more_vert
Experts call for urgent action to reduce stigma, improve treatment, and address rural inequities.
Generation X is now the cohort most affected by methamphetamine-related deaths in Australia, according to new research from the Burnet Institute.
The age–period–cohort–interaction analysis of meth/amphetamine-related deaths in Australia, 2001–2020, found that people born between 1962 and 1982 (Gen X) are experiencing significantly higher mortality risks than other generations, both earlier and later.
Oisin Stronach, lead researcher and PhD candidate at the Burnet Institute, says the findings reflect a combination of early drug exposure, changing drug markets, and age-related health issues.
“This generation came of age during the 1980s and 1990s, when amphetamine-type stimulants like ‘speed’ were more widely available in less potent forms,” Mr Stronach said.
Dr Amanda Roxburgh, a senior research fellow at the Burnet Institute and an expert in drug-related mortality, co-authored the study.
“We know from other research that there was relatively high prevalence of initiation of amphetamines during this time. As the market shifted in the 2010s to the use of higher purity crystal methamphetamine, this age group may have increased the frequency of their use, or to more harmful usage patterns,” said Dr Roxburgh.
Crystalised methamphetamine, known as “ice”, is associated with a much higher likelihood of developing dependence than earlier forms of amphetamines. Its use, particularly via injection, can significantly raise the risk of cardiovascular issues and premature death.
The study showed that, in general, deaths from methamphetamine more than quadrupled from 2001 to 2020, and that the biggest increases came after 2013, when high-purity crystal meth became available.
Mr Stronach said the data from the study points to a complex pattern of Gen X deaths.
“We found an upward trend in cardiovascular deaths since the beginning of the study period,” said Mr Stronach.
“Increased use has increased risk, and there’s the fact that this is now an ageing cohort,” he said.
Pharmacotherapy urgently needed
According to the study, the main causes of deaths were unintentional drug toxicity, intentional harm, cardiovascular disease, and accidental injury.
Unlike opioid-related deaths, which are mostly due to the suppression of breathing, methamphetamine causes death through different mechanisms.
“[Meth use] creates almost a fight–flight response,” Dr Roxburgh said.
“It increases the heart rate and blood pressure, and if someone’s got a background of any kind of cardiac issue, then obviously that could be problematic. It might be their first or only methamphetamine use, but it can still be highly toxic,” she said.
“It is largely the cardiotoxic effects of methamphetamine that lead to the death,” said Dr Roxburgh.
“We need a pharmacotherapy for methamphetamine. For opioids, we’ve got methadone, we’ve got buprenorphine; we don’t yet have an effective pharmacotherapy [for methamphetamine]. Researchers are working on it. There are trials going on in Australia to find one,” she said.
The stigma preventing treatment
Despite the risks of methamphetamine use, people who use methamphetamine often delay or avoid seeking help, due to stigma, shame, and a lack of appropriate services, say the researchers.
“One of the biggest barriers is stigma,” said Dr Roxburgh. “It stops people from coming in to get even basic health care, let alone treatment for their drug use. By the time they reach acute services, it’s often a crisis, or too late.”
Dr Roxburgh said that methamphetamine use tends to be portrayed in extreme and stigmatising ways, particularly in media coverage that focuses on psychosis or aggression, which can influence public understanding, which can in turn influence policy.
“There’s a small minority of people who do experience those acute effects,” said Dr Roxburgh.
“But they’re not representative. And yet they dominate the narrative,” she said.
Gen Z appears to be more risk averse
In contrast to Gen X, Gen Z may be engaging in less risky drug use overall — possibly due to better education, changing social norms, and increased visibility of drug-related harm through social media.
“There’s some evidence in other research among young people that they are using drugs less, drinking less alcohol, and engaging in less risky behaviour in general,” said Mr Stronach.
“This may be due to better information campaigns, and perhaps social media awareness.”
“Stigma may also be playing a role — methamphetamine has become such a stigmatised drug that it’s less appealing to start using in the first place,” he said.
“The Gen Z cohorts … probably [have] improved education around the associated risks … and the impact of social media and the stigmatisation of methamphetamine, may be potentially making it a less desirable drug to take,” said Mr Stronach.
The researchers acknowledge that while this might be a positive, it doesn’t help those already struggling, and particularly in rural and regional areas.
“In small towns, people can’t always access help anonymously,” Dr Roxburgh said.
“The lack of infrastructure in rural Australia is a real issue. We urgently need low-threshold services — places where people can go even if they’re still using and just get care.”
Low-threshold health services are designed to provide non-judgemental, basic medical care without demanding abstinence or that the person be in drug treatment. These measures are increasingly seen as a harm reduction measure that could help prevent deaths, especially among populations with complex health needs.
The researchers say that it is important that health services treat the secondary health issues that people who use methamphetamine present with, and not to merely focus on the methamphetamine use. This reflects equitable health for all people.
Rural, regional and remote Australia needs focused help
“In rural and regional Australia, there’s also been clusters of problematic methamphetamine use and harms. And it’s hard in those areas because, I would argue, that there’s not the infrastructure or services in place.”
“We also need to extend low-threshold services. Our system caters for people who use opioids, and we need to attract people who use other drugs, and update those services,” she said.
Long term, important work
Mr Stronach also works with the Burnet’s SuperMIX and VMAX longitudinal cohorts.
SuperMIX is the largest and longest running active cohort study of people who inject drugs in Australia, with over 1500 participants. People who inject drugs in the Melbourne and the Greater Geelong region are surveyed to determine the effectiveness of drug treatment programs and evaluate systemic causes of drug use.
SuperMIX is part of a broader study called MIXMAX, the largest active cohort study of people who use drugs in Australia.
Mr Stronach says these conversations with community, and these studies, are essential.
“Through this kind of research, we can put to paper lots of stories about what’s going on, and use those to advocate for better services, and to represent the lives of people who are dying. Make sure their lives are not invisible,” he said.
As an advocate with Students for Sensible Drug Policy Australia, Mr Stronach is working to bring lived experience and evidence-based reforms into the conversation.
“Young people have unique experiences of drug use, but they’re often under-represented in drug policy. That’s why I’m working to make their voices heard,” he said.
Dr Roxburgh agrees.
“We need to stop pretending this isn’t happening. And we need to offer care, not judgement.”
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.