IN FEAR OF THE ICE AGE

CHRIS Towie has worked as a GP for 20 years, but says he is now
considering retiring early from his Broadmeadows practice. The strain
of dealing with crystal meth addicts is too great, says Towie, 50.

"It's escalated enormously in the last 12 months. You would rarely
see a violent patient that is in a rage two years ago, now it's
common -- I would say I'm seeing about two a week. I've twice been
assaulted by heroin addicts in 20 years," he says.

But Towie says it is the female partners of male addicts who are most
likely to be abused. "Crystal meth makes people completely
unpredictable at times. They become quite severely paranoid, they
have feelings of persecution. They think they are all-powerful and
that you are trying to hurt them. In the withdrawal stage they become
severely depressed and often suicidal."

Methamphetamine is not new. It was first manufactured in Japan in
1919, 32 years after the related compound, amphetamine, was
synthesised in Germany. Amphetamines were distributed to German
troops during World War II, and methamphetamines were a commonly
prescribed drug in the US in the 1950s, used for conditions including
alcoholism, narcolepsy and obesity.

In recent times in Australia, crystal methamphetamine, a pure and
addictive form of methamphetamine also known as ice, has emerged as a
dangerous illicit drug. Yet when asked to describe the threat posed
by crystal meth, workers in the field provide two different pictures,
which on the surface appear contradictory.

The first picture -- one that is becoming more familiar -- is of a
crystal meth addict in the grip of psychosis or a violent rage. Hard
to control and dangerous, they are menacing police, GPs and hospital
emergency departments with their frightening and erratic behaviour.

The second picture doesn't deny the reality of the first, but takes a
more sanguine view of the overall threat posed by crystal
methamphetamine. Everyone agrees that the drug is dangerous,
habit-forming and unpredictable in its effects, but members of the
"don't panic" school of crystal methamphetamine researchers are, at
this stage at least, unwilling to be drawn into apocalyptic
predictions about the drug's impact on society. "Someone said it
would be the scourge of a generation, but I don't know about that,"
says Dr Jen Johnston, researcher at the Turning Point Drug and Alcohol Centre.

"It's a drug that is different to all the others," says Inspector
Steve James, director of the Victoria Police drug and alcohol
strategy unit. "It can end up in paranoia and extreme violence. Is it
an epidemic or a pandemic? No. But one case is one case too many."

This year the National Drug and Alcohol Research Centre tried to
estimate the number of dependent methamphetamine users in Australia.
The figure arrived at -- 73,000 -- was extrapolated from a range of
data including arrest statistics and admissions to hospital and for
drug treatment. The numbers are not a head count but a sophisticated
mathematical guess. They support the view that crystal meth poses a
serious threat. Most significantly, the research centre's work found
that the number of recorded hospital admissions for stimulant-related
psychosis had risen by 58 per cent since 1999.

These figures suggest there are now more people heavily using
methamphetamine than are heavily using heroin. They further suggest
that the number of people affected by the drug is comparable to those
affected by heroin during its peak in the late 1990s.

It was this data that this week prompted the head of the Australian
National Council on Drugs, former Coalition minister John Herron, to
describe crystal methamphetamine as "a huge problem". Dr Herron also
says he is alarmed by reports from the United Nations Office on Drugs
and Crime showing that the number of laboratories producing
methamphetamines in Asia is on the rise. But even more worrying than
the growth in Asian manufacture, he says, is the capacity for local
production: heroin has to be imported to Australia, but
methamphetamines are synthetic and can be made anywhere.

The council intends to outline policy options for the Federal
Government to tackle the problems posed by the drug. Herron will not
be drawn on what these options might be. One challenge in treating
crystal methamphetamine addiction is that there are, as yet, no
approved pharmacotherapies for the drug -- the equivalent of, say,
methadone, as treatment for a heroin habit -- although small trials
are under way.

Deb Homburg, the chief executive officer of Buoyancy, an agency that
provides counselling and therapy for drug users, says because
amphetamines and methamphetamines are synthetic drugs, they are
harder for the body to process than the plant-based opiates and more
toxic if used over an extended period. Users who wish to recover from
a destructive habit need time, nourishing food and a great deal of
rest. Heroin was the "tune-out, drop-out drug" says Homburg, "the
drug for the war in Vietnam". But amphetamines have an opposite
effect, although, like heroin they limit emotional range, which
appeals to users who wish to escape emotional pain.

