Download Footprints across the Territory

Remote Alcohol & Other Drugs
Workforce Program
Yarning about Ice:
Methamphetamines in the NT
Footprints across the Territory
1
Workforce History



NT
In 2006 funding through the Council of Australian
Government was provided to establish a Remote Alcohol
and Other Drugs (AOD) Workforce to deliver services
within remote communities.
Funding is provided to both
 Department of Health
 Aboriginal Medical Services
Central Program Support Unit is funded to provide
service to both DoH and AMSs
Footprints across the Territory
2
Remote AOD Workforce Program
NT
Program
Support
Worker
Health
Centre
Support
Footprints across the Territory
3
Remote AOD Workforce Program
Footprints across the Territory
4
Remote AOD Workforce Program
Footprints across the Territory
5
Program Objective

NT
To develop and implement a Remote AOD
Workforce which is:





based within a primary health care service
providing a service to people that currently have
limited access to AOD services
culturally appropriate
evidence based
sustainable
Footprints across the Territory
6
Program Area
 20+ communities across NT
 Central Australia
 Barkly
 Top End
Footprints across the Territory
7
Remote AOD Workforce
NT
Funded positions for 2014/2015

Department of Health Centres
 Borroloola
 Nauiyu (Daly River)
 Gunbalanya (Oenpelli)
 Jabiru
 Umbakumba
 Angurugu
 Elliott
 Ali Curung
 Titjikala

Aputula
Footprints across the Territory
8
Remote AOD Workforce

NT
Aboriginal Medical Services
 Danila Dilba
Darwin
 Katherine West Health Board
Katherine West
 Miwatj Health
Nhulunbuy (Gove)
 Wurli Wurlinjang
Katherine
 Anyinginyi
Tennant Creek
 Central Australian Aboriginal Congress
Ltyentye Aperte (Santa Teresa)
 Western Arrernte Health Aboriginal Corporation
Ntaria (Hermannsburg)
Footprints across the Territory
9
Program Support Unit







-
General Manager- Jenn Frendin
Clinical Supervisor- Lauren Buckley
Clinical Mentor- Andrew Scholz
Training & Education Officer- Tony Hand
Business & HR Senior Project Officer- Denise Durston
Workforce Development Officer- Jess Thompson
Administration Officer- Arun Jayachandran
Phone support
Training & education
Clinical supervision
Workforce coordination
Footprints across the Territory
10
Meth, Ice, Speed- what’s the difference?




Speed, base, crystal meth= all methamphetamines
Ice – purest form
Amphetamine (Speed), Methamphetamine (Ice) , 3,4methylenedioxymethamphetamine (Ecstasy or MDMA) are all
psychostimulants and share a common parent chemical which
can be created into slightly different drugs and forms such as
base (waxy or oily), powder and crystals.
Methamphetamine and Amphetamine have similar actions in
the body but Meth more easily crosses the brain and has
stronger effects and targets dopamine more than MDMA
Footprints across the Territory
11
Common meth-conceptions: what
do you ‘know’ about ice?






Media hype
Images of picking & sores
Addictive after 1 dose
Meth Mouth
All users are violent and psychotic
Stereotype of ill kempt, thin, snappy, schizo
Footprints across the Territory
12
Why an ice media epidemic?






Price decrease
Increase in purity
Increase in availability
2% of population using ice- half of what it was
in 1998
Episodes of care increased 1-3%
Ice users using more frequently
Footprints across the Territory
13
Ice in Remote NT




Ice use is apparent in urban and regional
centres in NT
Anecdotal and spasmodic use in Aboriginal
Communities
Limited data
People that use ice are reluctant to access
health care
Footprints across the Territory
14
What does the ‘average’ ice user
look like?







Age 28 years
Caucasian male, FTE, young professional, tradesmen, mines
70% use less than once p/month
30% regular uses- once p/month or more
70%- not dependent, young, working, swallowing/snorting,
mild MH, sleep problems
30%- dependent, smoking/injecting, MH issues, sleep &
nutrition issues, risky activities
Tipping point for dependence- more than once per week or
more
Footprints across the Territory
15
Who’s at risk?






