Emergency Department Strain As Ice Problems Grows

The burden of crystalline methamphetamine ("ice" or "crystal") and other amphetamines on already stretched public hospital resources is significant and set to grow, emergency physicians and drug specialists have warned in the latest Medical Journal of Australia (MJA), prompting an urgent call to beef up health and social drug intervention services.

Two new studies have found that a significant number of patients are presenting to hospital emergency departments with ice- and other amphetamine-related conditions, including heart problems and psychosis.

Australian hospitals faced a more than fourfold increase in the number of episodes of druginduced psychosis over the 10 years to 2004, say Associate Professor Louisa Degenhardt and her colleagues at the National Drug and Alcohol Research Centre of the University of New South Wales.

The group studied national hospital separations for cannabis- and amphetamine-related psychotic episodes among patients aged between 10 and 49 years. They found the number of separations where drug-induced psychosis was noted by the treating doctor as being the primary problem increased from 55.5 per million population in 1993-94, to 253.1 per million population in 2003-04.

Despite recent media attention on the relationship between cannabis use and psychosis, they found relatively stable numbers of hospital separations for cannabis-induced psychosis over the five years from 1999 to 2004.

"In contrast, hospital separations for amphetamine-induced psychosis had increased, particularly among those aged 20 years and older," says Assoc Prof Degenhardt.

Hospitalisations for amphetamine users were highest among the older age groups. "(This) may be due to the higher rates of injecting and of crystalline methamphetamine use reported among these groups," she says.

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"Although concern about links between cannabis and psychotic symptoms is understandable, amphetamine use seems to have a higher risk of psychotic symptoms requiring hospital treatment and represents a risk for more users in all age groups." Registrar in Emergency Medicine at Royal Perth Hospital (RPH), Dr Suzanne Gray, and colleagues studied all amphetamine-related presentations to RPH's emergency department (ED) over a three-month period in 2005.

They found that 1.2 per cent of all ED presentations were related to amphetamine use, including the drugs known as ice, ecstasy, and speed. Serious amphetamine-related presentations resulted in prolonged length of stay in the ED and consumed considerable resources.

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"A third of patients required sedation, which correlates with a high pre-hospital, nursing, medical and security load to manage these patients safely," says Dr Gray.

"Further contributing to the impact are the high rates of repeat attendance and the large proportion of patients with underlying psychiatric illness and a history of drug dependence.

"With increasing availability and use of amphetamines, the burden on emergency services will continue to grow."

About half of all patients admitted for amphetamine use were aged between 20 and 29 years, the majority of them single white men.

Amphetamine use is associated with violence, antisocial behaviour and risk-taking, Dr Gray and colleagues said - 20 per cent of all amphetamine-related presentations to the RPH ED involved the police at some stage.

"Also of great concern is emerging evidence of serious long-term effects, including depression, anxiety, psychosis and memory disturbance," she says. In an accompanying editorial, Dr Gordian Fulde and Dr Alex Wodak of St Vincent's Hospital, Sydney, support the view that amphetamine-related presentations are a great burden on the health care system and believe there is a pressing need to increase health and social resources to cope with the growing problem of amphetamine use.

"Although we should be wary of predictions that illicit drug problems are destined to deteriorate inexorably and indefinitely, it is likely that amphetamine-related problems will continue to worsen in Australia for some time," say Dr Fulde and Dr Wodak.

"The evidence for effectiveness and cost-effectiveness of health interventions for illicit drug use is far more impressive than the evidence for drug law enforcement.

"It is time that Australia regarded illicit drugs in general, and methamphetamine in particular, as primarily a matter for health and social interventions, although drug law enforcement should continue to play an important role."

The articles can be found in full at www.mja.com.au The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated. CONTACT: Professor Louisa Degenhardt 02 9385 0230 Dr Suzanne Gray 0408 445 574 Dr Gordian Fulde 0419 718 328 Kylie Walker, AMA Public Affairs 02 6270 5471 / 0405 229 152

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