“If we wish to annihilate the junk pyramid, we must start at the bottom of the pyramid: the addict in the street, and stop tilting quixotically for the higher-ups so-called, all of whom are immediately replaceable. The addict in the street who must have junk to live is the one irreplaceable factor in the junk equation. When there are no more addicts to buy junk there will be no junk traffic. As long as the junk need exists, someone will service it.”
(William S Burroughs, Naked Lunch, 1959)
Are we in the midst of an “ICE” epidemic? Was the PM correct to say methamphetamine (“ICE”) is our “worst drug problem”, it is a “pernicious and evil” drug, it is “far more addictive than any other illicit drug”? Mr Abbott was launching the national task on “ICE”.
Or is this another cycle of drug alarm and groupthink? Recall, “reefer madness”, the “killer weed”, “the next crack cocaine”, “the meth mouth”, “the faces of meth” and “hashish assassins” ad infinitum.
On 8th April Leigh Sales introduced the ABC 7.30 Report, “Revelations of ice use and suicide in the Australian Navy have shocked the Defence establishment and Australia’s political leaders.” This followed the previous night’s tragic report by Louise Milligan of nine suicides in young sailors at the West Australian naval base, HMAS Stirling. These perplexing and disturbing events demand reflection on the underlying causes of mental distress and suicide. But these important questions were conflated with “ICE”, a spin-off from the PM’s announcement of the task force. Next day, on Radio National’s AM program, Green Senator Peter Whish-Wilson, himself a military veteran, was interviewed about the parliamentary inquiry he had instigated into mental health in the military community. Again “ICE” was dragged to centre stage, not by the Senator but by Fran Kelly, the interviewer. Other media have been even more caught up in the “ICE” frenzy.
Addiction is not a switch to be turned off and on. Addiction takes time, months, sometimes years, to develop. Methamphetamine use over a long period becomes the substrate for addiction. The majority of long-term users have already well-established dependence on other drugs – polydrug users. They are drug tolerant and in drug-seeking overdrive; they seek more potent drugs.
Simple exposure does not cause addiction. Think for a moment of the hundreds of hospital patients receiving pain relief, virtually none will become “addicted”. The same drug, morphine, injected in the ‘street’ carries a high risk of addiction. Addiction (drug dependence) arises from an interaction between a vulnerable person (nature and nurture), the social environment (attitudes, norms of peers) and a drug.
Medicine is long familiar with amphetamines. They are not new. They have been used in asthma, depression (even anxiety), for appetite suppression and now may be prescribed for narcolepsy and attention deficit hyperactivity disorder. University students take the stuff to cram for exams and US pilots are kept alert by amphetamines during combat missions. Their stimulant effects are understood and the potential harms to the cardiovascular system are known.
Where do the amphetamines, methamphetamine, stand in relation to other substances?
The population prevalence rate of methamphetamine use in 12 months is 2 – 3 per cent compared with the 83 per cent for alcohol. Alcohol use disorders occur at 15 – 20 times the rate of methamphetamine disorders. For every methamphetamine-related death there are 65 alcohol-related deaths; for every emergency presentation there are 30 alcohol-related presentations; for every ambulance emergency call-out there are 25 alcohol-related call-outs.
Many suicides are underpinned by illicit drug use, including methamphetamine, but alcohol intoxication and dependence is a far more potent factor in suicide worldwide; of attempted suicides presenting to hospitals, 50 to 80% had been drinking heavily or were intoxicated at the time and at post mortem alcohol is the drug most commonly found.
The amphetamine drugs are harmful. They can cause psychotic disturbances; about one in seven admissions for schizophrenia have a concurrent stimulant disorder. They cause anxiety, aggression and depression, on withdrawal, as well as affecting the cardiovascular system. These are features too of alcohol intoxication and dependence as well as there being a veritable textbook of alcohol-caused mental and physical conditions and harm to others.
Policing and law enforcement are important especially to prevent the exploitation of vulnerable people. They can’t solve the “ICE epidemic despite the current wave of interdictions and arrests. Community-based solutions are needed – supports for families and children, educational and work opportunities for young people, early intervention and prevention, access to primary care interventions and to treatment and rehabilitation services; none of which are given priority compared with resources devoted to law enforcement.
As William Burroughs said,
“When there are no more addicts to buy junk there will be no junk traffic. As long as the junk need exists, someone will service it.”
And he should know.
Ian Webster is Emeritus Professor of Health and Community Medicine at UNSW and patron of the Alcohol and Other Drugs Council of Australia. He was formerly a National Mental Health Commissioner and Chair of the Australian Suicide Prevention Advisory Council.