TIM SENIOR:
So who are the people who are using methamphetamines?
HESTER WILSON:
Yeah, so this is really interesting, I don’t know if the next slide we actually have some of the information for people but the group of people that are using it are people generally more often in the ages of 20-30 maybe 35-40. Young men. Aboriginal and Torres Strait Islanders. LGBTQI+ individuals are a part of that community. They’re also more likely to be employed. So they are a little different to the group of drug users that I might be seeing in my drug and alcohol service who are opioid dependent who tend to spend time in jail, not be working and this is a gross generalisation, it’s not the case for everyone. But they don’t see themselves as people who are drug users. They may not use as often so they don’t see themselves as having a problem, they wouldn’t see themselves as the sort of person that would go to a drug and alcohol service and they prefer to treat themselves.A lot of them don’t see that they need help but when you actually look at them and this is Quinn from 4 years ago, 50% of them when you looked at what was going on, when you compared it to the DSM, that 50% of them were actually dependent. So that there was significant issues there in this group of people that they didn’t actually recognise. They were using often more than weekly. There were injecting and they’d experienced financial issues. So there really was quite a lot of impact that was having on these subjects lives but they didn’t actually see it quite often as an issue for them. So they are a slightly different group and they are a group who we are seeing in our general practice and who want to be been in general practice rather than going to the traditional drug and alcohol services.
TIM SENIOR:
We’ve just a few questions coming through just before we move on, asking about the different between ice and other amphetamine type substances, such as MDMA and ecstasy.
HESTER WILSON:
So MDMA is a different molecule, it’s a different drug. It’s structure is different, it has slightly different effects but it’s still a stimulant. One of the issues for us in Australia that people think they’re getting MDMA but quite often they’re sold amphetamines. So MDMA tends not to make people as aggressive, it’s known as the love drug or the cuddle drug, it tends to be a more touchy-feeling drug. It has issues as well. But the problem that we have is that quite often people don’t know what they’re getting. And we’ve seen that in some recent deaths – tragic deaths – in young people in our communities, who actually didn’t know what it was that they were taking. And I’ll be controversial here for a moment but I think we really do need to think about ??cool?? testing and how we do that to protect people who choose to use these drugs. I think it’s very easy for us to say don’t use but the fact is that people do.So what can we do to actually make sure that people are safe.
There was another part to the question, did I miss a bit?
TIM SENIOR:
No – someone else has commented on the difference between ice and the version that we sometimes prescribe – occasionally Duromine – for weight loss which is another in that group.
HESTER WILSON:
Yeah, so that’s an amphetamine. So they’re in the same class, slightly different structure and as I say, with methamphetamine or the ice – which is the one that we’re seeing the issues with here, it’s much more potent and unlike Duromine where you know you’re getting a certain dose every time you take it and you know it’s not adulterated with other chemicals, there’s a minefield of unknowns in the use of illegally developed and created drugs that people buy.
TIM SENIOR:
There’s some other questions that we’re coming on to in some future slides. It would be nice to ask people – a poll next – there’s not actually off in the typical pictures that we see in the advertising.
HESTER WILSON:
And I think this is one of the things that is a worry for me. That there’s been this whole thing about the ice epidemic and photos of people absolutely losing it, destroying their lives and I’m not saying that this doesn’t happen but for many of the people that are using methamphetamines that actually come to harm – they look at this and they go “that’s not me, that’s not my friends, this is a beat up, this isn’t real”. And so it’s not a great awareness raising campaign. I think it’s much more likely to have an effect on the group of people that actually aren’t using. People who would be horrified by this. But not on the group of people that are actually using.That they don’t generally see it – “this is not me, this is not my friends”. And for us, this isn’t the patients that we see generally in the general practice setting. I’m not saying, it’s not all the time and there are many of us who see people with chronic complex illnesses and issues with their drug and alcohol use but it’s much more likely to be someone who doesn’t actually look like what these pictures portray.
