How Do You Get Dope Back Out of Water

10.1 The comedown
10.2 Risks associated with the different methamphetamines
10.3 Awareness of risks associated with different methamphetamines
10.4 Risks associated with methods of administration
10.5 The risk of law enforcement
10.6 Relevance of risks and preventing harm

10.1 The comedown

All users groups readily associated the comedown from drugs as a negative aspect to the experience. All also clearly identified the symptoms of a comedown as including a range of the following:

• depression
• feeling scattered
• anxiety
• short temper
• nervousness/ paranoia
• being unmotivated and
• experiencing difficulty sleeping.

Despite this, consistent across all user groups was the perception that comedowns themselves are not perceived as a risk. Instead, the effects are usually seen simply as a 'hangover'. For social users these hangover effects are something to be managed until they pass. This was usually achieved by other drug use, predominantly cannabis and/or alcohol, or simply sleeping it off and getting through it. The quotes below illustrate this view that comedowns are something to be managed rather than be considered risks:

However, for functional and dependent users, the effects of a comedown are often what prompts the next hit. Effectively, this means they do not experience a comedown. The quotes below contain examples the experiences of by functional and dependent users in these circumstances:

Examples from functional users:

Examples from dependent users:

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10.2 Risks associated with the different methamphetamines

Most of the perceived risks are seen to apply across all methamphetamines, but are considered to be exacerbated when using ice. It was believed to be harder to manage the short term risks of ice, as well as having greater potential for recreational use to become an addiction.

In contrast, speed and base, are seen to be significantly lower risk to use. The intensity of the high is not as great as ice, and users claim some maintenance of control over their thoughts and actions despite the disinhibitory effects. In short, while speed and base may increase confidence, users did not believe they were likely to place themselves in as risky or extreme situations as they may do while on ice.

Speed and base are also not considered to have as great a potential for addiction. This perception was based perceptions that speed and base have been around for a relatively long time compared to ice and many people make use of the drugs without showing any appearance of dependency. Further, speed and base are not perceived to have the physical dependency of something like heroin. In contrast, ice has been positioned to have the same potential of addiction as heroin. These views were consistent across the majority of groups whether they had used ice or not.
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10.3 Awareness of risks associated with different methamphetamines

Awareness of risks was relatively consistent across all groups regardless of the form of methamphetamine used and frequency of use. Risks are commonly divided into three categories: societal, mental health, physical. Both short term and long term risks are found in these three categories.

Societal risks

Societal risks are defined by situations that involve interaction with others. Short term societal risks are situations where the effects of a comedown could influence the user's interaction with others, such as:

• arguments with friends or family when feeling scattered, depressed, tired and so on
• lack of productivity and / or motivation at work and experiencing Manic Mondays, Terrible Tuesdays and Woeful Wednesdays and
• some younger users fearing their parents finding out.

These situations are readily identified as simple short term effects of using drugs rather than actual risks. Social and functional users see these effects as something that is accepted as part of the comedown and able to be managed in much the same way as a hangover from alcohol is managed.

Long term societal risks are identified as situations where drug use has impacted in other areas of life outside of the social behavioural context. These long term risks include:

• loss of family and/or friends
• lack of money, potentially leading to poverty
• loss of employment and becoming unemployable
• being stigmatised as a 'junkie'
• having to find other means than legitimate employment to support a drug habit, for example, theft
• inflicting violence on others including sexual or physical assault and
• incarceration in gaol or treatment centre.

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Mental health risks

Mental health risks are those that relate to the individual's state of mind. Short term mental health risks are often perceived to be symptoms of a comedown, and therefore something to manage. These included:

• depression or anxiety when coming down
• anxiety, stress or other emotions related to lack of sleep (difficulty in sleeping) and
• the potential for doing 'crazy' or extreme things during use of the drug.

Psychosis was identified as the main long term mental health risk. Users believed this to be caused by either long term use of methamphetamines over many years or an extended period without sleep. Other long term effects include the loss of all ability to reason and the risk of suicide caused by extreme depression.

