13.1 MethodologyAs described in the main section on methodology in this report, CIRCA conducted twelve in-depth interviews with methamphetamine users. These were as follows:
- six with users from the Illawarra region (4 male, 2 female, aged 18 to 27 years)
- three with users from Western Sydney (One 36 year old female, one 32 year old male, and one 33 year old male)
- three with users from Inner Sydney (through Redfern Community Centre, one 28 year old male, one 30 year old male, and one 34 year old female).
- methamphetamine use was not seen to be an issue in remote locations but to be more prevalent in urban areas and
- most people said it was not an issue in the NT "yet"
In addition to the interviews with methamphetamine users, four depth interviews were conducted with stakeholders, including Drug & Alcohol Units of several Aboriginal Medical Services and Mental Health Services across Australia. These were completed in NSW, SA, and WA.
Recruitment challengesRecruitment of users was conducted through Indigenous researchers, and through the Redfern Community Centre. Initially attempts were made to recruit through services, and over 30 organisations were contacted. This included Aboriginal Medical Services (AMS), and drug and rehabilitation services. It was not possible to recruit through these organisations for several reasons:
- indications that most users are not accessing services due to the stigma/ sensitivity and concerns regarding anonymity. Stakeholder believed that Indigenous users may be more likely to access mainstream services rather than Indigenous services and
- services that had methamphetamine users required ethics approval to participate.
In the end, Indigenous researchers were used to recruit methamphetamine users through their personal contacts. These researchers all knew several users, suggesting that in urban areas methamphetamine use is quite prevalent, even though many organisations noted that people are not presenting to Indigenous services. Top of page
13.2 Patterns of useMost people included in the research had reduced or stopped using methamphetamines, or were planning to do this despite still using regularly. Further, most were users of ice rather than other methamphetamines. Therefore, this provides a slightly skewed picture of patterns of use among Indigenous Australian. However, those who had reduced their use of methamphetamines talked of previous heavier consumption patterns, as well as current patterns.
This research suggests that drug use for many starts at an early age. While the age when people had started using drugs varied, almost all had started before they were 19 years of age, with several starting with marijuana at around 12 years of age. Only one person had started at an older age, being 28 years when they first started using speed, and this person also became involved in making speed at the same time as they started using.
Poly drug use was very common, with a wide range of drugs being used, including alcohol, cannabis, amphetamines, ice, speed, ecstasy/pills, benzodiazpam, coke, fantasy, and rush. A few people from Illawarra and Western Sydney had used heroin, and all three participants from Redfern had used heroin. Several talked of using ice and alcohol together, and marijuana to "help come down". Others talked of starting on speed and then using heroin to "bring you back down, and then the addiction set in". Alcohol binges, some for at least two days, and methamphetamine use was also common, although the research suggests that often the pattern is for methamphetamines to become the primary drug of choice.
"A lot of us started drinking and smoking (marijuana), and then speed comes along and you find you can drink a lot more, and go on big binges. I used to notice that they could be up all night and drink and drink and drink, and I started asking why, and asked them to score for me, and then I started scoring myself. It's all linked, it all fits together. You're not getting too smashed, too drunk, you're all right. Generally it will take over alcohol and smoking, and you'll end up drinking less and smoking (gunga) less. Not a lot of users are big drinkers, whereas once they were."
The way ice was used varied, with the most common technique including either smoking, snorting or ingesting the drug. There were a few that injected ice, while others had very strong objections to injecting because of a fear of needles or of contracting diseases. Research suggests these drug segments see themselves quite differently, and that 'shooters' and 'smokers' are discrete groups, especially given that all participants talked of using in a social setting/ with peers. There were about seven who injected ice, and of these three shared needles with 'trusted' partners in an exclusive arrangement. This arrangement was viewed as safe because of the exclusive arrangement with their partner. Injecting was seen as "better value for money".
Many had used drugs for numbers of years, up to 15 years. This is not surprising given that drug use had started at a young age. There were a few recent users who had been using methamphetamines for the last couple of years, although the majority had used for 10-15 years. Within this group some identified as social users (when they go out), while others were habitual users and had accessed treatment for the addiction. Around half of the participants had been or were currently utilising substance misuse services. A few used ice or speed 4-5 times a week, while others were occasional users. Social users spoke of regulating their use, although the boundaries may be somewhat blurred, creating an illusion of control.