TIM SENIOR:
We’ve got a poll next. Just curious as to given what you talked about, who the people who you might be seeing and the sorts of presentations, do people think that they are seeing, given that people present in diverse ways in general practice, on reflection do you think you might have patients who are using or suffering side effects from methamphetamine use? And I think the poll is open now, it would be interesting to see what the experience is of the group on the webinar?
PENNY:
I think I might close that poll off, just give maybe another 10 seconds Tim and I’ll close the poll off.
TIM SENIOR:
That’s perfect, so if you’ve not clicked one of the buttons yet, do it now before it closes.& There we go.So in which group – 69% of you say you think you have got patients. 23% of you don’t know and only 8% of you say no. Any thoughts on that poll Hester?
HESTER WILSON:
Look I think I’m interested. Yes. I would say yes. That we are seeing people and we may not realise it. For the people that are listening and looking in tonight, there’s 23% who don’t know. I really, hopefully by the end of this, you’ll have a bit more of an idea around that. For the group of 8% “nah”, you’re saying “nah I don’t see those patients”. I wonder is it a particular setting that you’re working in, but once again I would challenge you to be thinking in your patients, they’re may well be some people who are using. Now that doesn’t mean that all of them are going to come to harm and many people will use any of the illicit drugs without having any harm at all. And so they may, you may be seeing them in your practice but they’re not presenting with problems related to their use.But this is pretty common and particularly in that age group, the young guys between 20 and 35 if you’re seeing that group then you’re very likely to be seeing people who use.
So once again this comes back to some of the hype that has been around the issues with ice. Is there an ice epidemic? I think this is a really interesting question and it really annoyed me at the time because we all know what the definition of an epidemic way, and we weren’t seeing an epidemic. Certainly in the data up until 2013 there really hadn’t been a change in the prevalence of use but what we started seeing and this changed with the change to the more pure, more potent forms of ice, that we were seeing more people that were coming to harm. Now – and so what we saw in the papers was – this ice epidemic and the rise of crystal, you know, in Victoria and this is what hospitals, EDs, and police were seeing were more people were coming to harm, more people that were becoming aggressive, were becoming paranoid, and so it really is around the harm that people are having from the medications, rather than an epidemic itself. And we can see from the emergency department presentations up until 2016. And with this data, I don’t know if you can see on your page, but actually what we’ve got – the red line is women, the blue line is men and the grey line is both. And you can see a steady increase in presentations to the emergency department and a steady increase in admissions. So this is not just people that had an injury or needed to be seen for four hours in the emergency department but actually needed to be admitted to hospital to have their conditions managed.
I guess I would say, just in terms of the hospitalisations and this data, how correct this data is, it depends on what’s put in to data from the hospital, so it would be quite variable. So it may be an underestimate, the other thing is that do hospitals or EDs always pick up that methamphetamine is the issue behind why the person’s presenting, just like we have that issue in general practice.
TIM SENIOR:
Yeah, and we’ve got a comment from someone in the audience – they work in a custodial setting and that setting is obviously very different where they’re seeing the severe effects. I think patients in the custodial setting, obviously they’ve come into contact with police and other services.
HESTER WILSON:
Yes, yes, absolutely. Absolutely. So this is a chart from Degenhardt, this is the latest data from 2016. And once again it shows you that increase in the 25-34 year olds particularly, but there is an increase in all age groups. Even older age groups, you know for example if you are thinking to yourself, most of my cohorted patients that I see are over the age of 50.We are seeing an increase in use, it’s not a huge amount but there is an increase of use of probably, what you say out of 100? Maybe, I don’t know, 0.2%?Something like that. So it is changing, there is increasing use. And the other thing that they’ve found –
TIM SENIOR:
Sorry there was a question earlier which people might be interested in – I don’t know if we have an answer – but wondering why there’s become increase in use and asking did “Breaking Bad” contribute to its rise? The audience did comment on that.
