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Cate Swannell
Med J Aust 2017; 206 (6): 236. || doi: 10.5694/mja17.n0304
Published online: 3 April 2017

Ice use adds up to 150 000 emergency room visits a year

Methamphetamine use adds between 29 700 and 151 800 additional emergency department visits in 1 year, according to researchers from Curtin University, the University of New South Wales, the University of Newcastle and Monash University. The study, published in Drug and Alcohol Review, estimated past year rates of health service utilisation (number of attendances for general hospitals, psychiatric hospitals, emergency departments, general practitioners, psychiatrists, counsellors or psychologists, and dentists) for three levels of methamphetamine use (no use, < weekly, ≥ weekly) using panel data from a longitudinal cohort of 484 dependent methamphetamine users from Sydney and Brisbane. “We estimate methamphetamine use accounted for between 28 400 and 80 900 additional psychiatric hospital admissions and 29 700 and 151 800 additional emergency department presentations in 2013,” the researchers wrote. “More frequent presentations to these services were also associated with alcohol and opioid use, comorbid mental health disorders, unemployment, unstable housing, attending drug treatment, low income and lower education.” They concluded that: “Better provision of non-acute health care services to address the multiple health and social needs of dependent methamphetamine users may reduce the burden on these acute care services.”

Mapping malaria drug opens new possibilities

International research led by the Walter and Eliza Hall Institute of Medical Research (WEHI) has for the first time mapped how one of the longest-serving malaria drugs works, opening the possibility of altering its structure to make it more effective and combat increasing malaria drug resistance. The study, published in Nature Microbiology, produced a precise atomic map of the frontline antimalarial drug mefloquine, showing how its structure could be tweaked to make it more effective in killing malaria parasites. The team used cryo-electron microscopy, which produces images of biological molecules in their natural state in unprecedented detail, to see exactly how and where the drug binds the malaria parasite. Mefloquine has been associated with some serious side effects, including neurological symptoms. Dr Wilson Wong, from WEHI, said that the detailed atomic map would enable future drug improvements. “We now know mefloquine binds to a hotspot of activity on the ribosome surface,” he said. “However, our map of the ribosome and drug-binding site showed the fit is not perfect. We were able to mimic this interaction with compounds that were able to block the protein machinery and kill the parasite more effectively.”

  • Cate Swannell


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access_time 02:46, 3 April 2017
Kees Nydam

The sad tragedy befalling individuals caught in the wicked tangle of methamphetamine dependence cannot be denied. However, I am concerned about what I see as attribution bias, which is so often ubiquitous in the medical literature. It even permeates word choice. The evidence is compelling that there has been a steady increase in the purity of methamphetamine-like-substances (ALS) available in Australia in recent years. But I wonder if we have arrived at a point where all ALS can be referred to as ICE. To some chemists, crystalline ALS less than 80% purity owes its “ice” appearance to non-methamphetamine adulterants. In my clinical practice this is of greater concern than ICE. There may well be strategic or tactical reasons to defend this. I further wonder if they are the same reasons that lead to some researchers attributing ICE alone as the principle reason for so many additional emergency department visits when they could have as equally been justifiably coded as resulting from the many social and other determinants not coded. The risk is that we demonise the wrong thing(s). The non-coded are the real elephants in the room. I urge we do not forget H.L. Mencken’s quote “For every complex problem there is an answer that is clear, simple, and wrong”


Competing Interests: No relevant disclosures

Assoc Prof Kees Nydam
CQU

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