National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69
3.6 Effects on family and community
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ATS use also has considerable implications and consequences for the families and friends of users, and the wider community. The social and behavioural effects outlined above (e.g., driving risks, spread of STIs, aggression and violent behaviour) significantly impact at both an individual and community level. Family relationships are affected both in regards to the impact on parents of an ATS user (see Chapter 4; ‘Prevention and Harm Reduction’) and on children exposed to parental ATS use. Children are affected by ATS use during pregnancy and by the impact of growing up in an environment where people are using drugs. Backyard manufacture of ATS is an issue that affects both children and community members through exposure to laboratories and associated chemicals. These factors are discussed below in relation to existing research.
The detrimental effect of ATS on relationships was highlighted throughout the consultation process. The impact of ATS use on peer relationships was identified as an area to target in prevention programs. It was suggested that a heavy ATS use can result in a ‘loss of mateship’. The detrimental impact on relationships was also mentioned in relation to consumers’ alienation from their family and friends. Within Indigenous communities, it was suggested that a great sense of shame is experienced over ATS use and there can be a loss of cultural identity and connection. Paradoxically, while many might use ATS in social settings, adverse impact on people’s social and family relationships can be a significant factor in treatment seeking.
ATS use during pregnancy
The 2004 NDSHS found that women who were pregnant and/or breastfeeding in the previous 12 months were less likely to consume alcohol (47%) and any illicit drug (6%) than those not pregnant and/or breastfeeding (85% and 17% respectively) (Australian Institute of Health and Welfare, 2005a). Births in mothers with opioid, stimulant or cannabis diagnoses are linked to several negative birth outcomes (e.g., low birth weight). A recent study of over 400,000 linked birth records from 1998 to 2002 (Burns et al., 2006) found 1,974 mothers had an opioid diagnosis, 552 a stimulant diagnosis and 2,172 a cannabis diagnosis (Table 3.3). Births in mothers with these drug-related diagnoses were more likely in women who were younger (particularly in the cannabis group), who were not married, who were Australian-born, and who were Indigenous. Mothers with a drug-related diagnosis were also more likely to be without private health insurance.Top of Page
Table 3.3: Maternal demographic characteristics of pregnancies to mothers with and without a drug-related diagnosis code, 1998–2002 (%)
Source: AIC, DUMA collection 2006
Other studies have found that fetal exposure to methamphetamine can lead to multiple prenatal complications, such as intraventricular hemorrhage, fetal growth restriction, increased risk of preterm labour, placental abruption, decreased birth weight, cardiac defects, cleft palate, and behavioural effects in neonates (National Institute on Drug Abuse, 1998; Plessinger, 1998; Smith et al., 2003). Methamphetamine exposure throughout gestation has been associated with decreased growth in infants exposed only for the first two trimesters. They were found to be significantly smaller for gestational age compared with the unexposed group (Smith et al., 2003). Neurotoxic effects include neurochemical alterations in areas of the brain associated with learning, leading to cognitive impairment, behavioural deficits, increased motor activity, and enhanced conditioned avoidance responses.
However, as reviewed in Dean and Mcguire (2004), a number of other studies have failed to demonstrate a relationship between malformations and amphetamine exposure. Taking into consideration the entire body of research reviewed, the authors concluded that the use of amphetamine in regular low doses poses little teratogenic risk. However, further research is required to address the possibility of cardiac malformations and whether dependent or binge patterns of amphetamine use may confer a greater risk to the foetus. With regards MDMA use during pregnancy, Dean and McGuire (2004) found insufficient evidence to make firm conclusions about the potential teratogenicity of MDMA.
