Amphetamines: client demographics and treatment

In 2019–20, amphetamines were reported as a drug of concern in over one-third (36%) of all treatment episodes, either as a principal or additional drug of concern:

  • amphetamines were the second most common principal drug of concern for the fourth consecutive year (28% of all treatment episodes), having surpassed cannabis in 2015–16 (46,281 episodes) and increasing to 60,987 episodes in 2019–20
  • the most common additional drugs of concern reported with amphetamines include cannabis (33%), alcohol (20%) or nicotine (19%), but these drugs are not necessarily the subject of any treatment within the episode (Figure DRUGS1; tables SD.6–8).

Amphetamine use and harms

Amphetamines stimulate the central nervous system and can result in euphoria, increased energy, decreased appetite, paranoia and increased blood pressure (ADCA 2013). Long‑term effects include high blood pressure, extreme mood swings, depression, anxiety, psychosis and seizures.

Methamphetamine comes in a range of forms, including powder, paste, liquid, tablets and crystalline. Methamphetamines are part of a broader category of stimulants that also includes cocaine, and 3,4-Methylenedioxymethamphetamine (MDMA). Stimulants can be taken orally, smoked, snorted/inhaled and dissolved in water and injected. Some of the harms that can arise from the use of methamphetamines and other stimulants include mental illness, cognitive impairment, cardiovascular problems and overdose (NDS 2017).

The Alcohol and Other Drug Treatment Services National Minimum Dataset data available for amphetamines correspond to the Australian Standard Classification of Drugs of Concern (ASCDC) for the general ‘amphetamines’ classification, in which methylamphetamine is a sub-classification. Data on different forms of amphetamines—methylamphetamine specifically—have not been separately reported over time due to the nature of the classification structure used in this collection. This report provides information on methylamphetamines as a principal drug of concern for the first time.

A client’s usual method of administering their principal drug of concern can provide an indication of the form a client used, particularly for amphetamines. For example, those smoking (clients who report either smoking or inhaling amphetamines) are most likely to be using the crystal form, and those ingesting or snorting are most likely to be using the powder form. For clients injecting amphetamines, it is less clear as each of the base, crystal, powder, or liquid forms, can all be injected. However, according to the most recent data from the Illicit Drug Reporting System, of injecting users who were injecting methamphetamines, crystal was the form most often used in the previous 6 months preceding interview, followed by powder (NDARC 2020).

According to the 2019 National Drug Strategy Household Survey (AIHW 2020), the proportion of people aged 14 and over using meth/amphetamines in the last 12 months remained stable in 2019—1.3% compared with 1.4% in 2016. Crystal methamphetamine (‘ice’) continued to be the most common main form used among people who had recently used meth/amphetamines (57% in 2016 and 50% in 2019).

 

Reporting methamphetamine over time

The Australian Standard Classification of Drugs of Concern, 2011 (ASCDC, ABS 1248.0) is set up with 3 levels of classification which includes the broad group (e.g. Stimulants and hallucinogens), narrow group and base-level categories which are the most detailed.

Data available in the AODTS NMDS reports the narrow group ‘amphetamines’ classification. Base-level categories within this narrow group include:

  • Amphetamine
  • Dexamphetamine
  • Methamphetamine
  • Amphetamine analogues
  • Amphetamines, not elsewhere classified (nec)
  • Amphetamines, not further defined (nfd).

Changes to coding for methamphetamines has been difficult due to jurisdictional differences in client management systems, and the use of only broad or narrow group coding by some agencies. This has improved over time due to advancements in workforce training, agency coding practices and new system updates.

Client demographics

In 2019–20, 34,307 clients received treatment for amphetamines as a principal drug of concern, two-thirds (66%) of clients were male and about 1 in 6 (18%) clients were Indigenous Australians (tables SC.6, SC.8).

For clients whose principal drug of concern was amphetamines:

  • male (69%) and female (72%) clients with amphetamines as their principal drug of concern were most likely to be aged 20–39 (70%) (Figure AMPHET1; Table SC.7)
  • the rate of Indigenous clients receiving treatment increased from 782 per 100,000 people in 2015–16 to 1,051 in 2019–20  (Table SCR.26).

Figure AMPHET1: Clients with amphetamines as a principal drug of concern, by age group (years) and sex, 2019–20 (%)

The butterfly bar graph shows clients with a principal drug of concern of amphetamines were most likely to be aged 20–39 in 2019–20. This pattern was similar for both male (69%) and female clients (73%).

In 2019–20, where amphetamines were the principal drug of concern:

  • almost 4 in 5 (78%, or 47,599) treatment episodes within the amphetamines group were for methamphetamines as a principal drug of concern (Table SD.9)
  • smoking/inhaling was the most common usual method of use for amphetamines (53% of episodes), followed by injecting (37%) (Table SD.55)
  • for methamphetamines only, the usual method of use was similarly distributed; smoking/inhaling was the most common usual method of use (52% of episodes), followed by injecting (39%).

Clients can nominate up to 5 additional drugs of concern, but these drugs are not necessarily the subject of any treatment within the episode. In 2019–20, where amphetamines were the principal drug of concern:

  • clients reported additional drugs of concern in just under half (45%) of episodes
  • additional drugs of concern were most commonly cannabis (33%), alcohol (20%) or nicotine (19%) (Figure DRUGS1; tables SD.6–SD.7).

