Wednesday, March 22, 2006

Ice

The gripping Four Corners show on ‘ice’ amphetamine last Monday gave a valuable assessment of the role of this drug in Australia. Twice as many Australians are now addicted to ice as heroin.

While use of heroin in Australia fell following the so-called 'heroin drought' of 2001, some of this fall represents substitution towards stimulants such as ice and to a less extent cocaine and other stimulants. This is clearly not the whole story since increased use of these dangerous stimulants began before the ‘drought’ but it is part of the story.

Heroin use used to cause lots of overdose deaths. Now these deaths have fallen but large numbers of ice users are being admitted to general and psychiatric hospitals with stimulant-induced psychoses. The extent of the damage was clear from the Four Corners show.

My colleague Lee Smith pointed out to me that extended interviews from the show are available here, the show itself is here, while the program transcript is here. A report co-written by myself and Lee Smith on the heroin drought and the role of substitute drugs will be released shortly.

Update: Online resources on ice are catalogued by the Four Corners team here.

24 comments:

Sam Ward said...

All this goes to show is that the war on drugs is a complete waste of time. Dry up the heroin and people will just take something else - the need to alter conciousness is still present, and people will do it with whatever is available.

I've had Meth before and I can definitely see the dangers involved with it (especially to the cardiac system), but there are certainly more dangerous things you can do that are legal (like ride a motorbike on a busy highway, drink 2 bottles of Jack Daniels, or have a picnic in Redfern).

The dangerous of illicit drugs are always seen to be so much more dangerous than they really are.

conrad said...

I agree with the other comment. The war on drugs seems pointless to me also, and it seems to me that the money may well be better spent on harm reduction and rehabilitation.

The substitution of a drug like ice for heroin is exceptionally good example of this, since it creates lots of people harmful to everyone else (potentially permanently), versus people who would be just harmful to themselves if given the drugs they wanted in the same way as they can buy other harmful drugs like cigarettes. It would be interesting to know how many people would take it regularily if all drugs were easily available.

In this respect, I'll be interested to see what you come up with. I'd love to see a $$ analysis of the tradeoff between the actual cost of the war on drugs versus the somewhat limited benefits that education and rehabilitation might have in a drug legal world.

It would also be interesting to try and estimate what the demand would be for neurologically damaging drugs if current illegal but not so damaging drugs were made legal.

Of course I realize that these things are next to impossible to estimate, so good luck if you are trying to!

Sam Ward said...

"It would also be interesting to try and estimate what the demand would be for neurologically damaging drugs if current illegal but not so damaging drugs were made legal."

This is a key point, IMO.

If these sort of drugs were made fully legal, it would be in the interest of drug companies to develop analogue versions of them that had the same desired effect, but reduced risks.

A new mix of ecstasy that was completely harmless but still gave the user the associated high would be an undeniably good thing, in my opinion.

However, what this really comes down to is that the opponents of illicit drugs are not *really* opposed to them because they are dangerous, but rather because they produce a high. When these drugs were initially banned it was because people who sought enjoyment with the aid of pharmaceuticals were seen to be morally weak, period. It had nothing at all to do with the dangers.

conrad said...

Another good example of harm reduction would be if people could buy THC, rather than have to smoke marijuana.

At least on mice studies, THC by itself is much less harmful than inhaling a mouthful of carcinogens with THC(if I remember correctly, the main short term negative effect was an increase in blood pressure = higher risk of stroke etc., which you get with marijuana anyway). Its most certainly going to be less harmful than eating marijuana also, since you wouldn't get a whole pile of compounds that do odd things to your digestion.

If it was easily available (as easily as Marjiuana, which is basically available to anyone that wants it), it seems reasonable to suspect that most people would prefer THC to marijauna (and bronchitis, lung cancer, etc. that come with it).

So there is a clear-cut case of the war on drugs causing harm.

