Ice (methamphetamine, or crystal meth) is quite different from other drugs of dependence in three important ways.
Crystal methamphetamine, or ice.
For nicotine, alcohol and cannabis, the harm often manifests many years after initiation of use despite the inherent dangers. Not so with ice. The harm becomes severe and intolerable very early on. This is almost invariably the case as use quickly becomes compulsive due to the highly addictive nature of the drug.
The result is that the time using ice tends to be much shorter. Before too long consequences become so severe, both to the user and their immediate environment including family, that change is inevitable, either cycling in and out of use or cessation, either spontaneous or due to forced withdrawal in prison or hospitalisation.
This difference in patterns of use is likely to impact on the raw statistics in an unpredictable way and indicate much lower use of the drug than actually is the case. At any point in time the number of users will seem much lower, despite the consequences being more noticeable, compared with total numbers who have used the drug because of the shorter average time using.
The second point of difference is that ice stimulates compulsive sexual acting out. While other drugs stimulate sexual appetite, none does more so than ice: Not only enhanced desire and sexual performance but risky sexual behaviour.
The third difference is that conventional treatment is largely ineffective. Those who become dependent on the drug do not seek treatment until after an average of three years from initial use and not until symptoms become very severe, and they do not stay long in treatment.
Facts and figures disseminated by the National Drug Strategy Survey and the Australian Crime Commission inform us of the extent of the ice epidemic. Noticeably, Australia has one of the highest rates of use of methamphetamine in the world, particularly among developed countries, increasing 10 per cent since 2011; drug seizures are at record levels and the weight of amphetamine-type drugs detections has increased 230 per cent from 2010-11 to 2012-13.
Among those with experience working in the field and reviewing the research, it seems that the main strategies to reduce social harm from ice use involves supply-and-demand reduction, rather than about users’ rights or harm reduction. This is due to the associated high levels of mental illness, crime and violence, harm to family members and the community, the highly addictive nature of the drugs and the high-risk sexual behaviour.
Of great concern is the potential spread of HIV and STDs between drug users and into the non-drug-using community associated with methamphetamine use. Methamphetamine use has been found to be independently related to prostitution, sex with injecting drug users and having a sexually transmitted disease. The inherent dangers of this drug to users and the community have been apparent for some time and yet policy does not reflect the urgency to implement effective strategies needed to avert a looming social crisis.
Not only are no practical harm reduction measures available, including drug substitutes, but treatment is difficult as users are unlikely to seek or engage in treatment. However, particularly heavy or dependent users (some 73,000 in Australia) are more likely to come into contact with law enforcement and the courts and, as a result, the court system has an important role in responding to ice-related problems and dependence.
There exists an opportunity for the courts and health systems to take an integrated approach along the following lines. Mandatory detention is of vital importance in any treatment response as it takes some time to go through withdrawal (psychosis/depression) and it is virtually impossible to retain people in treatment during this phase. As crime is so closely linked to stimulant use, some period of detention (three months) is legitimate, justified and necessary for effective treatment.
Specifically designed ice prisons/detention centres need to be established, as happens in other jurisdictions (such as Canada).
Focus needs to be integrated with health/mental health services responding to withdrawal and other health problems (cardiovascular, dental, STDs, HIV and so on), drug and alcohol services focusing on education about the harm and psychological and social change required, and an out-reach service (like parole) to monitor progress and prevent relapse by intervening in other social risk factors, especially among indigenous communities.
In other words, instead of diversion into health or treatment services, which have failed, involuntary treatment including dedicated prisons need to be a part of those health and treatment services for treatment to be effective. Civil libertarians will be up in arms, but if we are to tackle this very serious and growing problem, an integrated and uncompromising approach as suggested is imperative.
As there is no evidence that the harm-minimisation policies have benefited users or the community and with the looming ice crisis, perhaps we can learn from the experience of Sweden. Sweden went from being one of the first European countries to experience a large-scale drug problem in the 1960s to now being a country with one of the lowest rates of drug use.
Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow and a member o the Drug Advisory Council of Australia.