What is meth? Ice? Crystal? Speed? Is there really an epidemic in WA? Do men use more than women? Isn’t meth a problem for specialists? Actually, GPs are especially well placed to help.
Methamphetamine is synthetic and derives from phenethylamines, endogenous trace amines with structural similarity to the monoamines (dopamine, nor-epinephrine, serotonin). Adding a methyl group to phenethylamine gives a-methylphenethylamine AKA amphetamine. Adding a second methyl group gives a-dimethylphenethylamine AKA methylamphetamine
Methamphetamine exists in three main forms of differing purity. The powder (street name “speed” 10% pure), the oily sticky base (street name “base” 20% pure) and the crystalline form (street name “crystal “or “ice” 80% pure).
Methamphetamine use has declined since 2001. But, since 2010, there has been a marked and continued increase in the number of methamphetamine users that prefer the crystal form (ice). Ice is more potent and can be smoked or injected producing rapid onset of intense effects.
Higher rates of dependence result and, in turn, individual and societal harms increase. WA has more methamphetamine users (2.7%) than anywhere in Australia (1.4% national average). The proportion of methamphetamine users preferring ice nearly doubled in WA between 2010 (43.9%) and 2013 (78%). This was far higher than the national average (50%). Australian men use more methamphetamine than women.
Methamphetamine use declines with almost any form of constructive engagement in a treatment service (e.g. both placebo and treatment groups improve in multiple studies of various treatment modalities). But, poor treatment uptake (10%) and retention (<50%) is well documented.
The good news, however, is 53% of users visit a GP compared with 10% for specialist services. GPs are in a position to establish perhaps the most important treatment tool for methamphetamine users: rapport.
Treatment in the short-term, should exclude emergent problems including CVD (e.g. ischemia, dissection, arrhythmia), renal, and psychiatric. There is inadequate evidence to support any medication or psychotherapeutic intervention for withdrawal. Limited and brief (3-5 day) use of benzodiazepines may assist with anxiety and agitation.
In the long-term, develop a therapeutic alliance. Treat common medical (e.g. skin and dental infections) and psychiatric (e.g. depression) problems. Educate on harms and harm minimisation (e.g. safe injecting). Encourage renormalisation (community involvement, relationships).
Consider clinical psychology. There is some evidence for CBT. Off-label naltrexone and bupropion (in less frequent users) have some evidence for effect in relapse prevention. Baclofen is not recommended. Direct users and loved ones to the Meth Helpline (1800 874 878) or the Parent and Family Drug Support Line (9442 5050, metro; 1800 653 203, rural).
When you need advice, contact the Clinical Advisory Service at Next Step. Finally, expect sporadic engagement, it’s not personal.
Key Messages:
- Treat medical and psychiatric complications of methamphetamine use
- Withdrawal management is ineffective without sustained follow-up engagement (e.g. counselling)
- Rapport and long-term support to redevelop positive community engagement is important
References available on request
Author competing interests – No relevant disclosures. Questions? Contact the editor.
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