One can also imagine less clear cut cases where you might distribute it in communities that are currently hooked on more harmful drugs (like petrol sniffing). Having people take clean THC is undoubtedly better than having them sniff petrol, so you could wean them off completely harmful substances to still enjoyable but less harmful substances.

hc said...

Sam, On your first comment there is a widely accepted theory that drug addicts are self-medicating their problems by their drug use. The issue is whether anxieties and so on can be dealt with more effectively and I think they can. Essentially the provision of buprenorphine and methadone to addicted opiate users is provision of a less harmful addictive opiate substitute. So on your last point drug companies do have interests in developing safer substitutes - for example Reckitt Benckiser have developed buprenorphine to help users withdraw from heroin and for long-term maintenance of addicted users. Its the perfect product - inelastic demands and huge numbers of users. In Finland heroin addiction has almost vanished - users are addicted to this alternative.

Conrad I hear what you are saying about people substituting to more harmful drugs but the story isn't clear at all. Overdose deaths have dropped drastically with the decline in heroin use. But I agree if you look at the 'Four Corners' show that those surviving as ice-addicts are in a very sad state.

By the way Sam use of ice is different from use of conventional meth. And these users are using ice in vast quantities. There is definite evidence of brain shrinkage and damage. There are widespread problems of psychosis with sustained use. This is completely different from occasional recreational use.

I'll be posting a lot more in the coming months on drugs and drug policies. I am opposed to legalisation of drugs -- I think as a social experiment it could induce social disaster. I am even opposed to legalisation of marijuana given emerging neuroscientific evidence. More later.

Sam Ward said...

Are ice and meth not the same thing? What I had was a yellow rock which we smoked.

hc said...

Sam, My understanding is that 'ice' or methamphetamine, is a chemical derivative of amphetamine, of similar composition. Yes and it can be smoked. It is true most so-called amphetamine in Australia consumed today is 'ice'.

The yellow stuff is labelled 'speed' by Australia's Illicit Drug Reporting System (IDRS) - it is usually of low purity and strength. Ice is clearer, has a crystal form but might have green, blue or pink tinges.

The main way speed is distinguished from ice is by means of the greater purity of the latter.

By the way you guys over in the West are the pigs when it comes to use of 'ice' - Australia's biggest consumers on a state basis.

conrad said...

Harry,

I can't quite work out what you mean about marijuana, but if I assume it is the potential for major mental health problems that you are worried about with Marijuana, then this is illogical.

The main problems with marijuana are not dissimilar to nicotine, although there is of course far less data out there. However, it seems safe to assume that it includes things like high blood pressure, cancer, etc.

However, speaking of mental health, high blood pressure leads to things like strokes and the like (and this is relatively common -- the figures for smokers must be easy to get). Strokes undisputably can cause mental health problems, as thats just what happens when little bits of your brain get destroyed. In addition, having, say, neglect (or other less exotic damage), is going to be no more fun than having schizophrenia, and just as expensive for the general public. As far as I'm concerned these costs *should* be attributed to things like smoking and marijuana, but they usually are not.

WHen taken in this perspective, the fact that an extremely small number of heavy users who are generally young might get mental health problems that they might not otherwise get is basically insignficant when compared to the mental health problems they will get due to high blood pressure and other aspects of general ill health which smoking marijuana causes. (I could also point out that there is also a correlation between high blood pressure and Alzheimer's onset)

So forget the mental health hype in this case (marijuana causes schizophrenia!), and take the mental health reality, that both cigarettes and marijuana cause mental health problems, but this is mainly later in life, and it is mainly caused by an indirect effect, which for some odd reasons, most people don't worry about as much.

hc said...

Conrad, As I posted on February 27 I do not believe marijuana causes psychosis. I believe it can precipitate problems with those predisposed and can worsen the experiences that psychotics endure, but no, I don't think it causes it.