HESTER WILSON:
I don’t know whether – certainly I couldn’t watch “Breaking Bad” after the first couple of episodes because it was too much like work. But I think it’s about availability and cost. And MDMA was a favourite before methamphetamine was very, very available. But it’s just what’s around. And as a species we have had a relationship for eons with being intoxicated. Now there may well be some in the audience and we know there are some people in our communities who don’t drink, don’t smoke, don’t ever use drugs but the majority of our community do use substances that intoxicate and as a species, we like being intoxicated.
TIM SENIOR:
We could even run a poll asking “who’s smoking, drinking or doing anything else” during the webinar!
HESTER WILSON:
So one of the other things looking at Degenhardt’s trial was that the increase in frequency of use and the increasing in smoking. In the past people would have been taking it orally.It would have been really common and it still is common, particularly in the party scene but people moving towards smoking. Now smoking is an easy thing to move towards. It’s not like injecting, there’s another step, another step into the other when people go to inject. With smoking, people will consider themselves as a recreational user. But we know particularly with the methamphetamine, because of its structure, because of how lipophilic it is, if you smoke, you probably get the same, maybe a tiny bit smaller, impact. You have very quick onset straight into the brain and get the effects as you do from injecting. The increasing impurity and the low grade speed increasing in purity. And it’s cheap. So what you could buy at which was low purity some years ago – is the same price now but it’s much more pure. So people are perhaps using the same amount and having more side effects because it is so pure.
TIM SENIOR:
The useful comment here that I think is worth drawing people’s attention to – because people are obviously seeing different effects where they are in different populations and someone is saying that in their socio-economic area where people have very little financial or educational buffer, they see more often the spiral into unemployment and dysfunctional relationships and effects on mental health, as a result of drug use.And I think we are – we do all see different things in our different communities and the statistics by their nature show a general thing with an outreach and a ranger.
HESTER WILSON:
Look and the other query I would be thinking about when working in a community that has low socio-economic status is it the ice that’s causing their issues or is the ice actually a symptom of the whole kind of – life story – history of trauma, history or poor, unstable or no employment. It’s a complex story. And there’s complex stories around why people continue to use as well.
TIM SENIOR:
I think the next slide takes us on to some of the effects of amphetamine type substances which is psychosis.
HESTER WILSON:
Yes and this is something that I briefly mentioned before. The drug induced psychosis, the positive symptoms. So it’s the positive symptoms of psychosis, the irritability, the hallucinations, the delusions and in this group of people, there’s an experience that many ambulance officers and police and ED workers have had around people kind of being Rambo charged, super strength, very very difficult to contain. And that’s psychosis is short lived. So it disappears within hours, certainly within days. But are these group of people who continue to use and have episodes of drug induced psychosis, are they actually developing a psychotic illness with continued use?
And certainly an Australian study from 10 years ago, they estimated that it had an 11 times higher risk than the general population of developing an ongoing mental illness or psychotic illness. And certainly in my drug and alcohol setting there are a number of people that I see who psychosis very clearly stared out a very short lived psychosis to do with their drug use but they’re left with ongoing symptoms after they cease use. And it’s not just the 6 months, it’s not just a year, it’s ongoing.So the question for me is what kind of damage are the amphetamine type substances doing to the brain? And we know with people that are high risk, if younger onset of use, your brains are fully formed til you’re 25, so you know – you’re going to be damaging your brain larger amounts. People who already have other mental health issues and alcohol dependence were at higher risk. And there is an interesting little article that looks at some of the permanent brain effects if you’re interested down the bottom of the page there.
TIM SENIOR:
And just before we move on, we’ve got a few people asking how much – you mentioned that it’s cheap? We’ve got a few people asking how much it costs?
HESTER WILSON:
Most people would be looking at $50 for a “point” – what they call a “point”. Don’t ask me what that is in grams, I’m sure there’s someone out there better at maths than me that can tell us. But $50 would be a usual deal that people would buy, you might share that between 2 or 3 of you if you don’t use very often.Up to kind of $400 a day is the usual amount that we’re seeing in Sydney.
TIM SENIOR:
So 0.1gm is a point according to one of the participants. Thank you very much.