Dr Rosanna Capolingua and Professor Geoff Dobb on the AMA's Position Statement on Methamphetamine

QUESTION: How big a problem is Ice in Australia?

DR ROSANNA CAPOLINGUA: You know, there is something like 73,000 known methamphetamine-dependent users, but we know that there are many others who are - we hate using the term recreational users. So there's a lot of Ice being used across Australia.

And even though that number of dependent users is 73,000 it's almost twice the number of heroin users in Australia, and we know that it accounts for something like 1.2 per cent of emergency department admissions, which is an extraordinary proportion. The effect of methamphetamines is significant on the individual and the community.

QUESTION: You say you want the government to focus on this problem; I thought - certainly the state government, we've been out here a number of times hearing the latest initiative, are you saying they're not doing enough?

DR ROSANNA CAPOLINGUA: This is a call across the country for State and Federal Government to focus on public awareness campaigns. People need to know how harmful methamphetamines are. Speed, Ice, Crystal Methamphetamine use is damaging; it causes serious mental health outcomes: aggression, violence, agitation, depression, anxiety and psychosis. Three out of 10 users develop psychosis.

So we need that public awareness and knowledge, that understanding to not take up the drug. Then we need a focus on the emergency departments. Each emergency department in Australia experiences the presentation of a methamphetamine user, often mixed with alcohol. They can be quite violent and aggressive, they're threatening to the staff in the hospital and to other patients here. We need to make sure that the doctors are able to look after these patients properly in the appropriate environment: to isolate them for their own safety and care for them.

QUESTION: So is this an overhaul of the way the Health Department deals with the issue?

DR ROSANNA CAPOLINGUA: There needs to be specific focuses. Different hospitals in different areas have the ability to cope more than others. But even at times when there's more than one presentation on a night, they are struggling.

We also need to think about what happens to the patient after they're allowed out of their isolation room. How do we help them when they're on their way home, if they have a home; how do we help them to detox; how do we help them to look after their own physical wellbeing. So there is a lot of support services and an extension outside the hospital that needs to be done as well.

QUESTION: Is there a case for setting up separate facilities just for dealing with these people?

DR ROSANNA CAPOLINGUA: We need to think about general drug facilities and supports across Australia. When it comes to methamphetamine users detox is very difficult, it's very hard to do alone and it would be good to be able to have, where appropriate, hostel-type environments with supported detox programs, or detox in the home which means that you need to bring people in on a regular basis to support the patient detoxing. GPs also need support; often the methamphetamine user goes there first.

QUESTION: What about emergency departments, you mentioned that they can become violent. What are you seeking specifically to ensure the safety of staff?

DR ROSANNA CAPOLINGUA: Emergency departments require the appropriate facilities to cope with patients that may be aggressive or violent: isolation rooms and appropriate staff to supervise when patients are put in isolation rooms. ED staff need to continue to be able to look after the other patients who present.

Perhaps Geoff would like to make a comment on that?

DR GEOFF DOBB: Look it's these - it can be very dangerous to emergency department staff and put the staff in emergency departments in danger. We know that in the last few days, just at Royal Perth Hospital, we've had one young person who's had a bleed into their brain that has affected them probably for the rest of their life as a result of methamphetamine use causing a stroke,. And five other patients in the last few days have needed to be referred to psychiatrists because of acute psychosis.

QUESTION: Use is the highest in WA. The state government did have an Ice Summit last year and did have a range of recommendations. Is that enough and have they been implemented?

DR GEOFF DOBB: We know that we need additional support across the community. We have now got drug liaison officers in some of our emergency departments, and this is a very important step forward in which WA is currently leading Australia.

We would like to see that taken up across the rest of Australia, but we would also like to see much better facilities in the community. Hostels to facilitate detoxification of patients who have been on methamphetamines and also support for general practitioners and increased general practitioner training on the things to look out for and the ways in which to support their patients who are addicted to methamphetamine.

QUESTION: Have you done any sums; do you know how much all that would cost?

DR GEOFF DOBB: Look, very difficult to come to a total. Really, this needs to be blended in with the rest of the health services. Methamphetamine usage can't be taken in isolation; often there are additional social or other medical problems that these patients have, and all of their problems need to be dealt with together.

QUESTION: Rosanna, just because this is national package as well: just in terms of the link with mental health problems can you explain the link there with Ice use and mental health problems?

DR ROSANNA CAPOLINGUA: Over three-quarters of ice users or methamphetamine users - so we'd be talking about speed as well here - actually develop serious mental health problems. Over three-quarters of those, so we're talking about depression and anxiety, lack of motivation, agitation and inability to concentrate.

We've seen the violence, we see it in emergency departments and we also see it out on the streets. Many stories in the news feature violent episodes associated with methamphetamine use, and of course three-out-of-ten methamphetamine users will also develop psychosis.

We're talking significant serious mental illness. These people are hurt and damaged by methamphetamine use; we have to encourage people not to use this drug and we have to help those that have been caught in its trap.

ENDS