Know your ice enemy

AMONG the many doctors receiving Australia Day awards this year was Senior Australian of the Year, Professor Gordian Fulde.

Gordian was my first emergency department boss in 1983 – one of the first Australian doctors to be formally trained in emergency medicine.

My years of inner-city training in emergency medicine exposed me to the huge amount of harm caused directly by alcohol and other drugs.

It is significant that Professor Fulde’s recognised achievements include lobbying for greater control of late-night drinking venues, and educating the public about the increasing harms of stimulant drugs like “ice”.

Back in 2007, Gordian Fulde and Alex Wodak, writing in the MJA, warned people in an editorial about this (then) relatively new drug scourge.

• Related: MJA -- Estimating the number of regular and dependent methamphetamine users in Australia, 2002–2014
• Related: MJA InSight -- Dealing with ice “a hard slog”

In the same issue of the MJA, a group from Perth described the serious, and growing, impact on emergency departments.

All these years later, the results of addiction to alcohol and other drugs continues to present an enormous burden to emergency departments all over the country. While the road toll continues to fall due to a combination of better driver regulation, road design and vehicle design, the toll from substance addiction continues to rise.

The Australian Medical Association has a strong history of lobbying on public health issues as diverse as cigarette smoking and road safety, with some success.

The recent scourge of sympathomimetic drugs like ice, however, presents a double threat – both to public health and safety and to the safety of health care professions at the front line.

While the narcotic and barbiturate addicted people I saw in the 1980s were mostly stuporous (at least, until the naloxone kicked in), today’s ice-affected people tend to have super-human strength and aggression, often coupled with psychosis. It is not uncommon to require a whole team of clinical and security personnel to restrain an acutely agitated person affected by these drugs, often with police as back-up.

Ice is a smokable formulation of crystalline methamphetamine – now easily obtainable in Australia.

According to emergency physician Daniel Fatovich, crystalline methamphetamine is now the second most widely used illicit drug around the world – second only to marijuana.

Unlike most narcotics, it does not need to be imported, being readily available from a multitude of local “drug labs”. The combination of ready availability, relatively low cost and the instant rush obtained from smoking have made ice a very dangerous habit indeed.

• Related: MJA -- Recent warnings of a rise in crystal methamphetamine (“ice”) use in rural and remote Indigenous Australian communities should be heeded
• Related: MJA -- Comparison of crystalline methamphetamine (“ice”) users and other patients with toxicology-related problems presenting to a hospital emergency department

Every day, ambulance officers and mental health workers in the community, and doctors and nurses working in emergency departments, are exposed to physical danger from extremely aggressive, agitated people. This is in addition to the havoc wrought on addicts and their families – adding to the existing burden of community and family violence.

Serious work has commenced, which attempts to understand the “epidemic” and propose effective solutions.

The 2015 special report, Methamphetamine: focusing Australia’s National Ice Strategy on the problem, not the symptoms, should be essential reading for all. It is only through understanding the dimensions, driving forces and users of this drug that we can contribute to keeping our colleagues and our patients safe from its effects.

Ironically, those effects are chilling.

Dr Sue Ieraci is a specialist emergency physician with over 30 years’ experience in public hospitals. She has held roles in medical regulation and clinical management. Her interests include policy development, health system design, and the problems of pseudoscience and misinformation in health care.