1. An information session about Methamphetamine A presentation by Darren Hayden – WorkCover NSW “A new Ice Age?” An information session about Methamphetamine A presentation by Darren Hayden – WorkCover NSW

2. - “The hazards associated with the effects of substances of abuse on clients of emergency service workers, (including crisis care workers), and employees of the Accident and Emergency departments of healthcare facilities.” Focus - “The hazards associated with the effects of substances of abuse on clients of emergency service workers, (including crisis care workers), and employees of the Accident and Emergency departments of healthcare facilities.”

3. Consider this comment – Consider this comment – New South Wales Police Commissioner Ken Moroney was quoted by The Australian as saying, "I don't know in all the time I've been a policeman, which is 41 years, of a greater scourge on the community. The physical and mental manifestations of this drug are absolutely horrific. It has the potential to destroy generations".

4. What is “Ice”? Crystal Methamphetamine Hydrochloride is an extremely addictive synthetic central nervous system stimulant that affects certain parts of the brain. Crystal Methamphetamine Hydrochloride is an extremely addictive synthetic central nervous system stimulant that affects certain parts of the brain. “Ice” is a street name for crystal methamphetamine hydrochloride. Ice is more potent than other forms of amphetamines. It is more pure that the powder form of methamphetamines (“speed”).

5. Ice often appears as large, transparent and “sheet-like” crystals that may have a hint of pink, blue, green, or even brown coloration, all depending on the method used to "cook“ (manufacture) it.

7. How is it made ? Anhydrous nitrate Anhydrous nitrate Ephedrine Ephedrine Red Phosphorous Red Phosphorous Lithium Lithium Antifreeze Antifreeze Lantern fuel Lantern fuel

8. How is “Ice” taken Ice is known to be smoked, swallowed, snorted, injected or inserted anally (“shafting”). Some people smoke ice using a glass pipe, while others heat it on aluminium foil and inhale the vapours (“chasing”). Glass Ice pipe and drugs.

9. Methods of use

10. “Ice” use in Australia In 2004, 3.2 per cent of Australians aged 14 years and older had used amphetamines for non-medical purposes in the previous year. Over 38 per cent of this group reported the type of amphetamine they used was ice. Australian Institute of Health and Welfare (AIHW) 2005, 2004 National Drug Strategy Household Survey: Detailed findings,Canberra: AIHW Ice use among injecting drug users increased from 15 per cent in 2000 to 52 per cent in 2004. National Drug and Alcohol Research Centre (NDARC) 2005 Australian Drug Trends 2004: Findings from the Illicit Drug Reporting System, Sydney: NDARC In 2004, 63 per cent of a sample of people who used ecstasy had tried ice at least once and 45 per cent had used ice in the past 6 months. NCDARC 2005 Australian Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drug Initiative, Sydney: NDARC

11. Closer to home…… In NSW there are currently approx 37000 regular users with 28000 dependent on it

12. Stages of ICE use Rush ( 20 – 40 minutes) Rush ( 20 – 40 minutes) High ( 3 days ) High ( 3 days ) Binge Binge Crash Crash

13. What are the effects of “Ice” "dopamine" is released when we experience happiness "dopamine" is released when we experience happiness abnormal amount of dopamine is released in the brain, causing intense euphoria abnormal amount of dopamine is released in the brain, causing intense euphoria brain gets use to the chemical reaction, creating the need for the user to ingest meth more often and with a higher dose brain gets use to the chemical reaction, creating the need for the user to ingest meth more often and with a higher dose United Nations recently named meth-amphetamine as the world's most addictive illicit drug. United Nations recently named meth-amphetamine as the world's most addictive illicit drug.

14. Dilated pupil - stimulant intoxication

15. after taking ice, a person may experience: feelings of euphoria, excitement and well being increased alertness, confidence, libido, more energy, feelings of increased strength, talkativeness, restlessness, repeating simple acts, itching, picking and scratching tremors of the hands and fingers speeding up of bodily functions, such as increased breathing rate, body temperature, blood pressure, a rapid and irregular heartbeat and excessive sweating difficulty sleeping, reduced appetite, dilated pupils, dry mouth, stomach cramps, nausea, dizziness, blurred vision and severe headaches

16. abrupt shifts in thought and speech, nervousness, panic attacks, anxiety, paranoia irritability, aggression, hostility and “amphetamine psychosis”, including hallucinations, paranoid delusions and bizarre behaviour. The variable purity of each batch of ice increases the risk of negative effects and overdose.

17. ICE : not a great injection drug

18. The human face of “Ice” addiction

19. A common side effect of ice use is the sensation of bugs or insects crawling under the skin of the user. (“formication”). Many users will pick and scratch at these bugs causing “bug sores” typical to an ice user/addict. A common side effect of ice use is the sensation of bugs or insects crawling under the skin of the user. (“formication”). Many users will pick and scratch at these bugs causing “bug sores” typical to an ice user/addict.

20. Meth needle marks

21. Coming down… a person may experience symptoms such as tension, depression, radical mood swings, uncontrollable violence and exhaustion.

