National Amphetamine-Type Stimulant Strategy 2008-2011
1.3 Why does Australia need a National Amphetamine-Type Stimulant Strategy?
Increasing productionOver the last 15 years, ATS production and use in Australia have increased and the potency of some ATS has increased. Globally, the production of ATS has similarly increased. As an indication of the rise in domestic production, detections of clandestine laboratories that manufacture ATS increased from 58 in 1996/97 to 390 in 2005/06 (Australian Crime Commission, 2007).
Prevalence and patterns of useAfter cannabis, ATS are the second most commonly used illicit drugs in Australia. According to the 2004 National Drug Strategy Household Survey (NDSHS), 9.1% of the general population aged 14 years or older has tried meth/amphetamine and 3.2% have used it in the previous 12 months (Australian Institute of Health and Welfare, 2005). Lifetime use of ecstasy was lower, reported by 7.5% of the population, while recent use was comparable to meth/amphetamine, at 3.4%. These figures translate to approximately 1.5 million Australians having used meth/amphetamine at some time in their life (approximately 530,000 used in the past 12 months). Approximately 1.2 million Australians have used ecstasy at some time in their life (approximately 560,000 had used in the past 12 months). ATS are used by a wide variety of people in Australia within different contexts. As with most other classes of drugs, ATS use is more common among males and most prevalent in the 20-29 year age group (Australian Institute of Health and Welfare, 2005).
Patterns of use extend from those who use occasionally (e.g., an occasional weekend) to more regular use. Regular users represent the minority, with the majority of ATS consumers using occasionally. For example, the 2004 NDSHS identified 0.6% of the population, equivalent to 97,000 Australians, who reported use of meth/amphetamine in the last week (compared to approximately half a million who had used at all in the previous 12 months) (Australian Institute of Health and Welfare, 2005). Another report suggested that there are approximately 73,000 people in Australia who are methamphetamine dependent, resulting in a number of problems (McKetin et al., 2005).
Problems of useThe total number of hospital bed-days for amphetamine-induced psychosis was 5679 in 1999-2000, rising to 8068 bed-days in 2003-04 (Degenhardt et al., 2007). In 2004/05 there were almost 15,000 recorded drug treatment episodes for amphetamine or methamphetamine (Australian Institute of Health and Welfare, 2006). Among those aged 15 to 54 years, there was a total of 75 ‘drug induced’ deaths in 2004 for which methamphetamine was mentioned (Degenhardt et al., 2006). This represents an increase from 50 methamphetamine-related deaths in 2003 (a rate increase from 4.4 per million persons to 6.6 per million persons).
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Increasing doses of ATS and certain contexts of use exacerbate the risk and the severity of problems. There is growing evidence about a range of adverse effects, including:
- cardio-vascular problems including hyper and hypotension, increased heart rate and irregular heart-beat;
- in vulnerable individuals, a risk of cardio-vascular and cerebro-vascular crises, and irregular heart-beat; such as stroke;
- mental health problems including confusion, paranoia, anxiety, depression and psychosis;
- the likelihood of developing dependence especially associated with injecting ATS and smoking crystalline forms of methamphetamine;
- risk of blood borne virus (e.g., Hepatitis C and HIV);
- low levels of concentration;
- cognitive impairment;
- poor eating habits resulting in poor general health;
- sleep-disorders, fatigue, and consequent risk of accident and injury;
- increased impulsivity and risk taking;
- aggression and violence; and
- social and family disruption (use can impact on parents and children of consumers).
ATS production and distribution are associated with off-shore and domestic organised crime. Clandestine laboratories are inherently risky to those involved in production and their families (e.g., children may be exposed to the harmful chemicals and risky processes), those in the immediate locale and those with responsibility for the disruption and remediation of such sites (e.g., law enforcement officers and local government workers).
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Enhancing the responseA large proportion of people affected by ATS use (i.e., those who are not severely dependent and who are not experiencing severe problems) are suitable for opportunistic and brief interventions and there is an evidence base to guide such interventions.
There are particular challenges associated with treating ATS dependence and related problems but the evidence-base to support the development and implementation of specific interventions has been limited, especially when compared to other drugs such as tobacco, alcohol or heroin. There is limited evidence to inform treatment protocols for managing withdrawal, a limited range of pharmacotherapies, and the challenges of managing co-existing mental health problems such as anxiety and depression. Many people affected by ATS use have a tenuous link with services and retention rates are poor. Co-existing mental health problems create management challenges for law enforcement services, emergency services, mental health services and specialist drug and alcohol services.
There is increasing disquiet about the impact of ATS problems in rural and remote communities and some Aboriginal and Torres Strait Islander communities, where the relative isolation from services creates additional challenges for management.
There is a need to enhance the evidence-base about effective law enforcement, prevention, harm reduction, supply reduction and treatment interventions; to develop strategies to enhance treatment engagement and retention; and to improve coordination of care and referral among police, emergency services, general health and mental health services, and specialist drug treatment services.
More information about ATS use and related problems can be found in the following:
Australian National Council on Drugs (ANCD). (2007). Methamphetamines: Position Paper. Commonwealth of Australia. http://www.ancd.org.au/publications/pdf/pp_methamphetamines.pdf
Baker, A., Lee, N.K., & Jenner, L. (Eds.) (2004). Models of intervention and care for psychostimulant users (2nd Ed). National Drug Strategy Monograph Series No. 51. Canberra: Australian Government Department of Health and Ageing. http://www.health.gov.au/internet/main/Publishing.nsf/Content/health-pubhlth-publicat-document-mono51-cnt.htm/$FILE/mono51.pdf
AIDS Council of NSW (ACON). Crystal. http://www.acon.org.au/health/index.cfm?cat_ id=103 Drugs & Crime Prevention Committee (DCPC). (2004). Inquiry into Amphetamine and ‘Party Drug’ Use in Victoria. Melbourne, Victoria. http://www.parliament.vic.gov.au/dcpc/Reports/DCPC-Report_Amphetamine_2004-05-05.pdf
National Drug and Alcohol Research Centre (NDARC) website has several references on ATS. http://ndarc.med.unsw.edu.au
National Institute on Drug Abuse (NIDA). Methamphetamine: Abuse and Addiction. http://www.nida.nih.gov/ResearchReports/Methamph/Methamph.html
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