If we're serious about tackling ice, we need to try something new

Methamphetamine use has been a major health problem in Australia for more than a decade, particularly since the heroin supply was severely restricted. Better availability and higher purity of “ice” have increased the level of harm to users, leading to calls for new thinking and action.

New national rules requiring drug and alcohol tests on construction sites, and expanded roadside drug testing in several states, offer the potential to identify ice users while they are still functioning members of society.

But the challenge is to intervene before they hit crisis point.

Australia’s experience of methamphetamine is relatively recent, while countries such as the United States have been dealing with it for decades. We should therefore look abroad to evidence-based initiatives that have – and haven’t – worked.

Unfortunately, treatment programs are not the only answer. While they may be important for some ice users, overall, two decades of research shows that:

Despite an urgent need, there are currently no widely accepted psychological or pharmacological treatments for methamphetamine dependence.

We need to look to other, more controversial solutions, such as prison diversion programs. The Hawaii Opportunity Probation with Enforcement, or HOPE, is one such program and it has achieved substantial reductions in drug use.

HOPE is a sentencing option for substance-using offenders, which mandates sobriety from drugs as an alternative to usual probation. Similar models have been effective for addicted doctors and drunk drivers. The 24/7 Sobriety Program is now in place in more than 30 US states and has resulted in reductions in drink driving and domestic violence.

The HOPE program operates like this: people at a high risk of recidivism are screened for eligibility. If successful, they’re allocated a colour. They must call the HOPE hotline each morning and if their particular colour is stated, they must attend their probation office before 2pm that day for a drug test.

During the first two months of the program, they’re randomly tested once a week. Good behaviour through compliance and negative drug tests will mean they’re able to receive a new colour, which is associated with less regular testing.

If the participant returns a positive drug test or fails to appear for testing, a warrant to appear in court is immediately issued and they’re brought before the judge within 72 hours.

If the person has violated the HOPE conditions – if they haven’t maintained their abstinence – there are swift sanctions such as an immediate sentence for a short jail stay. This is usually several days, with credit given for time served.

If a person consistently demonstrates they cannot abstain from drugs, then treatment is mandated. However, participants in the HOPE program can also ask to attend treatment if trying to abstain by themselves is proving too difficult.

The court-based community supervision strategy for probationers began as a pilot program in October 2004 and has expanded to more than 1,500 participants. The first evaluation of HOPE found that completers were:

• 72% less likely to use drugs
• 55% less likely to be arrested for a new crime
• 61% less likely to skip appointments with their supervisory officer
• 53% less likely to have their probation revoked.

One of the more important findings is that most offenders were able to desist from drug use in the face of a credible sanction. This has important implications for treatment resource allocation, as fewer need to be treated, but the treatment programs used must be of a high quality and have demonstrated effectiveness.

Such a scheme could work in Australia, where some employees and road users are already being tested for ice and other drugs.

People failing tests more than once could be mandated to enter HOPE-style program, ensuring their drug use is addressed, rather than simply fining them and waiting for their situation to spiral downwards.

Initial pilots should be run to iron out problems and ensure resourcing is adequate.

Random drug testing and swift and certain justice might seem extreme, and could be argued to impinge on human rights. But most people have nothing to fear. The program is effective in getting people to stop using drugs and not filling our prisons or expending massive amounts of tax dollars building new ones.

We know ice is a major contributor to harm among users and to the community, and we need to respond proportionally. Doing so will require governments to think big, break down walls between departments and challenge short-term discussions focused on individualised budgets so that an evidence-based system with longevity can be built.

Further reading: Swift and certain sanctions: does Australia have room for HOPE?

Ashlee will be on hand for an Author Q&A between 3 and 4pm AEDT on Friday, October 16, 2015. Post your questions in the comments section below.

Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Queensland government and Australian Drug Foundation, travel and related costs from Australasian Drug Strategy Conference. He is affiliated with academic journal Addiction. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.

Ashlee Curtis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.