National Amphetamine-Type Stimulant Strategy Background Paper

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In 2005, there was a total of 68 drug induced deaths in which methamphetamine was
mentioned among those aged 15 to 54 years, compared to 75 in 2004 (Degenhardt &
Roxburgh, 2007). Of these deaths, methamphetamine was found to be the underlying
cause in 26 cases in 2005 compared to 17 in 2004. Deaths from ecstasy consumption have
variously involved persons with pre-existing cardiac conditions (World Health Organisation,
1997), hyperthermia, and ingestion of excessive amounts of water (Darke et al., 2000).
Deaths following MDMA use are frequently the consequence of a serotonin syndrome and/
or of sympathomimetic overstimulation, both of which are exacerbated by environmentally
caused overheating (Schifano, 2003).
A study conducted by Schifano and colleagues (2003) investigated the number of ecstasyrelated
deaths occurring in England and Wales between August 1996 and April 2002
recorded in the National Programme on Substance Abuse Deaths database. A total of
202 ecstasy-related deaths were recorded and showed a steady increase in the number
of deaths each year. Of these, ecstasy was implicated as the sole drug causing death in
only 17% of cases, with a variety of other drugs (mostly alcohol, cocaine, amphetamine
and opiates) being identified. Toxicology results revealed MDMA accounted for 86% of
cases, MDA for 13% of cases, and single deaths were associated with MDEA and PMA.
An analysis of ecstasy-related deaths in Australia during 2000-2004 using data from the
National Coronial Information System (NCIS) found 112 such deaths (Fowler et al., in
press). Ecstasy was deemed to be the primary contributory factor in just under half of these
cases, and the sole drug present in only six of these deaths (Fowler et al., in press).
Negative effects of specific routes of administration
Some effects are associated with specific routes of administration, as detailed at the
National Leadership Forum on Ice (Ministerial Council of Drug Strategy Joint Communiqué,
2007). Nasal use by snorting has a delayed effect of approximately five minutes subsequent
to dose. There is a potential risk for Hepatitis C to be passed on from tiny, often invisible
amounts of blood on shared snorting equipment. Oral use of crystal methamphetamine by
swallowing can cause irritation as crystal particles travel to the stomach. Anal and vaginal
use, known as ‘shelving’ and ‘shafting’, can damage the lining of the anus or vagina and
increase the chances of HIV and Hepatitis C transmission. In addition to the typical health
and medical effects associated with smoking including addiction, smoking equipment
can cause burns to mouth or gums, and Hepatitis C can be transmitted if equipment is
shared. In addition to smoking, injecting is the route of administration most associated with
dependence, and the latter mode of administration poses risks of contracting blood borne
viruses, and repeated injection in the same spot can lead to vein inflammation, scarring,
abscesses, blood clots and vein collapse.
There is a paucity of research investigating transitions to injecting from other routes of
administration. Those studies that have investigated this area have mostly recruited heroin
users (e.g., Gossop et al., 1988; Neaigus et al., 2001; Parker et al., 1988). A paper by
Strang and colleagues (1992) identified the pertinent issues, including variations of route
of administration by time and place; influence of availability of drug paraphernalia; influence
of context; and the association between changes in route of one drug and changes in route
of other drugs.