St Vincent's Hospital Leads Way in Approach & Treatment for Users of Ice

Catholic Communications, Sydney Archdiocese,
21 Aug 2015

Methamphetamine or ice or crystal meth is cheap, widely available and can be made in small scale labs

Australia's oldest hospital is once again leading the way in healthcare and breaking new ground in the approach and treatments for users of methamphetamines - or "ice" as the drug is frequently known.

Just as doctors, researchers and staff at St Vincent's Hospital, Darlinghurst led the way in palliative care and the treatment of those with HIV/AIDs throughout the epidemics of the 1980s and 1990s, and broke new ground in 2012, with the establishment of the Kinghorn Cancer Centre where researchers work with clinicians to create individually-tailored treatments for people with cancer, St Vincent's Hospital's Drug and Alcohol Services have become leaders in the battle against ice.

One of the first clinics in Australia to offer a specific program to treat users of ice, St Vincent's Alcohol and Drug Services are currently conducting safety trials into a drug used to treat Attention Deficient Hyperactivity Disorder (ADHD) which in higher doses may prove to work in much the same way as nicotine patches which help prevent cravings in smokers, making it easier for them to quit.

In addition, St Vincent's Alcohol and Drug Services has just launched a federally-funded ground-breaking pilot scheme called S-Checks.

Although there has been an increase in users on methamphetamines admitted to Emergency Departments it is still a very small percentage of all admissions

S-Check stands for "Stimulant Check up Clinic" and offers confidential and non-judgemental free psychological and physical checkups in a bid to encourage those who have tried or are currently using ice on a semi-regular or regular basis to come forward.

"We are aware many of those involved with methamphetamine use are not coming forward. We  also know there is a 10 year delay between the time people begin experiencing problems with methamphetamine use, and the time they seek help," says Associate Professor Nadine Ezard MBBS, MPH, PhD, FAChAM. "Ten years is a long time and we know that treatment is better and more successful if people seek help earlier, and before their usage involves very high doses."

At St Vincent's S-Check Clinic after those on methamphetamines, cocaine or ecstasy come forward for psychological and physical health checks, counsellors at St Vincent's Alcohol and Drug Service discuss the outcomes which may include battles with depression or anxiety.

"The most common health problem with stimulants is anxiety and depression," Dr Ezard says and in helping to treat both conditions, treatment for methamphetamine use can also be addressed.

Instances of men and women on high doses of methamphetamines continue to grab the media headlines with reports of violent explosions, psychotic episodes and destructive out of control behaviour. However Dr Ezard is quick to point out that the majority of those who use ice do not become aggressive and behaviourally-disturbed.

Associate Professor Nadine Ezard, Clinical Director, Alcohol and Drug Service, St Vincent's Hospital

A recent national survey taken of people across Australia, but which did not include the homeless or those in institutions, found that 70 percent of those who took methamphetamines did so less than once month. Nor do the majority of methamphetamine users react aggressively or violently while under the influence of the drug.

But when they see media reports of violence and aggressive behaviour by people high on ice in the media, they don't see this as having anything to do with themselves or the fact that they might have a problem.

"Even if a person is already experiencing problems such as the loss of a relationship or losing their job, they don't recognise themselves in the people presented on the television and think that their problem is not severe enough to need help," she says.

The current trend in the media and among politicians to sensationalise methamphetamine use, also leads to teenagers or young adults disregarding messages about the dangers of ice when an experimental puff of the drug at a party doesn't instantly turn them into a scary crazy person.

But there is no doubt ice usage has increased in Australia over the past several years.

"For the past eighteen months we have known anecdotally something was going on. We also know there has been an increase in presentations at Emergency Departments and admissions to hospitals, and that methamphetamine use is a growing problem," she says.

Amphetamines in powder form have been widely used in the past and were prescribed to help focus, alertness and concentration in pilots during World War II and in the US continue still to be legally available as an appetite suppressant in diet pills.

S-check is a ground breaking program by St Vincent's Hospital to encourage those on ice, cocaine and ectasy to seek help

Methamphetamines which are sold as crystals or ice have a similar effect to amphetamines. Although slightly different in chemistry, like amphetamines ice decreases the need for sleep and food while increasing attention, concentration and focus.

Cheap, easily made in small scale labs and widely available, ice taken over a long period and in high doses is extremely harmful affecting memory, cognitive awareness, malnutrition and triggering psychotic episodes as well as adversely affecting the heart as well as the brain.

Even in small doses methamphetamines are not safe.

Like amphetamines, methamphetamines increase the heart rate and increase blood pressure and can cause cardiovascular problems, and in some cases for those with undiagnosed heart problems death may even occur.

However although there is concern about the increasing use of methamphetamines in Australia, Dr Ezard is quick to point out that from a public health perspective, the problem of ice is eclipsed by far by the problem of alcohol abuse.

"Although we see reports in the press that there has been a seven-fold increase in presentations to hospital emergency departments in users of methamphetamines since 2009, this still accounts for less than 0.1% of admissions to hospitals and although there has been an increase, it is not as high or as important as admissions for other substance abuse, particularly alcohol," she says.

St Vincent's Hospital continues to be a world leader in medical research and surgery

Although those admitted to hospital are long term high dose users, Dr Ezard is concerned that media coverage of the so-called "ice epidemic" has created a stigma preventing semi regular and regular users from seeking help.

"I interviewed a man this week about coming to us for treatment who said although he had been in hospital he hadn't told anyone he was a methamphetamine user because of the stigma. He doesn't use any other drugs, doesn't smoke cigarettes and doesn't see himself as a disturbed person when he has taken the drug. He is not aggressive by nature. But he was too ashamed to tell the hospital treating him that he used methamphetamines," she says adding that the reason he has finally sought help is because he discovered his use is increasing and he was unable to go four days without the drug.

"As time goes on, and the longer someone uses methamphetamines, more and more problems develop," she says but remains concerned that the stigma attached to ice is preventing many people from seeking help.

"The stigma attached to methamphetamines is similar to the stigma attached to heroin in the 80s when fear was so instilled in parents that many believed that when they sent their teenager off to a party or to school, their son or daughter would come back a heroin addict," she says. "Now that same fear surrounds methamphetamines."

The current trial underway at St Vincent's Hospital and at Newcastle Private Hospital into the safety of the ADHD drug, Lisdexamfetamine may well prove successful enabling a further trial into whether higher doses of the drug can help with easing the roller coaster highs and lows of methamphetamine withdrawal.

Stigma of ice and parents fears echoes fears fuelled in the 1980s about heroine

But above all what Dr Ezard says is urgently needed is a national "logical level-headed" discussion around methamphetamines.

"Certainly methamphetamines are an increasing problem for the community. But we must not get this out of perspective. There are still far greater problems we need to address in the public health sphere, including alcohol abuse and domestic violence," she says and predicts that rather than ice, the next major drug problem facing Australia will be the over-use of opioid pain killer medications.

Already in the US abuse of prescription pain killers has reached epidemic proportions.

For most opioid pain killer addicts, the narcotic analgesics were originally prescribed for legitimate illnesses such as scoliosis or an injury and then became an addiction.

To find out more about St Vincent's Hospital's S-Check - Stimulant Check Clinic - see or call S-Check at the O'Brien Centre, Darlinghurst on 02 9361 8079.