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

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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
are accessing a service through court orders or prior to sentencing. An AOD counsellor toldresearchers:“[Most] clients are either mandated through corrections orders, or they might have beencaught with drugs, and have a court date, and their lawyer advised them it would be better forthem if they were doing AOD...”.While acknowledging an increase in methamphetamine users from 10 per cent of clients in 2008, to15 per cent in 2013, the worker reported that these clients saw themselves as occasional users, anddid not see their use as problematic.Workers in non-AOD sectors also noted that when a person presents to a service, the onus is on theclient to reveal whether they or their family members are using methamphetamine. As such, theactual number of people accessing services in crisis with problematic methamphetamine use, or as aresult of problematic methamphetamine use (from a family member) may be hidden.Challenges in accessing AOD servicesMany young people were reluctant to access AOD services, a youth homelessness worker noted:“If I went through my last 50 clients, I can probably say only one of them I’ve got to goto an AOD counsellor...”Another Grampians region youth homelessness worker noted:“Not many of our clients are accessing drug and alcohol services”Both youth and adult services noted that clients often presented in crisis, and if they were unable tobe seen immediately, they would leave and may not engage with services again.Particularly in smaller towns, workers noted that people without a history of substance misuse issueswere reluctant to present for treatment, due to the stigma associated with drug use. This potentiallymasks the level of problematic methamphetamine use within communities.Another key concern was that many people (particularly young people) accessing services wereforced to leave their town or region in order to seek treatment. This could mean people travellingfrom regional areas to Melbourne for treatment, or between region to region, and leaving existingsupport structures behind (including family, friends, partners and children). In some instances thiswas a deterrent for seeking or accessing services.Detoxification/Withdrawal:Workers from a range of sectors noted that waiting times for treatment meant it was hard to keepclients committed to breaking their dependence. As a Hume Region youth worker noted, a client maysay:“’OK I’ll go to rehab’, well I can’t get you into rehab for six weeks, and you have to detox first, but Ican’t get you into detox for eight weeks”51
Page 1 and 2: IMPACTS OF METHAMPHETAMINEIN VICTOR
Page 4 and 5: CONTENTSACKNOWLEDGEMENTS 61. EXECUT
Page 6 and 7: AcknowledgementsPenington Institute
Page 8 and 9: communications interventions. Local
Page 10 and 11: 3. IntroductionMethamphetamine is a
Page 12 and 13: Component Four: In-depth interviews
Page 14 and 15: That ABS analysis looked at 2010. I
Page 16 and 17: attribute poor health status to the
Page 18 and 19: Family relationshipsMethamphetamine
Page 20 and 21: Development of coalitions of suppor
Page 22 and 23: Table 2: Annual median purity of me
Page 24 and 25: Victoria accounted for the greatest
Page 26 and 27: methamphetamine-related offences ha
Page 28 and 29: 6.2.5. Data from Ambulance Victoria
Page 30 and 31: Table 8: Ambo Project summary of ca
Page 32 and 33: A homelessness worker in the Hume r
Page 34 and 35: Methamphetamine becoming cheaper:Al
Page 36 and 37: Compared with other substances, a n
Page 38 and 39: Many people noted that methamphetam
Page 40 and 41: “Indigenous communities are hard
Page 42 and 43: Services noted that methamphetamine
Page 44 and 45: An AOD worker noted that, in relati
Page 46 and 47: drug and alcohol stuff and the depr
Page 48 and 49: Police7.7. Impacts on service syste
Page 52 and 53: Services noted that it was often ha
Page 54 and 55: One of the respondents said he gene
Page 56 and 57: For both young men it was the escal
Page 58 and 59: Deciding to seek helpFor both Xavie
Page 60 and 61: 8. Drug testing populations: Waste
Page 62 and 63: Table 10: Number of doses consumed
Page 64 and 65: provision of wrap around services b
Page 66 and 67: 17. Australian Institute of Health
Page 68 and 69: 52. McKetin R, Lubman D, Lee N, Ros
Page 70 and 71: 87. Iversen J, Chow S, Maher L. Aus

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