Impacts-of-methamphetamine-in-Victoria-Community-Assessment-Penington-Institute

A leading addiction specialist based in a hospital said that although rare, in the past two years therehave been some cases of extraordinary levels of “agitated/excited delirium” (a clinical term), sointense that sedation and admission to an Intensive Care Unit was required:“In nearly 30 years of practice I can’t remember ever seeing a person so agitated that it requiredrestraint that necessitated transfer to ICU … the drugs that we normally use and the strategies wenormally use are unable to be effective.”In these cases, urine analysis had detected methamphetamine presence but due to not having accessto more detailed toxicological testing it was not possible to examine whether or not other drugs wereinvolved and therefore possibly a factor.It was noted that emergency departments are now being encouraged under the National EmergencyAccess Targets (NEAT) to have people triaged and then either admitted for treatment or dischargedwithin four hours [99, 100]. Difficult methamphetamine presentations could present challenges,because there may not be a place in psychiatric care ward warranted or available, but discharging(within the four hour target) a person who remained in a state of agitation may present a risk tothemselves or others.One department had introduced a ward where people can stay for a period of 24 hours (as opposedto the four-hour rule operational across Victoria). The “short stay” approach was deemed to havepotential.An emergency medicine specialist noted that people presenting quite often had a history of preexistingpsychosis, however the remainder could be white-collar workers, for example, who usedmethamphetamine on the weekend and began experiencing symptoms. Many patients’ psychosistends to dissipate or disappear after 24 hours, at which point psychiatric units may not admit aperson for extended care or conduct a psychiatric assessment for outpatient case management.Responding to methamphetamine-related psychosis involves drug and alcohol workers, as well aspsych teams [where they exist].This was reiterated by an NSP worker, talking about the need for psychiatric treatment formethamphetamine users having a psychotic episode:“Whether [just] drug induced or ongoing... if you’re using ice, very rarely will you get admitted. Andwhen they are in there, they are exited as a drug user, not someone who has a mental health issue”.In a situation where a code grey event occurs (hospital-wide internal security response to aggressivebehaviour), patients are placed in a secure room, with security staff from the hospital present, andspecialist doctors and nurses. Each code grey could last 30 minutes to an hour, meaning thoseresources were unavailable for anyone else in the hospital.It was suggested that in regional areas, where there were smaller hospitals and fewer staff, frequentpresentations (either currently occurring, or if they did occur) could “take an entire staff to calm anagitated patient”. Here, even a small number of presentations could “throw a small system [intochaos]”.Which services are people accessing?Looking at the reported increases in people seeking treatment, counselling and support formethamphetamine use, it is important to note how people are accessing services. Some individuals50