Physical risks

Physical risks are those that affect an individual's body. Users of all methamphetamines identify that there were short term physical harms associated with their drug use, including:

• teeth grinding and through this, teeth decay
• loss of weight, which was a concern more for males than females
• loss of vitamins and nutrients that was detrimental to the body
• harm from the other ingredients used to 'cut' the methamphetamine and
• the potential for accident or violence for oneself or from others

The long term physical risks identified were similar to the short term risks, just more extreme. Users identified that frequent use over the long term could cause:

• continued weight loss to the point of looking malnourished
• rapid ageing
• loss of physical appearance in terms of developing acne, looking gaunt, having pale skin
• for ice users, the potential to develop scars caused by scratching their skin and
• potential for increased blood pressure, heart problems, and stroke (more so for dependent users)

The risk of sexually transmitted infections through unsafe sexual practices, particularly HIV and hepatitis, was considered both a short term and long term risk²³. This was perceived as more relevant to the gay community than heterosexual users.
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10.4 Risks associated with methods of administration

The one area of potential physical harm from use where awareness was not consistent across behavioural contexts and target audiences, was the specific risks associated with different methods of administering the drugs. Whereas most respondents were knowledgeable about the risks associated with injecting, there appears to be only limited awareness of the risks of smoking methamphetamines, and almost none on the risks of snorting or swallowing.

All users identified that when injecting drugs, there is potential harm from blood borne diseases such as Hepatitis C and HIV. Similarly, the majority were aware of the potential for vein damage caused by injecting. In contrast relatively few recognised any potential for the transfer of contagions from smoking methamphetamines with others, and while the possibility of lung damage was noted, this was not considered to be more likely than if smoking cigarettes or marijuana. Those who reject smoking cigarettes and marijuana tend to believe that inhalation of any substance could cause damage, and those that do smoke cigarettes and/or marijuana do not feel that smoking methamphetamines was likely to cause any more damage than these two substances.

Few, if any, identified the potential damage to teeth, throat or stomach lining from ingesting methamphetamines, particularly base. In fact, among regular social users of base, ingestion is considered a safe way to use the drug and actually enhances its appeal for use. While it is thought that some caution may be needed if someone were to swallow ice, this is more associated with belief that ice is simply more dangerous to use than other methamphetamines than any knowledge in regards to the physical damage swallowing could cause.

Snorting was a method of administration associated with the use of powdered speed rather than any other methamphetamine. This method of administration polarised users. While all assume that the method of use could cause damage to nasal passages and headaches, there are those who like the physical act of snorting and will do so regardless of these effects. For others, these effects just cause them to reject the method of administration even if powdered speed is available. Figure 8 summarises the risks associated with different methods of administration and the awareness of these risks across user groups.
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Figure 8: Risks²⁴ and awareness associated with methods of administration

Text version of Figure 8

List of methods with associated risks/awareness:

• Injecting
  • Risk of: blood borne diseases; Hep C, HIV; and vein damage
  • Awareness is high across all groups
• Smoking
  • Risk of: lung damage; and transfer of Hep C, other diseases.
  • Low awareness of the possibility of disease and the extent of lung damage
• Swallowing
  • Risk of: damage to throat/stomach lining; and damage to teeth.
  • Awareness is: low, especially among regular users of base who swallow; and perceived as a safe way to use.
• Snorting
  • Risk of: damage to nasal passage; and headaches
  • Awareness is: considered likely; polarised method of administration.

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10.5 The risk of law enforcement

Law enforcement is considered more of a 'nuisance' than a risk or deterrent. It tends to impact more on ravers, gay men, regional and rural users, and functional users whose occupation involves driving, such as taxi and truck drivers, than other target audiences.

Regular attendees of raves, dance parties and festivals readily identified that there tended to be a greater police presence at these events than there used to be, and gay men claimed that there was often regular police surveillance of sex on site venues, and areas such as parks where sexual behaviour commonly occurs. Respondents from regional and rural towns indicated that often the police in their local town would have a 'crack-down' on drugs. This usually involved a greater police presence around social venues such as pubs and clubs on a Friday and Saturday night, and around the locations of suspected dealers for a short period of time. Functional users such as taxi and truck drivers indicated that police roadside drug testing would likely impact on their drug use if it were introduced in the state where they lived. This is due to the potential for loss of licence, and therefore their income.

