From epidemic to evidence: Effectively managing the harms sssociated with crystal methamphetamine

February 2016
Professor Ann Roche, NCETA

2015 saw an unprecedented level of interest in the drug colloquially known as ‘ice’. Crystal methamphetamine (or ‘ice’) dominated the media throughout much of last year. Hardly a day went by without the headlines and the media hype becoming more extreme, sensationalised or exaggerated with various media outlets vying to outdo each other. Some of this jockeying was no doubt motivated by genuine community concern; however, some seemed little more than the inevitable quest for airplay dominance. 

Throughout 2015 we also saw growing concern by the AOD sector over increasing numbers of crystal methamphetamine-related presentations to services and a widening range of harms reported from various quarters. This was accompanied by the involvement at a political and governmental level of the National Ice Task Force and a number of other enquiries and investigations, together with an endless array of conferences, forums, workshops and training sessions on ‘ice’. 

It’s hard to recall a time when so much attention by so many was focussed on a single drug issue. Possibly the closest parallel was seen in the late 1990’s. At the height of the heroin overdose era, when approximately 1000 deaths a year were attributed to heroin, there was a similar media flurry, the emergence of experts, political engagement at multiple levels, community activation, concern and endless debate. 

Much of what transpired during 2014/15 in relation to crystal methamphetamine was inaccurate and exaggerated. It had potential to exacerbate harms rather than alleviate them and to increase stigma and reduce treatment seeking. However, a number of positive and constructive changes also emerged. The profile accorded AOD issues was a welcome relief following the relatively moribund decade that preceded it. The level of community interest and engagement was pivotal. The diversity of political and policy attention, while at times challenging, provided opportunities for renewed support and resourcing of a somewhat battered, flagging and resource-stripped sector. 

The National Ice Taskforce Report released in December 2015 also provided a much vaunted focal point for action. Although there were concerns in some quarters about the direction that the Report might take, having been chaired by a senior ex-law enforcement officer, these concerns were alleviated by the Report’s comprehensive and balanced approach to dealing with the broad range of complex issues associated with crystal methamphetamine. It provides a useful blueprint for action and policy development. 

Importantly, much of the rhetoric and near hysteria about ‘ice’ in 2015 appears to be abating in 2016. The incorrect hype about ‘epidemics’ is slowly being replaced by a more accurate and considered understanding of the actual evidence which shows not an exponential expansion in use by huge numbers of people but a shift to crystal meth by a majority of existing users and some limited uptake by a much small number of users new to meth. 

These important shifts in our understanding are of vital importance to ensuring that appropriate interventions and policies are in place. The ramped up rhetoric of 2015 ran the very real risk of increasing the use of crystal methamphetamine by stimulating ‘social norming processes’. Averting this possibility is important. 

The evidence also tells us that the harms associated with crystal methamphetamine, a highly potent and much more concentrated form of methamphetamine with a stronger addiction-producing propensity, can be much greater with a more rapid onset than those likely to be encountered by users of other forms of meth. There is an important range of largely untapped harm reduction strategies than need to be activated to reduce the escalation in adverse outcomes being experienced by people who use crystal meth. 

Encouragingly, we are beginning to see the re-invigoration of the AOD sector with much needed funding and resourcing slowing emerging that will allow appropriate and evidence-informed responses to crystal methamphetamine. There is much to be done however. The distortions and inaccuracies, too commonly perpetrated throughout 2015, still require rectification. Factual, evidence-based approaches need to be privileged above those driven by hype and rhetoric. 

The upskilling of not only our frontline workforce but also our policy makers is gaining traction but has a good way to go. The workforce and the organisations within which they work need to be adequately resourced and supported. These are not transient issues we are dealing with – as history teaches us. 

Today’s ‘ice’ epidemic will likely morph into tomorrow’s next drug ‘scare’. The underlying drivers and responses will remain pretty much the same however. The long term maintenance and sustainability of our workforce and services is therefore paramount. We require workers and services that are resilient and flexible to address not only today’s ‘epidemic’ but also tomorrow’s inevitable crisis. Myopic single drug responses are doomed to failure or at least limited effectiveness. An opportunity exists for the sector to re-assert itself as evidence-based and comprehensive in its focus. In this sense, the ‘ice epidemic’ has provided a helpful lever to enable us to argue, yet again, for the appropriate responses that we have been striving to achieve over the past 2-3 decades.