SPEED SIGNS: What we know about methamphetamine users and what it means for treatment

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SPEED SIGNSWhat we know about methamphetamine
users and what it means for treatment
ATDC First Annual Conference 27-29 April 2008

• Nicole Lee, PhD
• Head of Research
• Turning Point Alcohol and Drug Centre

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What Is Methamphetamine?
Stimulant Drugs
Pharmaceuticals MDMA
Caffeine Nicotine Cocaine
AMPHETAMINES
ICE - BASE - SPEED
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Forms of Methamphetamine
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History

• Long history as pharmaceutical drug
• Currently used mostly in the treatment of ADHD
• Used since 1927 in the treatment of asthma,
  hayfever, obesity, fatigue and depression
• Used by soldiers in WWII to combat fatigue
• Widespread problems with non-medical use
• Listed under International drug control
  conventions since 1970s
• Beginning of illicit production

Lee et al (in press)
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Prevalence

• Prevalence of illicit use high around the world
• SE Asia a major hub for methamphetamine
  production
• Affecting Australia and New Zealand
• Highest use among English speaking countries

Lee et al (in press)
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International Comparisons
AIHW (2007)
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Use Australia 1991-2006
AIHW (2008)
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Prevalence
AIHW (2007)
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Main Form Used
AIHW (2008)
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Age

• Have used in the last 12 months
• General population 2.3
• 20-29 year old 7.3
• 30-39 year old 3.9

AIHW (2007)
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Gender

• Overall 2.3
• Males 3.0
• Females 1.6
• Main form
• Women Speed (50), Ice/Base (29/15)
• Men Speed (60), Ice/Base (26/11)

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Polydrug Use

• High rate of polydrug use even among
  non-dependent users
• Alcohol 87
• Cannabis 68
• Ecstasy 49
• Cocaine 14
• Pharmaceuticals 19

AIHW (2007)
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Injecting

• NDHS (2008)
• 70 of IDUs injected meth in the last 12mo
• IDRS (2007)
• 94 of IDUs ever injected meth
• 73 injected meth in last 6 mo
• ?Meth users that inject
• 9 EDRS respondents inject meth

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Attitudes

• Reluctant to come into treatment
• Dont see themselves as hard drug users
• Dont believe that treatments are available
• Dont believe AOD services have clinicians who
  know how to treat stimulant use

Connolly et al (2007)
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Lag Time to Treatment
Lee et al (2007)
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Acute risks

• High dose
• Acute behavioural disturbances
• Psychotic episodes
• Angry or violent outbursts
• Crash (hangover)
• Neurotoxicity

• Any dose
• Unknown content
• Unsafe sex
• Overheating and dehydration
• ?Mental health effects

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Dependence

• Around 73,000 dependent users
• Equates to 11 of recent users (last 12mo)
• Far more common among
• Injectors
• Smokers of crystal methamphetamine
• Regular users (more than weekly)

McKetin et al (2005)
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General Population of Users

• High rates of use across the community
• Tend to be younger
• Mostly using speed and occasionally
• Ice use primarily limited to heavier users
• Low rates of injecting among general population
• High rates of polydrug use
• Low rates of dependence
• Low treatment contact

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Neurocognitive Effects

• Heavy users show deficits in brain functioning
• Memory and concentration
• Decision making
• Most deficits appear to be recoverable with
  abstinence
• Depending upon severity and length of use

Aaron Paulus (2007)
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Risks of Long Term Use

• Poor physical health
• Sleep problems
• Weight loss, nutrition
• Palpitations and chest pains
• Tremors
• Skin problems

• Poor mental health
• Agitation, aggression
• Low motivation
• Depression and anxiety
• Paranoia, hallucinations
• 75 of long term users report some mental health
  symptoms

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Mental Health

• High rates of mental health problems
• Chronic and acute depressive symptoms 80
• High rates of acute psychotic symptoms 11
• Probably related to increase in dopamine
• Surge in short term ?psychotic symptoms
• Depletion over long term depression

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Dependence and Withdrawal

• Associated with withdrawal
• Sleep and appetite disturbances
• Depression and anxiety
• Craving
• Symptoms usually last 7-10 days
• Brain abnormalities similar to mood disorders
• Relatively mild?

McGregor et al (2007) Jenner Saunders (2004)
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Withdrawal
Lee et al (2007)
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Users in Treatment

• 4th most common presentation
• No increase in AOD episodes
• Increase in hospital separations
• Most treatment males
• Most self referred
• 73 injectors
• 67 polydrug concerns

NMDS (2007)
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Two Groups?

• Low End
• High community use
• Younger
• Using speed
• Using occasionally
• Low rates of injecting
• High rates of polydrug use
• Low rates of dependence
• Low treatment contact

• High end
• High rates of use
• Using ice and base
• Using regularly
• Injecting
• High rates of polydrug use (?dependence)
• High rates of dependence
• Some treatment contact

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Dependent Users

• Provide evidence based AOD treatment for
  methamphetamine dependence
• Address mental health and other problems as
  required

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What Works

• No specific pharmacotherapy has been found to
  date for withdrawal or dependence
• Treat symptoms as required
• Psychological treatments effective
• Brief cognitive behavioural therapy
• Contingency management
• Others ??

Lee Rawson (in press)
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Brief Intervention

• Baker, Lee et al (2005)
• After 2 sessions 46 abstinent at 6 mo
• After 4 sessions 49 abstinent at 6 mo
• Self-help booklet 27 abstinent at 6 mo
• Overall reduction in use in all groups
• Assessment and followup effective
• Improvement in depression

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Broadening Treatment

• Risk of focusing only on dependence and Ice use
• Users may not identify with those images
• May miss a group of users who would benefit from
  intervention

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Non-Dependent Users

• Attract mid level users into treatment
• Address harms associated with use
• Mental health problems
• Physical health problems
• Early intervention
• Prevent transition to injecting
• Prevent transition to regular use and more potent
  forms

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Early and Brief Intervention

• Studies have shown that for many people MH
  symptoms cease with abstinence
• Neurobiological studies show changes in the brain
  that correspond to MH problems and that resolve
  with abstinence
• Early intervention with meth use may reduce the
  incidence of MH problems

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Treatment Innovations

• New technologies attractive option
• Young population
• Low treatment seeking
• Provides
• Soft entry to treatment
• Easy access to information
• Anonymity
• Reach

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Innovations in Treatment

• CounsellingOnline (live, 24/7)
• 30,000 visitors a year
• Online 25 vs telephone 18
• Online self assessment and brief self help
• 100 visitors a month
• SMS/mobile phone
• Computer and CD-Rom based therapy

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Access Point Stimulant Treatment Centres

• Specialist staff
• Aims to attract range of users into treatment
• Counter the myth that treatments arent available
• Signal expertise in methamphetamine treatment
• Focused on symptoms rather than drug use
• Provide a separate space
• Provide a range of brief and longer interventions
• Provide online interventions and resources
• Extensive evaluation