Over the 10-year period to 2019–20:

  • the number of closed treatment episodes where amphetamines were the principal drug of concern increased almost 5-fold (rising from 12,563 episodes up to 60,987)
  • almost 4 in 5 (78% or 47,599) closed treatment episodes within the amphetamines group were for methamphetamines only in 2019–20, increasing from 12% (1,530 episodes) in 2010–11 (Figure AMPHET2)
  • treatment episodes where clients reported injecting, smoking or inhaling amphetamines over 6-fold from 8,924 in 2010–11 to 54,606 episodes in 2019–20 (SD.55).

The rise in reported episodes for methamphetamines may be attributed to a combination of factors including improvements in agency coding practices for methamphetamines, treatment system updates and increases in funded treatment services (Figure AMPHET2).

Figure AMPHET2: Closed treatment episode proportions for Amphetamines, by ASCDC groups, 2010–11 to 2019–20 (%)

The line graph shows that methamphetamine has remained the most common base-line group since 2015–16, increasing dramatically from 51% in 2017–18 to 78% in 2019–20. Amphetamines not further defined was the most common base-line group from 2010–11 to 2014–15 before being overtaken by methamphetmines, decreasing from 41% in 2015–16 to 17% in 2019–20.

Treatment

In 2019–20, for treatment episodes where amphetamines were the principal drug of concern:

  • the most common main treatment type was counselling (41% of episodes), followed by assessment only (21%)
  • the most common source of referral was self/family (36%), followed by health services (30%) (Figure AMPHET3; Table SD.53)
  • almost 1 in 6 (17% or 2,850 episodes) of all episodes arising from treatment referrals diverted from the criminal justice system related to amphetamines (Table SD.13)
  • treatment was most likely to take place in a non-residential treatment facility (62% of episodes) (tables SD.58, SD.60).

Over the 10-year period to 2019–20:

  • counselling has remained the main treatment type for amphetamines as the principal drug of concern, peaking at 48% of treatment episodes in 2010–11 and falling to 41% in 2019–20 (Figure AMPHET3; Table SD.58).

Figure AMPHET3: Closed treatment episodes with amphetamines as a principal drug of concern, by main treatment type, reason for cessation or source of referral, 2010–11 to 2019–20 (%)

The line graph shows that from 2010–11 to 2019–20, for treatment episodes with amphetamines as the principal drug of concern, counselling was consistently the most common main treatment type, fluctuating from 38% in 2015–16 to 44% in 2016–17 and 41% in 2019–20. Assessment only was the second most common main treatment type over this period, fluctuating from 22% in 2015–16 to 17% in 2017–18 and 21% in 2019–20.

For treatment episodes where amphetamines were the principal drug of concern in 2019–20:

  • nearly 3 in 10 (28%) of episodes lasted less than 1–3 months; a further 25% ended within 2–30 days (Table SE.25)
  • the median duration of treatment episodes lasted nearly 5 weeks (33 days) (Table SE.23)
  • episode duration varied widely depending on the main treatment type—episodes with a main treatment type of counselling had a median duration of 10 weeks (68 days), rehabilitation had median duration of just over 6 weeks (38 days) and episodes with withdrawal management ended after 1 week (7 days) (Table SD.64)
  • half (51%) of episodes ended with an expected cessation
  • expected/planned endings to treatment were most common for episodes where self/family was the referral source (37%)
  • over one-quarter (26%) of episodes ended unexpectedly (Table SD.61).

Over the 10-year period to 2019–20:

  • the number of episodes for clients smoking/inhaling amphetamines increased nearly 12-fold, from 2,797 episodes in 2010–11 to 32,231 episodes in 2019–20.
  • the number of episodes where clients injected amphetamines increased almost 4-fold, from 6,127 to 22,375 (Table SD.55, Figure AMPHET4).

Injecting as a method of use for amphetamines has been rising since 2011–12, which may be attributed to patterns arising from an increase in the availability of crystal methamphetamines, as well as an increase in treatment episodes, and for injecting clients who might have been using amphetamines and heroin interchangeably (AIHW 2015).

The National Drug and Alcohol Research Centre (NDARC) analysed AODTS NMDS data from 2002–03 to 2018–19 where methamphetamine was the principal drug of concern. It was found that increased treatment episodes for methamphetamine since 2002–03 are due to smoking as a method of use. Treatment for this method of use occurred among younger clients (median age 30 years) whose main treatment type was either assessment or support and case management only (McKetin et al. 2021).

Increases in AODTS NMDS treatment episodes for smoking methamphetamine from 2010 onwards coincides with increases in importation of smokable high purity methamphetamine into Australia (Degenhardt et al. 2017).

Figure AMPHET4: Number of closed treatment episodes for own drug use with amphetamines as a principal drug of concern, by method of use, 2010–11 to 2019–20 

The line graph shows that where amphetamines were the principal drug of concern, injecting was the most common method of use between 2010–11 and 2013–14, ranging from 6,127 to 12,596. Smoking/inhaling replaced injecting as most common method of use in 2014–15 (15,121 episodes) and has remained the most common method of use until 2019–20 (32,231 episodes).

References

See reference list.