No I am referring (i) to research that suggests that the development of the cortex sections of the brain can be delayed by marijuana use, particularly among the young, and, (ii) to evidence that large numbers of people are presenting themselves to drug use clinics with problems of controlling their marijuana use.

(i) is still being tested but (ii) is undeniable. (i) is connected to the view thgat the human brain is still growing and developing as people move into their early twenties asnd that cedrtain types of drug use might inhibit this growth.

Of course I agree that nicotine has many of the harmful effects of cannabis - but again recent research is suggesting most damage from nicotine might occur among young rather than older smokers.

I am not a drug use puritan. But I believe use cannabis and nicotine use is unwise particularly among the young.

conrad said...

Its funny that I think that things like THC should be legalized and you don't since I currently believe (and I'm reasonably well informed)

1) Marijuana can cause psychosis in a very small percentage of users
2) Marijuana almost certainly does affect brain development in younger people (teenagers), as most neurotoxins do.

So I'm more pessimistic than you in that sense.

Thats why I'd like to see a proper cost/benefit ratio to drug legalization, rather that stupid obfuscation which is often released by government organizations. You could include things like potential psychosis and the like as parameters to see where the trade-off lies, so in case more evidence came out, you could just adjust the parameter to see what would happen to the model.

I look forward to it!

hc said...

Conrad, So I assume that you guess is that such an empirical study would confirm that costs of use (that you recognise) would be low relative to benefits and control costs. I am not sure but I have spent a fair bit of time in clinics talking to people who say that excessive cannabis use is a serious problem irrespective of whether it causes psychosis. And cigarette use is the major preventable cause of death these days. I guess I am a bit unclear why you believe the benefits from trying to prevent people using (a form of harm reduction in itself) are so low.

conrad said...

The main reason I think that banning drugs doesn't work is that for some of them, banning them doesn't cut supply much. How many people who want large quantities of marijuana have a problem with supply ? I'm not sure of the ecstasy figures (I can't say I'm hanging around such circles :), but at least in Melbourne and Sydney, there didn't seem to be much of a supply problem when I was younger.

As for heroin, I think we see a more mixed pattern, but whenever there is a surge in production overseas (like the mid 90s, and early 80s so I'm told), the cost here for first time users gets less than alcohol for a lot of people. There is also never any supply problem in Melbourne or Sydney caused by police taking it off the streets (just walk down some of the dealing streets -- I believe the police figures are that they take about 5% of the supply). I guess we will see that again sooner or later thanks to events in Afghanistan (for years and years presumably), and we'll also see that the police have no real ability to deal with it.

In addition, I believe the costs of drug abuse are fairly high. However, the costs of drug enforcement are also high, both in terms of direct costs (policing, jailing etc.), and indirect effects (people coming out of jails, police enforcing things large amounts don't think should be -- like marijuana etc). So I think the trade-off is high versus high.

Alternatively, some of the costs of education are relatively small, but they don't get spent because of poor policies. Remember when the governement started saying that people should drink water with ecstasy, and people stopped dying of dehydration ? That worked quite well. Now we have a stupid add campaign which tells people if the take ecstasy they will die a nasty death, despite the death rate for ecstasy being tiny (lower than many prescription drugs), so users start believing nothing the government tells them. If drugs were legalized, you could have a real information campaign that offered advice on minimizing damage (like don't take huge amounts of ecstasy, or ecstasy and speed together etc.), and some of the harm might be minimized.

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Anonymous said...

Econ student says:

I am really concerned about the increasing use of ice. Two people I know of were chronically using the drug and ended in drug paranoia, and unsurprisingly death. Ecstasy use is a concern, but appears far less harmful than ice.

From anecdontal evidence I believe that the quality of ecstacy, that is, the MDMA component of it, is declining. Perhaps due to increasing pressure from law enforcement agencies. I think an interesting area to research would be to determine if the quality of MDMA is decreasing and whether this correlates with increase in use of ice (unfortunately my stats aren't great).

