The final episode of the award-winning American TV show Breaking Bad aired last night. Set against the backdrop of illicit crystal methamphetamine production, the series highlights the huge problem parts of the US have with this particular drug.
In the UK, methamphetamine remains largely unrecognised when compared to other illicit drugs such as heroin and crack cocaine and for most fans of the series, the DVD box set is as close as they are likely to get to a hit of “crystal meth”.
So, is methamphetamine a problem in the UK? And if not, why not? To answer this we need to look at levels of drug use and compare this between different countries. Population surveys suggest that the US and parts of Eastern Europe have established methamphetamine problems along with other countries including South Africa and Australia.
It’s an established drug of misuse in countries such as the Czech Republic, where it is manufactured in “meth labs” similar to the one portrayed in Breaking Bad. Despite this, methamphetamine accounts for only 1% of the total drug seizures across Europe.
A very different pattern is seen here in the UK. Despite the UK often being described as the drug capital of Europe, methamphetamine hardly registers as a problem. A recent Home Office population survey suggested dramatic differences in the different drugs used last year. It suggested there were 2m cannabis users, 627,000 powder cocaine users, 415,000 Ecstasy users, 120,000 ketamine users, 27,000 heroin users - but just 17,000 methamphetamine users.
Population surveys provide an estimate of the number of people using a particular drug but do not tell us anything about the harm resulting from use. The UK is fortunate in having a well developed system which records the number of people attending drug treatment services, the drugs they are using and the problems they experience. Last year there were around 50,000 new presentations for heroin and crack combined compared to just a few hundred for methamphetamine.
But there appears to be only one sub-population in the UK where methamphetamine use is a current concern; a small part of the gay community has rapidly adopted the drug. Unlike the rest of the world, where methamphetamine is used to “get high” and is strongly associated with deprivation, in the UK it is being used by a small proportion of, usually affluent, gay men living in metropolitan areas. In this sub-population, the drug is particularly used to enhance sexual performance often in combination with other drugs and often by injection.
With a diverse and well-established drug market, it may be that there is simply no room for methamphetamine in the UK, other than in particular sub-populations.
Drugs with similar stimulant effects such as powder cocaine, crack cocaine and amphetamine have all been established in the UK for many years. Even the relatively new drug mephedrone - initially a cheap legal stimulant which was subsequently banned - rapidly overtook methamphetamine, with an estimated use by 174,000 people last year.
Another issue is cost. While most of the stimulants mentioned above can be bought for between £20-50 a gramme, methamphetamine usually cost well over £100 for the same amount, although its effects are strikingly long lasting. Such high prices are likely to reduce its appeal outside more affluent users.
So while audiences are glued to their televisions for the climax of Breaking Bad, it seems that at present, outside a small part of the gay community, UK drug users have shunned methamphetamine. It remains to be seen if the drug will gain a foothold in mainstream drug using populations, but given the terrible cost that methamphetamine inflicts on the user, their family and wider community, clinicians like myself, are hoping it is one drug the UK will avoid.