Crystal meth: stimulus for services?

On 18th January, methamphetamine becomes a Class A drug - not because we have a crystal meth problem in the UK, but because the police felt that unless it was a Class A drug, they would be unable to allocate sufficient resources to tackle supply should the problem grow. So what are the prospects?

Well, the drug is cheap to produce using easily available chemicals. And from the US evidence, the drug can made within national borders and so reducing the transportation costs and the number of middle men taking a slice of the profits before it reaches the streets. Already police have dismantled a meth lab on the Isle of Wight. On the other hand, because the effects of the drug last much longer than crack cocaine, profits could be reduced - a disincentive to develop the market here given the already significant prevalence of crack among chronic drug users. But the likelihood is that over time crystal meth will find some level within the drug culture which would probably not outstrip the market for crack unless something happened to the cocaine market prompting a consumer switch.

So how would a new generation of crystal meth users (whatever its size) be helped? Caring for stimulant users has been a challenge bedevilling the treatment field since the rise of illicit amphetamine use in the later 1970s. There is no substitute drug for amphetamine or cocaine to encourage users to come forward. Various drug regimes have been tried including substitute amphetamines and anti-depressants, but this is not standard practice. The only treatment tools to hand are talk therapies and so the quality of the service becomes of paramount importance - how welcoming and flexible is the service, how well trained are the staff?

Undoubtedly services for stimulant users have improved over the past five years: the lack of substitute prescribing is a less of a barrier than it was as services develop protocols and interventions for attracting and retaining users in treatment such as the use of alternate therapies to reduce craving.

But problems remain for those users coming forward with a dual diagnosis of drug dependence and mental health problems - and psychosis is often a feature of heavy stimulant use. Such people are still caught between drug and mental health services and there is no indication that this will be resolved anytime soon.

There are also more general issues around training a competent, empathetic workforce. This is even more important today as when the Conservative government in 1990 rejected recommendations from the Advisory Council on the Misuse of Drugs for a comprehensive overhaul of substance misuse training. The result has been patchy and under-funded training which has not kept pace with the rapidly expanding workforce, now drawn from a much wider pool of professional backgrounds and compounded by the minimal amount of time devoted to substance misuse in the training of doctors, social workers and other health and social care professionals.

http://www.coca.org.uk/uploads/(1)FINAL_tp-crack-protocol310505.pdf
http://www.smmgp.org.uk/download/guidance/guidance013.pdf
http://www.methamphetamine.org/html/treatment.html