Responding to people affected by ice.

Workshops for frontline workers.

Funded by

What we know.

What is ice?

Prevalence

Effects of ice

Risks and harms

What to do.

Reducing harms

Talking to someone who is intoxicated

Managing agitation and aggression

Responding to psychosis

Responding to other mental health issues

Treatment options

Referral

What is ice.

‘Amphetamines’

Methamphetamine

‘Speed’

‘Base’

‘Ice’

Amphetamine Dexamphetamine Otherpharmaceu9cals…

There is an ice epidemic. “ Myth or Fact?

NDSHS, 2014

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2001 2004 2007 2010 2013 2016

12–17

18–24

25–34

35–44

45–54

55+

12+

20102013

2016

59

39

20

22

50 57

Weekly use. 2010 9.3% 2013 15.5%

No change in prevalence Switch to purer form

Frequency up Also purity up and price down

72.7

53.0

39.5

26.4

13.9

2.2

22.2

11.7

34.7

51.2

79.3

NDSHS, 2014

MethamphetamineusersGeneralpopula9on

Treatment presentations Hospital separations Ambulance call outs

ED presentations Drug induced deaths

Arrests

NMDS, 2013-14; Lloyd et al, 2015; Roxburgh & Burns, 2015

Methamphetamine is highly addictive.

“ Myth or Fact?

Harms. v

Use.

Irregular users < once a month

Occasional users

Once a month+

Regular users Once a week+ Daily users

NDSHS, 2014

All meth

Ice

Cannabis

Alcohol

70% 15% 15%

55% 20% 25%

55% 15% 20% 10%

35% 37% 6% 22%

You can get addicted after using once.

“ Myth or Fact?

Dependence. Adaptive state that develops

from repeated drug administration

Methamphetamine is the most dangerous of all

drugs.

“ Myth or Fact?

0 10 20 30 40 50 60 70 80

Amphetamine

Cannabis

Methamphetamine

Tobacco

Cocaine

Heroin

Alcohol

Harm caused by drugs 100=maximum

Harmtoothers Harmtousers #REF!

Source: “Drug harms in the UK” by David Nutt et al. The Lancet

Immediate effects of methamphetamine.

Mild intoxication Moderate intoxication

Toxicity

Euphoria and wellbeing Energy

Attention, alertness and memory Sex drive Appetite

Nervousness, anxiety, panic Agitation

Psychotic symptoms Jaw clenching, teeth grinding

Nausea, vomiting Headache

Hot and sweaty, racing pulse

Chest pain Aggressiveness Tremor, seizure

Severe headache Unsteady walking Difficulty breathing

Hot flushed sweaty skin Confusion, disorientation

Muscle rigidity, spasm, jerking Severe agitation, panic, psychosis

Methamphetamine gives you super human strength.

“ Myth or Fact?

Effects of long term use.

Heart, liver & kidney Teeth & skin

Sleeping problems Enduring mental health problems

Decreased motivation Weight loss, malnutrition

Poor concentration and memory

How methamphetamine works in the brain.

Fight or flight Energy Arousal

MOOD COGNITION

Appetite Wellbeing

Sleep Temperature

LEARNING FOCUS

Pleasure Reward

Attention Motivation

Reinforcement

Frontal lobe (prefrontal cortex) (thinking, planning, decision making)

Limbic system (memory, emotional and social processing)

Focus, attention and concentration Memory

Planning, decision making Emotion regulation, mood, impulse control

Flexible thinking Energy levels

Threat sensitivity

Getting to appointments Completing tasks

Following instructions Taking on new information

Thinking about consequences Goal setting and working towards goal

Stopping inappropriate behaviour Switching from one topic to another

Unexpected emotional outbursts

Recovery process.

Larger impairments than. Cocaine (20x) Marijuana (4x)

Alzheimers (6x)

Hester 2015

After 6 months abstinence cognition worse than current users.

No significant improvement after 9-12 months

Simon et al. 2004; Ludicello et al. 2010

Acute methamphetamine withdrawal

Protracted cognitive recovery

Acute alcohol/heroin withdrawal

Subacute withdrawal Cognitive recovery

Relapse.

0

20

40

60

80

100

120

3mo 1year 3years

Relapserates

ResiRehab

Controls

McKetin et al., 2012; Baker et al., 2005; Lubman et al 2014

87%

96%

59%

74%

“The most common outcome from treatment is relapse”

Witkiewitz, 2017

Easier to get off

than to stay off.

Post treatment period is crucial..

Risks and harms.

Psychological Depression, anxiety

Irritability, aggression Psychosis

Brain structure Loss of dopamine transporters Fewer dopamine receptors Loss of grey matter

Cognitive Poor attention

Poor working memory Poor executive function

Poor impulse control

Nutrition Weight loss

Under or malnutrition Under active immune response

Skin

Injury from picking at ‘meth bugs’

Infections BBVs STIs

Neurological Stroke Seizures

Teeth Gum disease Dental caries

Heart High blood pressure Fast or irregular pulse Heart attack

Kidneys Dehydration Renal failure

Dangerousmixes

An9depressants(withinsame2weeksoficeuse)

Alcohol

Opiates

Others9mulants

Reducing harms.

Drinkwater

Eatsomething

Don’tmixdrugs

Don’tshare

equipment

Carrycondoms

Getsomesleep

Gethelpifneeded

Responding to people who use ice.

Talking to someone who has taken ice.

Use calm even tones Be patient

Show concern Don’t be forceful, patronising or dismissive

Most people who use ice get aggressive.

“ Myth or Fact?

Dealing with agitation and aggression.

Ji_ery Irritated Agitated Angry Aggressive Violent

What would you do?

What are you most concerned about for the client, yourself, your service,

anyone else?

What do you feel most confident/least confident about?

Responding to psychosis.

Illusion Suspiciousness Paranoia Hallucina9ons Delusions

“I once thought Afghans were at my door. That scared the shit out of me. Kept thinking they're

gonna blow up my house (an apartment in Perth, Australia - what a target to choose)”

LiquidDelight on Bluelight

“I once heard a low distant rumble, and in the sky above what I knew was bushland there was an orange glow, so convinced there was a major

bushfire I made a friend drive me in that direction, only to find the glow was the lights of the city.. and

the rumbling.. umm yeah in my head!”

Popey’s Mate on Bluelight

State what you are concerned about Focus on immediate risks and harms

Short simple sentences Repeat

Reassure Fixed choice options

DON”T Touch or restrict movement

Judge content Dismiss or argue with delusions

Responding to other mental health issues.

17.8 19.9 19.9

29.7

17.6

20 21 24.7

First meth use First regular use First problem use First meth treatment

No MH treatment MH treatment

Lee et al., 2012

Treatment options for people who use ice.

There are no effective treatments for ice dependence. “

Myth or Fact?

Residen9alrehabilita9on

Dayrehabilita9on

Counselling

Briefinterven9on

Reduceharms

Highest success in treatment.

No specific pharmacotherapy Brief MI and CBT

Intensive CBT and CM ACT

Residential rehabilitation

Motivational interviewing Coping with cravings and lapses

Thoughts about using Relapse planning

1300 988 184

icetraining@360edge.com.au

360edge.com.au

theleejenngroup

@the360Edge @DrNicoleLee