The Cold Truth about ICE: and other new drugs effecting young people

Rydges Melbourne Tuesday 25th March, 2014

Natasha Sindicich and Dr Lucy Burns

Funded by the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund

http://www.youtube.com/watch?v=yxKst8BaPbc

Overview •  Definition •  Effects •  Psychosis •  Australian market

ice/crystal meth market

•  Drug use •  Criminal activity •  Risk behaviours •  Treatment and barriers

Young people

•  New drug use trends •  Summary and conclusion New Trends

•  ‘Ice’ or ‘crystal meth’ is a highly crystalline form of the drug methamphetamine •  Sold under the street names ‘shabs’, ‘goey’, ‘shabu’ •  Produces a sense of well-being, and increases arousal and alertness – in

small doses

What is ice/crystal meth phetamine

Crystalline methamphetamine ‘ice’ or ‘crystal meth’ Up to 80% purity Usually smoked or injected

Damp/oily methamphetamine ‘base’ 21% purity Usually swallowed

Powder methamphetamine ‘speed’ 10% purity Usually snorted or injected

How do people take it?

Smoking ice → Very efficient way to use methamphetamine → Intense high + + + → More likely to lead to dependence

Route of administration of ice

•  Smoking is NOT a more ‘innocent’ way of using ice

•  Smoking ice is highly addictive

•  Smokers tend to use as much ice as injectors

Stimulates the neurotransmitters dopamine and noradrenalin

Desired effects of ice •  Euphoria (high) •  Confidence •  Alertness •  Motivation •  Energy

What are the effects of ice?

Why do people use ice? •  Going out with friends- nightclubs •  Just to hang out at home with friends •  Listening to music •  For creativity (e.g., drawing) •  To have energy to get things done (e.g., household chores)

Coming down “…what it gives to you today, it takes from you tomorrow.” •  Feeling irritable, Feeling ‘down’, Lethargy and Paranoia

The best strategy to deal with the come-down is to rest and give the body and mind time to recover from using, however can lead to other drug use

Other potential harms of methamphetamine are:

•  Social issues (relationship break-downs, dealing) •  Aggression •  Physical decline:

•  Teeth and gum problems (due to teeth grinding, dry mouth) •  Kidney problems (as methamphetamine strains the kidneys) •  Stroke and heart attack (from cardiovascular strain)

•  Dependence •  Psychosis → Tremendous distress for some users → Big strain on hospital resources → Media publicity

What are the potential harms of ice?

Ice (and other forms of methamphetamine) can cause a brief psychotic episode

-Hearing or seeing things that aren’t there -Feeling suspicious and feeling that others are watching -Strange thoughts (feeling that others know what you are thinking) -Repetitive behaviors (pulling things apart) -Tactile hallucinations (feels like there are bugs under their skin) -Olfactory hallucinations (smelling rotten flesh) -Incoherent speech

What is methamphetamine psychosis?

Methamphetamine has been shown in research studies to bring on psychosis in people with no history of mental health problems

¼ of regular users experienced psychotic symptoms in the past year (McKetin et al., 2006) Symptoms can vary in intensity and can become more severe Psychosis usually lasts about 2 to 3 hours (provided they stop using after symptoms start) Symptoms can last for a few days or longer→ hospital treatment

How do we monitor ice/crystal meth use in Australia?

•  Australian national drug market surveillance systems •  a source of evidence-based data on the trends in the dynamic Australian

drug market.

Ecstasy and Related Drugs Reporting System

Participants: Regular psychostimulant users (RPU)

Main Drugs: Ecstasy, methamphetamines, cocaine, GHB, Ketamine, LSD, analogues, cannabis etc.

•  Three main components: 1.  100 face-to-face interviews; 2.  Key expert interviews (e.g. law, health and industry

personnel); 3.  Population indicator data (e.g. hospital admissions,

overdose deaths, Australian Crime Commission data etc).

What is the EDRS methodology?

•  Data is disseminated via: 1.  Yearly reports (national and jurisdictional) 2.  Quarterly bulletins 3.  Yearly ‘Drug Trends Conference’ 4.  Academic publications 5.  Stakeholder meetings/presentations 6.  Responses to enquiries

Who takes part in our EDRS surveys?

