Monday, 15 June 2015

SPHPM research seeks to provide evidence-based recommendations to improve the health and wellbeing of methamphetamine users

Methamphetamine is an illicit synthetic psychostimulant which exists in three main forms in Australia – crystal (‘ice’), powder/pills (‘speed’) and paste (‘base’). Methamphetamine use is associated with a range of harmful physical and psychological effects. Media coverage is widespread but generally alarmist. Cross-sectional population survey data does not reveal an increase in the percentage of the Australian population reporting recent use of any methamphetamine – the figure has remained relatively stable at 2.1% since 2007 according to the Australian Institute of Health and Welfare (AIHW).

However, there have been significant increases in harms; in Victoria, methamphetamine-related arrests and ambulance attendances have increased (Lloyd 2014). At least part of the puzzle is explained by changes in the methamphetamine market and consumer behaviours. The purity-adjusted price of speed and ice has decreased dramatically since 2009, meaning that people obtain dramatically more drug for the same purchase price (Scott et al, 2015). Further, since 2010 there has been an increase in the proportion of people who use methamphetamine reporting ice as their preferred/most used form (corresponding with a decline in speed use). This is problematic as ice is typically more potent than speed (however, speed potency has increased in recent years to be close to ice), more likely to induce dependence, and is associated with increased harms related to methamphetamine use (AIHW 2014 and National Drug & Alcohol Research Centre (NDARC) 2014).

SPHPM Medical Science Honours Student, Chloe Lanyon, is undertaking a unique study for her honours research that will explore the impact of methamphetamine use in Melbourne. This study, titled Five-year changes in methamphetamine use, dependence and remission in a community-recruited cohort, is a continuation of the first longitudinal study of a community-recruited (i.e. non-treatment) cohort of people who use methamphetamine in Australia.

Ms Lanyon’s research draws on a community-recruited cohort (the ‘UnMET’ Study) of 255 regular, Melbourne-based people who used methamphetamine regularly when recruited in 2010. The study will map the ‘natural’ course of methamphetamine and other drug use over a five-year period (2010-2015) in this group.

Participants were administered structured face-to-face questionnaires at baseline (2010) and at 12-month follow-up (2011). Information collected included participant socio-demographics; methamphetamine and other drug use patterns; experience of methamphetamine-related harms; participation in risk behaviors; mental and physical health; engagement with drug treatment (including barriers to treatment access); personal methods of ceasing/reducing methamphetamine use; and, contact with the criminal justice system.

In 2015, Ms Lanyon’s research involves administering a 15-20 minute structured, computer-assisted follow-up survey to participants via phone. She will analyse data to examine associations between participant characteristics and methamphetamine dependence, remission from dependence, past-year and past-month abstinence and how these vary over time.

The research is poignantly timed; public dialogue on the topic continues and stakeholders seek appropriate initiatives to address this important public health issue. According to the United Nations Office on Drugs and Crime (2014), Oceania has the highest estimated population prevalence of methamphetamine use of all regions with available data, with this prevalence driven primarily by Australia and New Zealand.

Through her research, Ms Lanyon aims to investigate long-term outcomes of methamphetamine use among the established cohort; for example what are the characteristics of methamphetamine users who are more likely to remit from methamphetamine use or to progress/relapse to dependent and harmful use patterns? As well, she aims to map drug treatment pathways among the UnMET sample; for example, what are the characteristics of people who do and don’t access drug treatment for methamphetamine use, and what types of barriers prevent treatment utilisation?

Ms Lanyon hopes her research will provide the basis for the development of evidence-based recommendations to improve the health and wellbeing of affected Australians, including methods of improving engagement and retention of people who use methamphetamine in specialised drug treatment and other health services.

“Research tells us the majority of people who use methamphetamine are not in contact with specialised drug treatment providers. There is a lack of data internationally on this ‘natural’ history of methamphetamine use; a knowledge gap that my research can fill.

“The data may be used to determine which groups of people are most at risk, and to identify appropriate time-points in the methamphetamine use cycle to intervene, preventing the transition to more harmful use patterns,” Ms Lanyon said.

The project approved by the Monash University Human Research Ethics Committee (MUHREC) and it is anticipated that surveys will be completed by the end of July, with statistical analysis, preparation of Ms Lanyon’s thesis and academic paper for publication to be completed subsequently.

Ms Lanyon would like to thank the UnMET study participants for their invaluable contribution to this research; her honours year supervisors Prof Paul Dietze, Dr Brendan Quinn, Ms Dhanya Malandkar and Dr Peter Higgs; Burnet Institute research staff who contributed to the early and current stages of the UnMET study (special mention to Cerissa Papanastasiou); the Burnet Institute; the School of Public Health and Preventative Medicine; Monash University; and Curtin University, for provision of the funding that has made this study possible.  

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