With no medication treatment regimen to help people quit ice, what can GPs do?

From stories about country towns all but overtaken by the highly addictive drug, to news of a Queensland mother who locked her son in a reinforced metal cage in a desperate attempt to wean him off the drug – ice, in the public eye, is a fearsome drug.
 
The availability of the drug has soared in the past seven years, and ice is now the third most commonly used illicit drug among people who have recently used drugs, after cannabis and MDMA. 
 
But, according to RACGP Victoria Chair Dr Cameron Loy, a big part of the issue is the drug’s visibility, not its prevalence.
 
‘Ongoing usage is between 2–4% of the population, but it’s a very visible drug,’ he told newsGP. ‘If you had to deal with someone high on heroin versus ice, you’d choose heroin. The reason for that is that ice users are more likely to demonstrate violent behaviour.’
 
But low overall numbers don’t mean ice can’t become a major public health issue.
 
‘The rapidity of change is how it came to public attention,’ Dr Loy said. ‘Australia runs about 10 years behind the US and Canada in drug use.
 
‘You now hear awful stories of towns with interstate highways with a huge number of people addicted to meth, with really damaged communities. 
 
‘In Queensland, ice is manufactured on the coast and driven inland until it runs out around Mount Isa. So availability matters – it’s not linear.’
 
Dr Loy recently presented an RACGP training workshop in Melbourne designed to provide GPs strategies to help patients who regularly use ice.
 
‘The thing about issues like ice is that they hit general practice early,’ he said.
 
‘People who abuse substances are often quite marginalised in our society. We all have a story about the way people who were intoxicated were treated in emergency departments when we were junior doctors – and it was never a pretty sight.’
 
What that means, Dr Loy said, is that because many users do not engage well with the hospital system, they come to GPs instead.
 
‘We see this vulnerable population more often than many hospitals. [People who use ice] don’t access hospitals as well as you or I do,’ he said. ‘To be honest, there’s stigma and bias against people who are addicted.’
 
That places GPs on the frontline of efforts to reduce harms from ice.  
 
A major challenge is the fact that – unlike heroin, for example – there are no medication treatment regimens for ice.
 
‘We don’t have a medication substitute,’ Dr Loy said. ‘We can see that counselling, motivational interviewing and cognitive-behavioural therapy can help. But it’s a very challenging problem.
 
‘You’re going to be seeing these patients, carrying them along.’
 
So should a doctor take on more of a counselling role?
 
Yes, Dr Loy said.
 
‘We’re often a stable person in their lives when addiction gets bad, when their lives are falling apart, losing jobs, friends, relationships,’ he said. ‘A GP can be the stable presence in their lives.
 
‘General practice is where a lot of these very difficult personal and psychological issues sit – longstanding psychological disorders, substance abuse – and our job to embrace that part of medicine, and own it as a profession.
 
‘We’re used to asking patients if they drink or smoke. But we often don’t ask, “Do you use anything else?” When you ask, it’s amazing what you get told. Our patients generally trust us, they tell us.’
 
Another major challenge for people who use ice, however, is that withdrawing from the drug is often harder than from opioids, according to Dr Loy. Fuzziness and mental vagueness, low mood, difficulty getting through the day, poor sleep – all of these symptoms can last up to a year.
 
‘Methamphetamine withdrawal is a really difficult clinical problem,’ Dr Loy said. ‘It can last 9–12 months and, functionally, you’re probably worse three months after you stop.
 
‘We can say, “It’s excellent that you’re going to stop, but you’re going to feel really bad in three months’ time”. We need to get them past that.’
 
And, even then, there is more work to be done.
 
‘Somebody who ends up in jail or court because of substance abuse, that’s the end of a very long period of increasing life chaos, of a deteriorating quality of life for a long time – loss of friends, family, houses, homelessness, illness,’ Dr Loy said. ‘So it’s not as simple as, take the drug away and they’re better.
 
‘There’s a whole lot of stuff underneath, and that’s what GPs are really good at. We see not just the disease, but the person and the community, too.’

addiction addiction-medicine ice-addiction methamphetamine withdrawal