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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.
Thanks for the comments. I agree that understanding the underlying dynamics of drug use is crucial. It’s worth noting that alcohol still also exerts an enormous toll, is much more widely consumed in the community, and is associated with violence and other risky behaviour. Underlying mental health disorders are, of course, important, but we are also seeing more and more acute drug-induced psychoses. It is the ready availability, extreme addictiveness and the association with violence that means these sympathomimetics have a particular impact on the caring professions, as well as the users – especially pre-hospital.
How this discussion can continue without discussing underlying mental healrg is totally beyond me. The 2015 report makes no mention !!!
Until we, as a society, can embrace the fact that mental health is not just “nutters and looneys”, I suspect we are doomed. I invoke Santayana “Those who cannot remember the past are condemned to repeat it” and Max Planck “Science progresses, one funeral at a time”.
There are leaders in this area who are demonstrably Luddite in their position, many others who are blind to good analysis of the evidence. I won’t hold my breath for effective change!
I likewise recieved a boost to my wider medical education from the dynamic duo at St Vincents Hospital. My early mentor was Alex Wodak. He taught me that we demonise the drug alone at our own peril. I have not yet met any person who setout from an early age to be an “addict” in the same way as we set out to be a plummer, policeman, lawyer etc. It is a complex evolution that includes social, geenetic and other determinants slowly cooked over time.
The raging “ice” effected bull, has more than likely been on a trajectory for some time. Moreover a toxicology screen may just as likely demonstrate a smorgasbord of delicacies including alcohol, benzodiazepines, increasingly antipsychotics and something that may or may not be chemisrty grade crystal methamphetamine. The “ice” could be ketamine, crushed up light bulbs or anything else dressed up to look like “ice”. Yet due to attribution bias we preference only the one. By demonising a drug, we convert the war on drugs to a war between drugs.
Alex taught me that there is a triad between the person, the past and present environment and the substance(s). The net result is behaviour. Not very much is said lately about the culture that is at best ambivalent about the behaviour. What strategy do we have to change our culture?