into Australia and certain forms of drug usage are increasing. A variety of crime groups are playing a role in the drug trade.</p>
<p>Methylamphetamine, in particular <a href="http://www.druginfo.adf.org.au/drug-facts/ice">crystal meth or “ice”</a>, has been the subject of much scrutiny in recent times and concern is growing among Australian authorities. The <a href="http://www.parliament.vic.gov.au/lrdcpc/article/2132">Victorian parliament</a> held an inquiry in 2013-14 into ice’s impact in the state and the government recently <a href="http://www.parliament.vic.gov.au/images/stories/LRDCPC/Ice_Inquiry/Government_response.pdf">released</a> an “Ice Action Plan” in response.</p>
<p>So, how does the ACC intelligence document help inform the debate around ice? What practical lessons can Australian society and law enforcement draw from it?</p>
<h2>The current Australian market</h2>
<p>According to the 2013 <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">National Drug Strategy Household Survey</a> (NDSHS), 7% of Australians aged 14 and above reported using amphetamine or methylamphetamine at least once in their lifetime and 2.1% reported recent use. This has remained consistent with <a href="http://www.aihw.gov.au/publication-detail/?id=32212254712">2010 figures</a>. </p>
<p>What has changed, and significantly so, is the type of methylamphetamine Australians are using.</p>
<p>Users now prefer crystal methylamphetamine. This produces more powerful physical and psychological reactions than powder forms of the drug. Users of powder forms decreased from 51% to 29% while ice use more than doubled from 22% to 50% between 2010 and 2013. National Drug and Alcohol Research Centre findings from 2014 support this conclusion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=292&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=292&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=292&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=366&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=366&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76039/original/image-20150325-14494-941lgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=366&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Recent use of speed, base and crystal/ice by injecting drug users nationally, 2000-2014.</span>
<span class="attribution"><span class="source">2014 National Drug Trends Conference</span></span>
</figcaption>
</figure>
<p>The increased addiction/dependence potential for ice as the purest form of the drug is also evident. A great proportion – 25% of regular ice users – are using at least weekly. This is a much higher rate than the 2.2% of regular powder users who use weekly. </p>
<p>Increased demand for the higher purity of ice results in Australian users in particular being prepared to pay premium prices for this form of the drug. Figures suggest that the Australian price per kilogram of crystal methylamphetamine is A$320,000, whereas in the United States it is A$100,000. In China, a country flagged by the ACC report as a key player in transnational organised drug crime, the cost is as low as <a href="http://www.unodc.org/documents/ungass2016/Contributions/Civil/DrugFreeAustralia/Changing_the_Market_Culture_for_Methamphetamines_updated_1_October_2014.pdf">A$7000 per kilogram</a>. </p>
<h2>The business of drugs</h2>
<p>The business of illegal drugs shares some elements with the business of selling legal products. Common features include lots of working capital, a steady supply of raw materials, manufacturing facilities, reliable shipping and distribution and marketing networks. But it is knowing what criminal networks are operating at what level that is the key to an effective law enforcement response.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75940/original/image-20150325-14515-v6u93.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"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Terry Goldsworthy</span></span>
</figcaption>
</figure>
<p>ACC data indicates that detections of clandestine laboratories decreased by approximately 6% in 2012-13. The weight of precursor material being detected at the border has also decreased, despite the number of detections increasing. </p>
<p>Conversely, the weight and amount of amphetamine-type substance (ATS) detections at the Australian border, in particular detections of ice, continue to increase. This suggests that the outstanding threat is increasingly coming from abroad. Small-time Australian players are growing reliant on transnational crime groups.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=272&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=272&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=272&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=342&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=342&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75941/original/image-20150325-14484-64z979.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=342&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><span class="source">Australian Crime Commission</span></span>
