Friday, 15 August 2014

Ice, crystal, crystal meth or meth: Why is this drug so problematic?

A week doesn't go by without some sort of media story about 'ice' hitting the headlines. They usually involve stories of users committing violent crimes or law enforcement agencies announcing another huge seizure of the substance. However, the story of of the 26 year-old daughter of the late NSW Premier Neville Wran, Harriet being charged with the murder of a drug dealer and her alleged 'ice' addiction has once again brought the issue of methamphetamine and its associated problems to the front pages of newspapers across the country.

The question I have been asked since the story broke is why would a young woman who apparently had 'everything' end up using a drug like ice? I don't think many would have been surprised if her drug of choice had been cocaine, a drug usually associated with 'high-flyers' and the rich and famous, but why ice? What is the attraction of this drug and why is it so problematic?  

To understand the whole 'ice' issue, it is important to understand some terminology around amphetamines. Amphetamines are a group of stimulant drugs that increase central nervous system activity and can come in many different forms - powder, crystals, tablets or even as a liquid. One form of amphetamines is methamphetamine. Although this can come in the 'salt' form and be called 'speed', it is now much more likely to be sold in the crystalline form known as 'ice'. It may also be called other names such as 'crystal meth', 'crystal' and 'meth'. Even though speed and ice are similar drugs, ice has two important qualities that make it far more problematic than speed - it can be extremely pure and because it is in a crystalline form it is able to be smoked.

Speed (the powder form) is usually a very low quality drug, with purity levels usually well under 10% (sometimes less than 1% with seizures over 20% being extremely rare). Ice on the other hand is much more pure, with police reporting that some seizures can be up to 80% pure (although purity levels are highly variable). At the same time, because ice can be smoked due to its crystalline form (unlike speed that simply burns away if users try to smoke it) the drug reaches the brain extremely quickly (smoking is the fastest route of administration, even faster than injecting). Put these two things together and you have a real problem ... a very pure drug hitting the brain fast results in a very intense high, continue to smoke and over time you create a powerful 'reward pathway' that over time can result in dependence or addiction! This is an over-simplification of the process but hopefully you get the picture!

This sort of reward pathway is usually found in those who inject drugs and although speed users can of course have problems with their drug of choice, it was usually those who injected it that had the most serious dependence issues. That all changed when ice came onto the scene ... people who would never consider injecting a drug would smoke the drug having no idea how quickly they could find themselves with serious dependence issues! It is important to be aware that ice can also be injected and we have certainly seen those who inject other drugs, particularly heroin, moving to this high quality drug simply because it gives them better 'bang for their buck'. As a result, growing numbers of users have become dependent on methamphetamine and there has been an increase in related problems (e.g. psychosis and other mental health problems).

As already said, methamphetamine has been an extremely hot topic in the Australian media for some time and has become a significant drug issue within our community, particularly for frontline workers such as hospital emergency department staff and law enforcement. However, the impression that this drug has permeated mainstream society and is reaching epidemic proportions in the general community is not supported by any real evidence, in fact all the evidence we have would suggest that use is fairly steady and has actually gone down since the 1990s. The recently released 2013 National Drug Strategy Household Survey found that 7% of Australians aged 14 years and over have ever used methamphetamine (the same rate as for 2010). What had changed though was the form of the drug that was being used by users - since 2010 ice use had doubled and the use of powder had dropped dramatically. Without any doubt ice is much more available than it was in the past but this does not necessarily mean we have a larger pool of amphetamine users. What we have seen are changing patterns of use amongst this group and these are certainly resulting in greater harm to the users themselves, as well as the wider community.

Methamphetamine is a significant issue in the Australian community that needs to be addressed. We need to ensure that we put it into context though and do not focus on it to a point that we lose sight of other potentially more serious problems in our society. Let's make it very clear, for the majority of parents the 'ice epidemic' is a non-issue - most young people see ice as a 'gutter drug' and would not consider trying it. However, as the Harriet Wran story illustrates, no family is immune from these type of problems. Ice is a drug with unique qualities that do make it attractive to users, unfortunately it is these qualities that also make it so problematic!

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