Editorials
Substance‐related disorders
Volume 195 - Issue 10

Heavy stimulant use remains a significant health concern for Australia

Authors:  Rebecca McKetin and Dan I Lubman

Med J Aust 2011; 195 (10): 565-566. || doi: 10.5694/mja11.11197
Published online: 21 November 2011
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Stimulants increase the risks of psychosis and stroke

Stimulant use disorders (rather than recreational use) account for most of the harms associated with illicit stimulant use, and are more likely to occur with frequent use and more efficient routes of administration (ie, injection and smoking rather than oral or intranasal use).1 A driving factor behind many of the problems associated with stimulant use in Australia is the long-standing history of methamphetamine injection.2 The majority of dependent methamphetamine users in Australia inject the drug and have been using for a decade or longer.1

In this issue of the Journal, Sara and colleagues highlight the substantial number of heavy stimulant users in Australia.3 They estimate that almost half the people who report taking stimulants on more than five occasions progress to problematic levels of use, meeting criteria for either misuse or dependence. This amounts to around 97 000 Australians in the past year. Such findings are a timely reminder that heavy stimulant use is an ongoing issue in Australia that cannot be ignored.

Heavy stimulant use is associated with a number of public health concerns, the most salient of which is stimulant-induced psychosis. As Sara and colleagues point out, stimulant use disorders are concentrated among young men, who are the population subgroup at highest risk for developing psychosis, and the least likely to seek professional help for a mental disorder.4 Stimulants also exacerbate existing psychotic disorders and, in this context, they hinder the efficacy of antipsychotic drugs and increase the risk of violent behaviour.5

Heavy users are not only at increased risk of contracting HIV and other blood-borne viruses from injecting stimulants, but they are also at elevated risk of sexually transmitted diseases (including HIV) because stimulants increase libido.6 This situation creates a nexus for the spread of HIV between drug users and the broader population. Stimulants can further increase the risk of HIV transmission through immunopathological processes.6 As such, HIV prevention efforts for stimulant users need to focus on both safe injecting and safe sex practices.

Stimulants increase the risk of cerebrovascular events,7 particularly young ischaemic stroke, as emphasised by Phillips and colleagues,8 also in this issue of the Journal. Stimulants increase the risk of stroke as a consequence of hypertension and other catecholamine-mediated vascular changes that occur during intoxication, while vascular abnormalities and cardiac pathology that occur with chronic use are also risk factors.7 Heavy tobacco and cannabis smoking, as well as the risk of infectious endocarditis as a result of intravenous use, compound the risk of cerebrovascular incidents in this population.

Such public health concerns highlight the importance of early detection and intervention efforts. However, illicit stimulant use increasingly spans a broad segment of the population, including people who are well educated, employed and whose life situation would not otherwise point toward drug use. This “mainstreaming” of stimulant use, coupled with the community’s reluctance to disclose illegal drug consumption, can make stimulant use difficult to detect.

Given that stimulant users commonly seek help from general practitioners for a range of health issues, offering a safe environment to talk about drugs, where confidentiality is assured and patients do not feel judged, is a critical first step in identifying harmful use. This can be done in a non-confronting way by discussing how stimulant use (both legal and illicit) might be a factor in the aetiology of certain conditions (eg, sleep problems, mood disturbances, hypertension), and whether such use is contraindicated for prescribed medications. Being proactive in this way, at the very least, imparts knowledge with which patients can self-manage their health.

Once detected, it is important to appreciate that stimulant use disorders do not occur in isolation; they tend to co-occur with heavy use of cannabis, alcohol and tobacco, as well as with other mental disorders. Stimulant use can increase heavy drinking because it negates the sedating effects of alcohol intoxication. Cannabis and sedative drugs are often taken as a means of coping with the “come-down”, or after effects, of stimulant intoxication. Stimulants can also increase the risk of toxicity from medications prescribed to manage symptoms of depression that are almost ubiquitous among heavy stimulant users.9

The potential involvement of heavy stimulant use in physical and psychiatric problems seen within medical health care settings needs to be considered. Patients who desire treatment for stimulant use can be referred to generic drug and alcohol services (eg, counselling and residential rehabilitation), and specialised treatment programs have been established in some locations (eg, NSW Health’s stimulant treatment clinics10). There is little available in terms of evidence-based treatments. Intensive psychological interventions (eg, tailored cognitive behaviour therapy, contingency management) have shown some promise,6 although these interventions have not been widely implemented. More work is needed to develop and implement effective treatment options for heavy users of stimulants.

Authors

  • Rebecca McKetin BSc(Psychol)(Hons), PhD1
  • Dan I Lubman PhD, FRANZCP, FAChAM2
  • 1. Centre for Mental Health Research, Australian National University, Canberra, ACT.
  • 2. Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, VIC.

Correspondence: dan.lubman@monash.edu

Competing interests

No relevant disclosures.

References

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