There's A Way To Wean Addicts Off Ice. Why Is It Being Suppressed?
At the Dame Phyllis Frost Centre, where my sister Anna is imprisoned, they have a name for the 20 or so kilos that most of the girls add to their frames upon settling into the facility.
‘The Yarra Baby’. Yarra is the name of the unit where most of the women are placed when they are first imprisoned.
But the joke obscures a darker truth. Many of the women who enter the prison are coming off a heavy ice habit and food can represent their only comfort. Anna calls them her Yarra Babies, and relishes the role of helping them through the horrendous first few days of detox.
“When the girls are going through their withdrawals they just want to stay in bed and cry. They need someone to give them a hug and make them a sandwich,” she said.
Ice is an extraordinarily tough drug to quit. For long-term users, the withdrawal period can last up to 18 months and involve unrelenting depression.
“I don’t think anyone understands the mental and physical torture of coming off the high,” said Chrissy*, 39.
Some local treatment centres have received a bump in funding in recent years, as the National Ice Action Strategy has been rolled out. But waiting lists are still months’ long, and those who do get a place are treated only with talk therapy. For the nightmare withdrawals, patients might be given a bit of Valium, as Anna was each time she detoxed at the Curran Place centre in Heidelberg. But aside from that, they’re on their own.
“Some people try again and again but they just can’t get through that long stretch where they feel really horrible,” said Anna.
Perhaps it’s this inattention to physical withdrawals that explains the failure of the recent funding packages to make a bigger dint in the problem. Statistics on rates of use are notoriously unreliable, but Anna’s view is that ice is currently more popular than all the other hard drugs combined.
“Most of the girls that come in are ice users. Heroin is a pretty distant second,” she said.
Clearly, there is a gap in our current treatment model. Methadone was introduced in 1970 to cope with this exact same issue. But is there a methadone equivalent for amphetamines? Actually, there is.
It’s called the Stimulant Replacement Program and it provides clients who are coming off a heavy ice habit with a daily dose of dexamphetamine, a pharmaceutical amphetamine most commonly used in the treatment of ADHD. It has been quietly running at St Vincent’s Hospital Sydney since 2006. Like the methadone program for opioid dependence, it allows users to stabilise their lives without having to experience physical withdrawal symptoms.
And it’s been a roaring success. In 2014, the University of Newcastle conducted an in-depth appraisal of the program’s outcomes, finding that 69 percent of those surveyed had either ceased or reduced illegal amphetamine use after a median treatment duration of seven months. A majority also reported improvements in their physical and mental wellbeing, social functioning and employment outcomes. At 14 months, results had remained positive.
“My whole adult life my brain has had as its sole agenda to maximise access to crystal,” ‘Billy’ is quoted as saying in the report.
“And when I first started the program it just vanished completely and I could finally make choices free of that addictive overpowering regime in my brain.”
When people first quit illegal drug use, they can be faced with a labyrinth of psychological and practical challenges. They might need to repair broken bonds with family, to figure out a way to pay debts; to face the resurgence of a mental health condition which has been simmering away beneath the surface.
The SRP works because it manages patients’ physical withdrawal and allows them the space they need to work through this labyrinth. When patients are stable and ready, they can begin to slowly and safely ween off the dexamphetamine.
So why has the SRP never been further rolled out?
I’ve been keeping tabs on this program and any potential progress since I first heard about it in 2012. In that time, instead of rolling it out, state and federal governments have inexplicably funded several other similar trials, none of which has come to fruition either.
Right now, St Vincent’s Hospital is trialling a near identical drug called Lis-dexamphetamine: it requires an extra step of metabolism and is supposedly less tempting to crush and inject. This all sounds great, until you realise that this trial was slated to begin in 2015. With that rate of progress and a stipulated two-year trial duration, who knows how long it might be before the Lis-dex SRP sees the light of day.
Interestingly, in all the media promoting this latest trial, it’s touted as a ‘world first’. No mention anywhere of the safe and effective stimulant replacement program which is already in existence. Why should desperate families be forced to wait another indefinite period of time for a trial that will likely come to nothing?
“Obviously, if a treatment is successful, or even if it reduces harm to the patient, the patient’s family or the community, it should be supported by state and federal governments.” said Dr Julian Fidge, A Wangaratta GP with a particular interest in harm reduction. So why has the SRP never been rolled out?
Because it’s politically toxic. Despite publicly touting harm minimisation as their primary policy driver, both the Liberal and Labor parties endorse punitive measures around addiction. ‘Addicts’ are still viewed by large portions of the community as moral failures, liable for any fate that befalls them. Stigma is so pervasive that politicians who endorse programs such as the SRP risk alienating their voter base.
Long story short, our pollies are putting their own political fortunes ahead of the livelihoods of thousands of people affected by ice addiction. They are probably hoping that not too many people cotton on to their suppression of this program.
Well, we have cottoned on, and we deserve an explanation. The relevant ministers from state and federal governments should face the families who stand to benefit from this program and explain exactly why they don’t intend to implement it.
As Dr Fidge points out, “Sickness and suffering should not be the playthings of politicians.”
*Chrissy and Billy are both quoted in the Newcastle University report on eight years of dexamphetamine in the treatment of ice addiction.