Breaking the Ice: Using evidence to gain perspective on the ice epidemic and what it means for responses
Methamphetamine is a potent stimulant drug that comes in several forms: Primarily, powder/pills (‘speed’), base and a crystalline form (‘ice’). Recent media headlines suggest that Australia is awash with methamphetamine, particularly ‘ice’, devastating whole communities across the country. However, the population rate of methamphetamine use in the last 12 months is 2.1%, a figure essentially unchanged for the last 10 years (AIHW, 2014). So what is it that the media are really reporting?
Figures show that among recent users there has been a sharp increase in the number of people nominating crystal methamphetamine, or ice, as their preferred form of methamphetamine (AIHW, 2014), from 26.7% in 2007 and 21.7% in 2010, to 50.4% in 2013.
In addition, Scott et al. (2014) have shown not only increasing purity of ice from an annual average of 21% in 2009 to 64% in 2013 but the purity of traditionally lower grade speed has also been increasing from 12% to 37% between 2009 and 2013. Scott et al. (2014) report that the purity-adjusted price of both crystal and powder methamphetamine has been decreasing and they are now more similar.
The National Drug Strategy Household Survey (NDSHS) report (AIHW, 2014) has also noted a recent increase in frequency of methamphetamine use, with an increase in the proportion of people using it daily or weekly from 9.3% to 15.5%. Crystal methamphetamine users were much more likely to use ice on a regular basis with one-quarter (25%) using it at least weekly compared with 2.2% of those who preferred powder. With an increase to crystal methamphetamine as the preferred form to use, an increase in frequency of use and the increasing purity of methamphetamine (both ice and speed) points to an increase in risk and potential harms.
NCETA’s new paper under development (Lee et al., in prep) has examined the last 10 years of the National Drug Strategy Household Survey data. While 2013 data is still outstanding, the analysis has found crystal methamphetamine users and those who use at least monthly tend to engage in more risky behaviours than those who use only irregularly (less than monthly). Ninety percent reported engaging in some form of risky activity compared to 50% of irregular users. These included working under the influence and driving under the influence. In addition, people who used monthly or more had four to seven times the rate of mental health diagnosis. Ice users were also more likely than those who used other forms to report a mental health diagnosis. In addition those who used weekly are at least four times more likely to report that they had tried to cut back but couldn’t – a proxy measure of dependence.
Although 70% of people who report using methamphetamine use less than monthly, 2004 to 2010, the group of users became more ‘mainstream’ over time. They were more likely to be men (nearly twice as likely as women to use), living with a partner, employed and living in one of the capital cities. Although the 20-29 year age group had the highest number of users, there was a sharp increase in the proportion of 30-39 year olds recently using methamphetamine.
Increases in risks and harms in a mainstream population has several implications for developing effective responses. First, there is a larger group of methamphetamine users (70% of all users) who use irregularly (less than once a month) and are not seasoned users, but are putting themselves at high risks of harms. Harm reduction strategies are essential for this group.
Secondly, there is a smaller group of people who use methamphetamine once a month or more. While they are likely to be experiencing significant harms associated with their use (especially mental health concerns and risk of dependence), may not see themselves as ‘hard drug users’ and therefore may not access tertiary treatment services, which are generally reserved for the small number of daily users who present with complex needs requiring specialist intervention.
This group are not well catered for in the current health service system. 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.
Based on the best available data, although the number of users has not increased in the last 10 years, there have been significant shifts in the use of methamphetamine and the type of user. It is this shift that is likely to be driving the media focus.
Those who use more regularly, or using ice, are likely to be experiencing risks and harms, such as mental health problems, but may not be consider their problems severe enough to contact a tertiary treatment service.
Novel ways of responding to this group, such as online interventions and information and brief advice in locations where users go is crucial, as is a broadening of tertiary treatment services to focus on brief and early intervention in ways that is acceptable to high risk methamphetamine users.
AIHW. (2014). National Drug Strategy Household Survey detailed report: 2013. Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW.
Scott, N., Caulkins, J.P., Ritter, A., Quinn, C., & Dietze, P. (2014). High-Frequency Drug Purity and Price Series as Tools for Explaining Drug Trends and Harms in Victoria, Australia. Addiction. ePub ahead of print.