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Parental ATS use
In addition to the potential adverse effects of maternal drug use during pregnancy (outlined above in respect to ATS), research has found that rates of behavioural and emotional problems are more prevalent among children of illicit drug users, particularly oppositionaldefiant and non-compliant behaviours (e.g., Smith, 1993; Willens et al., 1995). In a study conducted by Patton (2003), reports from service providers indicated a range of problematic and dysfunctional behaviours in children raised in families where illicit drugs were used: fear of abandonment; separation anxiety; fear of losing their carer; fear of being left alone; self-blame for their parent’s departure; collecting food and hoarding it; overeating; intense fear of sirens and the police; inappropriate sexualised behaviour; sleeping difficulties; aggression (p.8).The impact of parental use has been illustrated by research conducted by the Department for Community Development (DCD) in WA (Leek, Seneque & Ward, 2004) found that in cases involving children:
- Drug and alcohol use contributed to 57% of cases studied;
- Drug and alcohol use was the second most common contributing factor for an application to DCD following neglect;
- Where a single main reason could be identified, drug and alcohol use was the main reason in 23% of cases;
- 44% of respondents to care and protection applications were drug and alcohol users; and
- Of those known to be AOD users, 42% were using psychostimulants and 54% were polydrug users.
- By age 7, on average, children had moved house over five times and attended two schools;
- The majority of primary caregivers of the children were unemployed and relied on government payments;
- Over 50% of parents reported that their children had been negatively affected by their drug use and 70% that their child’s exposure to active drug use was ‘distressing’;
- Child protection services were actively involved with 41% of the cases and had past involvement with 67% of the cases; and
- 24% of the children obtained scores in the clinically abnormal range on the Strengths and Difficulties Questionnaire (SDQ).
The ANCD report also analysed the ‘Patterns of Amphetamine Use’ database obtained by the Crime and Misconduct Commission. This sample consisted of 690 individuals of which 207 individuals (56% women) reported having children. In comparison to amphetamine users without children, those with children were significantly more likely to use base and crystal methamphetamine, as well as benzodiazepines (Australian National Council on Drugs, 2006). Of note, over a six-month period, those with children reported using crystal methamphetamine on twice as many days as those without children (55.1 versus 27.6 days). Of further concern was the prevalence of family violence in these households. It was reported that a higher proportion of amphetamine users with children had experienced physical violence from partners and nearly three times as many experienced regular partner violence compared to amphetamine users without children.
The ANCD report indicated that perhaps the most significant outcome for children raised by parents using illicit drugs was the increased prevalence of child maltreatment, both child abuse and neglect. However, it acknowledged that poor child outcomes cannot be directly attributed to parental illicit drug use given the variety of other adverse conditions commonly encountered, such as socioeconomic disadvantage (e.g., unemployment, poverty, transient lifestyle), poor mental health (e.g., co-morbid psychopathology) and social isolation (e.g., absence of social supports).
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Manufacture
In addition to parental use of methamphetamine limiting the ability to adequately care for and supervise children, manufacture of ATS in or near the home creates a high-risk, unhealthy and unsafe environment (Gutchewsky, 2003). Manufacture of ATS can involve a relatively simple chemical process that uses highly flammable, very toxic and corrosive chemicals (Caldicott et al., 2005). Several groups of people are therefore placed at risk in relation to manufacturing, including other adults, children, police, forensic scientists and emergency workers. Special consideration must also be given to environmental decontamination of ATS clandestine laboratory sites and to the protection of exposed populations during this process. Disposal of chemical waste products from ATS production, such as phosphorous-based solvents, can create pollution, and human and environmental risk (Irvine & Chin, 1991).The Minnesota Department of Health (2002) outlined the following common chemicals found in methamphetamine laboratories and their physical effects:
- Solvents (e.g., acetone, ether/starter fluid, methanol, white gas, xylene), which have been linked to irritation to skin, eyes, nose and throat; headaches; dizziness; depression; nausea; vomiting; visual disturbance and cancer;
- Corrosives/irritants (e.g., anhydrous ammonia, hydriodic acid, hydrochloric acid, phosphine, sodium hydroxide, sulphuric acid), which have been linked to coughing; eye, skin and respiratory irritation; burns and inflammation; gastrointestinal disturbances; thirst; chest tightness; muscle pain; dizziness; and convulsions; and
- Metals/salts (e.g., iodine, lithium metal, red phosphorous, yellow phosphorous, sodium metal), which have been linked with eye, skin, nose and respiratory irritation; chest tightness; headaches; stomach pain; birth defects; and jaundice/kidney damage.
Such issues are receiving increasing attention in Australia. For example, the Drug Misuse and Trafficking Amendment Act (NSW) recently established new penalties for the endangerment of children by exposure to illicit drug manufacture.
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