Crystal Methamphetamine – “Ice”

Smoke and Mirrors: Helping Families Through the Maze of Substance Abuse


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“Ice” is the street name for crystal methamphetamine which is a powerful synthetic stimulant drug that speeds up messages going to and from the brain. Other street names for “ice” include “meth”, “d-meth”, “crystal”, “crystal meth” “shabu”, “batu”, “tina” or “glass”. Ice is made from a combination of pharmaceutical drugs and chemicals, including acetone, bleach, battery acid and engine coolant. Ice is usually injected or smoked but can be snorted or swallowed.

Where does ice come from?

Most  of  the  ice  available  in  Australia  is  manufactured  in  China  but  is sometimes transported to Australia via other Asian countries such as the Philippines or Indonesia. Ice is imported because it is difficult to make, requiring considerable chemistry expertise. However there is an increased amount of production in Australian homes. What is made here is usually a powder (known as speed) or a damp oily powder that is often called “base”. Ice, speed and base all contain methamphetamines and have similar effects although ice is more pure and potent than speed or base.

What does ice look like?

Ice often appears as a large transparent sheet like crystal or a coarse crystalline powder. Ice is usually sold in “points” (0.1 gram) because it is so strong that only a small bit of it is used at a time.

How many people use ice?

Recent surveys estimate that 2.1% of Australians aged 14 years and over have used methamphetamine in the last 12 months and of these 50.4% report using ice (AIHW 2014). Ice also appeals to a wide range of illicit drug users including people who inject drugs like heroin and cocaine and people who take pills such as ecstasy and ketamine.

In recent years, the average purity of ice has increased while its price has dropped. Drug users are able to access a much more concentrated drug for a cheaper  price.  The  shift  towards  a  cheaper,  more pure form of ice has resulted in an escalation of harms caused by the drug, rather than a dramatic increase in the prevalence of use.

There has also been an increase in the number of women using and an increase in the percentage of young Aboriginal people presenting for methamphetamine treatment including ice use. Young people aged 20-29 are the highest users.

What are the patterns of ice use?

The pattern of ice use varies substantially across the population, from novices who only ever use the drug a few times to a minority of users who frequently use large quantities. Seventy-percent (70%) of all people who use methamphetamine use occasionally or less than once a month. Thirty percent (30%) use regularly or more than once a month and half of this group use weekly. Thus there are a relatively small number of people using regularly, although this number has increased since 2010 (Lee 2015)

It can take between one to two years before people who first use ice develop problematic use then another year before they develop mental health problems. There is however generally a long time lapse (up to five years) before a person with problem ice use enters treatment (Lee 2012).  This means that ice users and those close to them can face significant difficulties for long periods of time.

What are the effects of ice?

Ice use changes the brain and consequently behaviour. When a person takes ice, a huge amount of dopamine is released. Dopamine regulates pleasure, motivation, reward, attention and memory. That is why people feel a sense of euphoria and alertness.  Ice is most commonly smoked or injected, the short term effects of which can be felt within three to seven seconds.

Used  long  term,  ice  impairs  the  thinking  part  of  our  brain  that  controls planning, decision making and regulation of behaviour. This means the emotional part of the brain goes unchecked. People who use ice long term find  it  hard  to  think,  plan,  make  decisions,  regulate  their  emotions  or remember things.

The effect of ice differs according to dosage and length of use. Higher doses over longer periods of time cause the greatest harm. The short and long term effects include:

Immediate effects:

  • increased feelings of pleasure, excitement, euphoria and confidence
  • increased energy, alertness, confidence and libido, feelings of increased strength, talkativeness
  • restlessness, hand tremors, faster breathing, higher blood pressure, becoming hotter, becoming anxious, nervous or paranoid. Repeated simple acts such as itching, scratching or picking skin
  • difficulty sleeping, reduced appetite and poor nutrition, dilated pupils, stomach cramps/ nausea, dizziness, blurred vision or headaches
  • there is also a possibility that it may make people more aggressive with violent behaviour being more likely among heavy users, people who inject ice,  if ice users are intoxicated when using or if they have a pre-existing conduct disorder (Darke, Kaye, McKetin and Duflou 2008)
  • methamphetamine use is associated with increased sexual activity