"I am careful that I do not use too much or too often, and not in a regular pattern as I am very aware of the risk of addiction. I do not really use speed now, as I like the ice too much."
The perception of the level of control was the main factor that determined whether people saw themselves as an 'addict' or a 'social' user. Top of page
Stakeholders questioned the use of labels such as occasional users:
"I do not know anyone who uses ice occasionally, they might have started off being occasional users but it is a quite addictive substance as you would know."
As mentioned earlier, there were mixed responses when discussing the prevalence of methamphetamine use in Indigenous communities. Many organisations did not feel that it was very prevalent, although there were concerns that this may change in the near future, while a few identified a very high incidence of use in regional and remote communities. In WA, a stakeholder indicated that methamphetamines are available in rural and even remote communities in WA, especially coastal communities.
"There isn't a community in Australia where you couldn't get anything you want in 2-3 hours. Even in some of the remote communities. More and more Indigenous folk are selling to Indigenous folk. Previously it wasn't the case, but now it is."
This stakeholder identified young Indigenous women as an important target. He noted that he had heard of injecting use among children as young as 10-13 in a remote community in WA.
A service in Adelaide identified a very large number of Indigenous injecting methamphetamine users, and estimated that they see approximately 350 Indigenous clients a year. This stakeholder felt that access to clean needles and safe practice information was a key issue of concern for these users.
This stakeholder also felt there had been an increase in the use of ice due to limited availability of speed.
"It's getting harder to access the ingredients needed to make speed. So 'truckies speed' is vanishing."
Impact on familyThe stakeholders identified the significant impact of methamphetamine use on families and communities. One treatment service spoke of the concerns among families because “every authorised intervention is traumatic”, and that often the family feel very guilty about contacting authorities. This service indicated that families and communities find it very difficult to cope with methamphetamine use because of the aggressive behavior associated with use, and because often there are several users in the one family.
"Indigenous people are very tolerant people, and will put up with negative responses for a long time. Meth has changed all that. It is too much for the families to deal with. If Indigenous families can't deal with it, that's saying something."
It was noted that the prevalence of methamphetamine use has lead to greater concerns about safety in communities and for households. This stakeholder also believed that as Centrelink payments are spread over a fortnight, this means that "invariably there is someone in the community who has money on any given day of the week, so there is no recovery time in communities." Top of page
13.3 MotivatorsThe most common motivator identified for first trying ice or speed was peer pressure/friends, with a desire to try something new and to try something their friends were trying:
"To be accepted in the crowd."
"Because everyone else was doing it."
Drug taking was clearly seen as a socialising activity, and initial use was an experiment to address curiosity. Family break-up, weight loss, price and accessibility were also identified as motivators. In every case, the common experience was of friends or family encouraging use of the drug, or they had used the drug before and identified positive benefits. Several people said their friends/ family had compared ice to coke, and this encouraged the use. One person had been told that you cannot OD on ice when he first tried it.
Perceptions of speed before trying were primarily positive. Perceptions of ice were mixed, as there was some awareness of the negatives in terms of being addictive, potent and dangerous, but this was not true for all. These negative perceptions were based on what had been learnt at school, or in the media, or from people they had seen in the community.
"It was the same effect as my friends had said, but I didn't realise how hard it would be to get away from the drugs once you have started".
Most had a very clear memory of their first time – where, when, and who with. Participants remembered their heart racing, increasing confidence, and feeling excited. A wide range of 'first time' scenarios were identified, including in a stairwell of a building, in a car driving from the north coast, at a party, at a friends house, at a night club, and at an aunties house. For example:
"I was driving on a long trip with my cousin who 'had some lines' to keep awake and I tried it too."
"People said it's good, we drink all night, and can keep going the next day, and they said 'go on 'cous, just try it', and I didn’t want to be the odd one out."