•  2013 we interviewed 686 RPU across Australia •  Age range: 16-53 years •  Median age: 23 years •  127 participants (19%) of the sample were between 16-18 years •  Results will be split by groups: Younger (16-18 years) Older group (19+ years)

Demographics of participants Younger %

n=127 Older % n=559

Male 63 68

Australian 87 81

Indigenous (ATSI) 4 2

GLBT 10 13

Regular partner 39* 29

Live with parents 81*** 32

Not working 24* 15

Main income: Parental allowance Wages/Salary

20*** 55

3 67*

***p<0.000, **p<0.001, *p<0.05

Drug use

Recent drug use for young people

Recent drug use (past 6 months)

Younger % (N=127)

Older % (N=559)

Ecstasy use pills weekly+

29%* 18%

Ice/crystal 14% 6 days

26%* 4 days

Cocaine 28% 1 day

38%* 2 days

LSD 57%*** 4 days

40% 3 days

Tobacco 91%*** daily

74% daily

•  Drug of choice for younger people is:

1.  Ecstasy (41%) 2.  Cannabis (25%) 3.  Alcohol (11%) ... 6. Ice/crystal (2%)

Note: Days of use is out of the last 6 months, 180 days = daily, 6 days= monthly

Median age of initiation of drug use and injecting

16 17 15.5

18 19 20

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* of those who had injected (younger: 8% vs. older: 14% had ever injected a drug)

•  Younger participants were at the pointer end of drug use, age-wise starting earlier in their drug use and risk behaviours

Ice/Crystal Meth phetamine market across Australia 2013

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11 14

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28 22 21 21

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Ice/crystal meth use and market for young people

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Smoke Snort Swallow Inject

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•  Use in an average session is more for younger people 2 points versus 1 point (median) • Younger people pay more per point $95 versus $68 (median price) • Source is mostly friends (60%) • Place spent most time intoxicated is friends home or own home (70%)

Criminal Activity •  Young people were 1.9 times more likely to have been arrested in the

past 12 months (18% vs. 10%) than older people

•  Young people were in the past month: –  3 x more likely to have committed a property offence –  1.7 x more likely to have committed a dealing crime –  More likely to have committed fraud and/or a violent crime (numbers

were small*)

Crime committed under the influence: Property: 29%, Motivations: financial 43%, opportunistic 36% Dealing: 56%, Motivations: financial 43%, opportunistic 26% Violent*: 86%, Motivations: opportunistic 71%

What are the at risk behaviours for young people?

What are the at risk behaviours for young people?

Non-fatal overdoses: •  Stimulant OD: 29% Occurrences lifetime: 3 times Main drug:

Symptoms: high body temperature, increased heart rate, panic, vomiting Hours partying: 4 hours (range 1-48 hours)

•  Depressant OD: 18% Occurrences lifetime: 3 times Main drug:

Symptoms: losing consciousness/unable to be woken, vomiting, suppressed breathing,

Hours partying: 5 hours (range 2-48 hours)

Do young people realise they have a problem? Young people were more likely to report:

Drugs cause responsibility problems e.g. Repeated absences from work, school, uni (42%)**

Drug mainly attributed:

Drugs caused social problems with family and friends (relationships) (38%)** Drug mainly attributed:

Drug use has put you or others in risky situations e.g. Driving a car (37%) Drug mainly attributed:

Drug use caused legal problems (5%). Drug mainly attributed: ** p<0.05

Mental health of young people Mental health problem (31%): •  Depression and Anxiety (69%) most commonly experienced •  Paranoia (18%) •  Panic (13%)

Attended a health professional (15%)

57% of those who attended a health professional are currently on medication: antidepressants mainly

Psychological Distress Kessler 10 (K10): 11% had a cut off score over 30 which is indicative of a high likelihood of mental health disorder

Are they seeking help? •  Sought help from services (15%) •  Thought about it but didn’t (12%) because... 1.  Worked it out on their own 2.  Not a priority

Treatment providers visited in recent 6 month period: 1.  GPs (71%): 2 visits over 6 month period (range 1-12 visits) Those that visited GP and discussed drug use was mainly:

2. Emergency department (5%): 1 visit (range 1-3 visits) Those that visited ED and is was drug related was mainly:

3. Dentist (9%) 4. Psychiatrist or psychologist (5%) 5. Drug and Alcohol counsellor (2%)

New Trends in Drug use for young people

New Trends for young people in drug use?

Recent use (past 6 months)

Younger % (N=127)

Older % (N=559)

New Psychoactive substances

47%* 34%

Synthetic Cannabis 25%* 14%

New Psychoactive Substances (NPS) use: •  NPS is a general term used to refer to substances that have similar subjective

effects to existing illicit psychoactive substances •  In short they can mimic the effects of illicit stimulants like cocaine, meth, LSD,

cannabis etc. •  Many NPS of these are now listed as controlled drugs (i.e. they are now illicit)

in Australia.