More than weekly use- regular/dependent
More than monthly- harms increasing
Indigenous
Female
Youth
IV users
Footprints across the Territory
16
Ice: the good & not so good
The Good
 Can enhance energy and
feelings of well-being
 It can create a euphoric
high and sense of
confidence
 It can, in smaller doses
increase focus, reaction
time and attention and
visuospatial processing
The not so Good
 It is a powerful and highly
reinforcing drug
 Increasing use increases
harms associated with it
 Regular use associated
with anxiety, depression
and psychosis
 Ice use associated with a
range of risk taking
behaviours
Footprints across the Territory
17
Ice and the Brain



Methamphetamines activate the mesolimbic
dopamine system and creates a central role
in dependence
Methamphetamines increases the release of
dopamine and a decrease the reuptake in the
nucleus accumbens
Repeated exposure to methamphetamines
causes neuroadaptation and desensitisation
and dysregulation of the dopaminergic
reward system
Footprints across the Territory
18
Ice and the Brain




Releases huge amounts of dopamine & wears out that
system to nil or small amount
Dopamine needed for frontal lobe (decision making) &
limbic system (emotional regulation) to talk to each other
Problems with impulse control, mood, memory, emotion,
planning, decision-making
Trouble getting to appointments, completing tasks,
retaining & learning new info, goal setting, outbursts,
switching topics
Footprints across the Territory
19
Ice and Mental Health






Acts on D2R (dopamine receptors)
D2R significantly depleted for meth users
High impulsivity, immediate gratification, reward & risk
Two Australian studies found high levels of mental health
problems in ATS treatment entrants 40% met criteria for
depression (44% attributable to ATS)and 13% met
criteria for psychotic disorder.
Treatment and monitoring of depression is important, it is
effective and responds well, untreated depression is
associated with poorer treatment outcomes.
Polydrug use
Footprints across the Territory
20
Ice and Mental Health

Users tend to have lifetime hx depression &
anxiety and suicidal ideation and attempts
Psychosis- emotionally labile, hostile,
hallucinations, withdrawn, delusions
Violence- high rate of pre-existing conduct
disorders
DV in family previously or currently
High levels of trauma in users

First problem use has first MH symptoms




Footprints across the Territory
21
Ice and Mental Health

Many ATS user experience psychotic symptoms that are
mild (visual illusions, short lived hallucinations and odd
thoughts) but these worsen to auditory, visual and tactile
hallucinations, delusions of jealousy, persecutions

Psychosis can develop in some users very soon after
use and can persist for months

Brief interventions and motivational interviewing can be
quite effective when diagnosed quickly but are less
effective as use becomes more severe with dependence
Footprints across the Territory
22
Adverse health effects







Insomnia
Mood and anxiety disorders (which came
first?)
Weight loss & under nutrition
Cognitive deficits- trouble thinking and
making decisions
Psychosis / violence
Sexual risk behaviour
Route of administration issues
Footprints across the Territory
23
Managing Ice Intoxication







Use of BZD / olanzapine wafer for psychosis
No medicare approved treatment
Aggression minimisation
Slow light, do not touch patient if possible
No sudden movements
Speak in low calm voice
Broken record technique
Footprints across the Territory
24
Acute toxic effects





Can occur irrespective of dose, frequency of
use, route of administration, small amounts
Excited delirium, chest pain, tremors, heart
rate, breathing, seizures
Extreme anxiety, panic, paranoia,
hallucinations
OD can cause fatal cardiac arrest or stroke
Can lead to increased aggression & agitation
Footprints across the Territory
25
Withdrawal





Crash 1-3 days
Acute 7-10 days
Subacute 2 weeks + cravings, sleep
disturbances
Protracted withdrawal 18 months- 3 years
Depression
Footprints across the Territory
26
Post-withdrawal care






Exercise
Health screening- STI, HIV, BBV
Mental health screening K10, DASS21, SDS
Ice users feel worse 6 months into withdrawal
than as users- how do we help prevent
relapse?
Medication for depression?
Follow up ++
Footprints across the Territory
27
Effective responses