</figcaption>
</figure>
<p>The ACC’s <a href="https://www.crimecommission.gov.au/publications/intelligence-products/illicit-drug-data-report/illicit-drug-data-report-2012-13">Illicit Drug Data Report</a> flags increased seizures, border detections and associated arrests for ATS (excluding MDMA) at record highs. This echoes the findings of the United Nations Office on Drugs and Crime <a href="http://www.unodc.org/documents/wdr2014/World_Drug_Report_2014_web.pdf">2014 World Drug Report</a>, which identified global trends of record-high seizures of methamphetamine as compared with other ATS.</p>
<p>The ACC report indicates that transnational organised crime involvement in high-volume precursor importation and trafficking remains at high levels. Its concern about illicit importations concealed by legitimate markets is clear, particularly from a law enforcement perspective. </p>
<h2>Bikies are just part of the picture</h2>
<p><a href="http://www.qld.gov.au/law/laws-taxes-elections-and-complaints/queensland-laws-and-regulations/new-criminal-bikie-gang-laws/">Various governments</a> in Australia have made much of the role of outlaw motorcycle gangs (OMCGs) and their involvement in the methylamphetamine trade. </p>
<p>Tellingly, in this week’s report, they rate only two mentions. One is as a part of the wider criminal gang picture; the other as a case study for involvement in the drug trade in a small rural Victorian town. </p>
<p>Nowhere was the critical evidence of their dominance of this particular drug market put forward, despite what many <a href="http://www.parliament.vic.gov.au/images/stories/LRDCPC/Submissions/Submission_52_-_Victoria_Police.pdf">law enforcement agencies</a> have been claiming in recent years. The report outlines the following crime groups as being active in the meth market:</p>
<blockquote>
<p>… members of Australian-based outlaw motorcycle gangs, Australian organised crime groups as well as persons of Middle Eastern, Eastern European and West African backgrounds, and Vietnamese, Chinese, Canadian, US and Mexican serious and organised crime groups.</p>
</blockquote>
<p>As has been previously shown, while <a href="https://theconversation.com/the-end-justifies-the-means-why-queensland-is-losing-the-bikie-war-21948">OMCGs</a> no doubt have some involvement in the drug trade, they are not the kingpins.</p>
<h2>What are transnational organised crime groups?</h2>
<p>Transnational organised crime (TOC) groups are the most concerning threat to Australia when talking about organised and serious crime. They are clearly involved in the methylamphtamine market. More than 60% of Australia’s highest-risk <a href="https://www.crimecommission.gov.au/publications/intelligence-products/crime-profile-fact-sheets/methylamphetamine">criminal targets</a>, including transnational targets, are involved in the methylamphetamine market.</p>
<p>The UNODC <a href="http://www.unodc.org/pdf/crime/publications/Pilot_survey.pdf">looked at</a> 40 TOC groups and identified a number of their typologies and characteristics.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=579&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=579&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=579&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=727&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=727&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76056/original/image-20150326-12314-1odos23.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=727&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Transnational organised crime group typologies.</span>
<span class="attribution"><span class="source">United Nations Office of Drugs and Crime</span></span>
</figcaption>
</figure>
<p>Of these TOC groups, 70% carried out criminal activity in three or more countries. Most were involved in multiple criminal enterprises. They were actively involved in corruption and routinely employed violence and engaged in money laundering.</p>
<p>Unfortunately, the ACC’s report has a broad base and lacks detailed or overly new evidence. One issue that does seem to bear consideration is the rising role of transnational crime groups. With so much focus on domestic gangs as the peak criminal threat, perhaps we have taken our eye off the ball of the real criminal threat outside Australia’s borders.</p><img src="https://counter.theconversation.com/content/39313/count.gif" alt="The Conversation" width="1" height="1" />
<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>How does the ACC report help inform the debate around methylamphetamine, and what practical lessons can Australian society and law enforcement draw from it?Terry Goldsworthy, Assistant Professor in Criminology, Bond UniversityLaura McGillivray, Adjunct Teaching Fellow, Faculty of Society and Design, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.