0716-Lee-Nicole-AProf Jun16Methamphetamine use among young men is a concern and treatment tricky.

Australia has one of the highest rates of methamphetamine use in the world. About 2.1% of Australians aged 14 years and over report using it in the past 12 months. Most (70%) use less than 12 times a year. Significantly, there is no evidence of a large increase in new methamphetamine users. In fact, the percentage of users among the general population has been decreasing since 1998.

0716-Violent-patient-emergencyThe key problem over the past five years has been an apparent shift among people who already use the lower-grade ‘speed’ to higher-grade ‘ice’. Purity and availability have increased while price has gone the other way. Worryingly, the number of people using weekly or more has increased.

Some of these changes have created a ‘perfect storm’. As a result Australia has seen a significant increase in ambulance callouts, hospital visits, treatment seeking and police arrests related to methamphetamine use.

The use of a range of drugs (including alcohol) by young people has decreased substantially over the past 10 years. The largest group of users of methamphetamine are in the 20-29-year-old cohort. Young men have a higher rate of use with nearly 7% of men reporting they’d used the drug in the past 12 months, compared with 4.8% of women in the same age group.

Methamphetamine affects a range of neurochemicals in the brain causing an increase in serotonin and noradrenaline. Noradrenaline regulates the fight or flight system, which increases ‘threat sensitivity’ while methamphetamine increases dopamine levels. After moderate to heavy use the dopamine system can be seriously depleted resulting in a ‘flat’ feeling after using the drug.

It can take as much as 12-18 months of abstinence before the brain recovers to baseline levels. During that period, prefrontal cortex and limbic system functioning can be severely affected. High levels of dopamine have been linked to psychosis symptoms and low levels to depression.

Serotonin also affects mood. This partly explains the high rates of mental health problems among this group. Studies have found that at least 80% of regular users will experience symptoms of significant depression and 25% will experience psychosis. The stimulant effects of methamphetamine can also affect sleep quality.

One of the big risks linked with methamphetamine use is an increase in sexual risk-taking. Young gay men have high rates of use with many reporting that they use specifically to increase sexual pleasure. High levels of dopamine increases impulsivity, reduces decision-making ability and lowers inhibitions. Harm reduction is critically important for this group.

There is no pharmacotherapy that helps with dependence, but medicines for symptom management may be an option. Psychological therapy is proving effective with as few as two sessions of CBT and motivational interviewing resulting in increased abstinence, even among heavily dependent users.

Nonetheless, relapse rates are high compared with other drug users. The figures stand at around 80% at the one-year point, probably related to the long neurocognitive recovery time so post-treatment support is crucial to reduce the risk of relapse.

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