Longer-term effects

  • episodes of psychosis, high blood pressure, stroke, epileptic seizures, racing heart beat and chest pain; breathing problems; fits or uncontrolled jerking; extreme agitation, confusion, clumsiness; sudden, severe headache; unconsciousness; heart attack and death1
  • reduced immunity and increased susceptibility to infection
  • depression, anxiety, tension, paranoia
  • brain damage (reduced memory function)
  • malnutrition
  • lung damage from smoking ice, dental damage from snorting or grinding teeth and scarring, abscesses, vein damage and blood borne viruses (hepatitis C, B and HIV) from injecting.

Because ice is a strong form of methamphetamine, the side effects are more likely and will be more intense than other types of methamphetamines such as speed.

What are the social impacts of ice use?

Some people who use ice experience financial, work and social problems related to their use. Dependence on ice can result in people losing everything

– including their physical and mental health, family, job, possessions and relationships. Ice can have particularly dramatic effects on an individual’s mental health. These problems can be made much worse because some people who use ice become irritable, hostile and violent and/or experience psychological problems. It is also very dangerous to drive a vehicle or operate machinery after using ice.

Is ice addictive?

People who use ice can quickly develop a tolerance to the drug so that increasingly higher doses are needed to achieve the desired effect. There are a number of people who use ice recreationally who can regulate their use and minimise the impact of ice on their lives. However some people do develop a physical and and/or psychological dependence.

What is coming down and withdrawal like for ice users?

It can take several days for people to ‘come down’ from using ice. This period of acute withdrawal can involve an intense crash period, which can last for between 2-3 days involving intense periods of sleep. During this time, individuals may experience exhaustion; headaches, dizziness and blurred vision; paranoia, hallucinations and confusion; irritability and; feeling ‘down’. From a child protection perspective, care arrangements will be needed at this time as parents may be unable to care for their children.

Beyond the initial ‘come down’, people are likely to also experience a protracted withdrawal period in which they may feel unwell. During this time, people will have to go long periods before they see any change, with cognitive impairments lasting between 12 and 18 months. The protracted withdrawal period for ice is considerably longer than other illicit drugs, including cannabis and heroin.

While ice use can cause brain damage, it appears that abstinence from the drug over an extended period can reverse at least some of this damage.

How does ice use affect pregnancy?

Using ice during pregnancy can affect the development of the foetus. Amphetamine use has been linked with bleeding, early labour and an increased risk of foetal abnormalities and alterations to the brain. If amphetamines are used close to the time of birth, the baby may be unsettled, agitated and over active. Babies born to mothers who used amphetamines regularly during their pregnancy may be born with addiction; experience withdrawal symptoms, have neurological impairments; have disrupted sleep patterns and may fail to thrive due to poor sucking actions. These infants may also be prone to stress and anxiety and calming strategies may be needed in order to effectively soothe them. For infants who are removed from their parents’ care and placed in Out of Home Care shortly after birth, carers need to be made aware of and appropriately supported to overcome these challenges.

What are the effects of parental ice use on children and families?

While some parents are able to use ice in a way which does not impact upon their capacity to effectively parent their children, parental ice use does often result in a number of detrimental impacts upon children and family functioning. The impact varies according to the degree of parental substance use.  Some of the child protection concerns for children whose parents’ use ice are detailed in Table 1.

Areas of concern

Concerns

Household safety

Children whose parents use ice may be exposed to unsafe household environments. Key concerns for   a   childs   safety   may   include   a   chaotic household environment resulting in a lack of parental supervision and neglect; witnessing of active drug use practices; and exposure to and

involvement in criminal activity.

Abuse

Ice users may share their house with others and this may result in unknown people coming in and out of the house. Conversely they may take children with them to unsafe places to procure drugs. Both scenarios increase childrens risk to

sexual or physical abuse.

Areas of concern

Concerns

Neglect

Ice users may experience extended bouts of sleep and do not notice and respond to a childs needs. Parents who feel hot and or who are not hungry may fail to clothe or feed children. They may also neglect to take them to social or sports activities. Children may be left without supervision for long periods   of   time   making   them   vulnerable.   In addition, ice users may only mix with other ice users reducing childrens access to positive social

supports and safe spaces.