Across all of these target audiences, the risk of law enforcement tends to prompt a change in strategy of use rather than not using at all. Common practices include:

• taking drugs before entering the venue or at home
• only carrying a limited amount if there is need to take some to the venue
• ensuring that the drugs can be disposed of readily, such as having loose pockets so they are easy to empty, should the police arrive or
• hiding drugs in difficult to search places such as underwear and
• not driving under the influence – get a cab instead or have a designated driver, much like the practice is with alcohol (more applicable to social users than functional users).

Often these strategies result in potentially risky drug taking practices. Some respondents claimed that in order to avoid having to simply dispose of the drugs when police arrive they would consume all that they had on them, or at least much of it. At times, this resulted in taking two or three times more than they had originally planned. Often, they had set aside these drugs for use throughout the night or weekend or for others. Others indicated that in a haste to use the drugs before the police arrived, they would take less care when administering. The main example provided was of injecting quickly and not taking as much care to follow needle hygiene and other harm prevention practices that they would normally.

Notably, the concept of community enforcement rather than law enforcement is a strategy that appears to have been used relatively successfully in some Indigenous neighbourhoods. The example given was of 'The Block' in Redfern. The community decided, several years ago, that ice was not allowed within the confines of the neighbourhood. If residents of The Block want to sell, buy, or use ice, they have to go elsewhere. Residents of The Block ensure that any offender is discouraged from doing so again should they breach the community rules. Ice users on The Block are the lowest of the low. This approach was implemented due to increasing levels of violence in the community in regards to use of the drug. Indigenous respondents claimed that it has been a significant deterrent. Top of page

10.6 Relevance of risks and preventing harm

While all users might be aware of a large number of risks, the perceived relevance of these to themselves strongly relates to the behavioural context in which they use methamphetamines. Social and functional users only see the short term risks identified in section 10.3 as relevant to them. They tend to have the perception that long term risks only occur to people who use methamphetamines very frequently over a longer period of time, that is, to dependent users.

Social and functional users do not perceive the long term risks they identify as applicable to themselves as they clearly differentiate themselves from dependent users by the self imposed parameters they place on their drug use. These parameters allow social users, in particular, to claim that they use responsibly, and responsible use will minimise long term harm. Simply stated, they do not see themselves as at risk of addiction or other long term risk as long as they stay within certain self-imposed boundaries, such as:

• managing the frequency and the amount they are using
• are conscious of the type of drug and on what occasions they use it
• monitor the accepted impact their drug use has on other areas of their lives
• are conscious of the money they spend (often they have a planned amount) and
• only use what and when their friends are using, and in the same quantities.

The quotes below illustrate this perception that responsible use is the primary means of ensuring that the long term risks that accompany dependency do not occur.

What is perceived as responsible use is shown by the examples given in the quotes below.

As a result of this perception, social and functional users talk about ways they 'manage' their drug use so that it does not become a problem and how they are able to overcome short term effects, rather than any 'harm minimisation' practices they use.
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Social users

Social users see short term physical risks as really the only risks necessary to manage as these are those that they identify as relevant to themselves. The potential for teeth grinding and decay is managed by ensuring that they chew gum or something similar while using. Loss of weight is managed by ensuring that they eat and drink before using and as soon as they can while coming down. Similarly, the more health conscious claim to ensure they replenish lost nutrients and vitamins by taking vitamin replacement tablets and eating protein based foods, such as eggs and nuts, when coming down.

The potential physical risk of accident or violence is managed by ensuring that they are always with a group of friends when using drugs. The perception is that should anything dangerous occur through an accident or violence, there is always a friend around to ensure help from emergency services if it is required. To avoid this potential altogether, social users claim they made a practice of testing the strength by only taking a small amount of a new batch of the methamphetamine first. This allows them to then ascertain how much of the drug they need to get the effect they are seeking, without risking the potential of their actions getting too extreme. The potential for harm from the ingredients that the drug had been cut with is managed in a similar way; by only trying a small amount of a new supply first. Buying from the same source is regularly cited as the best way to mange this potential risk. Carrying a condom, and then trying to remember to use it when it is needed, is seen as the only way of managing the potential of contracting a STI through unsafe sexual practices.