In contrast to heroin, amphetamines lead to overstimulation -- as a
prescription drug they are used for overcoming tiredness and, when
used recreationally (ecstasy is one of the drugs in this category),
they allow users to feel powerful, energised and in control. ("It's
the drug for the war in Iraq. It's the drug for individual corporate
effort. It's the drug of our times," Homburg says.)

But use can lead to exhaustion and depletion, a logical consequence
from taking a substance that suppresses appetite and allows users to
forgo sleep. Recreational users are familiar with "suicide Tuesdays",
which can come after a weekend of prolonged partying and a Monday
spent sleeping it off. Homburg says it is common for users not to
realise that the black mood that can arise on Tuesday is also part of
the aftermath of amphetamine use: what goes up, must come down.

National Council on Drugs executive officer Gino Vumbacca says the
council has a responsibility to warn Australians about the evil posed
by crystal meth. On the other hand, Vumbacca reflects that terrible
warnings were also made about the impact crack cocaine might have in
Australia, but that scourge never eventuated. "The majority of people
who try drugs, when they have a bad experience, they shy away from
that. The number of people who will try an illicit drug is quite
high, but the number of people who use regularly is low."

Fitzroy's Turning Point Drug and Alcohol Centre has interviewed a
small sample of injecting drug users each year since 1997, while a
small sample of so-called "party-drug" users have also been
interviewed annually since 2003. Researcher Jen Johnston says: "We
ask them about their pattern of drug use, over a whole range of drugs
and other risk-taking behaviour such as their sexual behaviour,
drink-driving and sharing needles among injecting drug users."

The study has found the proportion of people using crystal
methamphetamine declined between 2003 and 2005, which, as Johnston
says, "is going against the idea of an epidemic". In the first year
of the study, two-thirds of the ecstasy users had recently tried
crystal methamphetamine but by the third year this had dropped to
less than half.

Johnston says she believes the incidence of crystal meth use is
lessening as people have become more aware of the harm the drug can
do. "People see the harmful effects in their friends, or they may
experience it themselves," she says. These effects are frightening
and so people, sensibly, stay away from crystal meth.

Her views are echoed by New York psychiatrist and epidemiologist
Ernest Drucker, who recently visited Melbourne and gave a talk on
global patterns of methamphetamine use. "I wouldn't call it an
epidemic," he says. "Epidemic is an overused word, and I am speaking
as an epidemiologist."

Drucker says in discussing a dangerous substance such as crystal
methamphetamine it is tempting to fall into what he calls
pharmacological determinism: the idea that the drug will control how
people use it rather than the other way around. "Crystal meth
deserves to be demonised to some extent," he says. "(But) most get
the hell scared out of them and don't come back to the drug. The ones
who can't find their way out are the ones we see."

Those people who are most at risk from the drug are those "who are
not well-embedded in a social culture", he says. "They are very
vulnerable. If you have kids, a job, an apartment", the chances are,
he believes, you will not be a victim of the drug.

The National Drug Strategy Household Survey also detected a decline
in amphetamine use (a category that includes methamphetamines)
between a peak in 1998 and its last survey in 2004. The overall
number of people aged 14 and over who had tried amphetamines in the
previous 12 months had fallen from 3.7 per cent in 1998 to 3.2 per
cent in 2004, a figure that includes a decline in use among males
aged 20 to 29, the age group most likely to use amphetamines.

Project manager at the Australian Institute for Health and Welfare,
which undertakes the survey, Mark Cooper-Stanbury, points out that
the data is two years old. It may well be that the next national
survey, which will be undertaken next year, will show a rise.

Paul Dillon, a spokesman for the National Drug and Alcohol Research
Centre, says drug use is cyclical: "Drugs come into favour and out of
favour." Historically, drugs have lessened in popularity when people
have seen or experienced, their negative effects.

"What's interesting about methamphetamine is that it is a unique drug
with unique qualities. It cuts across so many cultural groups, it
impacts on so many different areas of society. There are many
different people who use it for many different reasons. People use it
to stay awake, to give them energy, to lose weight ..."

It is a drug more likely to be used by the middle-class, he says
(ecstasy can be contaminated with methamphetamines and is a
middle-class drug) and it is this quality -- the idea that someone
you know might come under its influence, or has already -- that is
contributing to concern about the drug.

"It's like heroin in the mid '90s," he says. "That's when white
middle-class people started dying of it." And that's when the media
decided that heroin was a story.

Additional Reporting By Jill Stark