22. Long Term Use Long-term use of ice can result in: high blood pressure and increased risk of heart related complications such as heart attack and heart failure malnutrition and rapid weight loss due to reduced appetite chronic sleeping problems reduced immunity and increased susceptibility to infections due to the person not sleeping or eating properly depression, anxiety, tension and paranoia

23. brain damage (there is some evidence that amphetamines may damage brain cells resulting in reduced memory function and other impairments in thinking) dental problems (from grinding teeth) smoking ice can damage the lungs snorting ice can damage the lining of the nose injecting ice can lead to scarring, abscesses and vein damage. Sharing injecting equipment increases the risk of contracting blood-borne viruses, such as hepatitis B and C, and HIV. “Meth mouth” tooth damage

24. Personality/Physical changes of regular ice users/addicts Loss of weight Loss of weight Withdrawal from activities Withdrawal from activities Scabs on skin (from excessive scratching) Scabs on skin (from excessive scratching) Rotting teeth Rotting teeth Strong chemical body odor Strong chemical body odor Unusual obsessive/repetitive behavior Unusual obsessive/repetitive behavior Aggressive behavior Aggressive behavior Uncontrolled, often violent emotional outbursts Uncontrolled, often violent emotional outbursts Paranoia/Delusions Paranoia/Delusions Full-blown toxic psychosis Full-blown toxic psychosis

25. Withdrawal Some of the symptoms may include: disorientation hunger extreme fatigue and exhaustion decreased energy, apathy and the limited ability to experience pleasure anxiety, irritability and depression craving ice.

26. Lisa Burns, Coordinator of Newtown Neighbourhood Centre states: Dramatic increase in use of “Ice” among clients of the centre Dramatic increase in use of “Ice” among clients of the centre Increase in drug related Increase in drug related crime ie: Break and Enter crime ie: Break and Enter Increase in Homelessness Increase in Homelessness Decline in behaviour (client attitude, edginess and propensity for aggression) Decline in behaviour (client attitude, edginess and propensity for aggression)

27. Increase in reported CRV incidents from 2/Year to 1/Week in last eight months Increase in reported CRV incidents from 2/Year to 1/Week in last eight months Increase in Workers Compensation Claims Increase in Workers Compensation Claims Lack of referral places (where to send Lack of referral places (where to send clients for treatment) clients for treatment) Lack of resources (counsellors all booked up) Lack of resources (counsellors all booked up)

28. Health Care Workers. Mr Beaver Hudson - Mental Health & Psychiatric Unit - St Vincent’s Accident & Emergency Department states: Increase in last two years Increase in last two years of “Ice” induced symptoms of “Ice” induced symptoms Paranoia: belief that staff are going to kill them (fighting for life, pleading with staff) Paranoia: belief that staff are going to kill them (fighting for life, pleading with staff)

29. Treatment Pharmacology oral medication - mechanical/physical restraints Pharmacology oral medication - mechanical/physical restraints “Ice Block.” Behavioural Assessment Room (contain behaviour & noise, & provides privacy & confidentiality for client) “Ice Block.” Behavioural Assessment Room (contain behaviour & noise, & provides privacy & confidentiality for client)Policies/Procedures Policies to deal with clients Policies to deal with clients behaviour (No tolerance, risk assess) behaviour (No tolerance, risk assess) Security staff essential to managing & restraining clients Security staff essential to managing & restraining clients Understanding behaviour/pattern of behaviour. De-escalation. Understanding behaviour/pattern of behaviour. De-escalation.

30. Team structures and one point of contact for client communication. Team structures and one point of contact for client communication. Introduction of training specific to managing affected clients Introduction of training specific to managing affected clients Staff debriefing on incidences. Staff debriefing on incidences. Different people have different reactions to situation. Support services. Different people have different reactions to situation. Support services.

32. What’s the story: Statewide Amphetamine, Ecstasy and Cocaine: A Prevention and Treatment Plan Amphetamine, Ecstasy and Cocaine: A Prevention and Treatment Plan New clinics at St Vincent’s Hospital and Royal Newcastle Centre New clinics at St Vincent’s Hospital and Royal Newcastle Centre Adoption of principles from National illicit Drug Strategy Adoption of principles from National illicit Drug Strategy Development of treatment plans, clinical guidelines and specialist training for Area Health Service Staff Development of treatment plans, clinical guidelines and specialist training for Area Health Service Staff Taskforce to combat use of illicit drugs by long distance drivers Taskforce to combat use of illicit drugs by long distance drivers

33. What’s been done about it?- Federally/Internationally National illicit Drug Strategy National illicit Drug Strategy Family, Parenting, School, Tertiary, Peer, Workplace education schemes and Workplace developing and Training to be rolled out to the states. Family, Parenting, School, Tertiary, Peer, Workplace education schemes and Workplace developing and Training to be rolled out to the states. Community mobilisation and social marketing campaigns Community mobilisation and social marketing campaigns Cooperation with other countries to control precursors: pseudoephedrine Cooperation with other countries to control precursors: pseudoephedrine

34. How can we help? Education/advisory campaigns Education/advisory campaigns Seminars/training Seminars/training Audits Audits Building of stakeholder relationships (Police, local councils, hospitals) Building of stakeholder relationships (Police, local councils, hospitals) Liaising with states/territories to develop strategies and programs. Liaising with states/territories to develop strategies and programs.

35. End of Presentation – Thank you Any questions? Any questions? Resources/Further Information available at - National Drug & Alcohol Research Centre (NDARC) at the University of NSW – http://ndarc.med.unsw.edu.au/ National Drug & Alcohol Research Centre (NDARC) at the University of NSW – http://ndarc.med.unsw.edu.au/ National Illicit Drug Strategy - http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-pubhlth- strateg-drugs-illicit-index.htm National Illicit Drug Strategy - http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-pubhlth- strateg-drugs-illicit-index.htm Australasian Amphetamine Conference - http://www.amphetamines.org.au/index.htm Australasian Amphetamine Conference - http://www.amphetamines.org.au/index.htm