Despite a colourful history of poly-substance use, my own experience with methamphetamine left me completely shocked. 

I’d tried meth a few times because people I knew used it, but it never had much lasting appeal for me. That changed when I was prescribed dexamphetamine – a prescription drug that made amphetamine use a daily experience. When I also started using methamphetamine more regularly, it became a problem.

I was disturbed by how I behaved under the influence of meth. Meth releases dopamine in a rush and it made me crave stimulation. I began to live in a perpetual state of drama and chaos. On top of that, I was constantly worried about the police. Occasionally that worry tipped me over into psychosis. I lost almost all concern about taking risks. When I took meth, I posed a far greater risk of harm to myself, the people around me and the general public than on any other substance.

I’ve been a supporter of a legalised, regulated market for all currently illicit substances for many years. But as a mental health professional, and someone who has used meth, the rise of methamphetamine use in Australia has raised many challenging questions.

I have had to reconsider everything I thought I knew about drugs. 

Between 2010 and 2018, admissions to hospitals relating to methamphetamine use increased nearly 10 fold. Most of these hospital admissions were due to psychosis. While it’s important to note that the risk and intensity of psychosis associated with methamphetamine use is dose dependent, psychosis often results in increased hostility. A 2017 report by St. Vincent’s Hospital Melbourne reported that, of the psychiatric admissions relating to methamphetamine use, half were aggressive towards staff. 

These numbers reflect my experiences working in a public psychiatric ward. 

Managing patients with methamphetamine psychosis was difficult and often distressing. For many staff, dealing with aggressive and violent behaviour took a real mental and physical toll of which they struggled with long after work hours.  Unpleasant physical management strategies like restraint and isolation were common, not by choice, but by necessity.  This also created an uncomfortable environment for other patients. 

The burden of methamphetamine use on individuals who use it, healthcare systems and society more broadly is real. 

I’m nervous about methamphetamine becoming any more socially acceptable than it is now. Where I grew up teenagers who may have been snorting some speed a couple of decades ago are today on the pipe at beach parties. The stigma that used to surround methamphetamine used by pipe or needle seems to have reduced within the drug using community, and it seems to have become more acceptable as a result. 

The question I am wrestling with now is whether we should include methamphetamine when we say we support regulatory changes that decriminalise or legalise psychoactive substances.

Firstly, considering the negative effects of the illicit market, it is no doubt preferable to legalise good quality methamphetamine. Keeping it criminalised does not help at all. But we also can’t ignore what the data says about the harms associated with methamphetamine, which exceed most other common substances, except alcohol. 

One suggested alternative has been the legalisation of dexamphetamine tablets of the type prescribed for ADHD. The availability of oral dexamphetamine and hopefully cocaine and MDMA may potentially stop some people taking up crystal methamphetamine in the first place. Personally, I’m not sure that such pills will have much of an impact on those who use crystal methamphetamine, and research has shown that dexamphetamine substitution is hit and miss when it comes to treating methamphetamine dependence.

Then there is the harm reduction side of the debate. 

An obvious improvement would be to increase funding for treatment and public health services. Many addiction services are limited in what they can offer both in terms of resources,  but also in terms of effective therapies for methamphetamine use and dependence.  In my medical experience, pervasive psychosis and associated hostility often occurs when remaining psychosocial support fall away or life circumstances become chaotic and isolated. 

Education around sleep, how to manage paranoia, and simultaneous use of other drugs may reduce some of the consequences of methamphetamine use.

But it is a drug that keeps you awake, often for days, which is a big risk for psychosis and isn’t great for the brain generally. How you act once you start taking it can vary greatly from how you thought you would act, based on all the education and advice you sought out before taking that first hit on the pipe for the night. 

To address the potential harms of methamphetamine we need to educate people on the high potential for harm. 

While honest education about MDMA or cannabis would represent these as mainly safe and commonly beneficial substances, when used responsibly, honest education about methamphetamine can, in all truthfulness, look a lot closer to the typical ‘horror porn’ approach our governments take. 

An unfortunate consequence of the propaganda our governments have put forth as ‘education’ is that so much of it gets dismissed by those who have used drugs or exist in a community of people who use drugs. When all drugs are portrayed as equally dangerous the message loses legitimacy. 

When the government insists on a one-size-fits-all fear mongering narrative, people are more likely to poke holes in their message. This alienates people from trusting them. 

Finding a strategy that works to illustrate the risks of methamphetamine use without stigmatising people who use it needs to be led by those with lived experience. Unharm’s Community Conversations provide a good place to start.

I think we, as a community of people who use drugs and people who advocate for safer and non-stigmatising access to these substances, must be willing to admit and acknowledge the very different risk profiles that exist between different psychoactive substances. 

I hope we do not go the opposite direction with methamphetamine and ignore the real risks we see playing out every day in hospitals and living rooms around the country for the sake of trying to reduce stigma. Stigma is unhelpful, but let’s be honest: Not all drugs are the same. 

Walking that line will be a delicate one, but essential to ensuring legalisation of methamphetamine does not lead to greater social acceptance of the substance, particularly when used by smoking or injecting.  

If you are passionate about the drug legalisation debate, we’d love to invite you to participate in an online community conversation. For more information, head here.