Methamphetamine in Melbourne: epidemiology of use, related harms and barriers and pathways to professional support

2017-02-08T01:09:27Z (GMT) by Quinn, Brendan
The use of methamphetamine is a significant public health concern. An extensive literature documents the characteristics, consumption patterns, experience of related harms and treatment utilisation trajectories among methamphetamine users recruited from drug treatment programs. However, few studies have examined these issues among out-of-treatment or community-recruited methamphetamine users. Our understanding of the pathways through which people engage with professional support services is therefore limited. The research presented in this thesis was developed to address these gaps. Specifically, this study aimed to: 1) examine the epidemiology of methamphetamine use and methamphetamine-related harms in metropolitan Melbourne, Australia; 2) identify and investigate barriers to professional support (i.e., specialist drug treatment, relevant health/support services) for methamphetamine users; 3) assess drug use, service utilisation and psychosocial changes in a cohort of methamphetamine users over 12 months; and 4) investigate factors associated with, and enablers of, access to professional support among methamphetamine users. A prospective cohort of regular (at least monthly) methamphetamine users (N=255) was recruited across metropolitan Melbourne during 2010 and administered a structured interview that covered: socio-demographics; drug use patterns and experience of related harms; methamphetamine market characteristics; health status; experience of drug treatment and relevant health/support services for methamphetamine and other drug use; and incarceration history and involvement in criminal behaviours. A cross-sectional analysis of baseline data indicated that the characteristics of the cohort generally mirrored those of studies in other Australian regions; participants were mostly male, unemployed and Australian-born, with high rates of mental health issues and polysubstance use. Participants reported most commonly using speed powder, most mainly injected methamphetamine, and 80% used methamphetamines at least weekly. A follow-up interview administered to participants during 2011 assessed changes among the cohort (n=201, retention rate: 79%) across the above domains during the 12 months following initial recruitment. Participants generally experienced positive outcomes over the follow-up period, including significantly fewer reports of very high psychological distress, unemployment and homelessness. Use of methamphetamine and other drugs decreased overall. Analyses suggested that some methamphetamine users are able to remit from (i.e., cease) methamphetamine dependence and problematic use patterns without professional support.