"They (friends) said it's like coke, and I said oh yeah, if it's like coke I'll try it." Top of page
A few women were encouraged by family members (mother and partner) to use ice for weight loss.
"I was with a school friend and her mother. Her mother took it quite often to help her clean the house. She offered it to her daughter (my friend) who was really overweight to help her curb her appetite. My friend was about 15, I was 14. We took it in a cup of coffee and then went out to a nightclub in Penrith. We were really excited about trying it; I only knew of positive things about speed, that it gave you energy and stopped you being hungry, and that you lose weight on it."
"The first time I tried ice was with my husband. He was tired of my whining that I had put on weight and thought I was fat. He told me that he would get me some, but he would control how much I had ‘cause he didn’t want me getting too hooked on it. We smoked it together, and I remember the first week I got a really bad chest infection from smoking it. I was really eager to try it ‘cause I knew you drop weight fast on it. It worked really well too, but the come down is hard and I get really moody when I am coming down."
The positive effects of methamphetamine user were easily identified. These related primarily to the emotional state achieved when using the drugs. Positives included:
- enjoyment, "happy feeling", euphoria, getting the high, feel good, confidence
- temporarily forget problems, all problems disappear
- weight loss and
- social elements.
- panic attacks, sleep problems, paranoia, psychosis, hallucinations (greater association with ice)
- family problems, effect on relationships - "Coming down and knowing problems are still around"
- violence/ aggression
- body aches and
- risk of infection/ vein damage (injecting drug users only).
The main source of information on the positives and negatives of methamphetamine use were friends/ peers, personal experience, and the experience of others around them. Media also contributed to the level of understanding of the impact of methamphetamine use, and through the media, drugs were seen to affect lower socio-economic families as well as role models. Top of page
Differences between speed and iceThe main perceived difference between speed and ice was the intensity of the high, or the potency, with ice identified as 'more potent'. However, a few noted that this came at a cost, as the 'come down' from ice was seen to be harder than for speed.
"a rush, like you could do anything"
"like you're racing inside"
Speed cheaper than ice, side effects not as bad, not as effective as ice
Minority prefer speed - because it is cut, is not as potent as ice
"makes you feel like Superman"
"potent, fast, quick effects"
Many preffered the high from ice to speed - more potent, powerful, immediate effect
"some super charge speed"
Negative - come down from ice is hard, has bad side effects, costs more, more addictive
Majority prefer ice - more effective/potent
Both ice and speed are strongly associated with an excitement and rush, although the intensity of ice is perceived to be greater, and this in turn has lead to a stronger preference for ice over speed.
There were mixed responses when discussing price, as some felt that speed is cheaper than ice, while others noted that ice is cheaper:
"Speed is the poor man's coke, and ice is the poor man's speed." Top of page
13.4 Knowledge of the risks and harm associated with methamphetamine useAs identified earlier, most had reduced use or stopped use in the last few months, with the others identifying a desire to change, although there had not been a significant change in their behaviour. Most imagined that in the future they would stop using. This therefore provides a skewed sample to some extent, as the participants were well aware of the risks associated with methamphetamine use and because of this had attempted to reduce or stop the use.
The research identified an increasing awareness over time of the risks and harm associated with use, primarily because the impact of the drug use on the lives of the participants was more significant over time. As well, several people identified the effects of drugs on others in the community as highlighting the negative impacts that drug use has over time. This included death, incarceration, mental illness, and being excluded from family/peer groups because of stealing and dishonesty. Many also had examples of paranoia that had lead to concerns about drug use. Others spoke of family break-up as the instigator for wanting to change. All of the risks were seen as real, and based on personal experiences, or experiences of friends/family.
"My mates don't talk to me no more. I had all the friends in the world, but no more friends or family coming around. Now I've cut down the love's starting to come back."
"Friends ripping each other off and getting angry over bad deals."
"You see spinners die – I've seen a lot of good people here die of overdose."
Aside from the long term risks identified above, paranoia and hallucinations were major risks identified in the research, and potential motivators for reducing use. One participant described trying to reduce his rate of use in an effort to avoid becoming paranoid as,
"the more you take the more chance you have of hallucinating and being paranoid".