Social users also identified ways they managed short term societal and mental risks, however these strategies were perceived to be more about managing the short term effects of a comedown than any real potential harm. To minimise the varying degrees of depression, anxiety, insomnia and paranoia experienced during a comedown, many social users plan ahead and ensure they have cannabis, alcohol or even a small amount of the methamphetamine (a minority) on hand to use. The potential for conflict with family and friends due to moodiness or a short temper is managed by trying to avoid these people as much as possible during that time.

The majority of social users minimise the potential for drug use to impact on their employment, through taking too much sick leave and generally lacking in productivity, by making sure they adhere to a time to stop taking drugs on the weekend. Many commented that as long as they stopped by a certain time on Saturday night or Sunday morning, the effects of a comedown had usually dissipated enough by Monday morning to ensure that colleagues or employers did not notice any difficulties they may be experiencing. The quotes below illustrate this,

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Functional users

Functional users identify with the same short term risks as social users. The exception is in regards to loss of employment, which for users in this behavioural context is a real short term risk. Manic Mondays and Slippers fear calling in sick too often so use methamphetamines again to enable themselves to get through a workday. These groups, however, also fear the potential of getting caught using at work and possible loss of employment. In contrast, for some Workers, loss of employment is more to do with not taking drugs than taking them. For this group, their use of drugs is due to the need to continue in employment.

Possibly, due to their frequency of use, many functional users tend to fear the potential for dependency much more than social users although they still maintain guidelines surrounding their use in order to minimise long term risk. Manic Mondays and Slippers advocate many of the same parameters of responsible use as social users and are often aware that they have broken the boundaries they set themselves, particularly those around employment. On the other hand, Workers have a different set of boundaries that they claim differentiate them from dependents. These include:

• always using smaller, measured amounts and never bingeing
• ensuring regular periods of time (days) without using where possible and
• maintaining control over and managing other areas of their life such as finances and homelife, and most importantly maintaining employment.

This last point is the boundary that Workers most strongly believe as differentiating them from dependents. In their perception, people who have become dependent on methamphetamines are not able to maintain a family, relationships and employment. The fact that they can, is the critical factor in Workers believing themselves as not being dependent or an 'addict', despite the frequency with which they use methamphetamines.

Dependent users

For the majority of dependent users, the long term societal risk factors are the most relevant. Many identified with the loss of employment and the need to find other methods of gaining money such as sex work or theft, loss of family (including some mothers whose children had been removed from them), and the potential for violent behaviour towards others. While some respondents from all dependent sub groups identified with these long term societal risks of drug use, all Heroin Co-Dependents found these relevant to their own lives.

For some dependents in the Meth Devotees sub group, these long term societal risk factors are not considered as applicable. While these respondents are regular injectors of speed and base, they claim to lead and manage a 'normal' life. They claim that this is illustrated by their ability to maintain employment, finances and relationships with others. This group is differentiated from the functional Workers sub group, as they openly admit to using the drug everyday in order to continue living a normal life rather than for work purposes only. Furthermore, while all Meth Devotees inject as a method of administration, a range of methods can be found among the Workers group. For this group of Meth Devotees, the risks most relevant are identified as physical (both long and short term).

Dependent injectors all claim to practice needle hygiene. They readily identified that access to needle and syringe programs enables them to ensure they have clean equipment and also provides them with knowledge on how to minimise vein damage. Injectors generally believed that given the accessibility to safe and clean equipment, they really had no reason to not practice safe injecting. However, most injectors indicated they knew others that sometimes shared equipment., though none claimed this applied to themselves.

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²³ Also argued in Rawson et al., 2002, cited in Illicit Drug Use in Australia: Epidemiology, use patterns and associated harm, (2nd edition), Ross, J., (ed), National Drug & Alcohol Research Centre, 2007.
²⁴ Descriptions of possible risks are based on information drawn from 'Crystal – Effects – Health – Sex – Help', ACON (the Blue Book), as well as respondent knowledge.

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How Do You Get Dope Back Out of Water

Source: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/phd-npi-methamphetamine-report-feb09-l~risks

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