Chil healt an exposure  to meth labs

If ice is produced within the home, children can be expose t highl toxi environmentresulting from drug manufacturing and cooking processes. Children may suffer respiratory, dental, liver and skin problems. These children are also at higher risk of developmental delays. Children living within toxic household environments are also at risk of accessing toxic substances and drug products available    within    the    home    with    potentially

dangerous consequences.

Table 1: Ice and child protection concerns

How should I engage with people who use ice?

Because of its effect on the brain, people who use ice may find it hard to:

  • get to appointments (reduced memory and planning)
  • complete tasks (reduced ability to focus and plan)
  • take on new information (reduced attention and memory)
  • goal setting and working towards goals (reduced planning ability)
  • stop inappropriate behavior (impulsivity)
  • keep up with conversations about different topics (less flexible thinking)
  • control unexpected outbursts (emotional dysregulation, impulsivity) When working with ice users, try to remember to;
  • be patient and flexible in the timing and format of appointments. Some people may need shorter more frequent visits
  • remind  people  of  appointments  and  be  assertive  with  follow  up including telephone supports
  • if a client needs to do something as part of a case plan help them plan tasks out
  • provide memory aids or written materials whenever possible and give smaller pieces of information more often
  • be persistent. Because of the acute or long withdrawal periods, it may take weeks, months and possibly years to achieve positive change
  • expect  and  be  prepared  for  relapses  in  ice  use.  Ensure  intensive support services are available for parents and children during periods of relapse
  • look for and recognise slow gains
  • be polite, respectful, warm and non-judgmental. If a person is under the influence of ice do not get involved in an argument
  • keep discussions short and succinct and wherever possible try and refer to things you have personally seen or experienced first hand.

What treatment and interventions help ice users?

Interventions that work in treating other drug dependency (relapse prevention, motivational interviewing, access to a general practitioner and or a psychiatrist) also work with ice users. It requires tweaking of existing services rather than a whole new line or area of treatment.

Effective interventions for ice users are based around brief interventions involving approaches such as Motivational Interviewing (MI), Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy. Ice users react well to brief interventions and four sessions of CBT and MI can help increase abstinence and reduce mental health problems.

Because of the long withdrawal period, many ice users only attend treatment for a short period of time. The challenge is to try and sustain engagement and positive changes. To do this assertive follow up is crucial. Telephone or internet counselling services and participation in peer support groups, such as Narcotics Anonymous are a viable treatment option for individuals who have demonstrated motivation towards behaviour change.

Currently there are not any pharmacological interventions approved for the treatment of ice users. This reduces the incentive to attend treatment because there is no drug to help ice users who are withdrawing to feel better.

Residential programs can be effective in complex cases, such as in instances where individuals are poly drug users, are in relationships with other ice users, are homeless, or have failed in their other attempts at treatment. However, there is also no strong evidence that short term withdrawal or detox programs have either short or long term benefits for ice users when administered without further or additional treatment and support.

To learn more working with parents who use ice watch  Dr. Alex Wodak’s presentation at the Research to Practice seminar.

References

Australian Institute of Health and Welfare. (2014). National Drug Strategy Household Survey detailed report 2013. Canberra: AIHW. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459375 accessed December 18 2015.

Darke, S.; Kaye, S.; McKetin, R,; and Duflou, J. 2008. Major physical and psychological harms of methamphetamince use. Drug and Alcohol Review 27:3: 253-262.

Lee, N. (2015) Breaking the Ice: Using evidence to gain perspective on the ice epidemic and what it means for responses. Drug and Alcohol Research Connections.

http://www.connections.edu.au/opinion/breaking-ice-using-evidence-gain- perspective-ice-epidemic-and-what-it-means-responses. Accessed 18 December 2015.

McLellan, A.T., Lewis, D.C., O’Brien, C.P. & Kleber, H.D. (2000). ‘Drug Dependence, a Chronic Medical Illness. Implications for Treatment, Insurance and Outcomes Evaluation’. The Journal of the American Medical Association. 284 (13): 1689-1695.

Stafford, J. and Burns, L. (2015). Australian Drug Trends 2014. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series. No. 127. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.