This same participant described a particular instance of hallucinating, where he believed he had worms crawling out of his skin. This encouraged him to try to reduce his rate of use. Many others referred to paranoia:
"I get heaps paranoid, I think people are talking about me, and I get in heaps of fights, I get angry."
The impurities in the drug, and the fact that "you don't always know what you're getting" was a common risk reported.
A few mentioned risks associated with sharing needles (Hep C and HIV/AIDS), although awareness was limited. The few that shared needles with a close partner identified this as a safe, exclusive arrangement. A stakeholder from a clean needle exchange program (SA) said that many users mix base with water and then inject, but that most are injecting incorrectly, risking vein damage. This stakeholder gave an example of running a session on safe injecting, where it was found that 95% of the users were injecting incorrectly.
There were some discussions of steps taken to minimise the risk and harm associated with methamphetamine use. Using with others was an important safety measure, as people were worried about overdosing or having a psychotic episode. A few spoke of not sharing needles, or only sharing with a trusted partner as a step to reduce risks. Top of page
When prompted about specific risks, many felt getting into trouble with the law was a possibility, and this included being pulled over by the police, being searched and caught in possession of the drugs or equipment or chemicals used in the manufacture of the drugs. The few social users did not see this as a realistic possibility. Losing friends was identified as a realistic possibility, due to violence, aggression and theft, as was not being able to "get a job". A few had experienced these risks themselves, or had seen this happen with others that they knew.
"I realised once my family packed up and left, I hit rock bottom and came to terms with things and it made me realise that I had to get off them [drugs] otherwise I would lose them forever.”
"There's a meth user here that's so talented, more talented than most, but he's ripping me off, ripped his family off, no-one has any love or respect for him anymore."
The social users did not feel that this is a potential risk, although they acknowledged this could be in the future.
"It hasn't really affected my relationships with friends and family too much yet, though I can see the potential for me withdrawing from them."
However, stakeholders felt users may be aware of the risks but "don't care – they feel they are 10 feet tall and bullet proof".
"When you are living in poverty with nothing, and all you ever see is the negative side of town, you are looking for a quick fix. Unfortunately meth does it so well. For many meth isn't a negative experience – for most it's a positive experience." (Stakeholder)
This difference in response is likely to be due to the skewed nature of the sample towards those who had or were hoping to reduce their drug use, and therefore more likely to have experienced significant negative effects. The few who identified as social users were less likely to associate their drug use with the risks identified, suggesting that this group do not view these risks as relevant.
The main sources of information on harm minimisation are television programs and advertising, doctors and friends. However, the research indicates that seeing others' negative experience has a significant impact.
"You would be surprised at the number of people who use heroin that see people on the ice, and they do see the results of it, this makes a few realise that Meth is not for them, and they will come in and get on a program, especially if there is no heroin around." (AMS)
A stakeholder from Adelaide discussed the need for targeted programs for methamphetamine users as there was currently very limited information, and certainly no Indigenous-specific information. Top of page
13.5 TreatmentMost participants had reduced or were planning to reduce their drug use, or "at least have it under control". The steps to reduce use included staying away from other users, and making a pact with their partners. Most were also accessing substance misuse services including assessment and referrals to detox programs and rehabilitation, residential rehabilitation, and relapse prevention programs. Knowledge of services comes from family, friends, and doctors. There was a high level of awareness of needle exchange programs, and the understanding of the importance of using use clean needles came from family, friends, television, and doctors.
The primary motivators for seeking treatment are to "keep out of jail", "keep their children", and because of a genuine desire to make positive changes in their life. A few had children and did not want their children to know of their drug use, or to become involved with drugs themselves. While about half had tried residential rehabilitation in the past, and had found it beneficial, all had relapsed. One person had stopped cold turkey, and had gone away to stay with family when they stopped. Several felt concerned that their use may increase despite their desire to reduce their frequency of use, and this was due to the ready availability of the drugs, being around others who also use, and the difficulty in being able to refuse an offer to use. As one participant stated, "the temptation is always present". Other motivators for reducing drug use were age, wanting a family, or losing their family. The older participants appeared to be more determined to cease drug use. It appears that ideas on treatment are influenced by what is known to work for others in similar situations to the drug user.
