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Methamphetamine – Information & Resources

CURRENT METHAMPHETAMINE CRISIS IN MANITOBA

Methamphetamine use in Manitoba has reached crisis levels. While Manitoba has previous experience with spikes in methamphetamine use, the current situation appears to be more extreme. Police reports indicate that the supply of methamphetamine is quite pure, very inexpensive and readily available.  Previous experience with methamphetamine use in Manitoba was primarily around smoked/inhaled administration. Currently, methamphetamine use is largely by injection. There is no clear evidence for WHY injection drug use has increased; however, many front line organizations report dramatic increases over the past 3 years.

Injection and smoked/inhaled use of drugs produce similar very rapid onset of peak drug effects.  Injection of drugs, however, is an all-or-nothing phenomenon – once injected into the bloodstream there is nothing that will diminish the impact of the drug except time.  With inhalation/smoking the user has more control over the amount of drug entering his or her system.

Key differences that that contribute to methamphetamine’s severe outcomes include:

• Purity of the product currently circulating
• Dramatic drop in the cost of methamphetamine ($30/point to $10/point)
• Injection predominates over other forms of use
  • much more difficult to control amount of drug entering system
  • increased risk of infectious disease transmission associated with injection drug use (e.g., HIV, Hep C)
• Methamphetamine has the most direct and intense effect on the brain of any other street stimulant

All of these factors may contribute to larger numbers of users in Manitoba and more extreme behaviours (e.g., aggression, psychosis) being exhibited.  These factors may also contribute to the increased numbers of fatalities associated with methamphetamine use since 2015.

RESOURCES FOR COMMUNITY MEMBERS

• Crystal Meth – Information for Families & Friends– This handout was developed by the Addictions Foundation of Manitoba as a resource for those who are affected by someone else’s use of methamphetamine.  It contains a basic description of the effects of methamphetamine, description of the “crash” or withdrawal, suggestions for how to help someone who has had a bad reaction to methamphetamine, recommendations for how to start the conversation with a loved one about use, advice for how to help yourself and others, as well as a list of supports and resources.  This handout is also available as a  French version (Meth en cristaux – Renseignements à lintention des familles et des amis) .
• Cracks in the Ice – This online information resource was developed by the Australian government with input from community members across Australia and in collaboration with researchers in response to the need for information about methamphetamine use and addiction.  Cracks in the Ice, an online toolkit provides evidence-based information about ice (crystal methamphetamine) for the Australian community. Cracks in the Ice aims to improve access to information, online resources and support for individuals affected by ice; their families and friends; health professionals working across a range of sectors; parents, teachers and students; and community groups.
  • Cracks in the Ice Booklet – This booklet provides a brief overview of the information contained on the online toolkit.

RESOURCES FOR SERVICE PROVIDERS

To help support front-line service providers in Manitoba, AFM has collected a number of resources related to methamphetamine.

Resources developed by the Addictions Foundation of Manitoba (AFM):

• Video Presentation of Workshop “Methamphetamine: What’s Old is New Again”
  • Video presentation (83 minutes) is available on YouTube.  It contains information on illegal substances, and is intended to inform medical professionals and service providers. The information in this video presentation will provide a fundamental understanding of the acute and chronic effects of methamphetamine, and will inform staff on how to approach individuals who use this drug.
• Educational Presentations:
  • Methamphetamine: What’s Old is New Again– PowerPoint presentation (approx. 60-90 min. duration) provides an overview of the nature of methamphetamine and the effects it can produce.  This presentation is suitable for providers in health care and social services.
  • Methamphetamine Induced Psychosis: Current Evidence & Recommendations for Treatment – PowerPoint presentation (approx. 45-60 min. duration) provides a review of methamphetamine psychosis, including the course of psychosis, current guidelines & protocols, and treatment recommendations.  This presentation is suitable for providers in health care and social services.
• Crystal Meth in Manitoba (Infographic) – Information is presented that reflects methamphetamine use in the context of AFM services.
• Methamphetamine Detoxification (Brief Summary) – This summary provides a brief overview of the clinical implications of drug withdrawal for those detoxifying from methamphetamine use.

Online training for frontline workers:

• Cracks in the Ice Training – This online training provides frontline workers, including peer workers, alcohol and other drug workers and clinicians, with information and resources about ice (crystal methamphetamine).  The aim of this comprehensive program is to enhance frontline workers’ existing skills and knowledge to effectively assist clients who use ice, as well as their family members, friends and colleagues.

Brief guidelines intended for frontline workers:

• Guidelines for the acute assessment & management of amphetamine-type stimulant intoxication & toxicity (2014)
  • This document provides a 2-page quick reference for the most critical clinical information.
  • It would be of greatest value in a hospital/medical environment.

• Methamphetamine: Effects & Responses (2015)
  • This is a brief and general overview of methamphetamine – its effects and treatment approaches.  The demographics/statistics noted on the first page are from Australia, but are likely reasonably representative of our situation in Manitoba.

Detailed guidelines, intended for managers and frontline workers:

• Responding to Challenging Situations Related to the Use of Psychostimulants (2008)
  • Many questions and concerns currently expressed about methamphetamine by front line workers relate to the negative behaviours displayed by those under its influence.
  • This document describes actions that can be taken before, during and after these challenging behaviours occur.
  • There is a separate section that details special considerations for specific service settings (e.g., needle exchange programs, community health centres, detox settings, community/outpatient counselling, outreach/home-based, residential treatment).
  • The essential information is summarized in a quick reference chart at the end of the document.

• Treatment Approaches for Users of Methamphetamine (2008)
  • A number of clinical resources exist that provide comprehensive approaches to the treatment of methamphetamine addiction.  This one, however, is one of the most complete and well-organized.
  • Few programs would find it necessary to read or refer to the full document – the table of contents is detailed enough that finding the appropriate information is quite easy.  The document even includes a 10 page “Summary of important points from each chapter” at the beginning, making it even more user-friendly.
  • Clinical topics include recognizing and managing intoxication, overdose, co-occurring mental health issues, withdrawal, other drug use/mixing drugs; overview of the range of treatment options; assisting families, carers & significant others; legal issues; and creating partnerships.
  • Appendices include: Severity of dependence scale; Example of family emergency plan; Example of young carer’s emergency plan; Example Memorandum of Understanding (for partnerships)
  • Quick Reference Guide for Methamphetamine – We have extracted key information from the above document for use as a convenient reference guide for frontline service providers.

• Guidelines for the medical management of patients with methamphetamine induced psychosis (2006)
  • These guidelines for the management of patients with methamphetamine-induced psychosis have been prepared to aid emergency, general, medical and psychiatric staff in the treatment of these patients in the emergency setting.

• Psychostimulant Check-Up Training Kit (2008) – This clinical resource package guides clinicians in administering a brief, motivational intervention to psychostimulant users.  If your agency is interested in a motivational approach to treatment of methamphetamine addiction, this package would be recommended.
  • Clinician Manual – This document describes the aims and overall philosophy of the approach, and includes a brief overview of general guidelines.
  • Response Booklet – This booklet provides the structured brief interview approach for psychostimulants like methamphetamine.
  • Check-Up Summary Form – This form would be filled out in collaboration with the client/patient to guide next steps.