Recent warnings of a rise in crystal methamphetamine (“ice”) use in rural and remote Indigenous Australian communities should be heeded

Alan R Clough, Michelle Fitts and Jan Robertson
Med J Aust 2015; 203 (1): 19. || doi: 10.5694/mja15.00066
Published online: 6 July 2015

To the Editor: Recent surveys indicate growing disquiet among health professionals nationally about the use of “ice” in some Indigenous communities,1 but with no clear evidence, as yet, of a feared general surge in its use.

During 2013 and 2014, we interviewed 304 key community leaders and service providers about alcohol controls in Queensland's rural and remote Indigenous communities. A number of these people offered diverging views about the use of amphetamine-type stimulants (ATS), including ice (Box). In parallel surveys in eight rural and remote communities, with participants recruited opportunistically, 953 community residents provided their views about trends in local drug use. Consistent with the information provided by the interviews, 393 residents (41%) asserted that new drugs were being used in their communities, 106 (11%) nominating ATS as the drugs involved, and 55 (6%) specifically nominating ice. A previous study2 indicated that no similar reports had appeared in surveys of alcohol, tobacco, cannabis and other substance use during the preceding 15 years in far north Queensland. The same applies to similar settings in Arnhem Land (Northern Territory), where few participants (< 1%) reported that they had ever tried any ATS, and none had used ice.3

It is of interest that cannabis appeared to have become endemic in around 4 years in Indigenous communities in both the NT4 and far north Queensland (A R C, unpublished data). Its widespread use followed a rapid rise from the late 1990s5 and early 2000s,4 enabled by locally embedded trafficking links with illicit drug suppliers outside the communities.5 Enforcement agencies have long held concerns that such links could also facilitate the marketing of ice. A similar, 4-year window of opportunity may, therefore, be all that is available to reduce the impacts of ice if demand for it emerges.

Effective prevention strategies and appropriate treatment approaches will require:

  • improving community-level understanding of ice and its health and social consequences (Box);
  • participatory research to better understand the resilience and protective factors that protect particular Indigenous individuals, families and groups from using ice, and to support the recovery of those who do use the drug;
  • studies to determine the extent of the problem; and
  • epidemiological studies to document current patterns and styles of ATS use, the precise nature of the substance used, and to monitor trends and patterns in the demand for novel substances such as ice among Indigenous Australians.

This will all require not only improved clinical capacity, but a sustained reinvestment in preventive services that have been seriously reduced in Queensland and elsewhere.

Selected comments about recent changes in the use of amphetamine-type stimulants (ATS), including “ice”, in Indigenous communities in rural and remote Queensland from statements made by 304 key community leaders and service providers interviewed during 2013–2014 about the impacts of alcohol controls in regional centres and affected communities in rural and remote Queensland

Interview participant characteristics

Selected comments by interview participants

Health service provider
Female, Aboriginal, 25–50 years

“People are wanting education about ice. They know nothing about it. They put it on top of bongs. We have ice users in [nearby regional town].”

Health service provider
Male, non-A&TSI, over 50 years

“In recent times, [community names] Queensland Health Clinics have NOT received any referrals due to amphetamine usage.”

Social welfare worker
Male, TSI, aged 25–50 years

“There is talk of ice here but there is more marijuana. I have heard of “snow cones”; marijuana laced with some powdered drug.”

Local government worker
Male, non-A&TSI, 25–50 years

“There is a rumour that ice is in the community.”

Drug and alcohol treatment worker
Female, Aboriginal, 25–50 years

“They are being introduced to ecstasy, ice, when they go in to [nearby town]. Utensils were found in the school ground last year, needles. They are opened up to another world of drugs.”

A&TSI = Aboriginal and Torres Strait Islander. TSI = Torres Strait Islander.

  • Alan R Clough
  • Michelle Fitts
  • Jan Robertson

  • Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD.



This research is supported by the Australian National Health and Medical Research Council, project grant 1042532. Additional support was provided by the Australian Primary Health Care Research Institute-funded Centre for Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations at James Cook University and the University of Adelaide. The information and opinions in this letter do not necessarily reflect the views or policies of the Australian Primary Health Care Research Institute or the Australian Government Department of Health. We thank the individuals working in key drug and alcohol services, enforcement and justice, mental health, community-controlled and government health services and Indigenous support agencies who provided constructive comments on early responses to the problem before the final version of this letter was submitted.

Competing interests:

No relevant disclosures.

  • 1. National Indigenous Drug and Alcohol Committee, National Aboriginal Community Controlled Health Organisation. NIDAC/NACCHO online consultation: amphetamine-type stimulants use. August 2014.
  • 2. Bohanna I, Clough AR. Cannabis use in Cape York Indigenous communities: high prevalence, mental health impacts and the desire to quit. Drug Alcohol Rev 2012; 31: 580-584.
  • 3. Lee KS, Conigrave KM, Patton GC, Clough AR. Cannabis use in remote Indigenous communities in Australia: endemic yet neglected. Med J Aust 2009; 190: 228-229. <MJA full text>
  • 4. Lee KS, Conigrave KM, Clough AR, et al. Five-year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia. Drug Alcohol Rev 2009; 28: 623-630.
  • 5. Clough AR, Cairney SJ, Maruff P, Parker RM. Rising cannabis use in indigenous communities. Med J Aust 2002; 177: 395-396. <MJA full text>


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