Ice report marks a welcome shift in thinking towards prevention and treatment

The federal government on Sunday released the final report of, and its response to, the taskforce established in response to growing community concern around crystal methamphetamine, or ice. The government has announced a significant funding injection of nearly A$300 million over four years – mostly reportedly new funding – for improved treatment services and community awareness.

The report and the government’s response to it mark a shift in focus towards support for better health responses. Will it be effective?

Methamphetamine use in Australia

Methamphetamine comes in several forms – mainly powder (“speed”), paste (“base”) and crystal (“ice”). They are all the same drug but vary in potency, purity and strength. Ice is by far the strongest.

Australia has one of the highest rates of methamphetamine use in the world. However, the rate of use has declined over the past 15 years and currently sits at around 2% of the population.

What has changed in the past few years is the rise in the preference for ice. Around half of regular methamphetamine users prefer ice. There has also been an increase in people using weekly (which is associated with dependence), increased purity and a decrease in price.

This created a perfect storm for significant problems.

While not an epidemic by any definition, the increase in ice use has resulted in a significant increase in problems and more users needing health services – including emergency departments, ambulances and specialist drug treatment services. This has created significant distress for users, their families, and health professionals.

Prevention and treatment

Prevention will always be a crucial part of the picture. The report recommended some new investment in prevention activities. This is largely through the Australian Drug Foundation’s Good Sports Program.

But expanding treatment is of higher priority than prevention activities, given that new uptake of methamphetamine appears relatively limited.

Despite more than two decades of research, no medicines have strong evidence for their effectiveness in treating methamphetamine dependence. Only a handful show promise. This leaves a gap in treatment options.

However, there are effective psychological interventions. The taskforce recommended strengthening these. They include:

• Two to four sessions of two well established psychological therapies – motivational interviewing and cognitive behaviour therapy (CBT). This helps heavily dependent methamphetamine users cut down or stay off the drug and also reduces depression.

• Twelve weeks of acceptance and commitment therapy, a type of CBT combined with mindfulness, a meditative technique to focus people on the present, is effective in reducing use. However, about 70% of people drop out before treatment is completed.

• Short- and long-term residential rehabilitation is also effective, but the dropout and relapse is high.

Research also shows methamphetamine users have the most successful treatment outcomes of all drug users when they receive quality, evidence-based treatment.

Together, these results indicate that a number of treatment options are effective – and that longer treatment is not necessarily better.

Treatment experts generally recommend a stepped care model. Stepped care involves starting with the least intensive intervention that is likely to be effective and stepping up or down in intensity from there.

Most people who access methamphetamine treatment choose outpatient counselling, so it is important to ensure that programs are easily accessible and staff offering these services are well supported.

The taskforce report also recommended expanding online treatment options, and research into low-intensity methods.

There is a high risk of relapse after treatment. Stopping is one thing. Staying stopped over time is more difficult. Around 80% of people have relapsed one year after residential rehabilitation.

Well-funded post-treatment support – such as outreach, follow-up support and low-intensity intervention – is needed to help people stay off ice. The report’s recommendations are relatively limited in this area, but have highlighted the importance of service linkage with social, educational and vocational long-term supports.

Targeting specific populations

There is a dearth of services in regional areas, which will receive a much-needed boost.

The report also contained important recommendations about boosting services for Indigenous people, young people, and people in correctional facilities.

Families are particularly affected by methamphetamine use and often receive mixed messages about how they should respond. The report highlighted the struggle families face and its first recommendation is the development of information and resources to support families and communities. The government also announced funds to support this.

The report also highlights the need to address ice and other drug use in workplaces.

The report recommends ensuring health workers are able to respond more effectively to methamphetamine. This includes updating existing guidelines, most of which are more than ten years old.

So, what now?

Ultimately, drug trends come and go. The switch among users from speed to ice, and the increase in problems as a consequence, has highlighted the gaps in Australia’s health system and its ability to respond quickly to unexpected changes in treatment presentations.

The proof of the pudding will be in the eating, especially as it looks as though the bulk of the funding will go through the Primary Health Networks tied to mental health delivery, rather than the specialist alcohol and drug treatment system. In the past, linking mental health and alcohol and drug treatment services has not been advantageous to the drug treatment sector. Good implementation is going to be key.

What Australia needs is a flexible, well-funded treatment system and an agile, confident workforce that can respond to any emerging trends in drug use as they arise.

Nicole Lee works as a consultant to health services to support best practice implementation of methamphetamine and other drug treatment and is the President of the Australian Association for Cognitive and Behaviour Therapy. She has previously been awarded grants by the Australian Government for research into methamphetamine treatment options.