Annabel Mayo Stimulant Treatment Program Alcohol & Drug Service St Vincent’s Hospital, Darlinghurst.

Image: "Racemic methamphetamine" by Boghog - Own work. Licensed under CC BY-SA 4.0 via Wikimedia Commons -

http://commons.wikimedia.org/wiki/File:Racemic_methamphetamine.svg#/media/File:Racemic_methamphetamine.svg

Methylamphetamine is a synthetic stimulant drug and a type of

amphetamine-type stimulant that is illegal in all Australian

jurisdictions.

It comes in several forms, including tablet,

powder, crystal and oil.

The most commonly available form in Australia is crystalline (‘ice’)

followed by powder (‘speed’).

N-methyl-alpha-methylphenethylamine

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CR ICE IS ?

2 high profile media

reports this week epidemic

scourge

plague

•ATS are the second most widely used illicit drug in the world, following cannabis.

•In 2014, the United Nations Office on Drugs and Crime (UNODC) reported approx 13.9 million to 54.8 million users worldwide.

•Australia has one of the highest rates of illicit stimulant use in the world – 2%

•Gradual increase in ice use over last 2 decades, mostly replacing speed use (IDRIS)

•Purity : Speed (10-20%) – base (40%) – ice (80%)

•Perception of increased harm as a result.

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○ At least one in ten people > 14 years of age have used these

substances

○ Around 10% accessing treatment

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Changing use

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• Preferred amphetamine. The number of methamphetamine users who prefer ice over other types of

methamphetamine has doubled, from 27% in 2007 and 22% in 2010, to 50% in 2013. The proportion

of people using it at least weekly has grown, from 9.3% in 2010 to 15.5% in 2013.

• More smokers.There has also been a increase in smoking as the main route of administration, from

around 20% of regular users to 40%.

• Purer. Other data show an increasing purity of ice, from an annual average of 21% in 2009, to 64% in

2013. The purity of traditionally lower-grade speed has also been increasing, from 12% to 37%

between 2009 and 2013.

• Cheaper. The price of both crystal and powder methamphetamine, based on purity, is now more

similar than in previous years, making ice a more significant economical purchase for users.

Growing harms

• increase in people seeking treatment at drug and alcohol clinics. The proportion of treatment

“episodes” where methamphetamine was the principal drug of concern doubled from 7% in 2009-

10, to 14% in 2012-13.

• More call-outs .There has been an 88% increase in ambulance call-outs in metropolitan Victoria

and a 198% increase in call outs for methamphetamine-related incidents in some regional areas.

• Regional crisis. People in regional areas are twice as likely to use methamphetamine as those in

major cities (and are more likely to drink at risky levels and smoke cigarettes).

• More hospital presentations - methamphetamine-related problems are the second-highest

among the four major illicit drug types, with 182 “separations” per million people in 2010-11.

• Legal system burden Arrests for methamphetamine-related crimes have increased by 30%

between 2010-11 and 2011-12. And a review of more than 80,000 Queensland roadside drug-

tests between 2007 and 2012 found methamphetamine to be present in 41% of positive results.

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• AOD treatment focus has been on harmful use of CNS depressants like opiates, cannabis and alcohol has obscured world wide use of stimulants, with the exception of tobacco.

• Many stimulants used everyday around the world: caffeine and other xanthines, betel nut, kratom, khat, sugar not seen as especially harmful until now. Cocaine and amphetamines have had a medical use.

• Psychostimulants are seen as having a role in improving performance, therefore tolerated.

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Amphetamines were developed in early 1800s in Germany. Methamphetamine developed late 1800s in Japan: used medically since

1920s, originally for asthma. Used in military settings to aid performance since 1940s Medically prescribed for some conditions: 1960s depression. obesity

2000s ADHD and narcolepsy. Recreational use of Amphetamine Type Stimulants (ATS) has been high in

Australia for several decades : speed and ecstasy (MDMA) as well as ice. In 1990s, “speed” precursors were banned in Australia so ephedrine

compounds became the major amphetamine precursor.

As a result, most illicit amphetamine here is now methamphetamine. Approx. half made here and half imported.

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The Public

Perception

A good discussion of the dynamics of this crisis. Gruen XL - Series 7 Ep 1 : ABC iview starting at 33.24 iview.abc.net.au/programs/gruen-xl/LR1513H001S00

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Now let’s refresh your neurobiology a little

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www.drogasycerebro.com This gives an idea of the three ways amphetamines work at the level of

the synapse.

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• ‘Crash’ peaks in 2 to 10 days, with residual effects lasting up

to 8 weeks

• Symptoms include:

– Feeling depressed, irritable, restless (‘suicide Tuesday’)

– Lethargy

– Increased appetite

– Cramps, aches, nausea, rapid heart beat, hot and cold

flushes

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Emerging classes of

stimulants

• Cathoniones (eg mephadrone)

• NBOMe’s (synthetic stimulants)

• Psychostimulant “Pre-Workouts” e.g. 1,3-Dimethylamylamine HCL

• Caffeine powder

• Botanicals

• Noortropics: smart drugs? e.g. IT world using modafinil piracetam gingko etc.

