Ice and methamphetamine use: Clinical considerations and complications

For several years it has been widely reported in the media that Australia is in the grips of an ice epidemic. Within the past three years, the opinion of the average Australian household has come to rate methamphetamines as the drug of most concern (National Drug Strategy Household Survey (NDSHS), 2016). However, data shows that the number of methamphetamine users in Australia has not actually increased for at least the past 18 years.

So why is it that this idea has taken hold? And why has this drug been deemed to be a problem significant enough that a National ‘taskforce’ addressing the related issues has been formed?

Increased harm

Although the figures clearly show that there has not been an increase in methamphetamine users, the level of harm to those users has increased. As use of this drug has become more visible, it has created the perception that methamphetamine is more of a concern than any other drug.

While there hasn’t been an increase in numbers of methamphetamine users as such, the numbers of those that report using the purer and more potent form – ‘ice’ – has doubled. Also, the frequency of use has increased with the level of dependency driving users to use more frequently – which tends to lead to an increase in crimes to fund drug use.

Another aspect of methamphetamine use that has resulted in increased harm is the fact that people are increasingly smoking it rather than injecting or taking it orally.

Although injecting drug use is widely perceived as being more harmful than smoking due to the inherent associated risks with making a hole in yourself (such as blood-borne infections), for methamphetamine users both smoking and injecting produces similar levels of damage to the brain, as well as being associated with high levels of dependence.

What is methamphetamine?

Methamphetamine, which is also called methylamphetamine, is a synthetic amphetamine-type stimulant which affects the central nervous system, elevating blood pressure, heart rate and other metabolic functions. While some amphetamines are useful in treating certain conditions such as ADHD and narcolepsy they are, of course, highly addictive.

There are four ways that methamphetamine is marketed on the street:

1. Speed – a white or off-white powder. It is typically fairly low in purity and can be snorted, injected or taken orally. This form is usually mixed with glucose.
2. Base – a damp or oily substance that varies in colour from white to yellow or brown. It is higher in purity than powder, can look quite different, and is called a variety of things including ‘pure’ ‘paste’ and ‘wax’. It is typically injected and sometimes swallowed.
3. Ice – a crystalline form of methamphetamine known as crystal meth or shard. All forms have the same chemical structure but they differ in potency, with ice being typically three to four times more potent than the powder form. Ice is usually smoked or injected.
4. Pills – methamphetamine is sold in pill form on the ecstasy market. The pills usually contain only a small dose of methamphetamine, which is often combined with the anaesthetic ketamine to give an ecstasy-like effect.

Effects on the brain

The main effect of methamphetamine on the brain is on the production of dopamine, as well as serotonin and noradrenaline. Dopamine is the ‘feel good’ neurochemical, released when we engage in pleasurable activities, and is crucial for proper functioning of the thinking and emotional centres of the brain.

“The main dopamine pathways run through the frontal lobe and the limbic system. The frontal lobe, in particular the prefrontal cortex, controls higher-order thinking processes such as planning, decision-making and impulse control. The limbic system controls emotions, social behaviour and memory” (Lee & Jenner, 2015).

“High levels of dopamine have been associated with the onset of psychotic symptoms. Low levels of dopamine have been associated with depression and movement disorders [such as] Parkinson’s” (Lee & Jenner, 2015).

Methamphetamine causes the brain to release massive amounts of dopamine, as well as stopping natural processes designed to limit the amount of dopamine within the brain, therefore causing brain cells to be flooded with dopamine for extended periods of time.

As stores of dopamine are used all at once through methamphetamine use, users have lower than normal levels of dopamine until they are replenished after a few days. Frequent long-term use results in damage to the dopamine system that can last more than 12 months, and usually results in flat/depressed mood and difficulty with planning, concentration and decision-making.

Brain recovery

Cognitive impairment can continue to get worse for up to six months after ceasing use. Verbal learning may recover in first few weeks but memory, abstraction and perceptual motor skills may still be affected one year later. While new learning, information processing speed and novel problem-solving skills may take years to recover.

Interventions

As a clinician coming into contact with someone who has been using methamphetamine, it is important to remember that these clients will not all present in the same way. Those represented in the media have a severe substance use disorder and unless you work in an emergency department or a specialist drug and alcohol service you may never see anybody requiring the level of intervention needed for this group. If you do, you can hope that sufficient funding has been allocated to the therapeutic community nearest you so that the residential rehabilitation needed is available.

For users with a mild-to-moderate problem, the most effective interventions for methamphetamine dependence are psychological therapies, and are similar to those for other drugs (e.g., motivational interviewing [MI], acceptance and commitment therapy [ACT], mindfulness-based cognitive therapy [MBCT] or mindfulness-based stress reduction [MBSR]). However, the way treatments are applied needs to take into consideration potential problems with:

• memory
• activity planning
• thinking through consequences
• goal-setting
• flexible thinking.

Adaptations of routine interventions include:

• reminders and more assertive follow-up for scheduled and missed appointments
• the use of memory aides
• flexibility with the time of day appointments are scheduled
• flexibility with the frequency and length of appointments.

There is a high relapse rate among methamphetamine users, so additional support and extra patience may be required.

The author can be contacted at [email protected]