Suggestions for “Tackling” the “Ice Epidemic”

There are some small signs of hope in the creation of a National Ice Taskforce by Tony Abbott. For instance, recognition that a strict law enforcement approach is failing now suddenly permeates our discourse, and phrases like “options in both the health and education space,” are appearing in major newspapers. But it is hard to take this talk seriously when it is bundled with fear-mongering and blatant misinformation. When journalists and politicians talk of the drug as “instantly addictive,” they make it clear that they have no literacy whatever in the addiction science of the last few decades. One has to wonder how much stock, exactly, we’re willing to place in the “health and education” solutions put forth by people who are so thoroughly misinformed. For whatever it’s worth, let me correct a few misunderstandings, and based on an accurate, unbiased, and multidisciplinary appraisal of the drug, offer some real solutions.

First of all, if we want to ‘tackle root causes’, we need to begin by understanding addiction. The causes of addiction are primarily neurobiological, not pharmacological. It is not that the drug is “addictive” so much as that the user is inclined to addiction due to their underlying neurobiology. Drug-induced addiction, I’m sorry to say, is a dubious concept. If methamphetamine had a fixed addictive allure, identical in all individuals, it would follow that all people who use meth would become addicted. Or, accounting for some anomalous, addiction-immune individuals, at the very least most would become addicted. On the contrary, a National Survey on Drug Use and Health in the United States found, in 2011, that only 3 percent of people who had used the drug had done so in the previous month. Addiction scientist, Carl Hart, points out that even at the peak of America’s “crack epidemic”, only 10 to 20 percent of users became addicted. These rates are typical of every “addictive” substance in every Western society. I am unaware of any drug, anywhere, at any time, which has been demonstrated to cause addiction in greater than half of those who try it, and very rarely in more than a quarter.

The reason for this is obvious, if one is familiar with the science of addiction. Most people do not have the neurobiology underlying addiction, and to such people even methamphetamine is likely to be relatively benign. All of which raises the question: what does cause addiction, or the underlying neurobiology? And the answer is stress, isolation, and abuse. An overview of the literature on this subject is beyond the scope of this article, but has been extensively outlined in Dr Gabor Mate’s book In the Realm of Hungry Ghosts. So, if we’re to begin by tackling root causes, we are to begin by reducing stress, isolation, and abuse.

Some practical suggestions for reducing stress, isolation, and abuse, among methamphetamine users:

  1. Stop demonizing methamphetamine users.
  2. Stop expending vast sums of money enabling law enforcement to abuse methamphetamine users.
  3. Redirect that money into support services for people who have been abused.
  4. Allow legal access to pharmaceutical Desoxyn (oral methamphetamine) for addicts. (Buying meth is pretty stressful. Affording meth is pretty stressful.)
  5. While it may sound lofty, we might treat methamphetamine addicts as human beings deserving of love and community, rather than making them synonymous with the word “scourge”.

Aside from the “addictive potential,” much has been made of the aggressiveness of methamphetamine users. Keeping in mind that most people who use do not go on to become addicted, it is well worth pointing out that aggression is very likely the result of abuse, and therefore specific to the addict population – a minority of “users”. In appraising the extent of this problem, then, we should look at two statistics: the incidence of violence, and the size of the addict population. In 2012/2013 financial year, there were 3,218 methamphetamine-related assaults. In 2014, there were 75,000 addicts. That’s about 4.29 assaults for every hundred addicts. So we’re talking about an extreme minority within a minority. Nonetheless, it is a serious problem, and we need practical strategies for tackling it.

To begin with, we need to further our limited understanding of the causes of this violence. There is no evidence whatsoever to suggest that a person simply takes methamphetamine and becomes violent due to its immediate effects. This proposition is dubious on the face of it. Presently, the best theory we have (and it is a very sound theory) is that violence among methamphetamine addicts is a result of the interaction and synergy between (1) dopaminergic and serotonergic damage and resultant impairment of executive functions (including self-control), and (2) psychosis resulting from sleep deprivation. This suggests some practical solutions:

  1. Legal availability of antipsychotic medications such as olanzapine, which have been shown to be effective in reducing the symptoms of amphetamine-related psychosis, for methamphetamine users.
  2. Legal availability of benzodiazepines, both for their sedative effect and their capacity to induce sleep, and therefore ameliorate effects of sleep deprivation. In my work in the harm reduction community, I have advised several highly aggressive individuals suffering from amphetamine-related psychosis. The administration of a benzodiazepine has, in my observance, induced sleep and, in so doing, ended a psychotic episode. One milligram of Xanax; sleep achieved; psychosis ended; potential for violence quelled. Simple.
  3. Safe spaces for use. Methamphetamine can cause or exacerbate paranoia. As can a euphemistic “War” on your kind. In an atmosphere of hysteria and repression, engaging in a felony without a victim, methamphetamine users have a very real reason to be paranoid, which we can and should remove from the equation.

This is the kind of conversation which Ken Lay convincingly makes it sound like he’s promising. But while the Australian, a household name in this country’s journalism, goes on printing stories about “LSD overdoses,” referring to 25i-NBOMe as “synthetic LSD,” and passing along, uncorrected, Tony Abbott’s claim that both amphetamine and MDMA (which he naturally called “ecstasy”) are forms of methamphetamine, I retain very little hope of a productive national conversation.