*p<0.05

2C-B

“Interestingly, unlike LSD, it left my mind almost completely unclouded. However, with my senses so overloaded, I found it hard to think about anything or even conceptualize who I was, where I was, or what I was doing.”

2C-I •  2C-I is a phenethylamine short-acting

synthetic psychedelic somewhat similar in effects to 2C-B. A standard oral dose of 2C-I is between 10-25 mg. Recent reports suggest that 2C-I is just slightly more potent than 2C-B (slightly less material needed for the same level of effects).

•  It has sometimes been confused with 2C-I-NBOMe,

“One of my favourite things about 2C-I is the way it alters my perception of music…it's like the music becomes a story, and every single note and sound is an element of that story…”

•  The effects of 2C-B have been described as a cross between the effects of LSD and MDMA, but that it is nothing like a combination of the two. It is mildly psychedelic, much less mind-expanding or dissociative than mushrooms or LSD, but much less directed than MDMA.

NPS drug use for young people Recent use (past 6 months)

Younger % Older %

2C-I 15* 7 2C-B 24** 12 Mephedrone 0 8* K2/Spice 8*** 2

Asked to rate the highs and the comedown and likelihood of taking it again:

Highs Comedown Take again NPS Synthetic cannabis

NPS the story so far…

•  Young people 2x more likely to purchase their drugs online than older people

•  Existing on the TOR network, or ‘dark web’, illicit and emerging substances are traded with little fear of prosecution on sites that run much like ebay (e.g. The silk road)

•  We monitored the number of domestic and international retailers that are selling substances to Australia •  Also the type of substances being sold

Other new trends: Sourcing drugs

•  Until its closure, the Silk Road served to greatly expand the availability of illicit and emerging substances online

• Bitcoin currency is used to further anonymise the connection and conceal the identity of the buyer and seller

249

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Number of retailers selling to Australia by time point and country of origin.

International Retailers

Australian Retailers • Conviction of high profile Australian Retailer shadh1

• Departure of Australian retailer EnterTheMatrix

• Interim ban on ‘synthetic drugs’ by Australian TGA

106

89 83 80 65

40 36 33 32 30 27 13

5 3 2

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434

338

196

355

104

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167

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International

Top 10 summary points 1.  Ice/crystal meth is a very potent drug even when smoked that can very

negative consequences including dependence

2.  Profile of a young recreational drug user from the EDRS looks like: were more likely to: have a regular partner, live with their parents, be unemployed, main income is their parental allowance

3. Younger users were poly drug using group- more frequent in their use

4. Younger ice/crystal meth users were more likely to smoke ice, use more per session, pay more per point and source it from friends and use in private locations

5. Younger users were more likely to have been arrested previously and to have committed property, dealing, fraud and violent crimes in the past month. High proportions were under the influence when committing these crimes and their motivations were financial or opportunistic.

Summary continued…

6. One- third identified a mental health issue, whilst one in ten scored highly on the K10 for psychological distress indicative of a mental health disorder

7. High proportions self-reported a social and/or responsibility problem due to their drug use mainly attributed to cannabis, ecstasy and alcohol

8. Few actually reported having sought help for their drug use, however, this is a group that does tend to come into contact with health services mainly GPs.

9. New Trends for young people include the use of NPS and synthetic cannabis- very early stages and the long term effects of addiction/dependence or chronic use are unknown. Can be fatal.

10. Drug access is becoming easier with the internet and technology

For most in this group excessive drug use and practices will taper with age, but for some in this group it does not and for some the harm can have life long consequences e.g. legal records, financial issues, severe psychological or physical harm

Resources to help (young) people with ice/crystal meth use

•  Manual by Turning Point for frontline workers

•  Meth.org.au- stimulant treatment programs (ADIS for closest clinic), counselling, online counselling, residential rehabilitations, medical trials for withdrawal being run with medications

Acknowledgements

Study participants

Agencies assisting with recruitment

Key experts

Agencies and individuals providing indicator data

Researchers and institutions across Australia

Current and previous national IDRS co-coordinators

Funders - Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund

Contact details:

(NDARC) Ph: 02 9385 0191 Email: n.sindicich@unsw.edu.au Website: http://www.ndarc.med.unsw.edu.au/group/drug-trends

tasha

ndicich