health 3 hours handout - home | 360edge
TRANSCRIPT
Responding to people affected by ice.
Workshops for frontline workers.
Funded by
What we know.
What is ice?
Prevalence
Effects of ice
Risks and harms
What to do.
Reducing harms
Talking to someone who is intoxicated
Managing agitation and aggression
Responding to psychosis
Responding to other mental health issues
Treatment options
Referral
What is ice.
‘Amphetamines’
Methamphetamine
‘Speed’
‘Base’
‘Ice’
Amphetamine Dexamphetamine Otherpharmaceu9cals…
There is an ice epidemic. “ Myth or Fact?
NDSHS, 2014
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2001 2004 2007 2010 2013 2016
12–17
18–24
25–34
35–44
45–54
55+
12+
20102013
2016
59
39
20
22
50 57
Weekly use. 2010 9.3% 2013 15.5%
No change in prevalence Switch to purer form
Frequency up Also purity up and price down
72.7
53.0
39.5
26.4
13.9
2.2
22.2
11.7
34.7
51.2
79.3
NDSHS, 2014
MethamphetamineusersGeneralpopula9on
Treatment presentations Hospital separations Ambulance call outs
ED presentations Drug induced deaths
Arrests
NMDS, 2013-14; Lloyd et al, 2015; Roxburgh & Burns, 2015
Methamphetamine is highly addictive.
“ Myth or Fact?
Harms. v
Use.
Irregular users < once a month
Occasional users
Once a month+
Regular users Once a week+ Daily users
NDSHS, 2014
All meth
Ice
Cannabis
Alcohol
70% 15% 15%
55% 20% 25%
55% 15% 20% 10%
35% 37% 6% 22%
You can get addicted after using once.
“ Myth or Fact?
Dependence. Adaptive state that develops
from repeated drug administration
Methamphetamine is the most dangerous of all
drugs.
“ Myth or Fact?
0 10 20 30 40 50 60 70 80
Amphetamine
Cannabis
Methamphetamine
Tobacco
Cocaine
Heroin
Alcohol
Harm caused by drugs 100=maximum
Harmtoothers Harmtousers #REF!
Source: “Drug harms in the UK” by David Nutt et al. The Lancet
Immediate effects of methamphetamine.
Mild intoxication Moderate intoxication
Toxicity
Euphoria and wellbeing Energy
Attention, alertness and memory Sex drive Appetite
Nervousness, anxiety, panic Agitation
Psychotic symptoms Jaw clenching, teeth grinding
Nausea, vomiting Headache
Hot and sweaty, racing pulse
Chest pain Aggressiveness Tremor, seizure
Severe headache Unsteady walking Difficulty breathing
Hot flushed sweaty skin Confusion, disorientation
Muscle rigidity, spasm, jerking Severe agitation, panic, psychosis
Methamphetamine gives you super human strength.
“ Myth or Fact?
Effects of long term use.
Heart, liver & kidney Teeth & skin
Sleeping problems Enduring mental health problems
Decreased motivation Weight loss, malnutrition
Poor concentration and memory
How methamphetamine works in the brain.
Fight or flight Energy Arousal
MOOD COGNITION
Appetite Wellbeing
Sleep Temperature
LEARNING FOCUS
Pleasure Reward
Attention Motivation
Reinforcement
Frontal lobe (prefrontal cortex) (thinking, planning, decision making)
Limbic system (memory, emotional and social processing)
Focus, attention and concentration Memory
Planning, decision making Emotion regulation, mood, impulse control
Flexible thinking Energy levels
Threat sensitivity
Getting to appointments Completing tasks
Following instructions Taking on new information
Thinking about consequences Goal setting and working towards goal
Stopping inappropriate behaviour Switching from one topic to another
Unexpected emotional outbursts
Recovery process.
Larger impairments than. Cocaine (20x) Marijuana (4x)
Alzheimers (6x)
Hester 2015
After 6 months abstinence cognition worse than current users.
No significant improvement after 9-12 months
Simon et al. 2004; Ludicello et al. 2010
Acute methamphetamine withdrawal
Protracted cognitive recovery
Acute alcohol/heroin withdrawal
Subacute withdrawal Cognitive recovery
Relapse.
0
20
40
60
80
100
120
3mo 1year 3years
Relapserates
ResiRehab
Controls
McKetin et al., 2012; Baker et al., 2005; Lubman et al 2014
87%
96%
59%
74%
“The most common outcome from treatment is relapse”
Witkiewitz, 2017
Easier to get off
than to stay off.
Post treatment period is crucial..
Risks and harms.
Psychological Depression, anxiety
Irritability, aggression Psychosis
Brain structure Loss of dopamine transporters Fewer dopamine receptors Loss of grey matter
Cognitive Poor attention
Poor working memory Poor executive function
Poor impulse control
Nutrition Weight loss
Under or malnutrition Under active immune response
Skin
Injury from picking at ‘meth bugs’
Infections BBVs STIs
Neurological Stroke Seizures
Teeth Gum disease Dental caries
Heart High blood pressure Fast or irregular pulse Heart attack
Kidneys Dehydration Renal failure
Dangerousmixes
An9depressants(withinsame2weeksoficeuse)
Alcohol
Opiates
Others9mulants
Reducing harms.
Drinkwater
Eatsomething
Don’tmixdrugs
Don’tshare
equipment
Carrycondoms
Getsomesleep
Gethelpifneeded
Responding to people who use ice.
Talking to someone who has taken ice.
Use calm even tones Be patient
Show concern Don’t be forceful, patronising or dismissive
Most people who use ice get aggressive.
“ Myth or Fact?
Dealing with agitation and aggression.
Ji_ery Irritated Agitated Angry Aggressive Violent
What would you do?
What are you most concerned about for the client, yourself, your service,
anyone else?
What do you feel most confident/least confident about?
Responding to psychosis.
Illusion Suspiciousness Paranoia Hallucina9ons Delusions
“I once thought Afghans were at my door. That scared the shit out of me. Kept thinking they're
gonna blow up my house (an apartment in Perth, Australia - what a target to choose)”
LiquidDelight on Bluelight
“I once heard a low distant rumble, and in the sky above what I knew was bushland there was an orange glow, so convinced there was a major
bushfire I made a friend drive me in that direction, only to find the glow was the lights of the city.. and
the rumbling.. umm yeah in my head!”
Popey’s Mate on Bluelight
State what you are concerned about Focus on immediate risks and harms
Short simple sentences Repeat
Reassure Fixed choice options
DON”T Touch or restrict movement
Judge content Dismiss or argue with delusions
Responding to other mental health issues.
17.8 19.9 19.9
29.7
17.6
20 21 24.7
First meth use First regular use First problem use First meth treatment
No MH treatment MH treatment
Lee et al., 2012
Treatment options for people who use ice.
There are no effective treatments for ice dependence. “
Myth or Fact?
Residen9alrehabilita9on
Dayrehabilita9on
Counselling
Briefinterven9on
Reduceharms
Highest success in treatment.
No specific pharmacotherapy Brief MI and CBT
Intensive CBT and CM ACT
Residential rehabilitation
Motivational interviewing Coping with cravings and lapses
Thoughts about using Relapse planning