I realise that personal experience is poor evidence, but having infrequently (3-4 times over period of 2.5 years)used both drugs and knowing heavy drug users, I wonder if this is the case. If so, this would lead me to the conclusion that if good quality MDMA were to be available on the black market, less ice would be consumed. And I believe that is a better overall outcome, albeit a harm minimisation approach (which is not in favour at the moment), and perhaps one that should be implemented. That is, police lay off ecstasy imports and get into the ice producers and importers.

In a more formalised policy this could lead to a legalisation of the MDMA drug, but if that happens, it's a long way off.

hc said...

Its a good question are ice and ecstacy substitutes? I assume they might be so if the quality of the first decreases, use of the second might increase. I'll try to rememmber to ask about it at the next conference I attend.

Econ student, I strongly advise against use of meth - leave it alone even on an experimental basis.

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Bill said...
This comment has been removed by the author.
Bill said...

It is becoming clear that marijuana use can aggrivate existing mental problems, in a small percentage of people. But what of the vast majority of the popluation that can handle this substance. Should they be collectively punished with
a) dealing with black market
b) inconsistent supply
c) inconsistent quality
d) Fines, jail and social stigma...
simply because a small fraction are unable to handle it?
While there may be many people presenting themselves with chronic cannabis smoking, the sheer numbers of every-day drinkers suggests to me there is a hidden problem with alcohol dependancy. There's even a worldwide program designed to dry out drunks - AA.
An alcohol analogy; A small fraction of people become violent and offensive when using alcohol. A larger percentage will develop long-term health problems due to their alcohol use (brain damage, liver desease). Remeber people, the recommended intake of alcohol on a weekly basis is 21 units for men, 14 units for women. Any more than than and you are technically a binge-drinker. One bottle of red contains 7 units. So much for responsible drinking - I know dozens of 'two scotches and a bottle of red' types. Should the bulk of the population be banned from using this substance simply because a small fraction 'can't handle their grog'? Clearly not, it is a matter of personal choice. So why isn't other (at present) illicit substances treated in the same way.
In my view, any restrictions on mind-altering substances needs to be based on harm, not historical artifacts left behind by a racist policy. (Reefer Madness in 30's).

I too know a herion user who switched to meth once the 'war on terra' dried up the supply.
I know others who, when marijuana supply runs dry, reach for more potent hallicinogens.
Its horses for courses really. Some like dissociative depressants (alcohol, ketamine), others like stimulants (meth, cocaine) others again like hallicinogens.

One serious argument for legalisation of every drug is to keep them out of the hands of youth. In my teenage years it was so much easier to procure cannabis than alcohol - alcohol is a controlled substance.

Oh and there is a method of inhaling THC without smoking it - Vaporisers have been availiable for years but have never become widespread.

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Anonymous said...

i live in melbourne - in my mid 30's - unfort dont have much time at the moment but i will be back to finish off what im about to start...
I can shed light on the 'actual' status of usgae, availability etc of the drugs > ice, speed, pills, weed etc
i google everything.. couple this with the fact that I have used and been subjected to the 'drug' world via fashion entertainment and club life in melbourne - predominantly!

I wasnt going to do this but honestly, i am sick and tired of reading everything and anything on the net re the so called ice epidemic etc No one has the facts straight! getting closer but no where near as close enough to really have an objective opinion enough to actually act upon this information to perhaps attack the problems to find the 'right' solutions etc
my apologies for grammar and sentence structure etc (just couldnt not say anything after reading all of the above comments...
Promise!! I'l be back to complete what ive started!
thanking the 2 who have been discussing back and forth - you are both responsible for this interaction (of mine! - u c, sometimes you have no choice - the choice is made for you - only if you know how to listen to yrself objectively and follow what yr gut instinct says - no matter what > bc its the right thing to do..)
apologies again..
hope you have been able to follow and comprehend all that i have said so far...