However, stakeholders challenged this with regards to accessing treatment services, suggesting that for most users' detoxification happens in response to incarceration:
"It has been my experience that the detoxification/ rehabilitation that the users get are prisons!" (AMS)
There were strong concerns among stakeholders that methamphetamine users often fall through the cracks in terms of accessing emergency at hospitals, being referred to mental health services and being sent to corrective services, with limited access to appropriate services and rehabilitation. Prison was also identified as potentially leading to unsafe practices with regards to sharing needles.
"People are flicked from drug and alcohol services to mental health services, and often end in the justice system. In the justice system there are unsafe IV practices. People take these drugs and unsafe practices of usage back to communities." (Stakeholder)
Barriers to accessing treatment services focused on the rules and lack of freedom that these services offer.
"I don't want to have to follow their rules."
"I feel the program is judging me, as in preaching." Top of page
Others acknowledged the psychological addiction:
"You have got to deal with the needle in your head, the psychological addiction, the feel of the steel."
Redfern provided an example of a community response to methamphetamine use. Users said that it had been decided within the community several years ago that ice was not allowed, and that when people use they have to go elsewhere, based on the increase in the levels of violence as a result of this drug use. The participants said that they cannot buy or use methamphetamines in the Block, and that using ice was really frowned upon.
These participants also said that people in the community will "growl" at you if you are using in the community, and based on the discussions this appeared to be a significant deterrent.
"I reduced my use because friends and family would growl at you. They'll tell you what you've done. It's everybody's business here."
"On the block they don't allow it. It was too devastating when it hit here, everyone was fighting each other, so consensus was that it wouldn't be allowed here. When I get on it, I go and score at Waterloo and have it there."
These participants felt that ice was on the bottom of the ladder in the drug hierarchy, and therefore there was no tolerance of this drug in the community.
"Alcohol is at the top, it's acceptable. Then gunga, then heroin, then speed, pill poppers and ice is really down on the bottom, because people don't know what they're doing, have no respect for themselves and other people. They go crazy." Top of page
13.6 Information, treatment and supportWhile the research is unclear with regards to the prevalence of methamphetamine use in Indigenous communities, especially remote and regional communities, it is clear that it is an issue of increasing significance. The users that participated in the research recommended television advertising as an effective method for delivering harm minimisation messages, with many recalling the advertising that demonstrates the effects of psychosis from methamphetamine use. Stakeholders felt that this is a critical message, as it is the one risk that can have a very significant impact, and potentially change the quality of life of the user forever, as it can often trigger mental illnesses like schizophrenia.
"It's like Russian roulette. It (a psychotic episode) affects 1 in 10. This is the message that needs to be promoted." (Stakeholder)
Stakeholders were also focused on prevention, and suggested that diversionary programs for young people are needed.
One stakeholder in particular felt that training for hospital and drug and alcohol services was needed in order to educate staff about methamphetamines and to assist in breaking down the stigma attached to users. It was felt that this would encourage more users to seek help. If possible, combating the impact of peer pressure on encouraging drug use should be a major focus, as positive recommendations from friends and family were important in every case when ice or speed was tried for the first time.
Redfern also highlighted an example of where the community can potentially address drug use, and it will be important to encourage a collaborative approach with communities so that the community owns the decision to limit the impact of drugs in the community. For other substance use issues, such as petrol sniffing in central Australia, empowering communities to address substance use can be very powerful and effective.
"They need pretty solid collaborative approaches and consultative approaches with key communities and workers in the sector – grass roots. Somehow they need to form some relationships where communities can take ownership of the problem and have input into the solution." (Stakeholder)
A few participants also recommended the use of role models when delivering messages about the harm associated with methamphetamine use, especially using people who have overcome their addiction in delivering messages about harm minimisation and risks. Given that awareness of the risks and harm associated with drug use tended to be based on their personal experiences, or those of others around them, this suggests that seeing the experience of other users that they can relate to may be effective. This approach will also need to account for the diversity within Indigenous communities in terms of age, lifestyle, and location (remote, regional and urban).