Cognitive function related to treatment success
Poor verbal memory, need visual cues
Slowed processing speed
Executive functions- disinhibited, inability to
avoid distraction, impulsive
3-4 sessions BI & MI
Holistic approach- sleep hygiene, diet, exercise,
mental health, cues & triggers
Outreach support, appointment follow ups, visual
cues, keep goals and tasks simple
Footprints across the Territory
28
Strategies in Primary Care







Need to enhance primary care detection- reduce
time between 1st problem use and seeking help
Stigma with users- treatment seeking latemedia demonising use
Up to 10 year treatment delay
Try to engage pts earlier
More likely to seek Rx earlier- MH, IV
Less likely- women, FTE, pre-contemplative
Most users not having problems with meth use
Footprints across the Territory
29
Strategies in Primary Care








Yarning about Ice tool
Do AOD Hx
Management of intox
Slowing down, engagement of therapeutic
relationship
Deal with anxiety & frustration early in treatment
Outpatient rx works best
Harm reduction, signs of risky & dependent use
CVD no 1 killer of all substance users
Footprints across the Territory
30
Ice Treatment in Primary Care








Engaging and rapport building essential to ongoing care
AOD screening essential to identify ATS use but must be connected
to useful intervention.
Initial presentations often for mood and sleep issues but empathy
assists engagement and referral
Screening: ASSIST or Yarning about Ice tool. BI and MI and Harm
min. quite effective with less severe use.
Reducing the risk of progressing to more harmful routes IV.
Care can be provided in a stepped manner based on treatment
goals and outcomes.
Integrate into the consumer’s overall physical health/wellness focus.
CARPA: p 239-242 Amphetamines and other stimulants, mental
health emergency p 202-205, psychosis p 224-226.
Footprints across the Territory
31
Trauma Informed Care

-
-


Ice use prevalent in those with history of:
Domestic and family violence, sexual abuse
(prior and current)
Trauma background- anxiety+,
hypervigilance+
High order thinking decreased
Trauma & brain- cognitive functioning
decreased
Footprints across the Territory
32
Harm minimisation
For everybody – especially the 15 % of users, using more
often than once a month
 If possible, don’t inject at all, consider only swallowing
and snorting as less harmful than injecting or smoking
 Set a limit on the amount you will use in any one session
 Set a limit on the frequency of use. Harms increase
significantly when using more than once monthly
 Use a test dose from any new batch as purity varies
dramatically
 Have regular and lengthy breaks between episodes of
use
Footprints across the Territory
33
Harm minimisation






Learn about the signs and symptoms of overdose/toxicity
of methamphetamines
Know where the suitable and acceptable specialist
services are if needed
Have a prior plan you have discussed with a trusted
friend if you become unwell
Don’t engage in vigorous sport and work whilst using
methamphetamines
Avoid combining stimulants
Avoid drinking alcohol and other drugs when using
methamphetamines
Footprints across the Territory
34
Harm minimisation








Don’t use for more than 2 days in a row
Use own pipes/needles, syringes and equipment
If injecting, plan ahead and use the needle and syringe
exchange when they are open/accessible
Use with friends and look after each other
If you feel you are losing control of your
methamphetamine, take a break and seek help or have
a friend seek help before you are really unwell
Prepare for a binge- sleep well, eat well
Not using alone
Dose titration
Footprints across the Territory
35
Cultural Considerations





Ice use at dependent level is associated with increased
aggression/violence and is disruptive of family/social relationships
and protective cultural factors.
Ice use is an international problem and is throughout Australia, NZ
and all of Asia.
The euphoric and increased sense of power and confidence may be
more appealing to disempowered young men.
Ice use is associated with criminal behaviour and the effects of the
drug and the strong risk of dependence can drive crime related
behaviour to acquire the drug
If Ice use were to become endemic in remote communities, there
are less resources to minimise the harmful effects of risky
administration (IVD) and risky sexual behaviour.
Footprints across the Territory
36
Yarning about Relapse and Relapse
Prevention Guide
Footprints across the Territory
37
Yarning about Ice
Footprints across the Territory
38
Thank you
Remote AOD Workforce forum April 2014
Footprints across the Territory
39
Resources
For more (08) 8958 2503 or 0439 184 398
www.remoteaod.com.au
 DACAS 1800 111 092
 ADIS 24/7 1800 131 350
 NTCATT 1800 682 288

Footprints across the Territory
40