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What are we going to do about

ice?

• Harm minimisation

• Understand the user: reduce stigma

• Understand the context of use:

Polydrug? Comorbid ?

• Look at best treatment options:

Counselling/ detox /rehab

Pharmacotherapy

Complex / short long-term/ neuro damage

Neuro-psych OT and SW inputs

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• Experimental

• Recreational

• Performance

• Sexual

• Injecting /Non-injecting

• Not dependent

• Not considering change

• Regular users

• Dependent users

• Gambling/steroid use

• Polysubstance use

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Irregular/infrequent/binge use, use often normalised in peer groups/community Often early stage of “using career” are “high functioning” Not engaged in AOD treatment and/or treatment naïve Many do not identify with traditional Alcohol and Drug Treatment Programs and organisations Do not feel as though Alcohol and Drug Treatment Programs have anything to offer them

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Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addicons (2011) By Patt Denning, Jeannie Little The Guilford Press

When SET + SETTING get stronger, the person more easily overcomes the DRUG

The Stimulant Treatment Program at St Vincent’s Hospital, Sydney opened in 2006. Hunter-New England STP is based at Newcastle Hospital. More STPs are being set up in Mt. Druitt, Wollongong, Taree.

•Primarily a counselling service with medical support (inc. limited pharmacotherapy)

•Clients: aged 18 +

•Clients: current or recent user of stimulant drugs

•$0

•Priority given to indigenous clients.

• Intake interview/Brief intervention

• S Check (Assessment): 4 sessions with Counsellor or G.P.

• Treatment offered: –Drop-in Clinic (Brief Intervention)

–Counselling interventions

–Counselling plus pharmacotherapy

–Link Group (Strengths-based group developed by Brian Francis,

based on Alan Jenkins ”Invitation to Responsibility”)

• Hospital Inpatient Support

• Community Action

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● Assessment ● Counselling Eclectic Skills

•Brief Interventions/SFT •Motivational Interviewing •Conversational model •Narrative Therapy •Psychodynamic Therapy •Cognitive Behaviour Therapy •Gestalt

● Community Link Group +

Assertive Phone + Outreach

● Psychoeducation

● Pharmacotherapy

Therapeutic priorities:

● Harm Minimisation

● Biopsychosocial

● Strengths-based

● Trauma-Informed

● Invitational/membership

● Collaborative

● Culturally aware

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● Understand the use and withdrawal patterns for ice. ● Be gentle and non-confrontational. Your threatening pose may cause you harm. ● Be non–judgmental. Clients will already feel overloaded with shame ● Understand that dissociation, memory loss and confabulation are part of the process – your clients aren’t always lying to you.

● Understand the ice economy

and the financial drivers for some clients.

● CBT not enough for irrational part of drug use, digging for early trauma too much. These clients often suffer PTSD and various types of dissociation. Learn about how you can help this.

● Rethink your use of the word “addiction”- it can be a prophecy self-fulfilled. (see Marc Lewis)

● Mental Health entanglements learn the meds and Recovery model so you can advocate.

● Look underneath the drug use and find the person there.

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A person who is overwhelmed by their failure to negotiate adult life, including and often traumatic past, and who has resorted to drug use, may value themselves as too low to deserve help.

This person may not see any future for himself/herself, may not see recovery as a possibility. How can this person heal?

• Ultimately, the most therapeutic support may be given through relationship, through compassion. These qualities that are stock in trade amongst nurses, can be powerful determinants of change. – seeing themselves reflected in your eyes

• Health care workers all have a role to play in advancing an understanding in patients/clients of what is happening in the brain and body in drug use and that recovery is possible.

The healing power of connection: healthy relationships and new bonding is

recognised across cultures including in Aboriginal traditions..

Kanyini

Kanyini means responsibility and unconditional love for all of creation and it envelops

the four principles of aboriginal life:

Tjukurrpa – Creation Period (or what non-aboriginals call ‘dreamtime’)

Kurunpa – Spirit, Soul, Psyche

Walytja – Family, Kinship

Ngura – Land, Home, Place or Mother

Kanyini is best expressed in English as the combination of the two words

‘responsibility’ and ‘love’, but it is actually a relationship; it is an enormous caring with

no limit – it has no timeframe: it is eternal.

This summary is from Bob Randall is a Yankunytjatjara man from the

Central Desert region of the Northern Territory, Australia.

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Enquiries: 9361 8078/9 (phone)

0430 307 900 (sms)

Clinic: Level 2, O’Brien Centre

Cnr. Victoria & Burton Sts.

Darlinghurst N.S.W

Monday-Friday

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@svhscheck www.scheck.com.au

Support Lines

http://yourroom.com.au/

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• NSW Alcohol & Drug Information Service (ADIS)

• NSW and ACT Aboriginal & Multicultural Quitlines

• 1300DRIVER – Truckies Helpline

• Drug & Alcohol Specialist Advisory Service (DASAS)

• Opiate Treatment Line (OTL)

• Stimulant Treatment Line (STL)

• Cannabis Caution Line

Questions?

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