Monthly Dose podcast: Episode 1 - The Ice Epidemic

The Ice epidemic is of major concern to governments around Australia. This podcast episode analyses the so-called "Ice" methamphetamine epidemic. Through an analysis of the available survey health data we conclude that the recent hype around crystal methamphetamine is misplaced. Methamphetamine use, while of concern, is not increasing. Indicators of drug use in Australian drug-using populations suggest that the use of methamphetamine has been stable since 2001.

At a time when governments around Australia are preparing responses to the so-called epidemic this podcast reviews the evidence, the media coverage and some health promotion approaches to methamphetamine use. The podcast is an essential listen for drug and alcohol service providers, policy makers and news makers who are concerned about evidence-based approaches to social and drug policy.

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Time for a reality check: footballers are just like the rest of us

LET'S be clear at the start about the outrage surrounding drug use in the AFL. It is not that the players are using performance-enhancing drugs, or that they are playing badly because of their drug use. Our moral outrage comes from the realisation that those players using these drugs are the exemplars of health. The West Coast story has revealed that it is the best and fairest who are using drugs — and it is not affecting their on-field performances. This has exposed to us an unsavoury reality: that people can and do perform at the highest level and use illicit drugs. Rather than seeking more drug tests for AFL footballers, we should be doing more reality tests for ourselves.

First, there is a reality about elite sport and alcohol consumption that few acknowledge. There is strong evidence that elite sport environments do not promote abstinence — in fact, they are associated with high and harmful alcohol consumption. This is the so-called U-curve: those who do not play sport and those who play high-intensity sport are both more likely to drink in a harmful, binge manner, compared with those who undertake sports with medium intensity.

Second, with regard to drug use, even the most rudimentary back-of-the-envelope estimates of the extent of illicit drug use among players would suggest that there are fewer AFL players using illicit substances than other men of the same age. National surveys show that 32 per cent of men and women aged 20 to 29 report having used an illicit drug in the previous 12 months. Even if the eight players the West Coast coach suggested had used an illegal drug were replicated in each club, the proportion of AFL players who had used an illegal drug would still be lower than that of the general community.

Third, as the recent moral panic about methamphetamine use illustrates, the facts rarely get in the way of good stories. The reality is that use of crystal meth and methamphetamine more broadly has been stable since 2001. Mirroring what happened with public opinion about crack cocaine in the US in the late 1980s, the hysteria about "ice" in Australia is not based on the reality that methamphetamine use has been stable, but on the fact that its use is being recognised among those in whom we least expect it.

So what is it that we are outraged about? The real outrage here is the realisation that maybe we have got it wrong. We are confronted by our own unrealistic expectations. Maybe it is unrealistic to expect AFL footballers to be drug-free.

Sportspeople are successful, high-achieving exemplars of health. That they may use drugs like the rest of the community confronts us because it illustrates how we construct those who fall short of our expectations in relation to being healthy (by smoking, using drugs or not exercising, for example). While health promotion messages are often framed positively on what we should do rather than what we shouldn't do, they rely implicitly on constructing those who do not follow the rules as failures. That is why the story of footballers grabs our attention so compellingly — even though they break the rules, these are the men we find almost impossible to see as failures.

Andrew Demetriou's defence of the education-based response to illicit drug use in the AFL's voluntary drug-testing regime is sound and based in the reality that people in our community do use illicit drugs. Naming and shaming individuals found to have used drugs once contributes nothing. AFL players have voluntarily agreed to allow drug testing for non-performance-enhancing drugs in their workplace. Given the high rates of drug use in the community, similar workplace testing universally, followed by a punitive approach, would net a vast catch indeed.

Drugs are illegal, and there are those who call for a "zero-tolerance" approach. This unrealistic law-and-order approach makes attractive rhetoric, but unfortunately does not produce the results that advocates seek or promise.

The American experience of punishing illicit drug users has produced high levels of HIV transmission and the most incarcerated society on earth. In Australia, we wisely have little interest in thus pursuing people who use illicit drugs, as we know that it is more effective to educate people and help them integrate back into work and family and social life. Ultimately, most of the community seek compassionate responses to people who use drugs, because these people, even when they are the sportspeople we idolise, are indeed part of our community.

What we should learn from the West Coast experience is not that we need to do more drug tests — we already know that drug use is part of the community. What we should do is test the reality of our expectations. A rational, evidence-based approach is what is needed. Judged on the available evidence, the AFL is on the right track, its drug policy is in touch with our social reality. It is those who advocate for a more stringent drug-testing regime in the hope of a drug-free world who need some reality testing.

Associate Professor John Fitzgerald is VicHealth senior research fellow in the Centre for Health and Society, University of Melbourne. Dr Mary O'Brien is postdoctoral research fellow at the Youth Research Centre, University of Melbourne. Professor Nick Crofts is director of Turning Point Alcohol & Drug Centre.

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We need more than a cultural 'reality check'

JOHN Fitzgerald's call for a "reality test" on illicit drug use (Opinion, 28/3) is timely but flawed when his focus is a limited cultural reality check, claiming that "people can and do perform at the highest level and use illicit drugs". Does this make it all right?

Amphetamine-based drugs such as "ice" are called "steroids of the brain" precisely because they do enhance performance. The reason that steroids, used to enhance muscle performance, are banned is precisely because they offer an unfair competitive advantage to the user.

Professor Fitzgerald's flawed conclusion is to revise our expectations and maybe go easy on illicit drug use in sport, based on the argument that 32 per cent of 20 to 29-year-old men and women in the community have used drugs in the past 12 months anyway. This position is countered by the West Coast drug experience, which reflects a long-standing serious social concern in that state, beyond sport, which prompted a parliamentary report in 2004. That report coincides with the period when some of the current footballers became addicted.

I agree, our national and global drug response needs to be based on evidence. Recent research evidence suggests we spent US$2.4 billion ($A3 billion) globally in 2003 on prescribed amphetamines-like drugs. Australia, along with the US and Canada, showed significantly higher than expected use. Illicit trafficking can never be accurately costed — not just in dollars, but also in terms of social tragedy, as we witness now.

Surely, evidence goes beyond just use and cost. The evidence should include how the addicted stars cope after retirement, given that addiction does not stop just because the last goal was kicked. Our reality check should include how our stars cope years after use of performance enhancing drugs.

Dr George Halasz, hon senior lecturer, department of psychological medicine, Monash Medical Centre, Clayton

Harsh penalties will make things worse

JOHN Fitzgerald's remedy to the moral outrage surrounding drug use in the AFL is a "rational, evidence-based approach" to drug policy that is "in touch with our social reality". But in Australia the reality is that the expert research evidence, for better or worse, is only one source of influence in drug policy debate and decision-making.

The way that the "methamphetamine" issue is being framed should leave little doubt about what other powerful messages exist concerning drugs and how drug users should be treated. For example, in February 2007 the Bracks Government announced a $14 million "war on ice". Newspapers have warned about the coming "ice age" and "ice storm", and printed pictures of people injecting and smoking methamphetamine. News stories of ice-related crime and violence are becoming commonplace, as are the stories about ice in sport.

To achieve rational drug policy, regardless of the setting, what is most needed is a counter to the "fear and threat" narrative that dominates public drug debates in Australia. We are not the drugs that we use, any more than we are the number of possessions we can gather. All people should be valued in and of themselves. In our drug policy, especially, we must find more positive and explicit ways to express and achieve this. The evidence is clear on one thing: harsh drug penalties make things worse.

Craig Fry, senior research fellow, department of health science, Monash University, Frankston

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