Doctors treating the ice epidemic
The little town of Bunyip is a few minutes’ drive from Drouin, in the lush dairy country of south-east Victoria. It has become a hub for the treatment of ice addicts. But the patients here are not just local. Some come by train; others are driven by concerned parents and friends. Some come hundreds of kilometres.
Dr John O’Donoghue is a friendly, quietly spoken man who – because of his approach and treatment modality – is of enormous significance to ice users in the Gippsland communities. He operates a small clinic near the top of a steep hill next to a chemist and opposite a sandwich shop.
I met him there, each of us standing at the opposing end of a long, grey lino-tiled corridor, immaculately polished and floodlit by evenly spaced fluorescent tubes. As I walk towards him I feel his disarming sense of acceptance and warmth.
“I’m just a part of a much bigger picture here,” he says. “The medical treatment is a small part of the help that is needed. There are often debts to settle, family and employment issues. Frequently fines to pay or prison time to serve. Someone has to help clean that mess up, because without it, there can be no progress. The GP is important, but no one is central to the process of getting someone back into life.”
O’Donoghue has a weary smile, an oversized stretchy cardigan and comfortable runners, loosely tied and worn with their heels folded down like slip-on slippers. I talk to him knowing that 200,000 Australians used ice last year. A few weeks after our interview, I read that in some corners of the country the number of young people seeking treatment for ice addiction has trebled in 18 months.
“Meth is the latest in a long line of narcotics. It won’t be the last. Its use is an illness, and our medical approach should be no different to the way GPs respond to other illnesses like diabetes, alcoholism and cancer. All of which are in far greater order of magnitude than ice,” he says.
“One of the biggest problems associated with ice at present is in the way some parts of the media characterise and sensationalise it... and that unleashed a kind of panic storm we simply did not need to have.”
He draws a long breath. “We need to stop the ‘othering’. It simply doesn’t help. In fact, it accelerates the fear and uncertainty and places wedges between patient and practitioner... We need to treat the broader community and the medical profession in the same way as we treat the presenting patient; that is, frequent regular contact, facts-based discussion over and over, and both with a calm confidence that this issue will not last forever. Just as heroin, cocaine or GBH didn’t, and they were all very big.”
The damage done
Back in the waiting room three young men sit looking anywhere but at each other. The mood of the room feels broken and they sit hunched forward in their dark clothes like shadows. Three badly damaged pieces of a jigsaw puzzle. Their complexions wan and waxy, their sweaty hands occasionally reflecting the ceiling light. None of them seemed interested in reading House & Garden, People or the fishing and hunting magazines. The room was remarkable because of its silence.
After some awkward introductions, characterised by a timid searching for eye contact and my failed attempts to stare at their scars and knee tremors without being noticed, I ask them how they are.
“I got on the stuff after losing my job in Hedland driving trucks,” one says. “The work just ran out. Up there, everything was big. In the gym each day for hours… working hard, earning tons and tons of money and on the gear each night. When it stopped, within a few days I was suicidal… I knew I was really ill and I came back to live with my mum. Now if I start to crave I load up on sleeping tablets, lock my door and go to bed. The craving passes, sometimes after three or four days. I have a daughter, I miss her, but she can’t see me like this...” He starts to cry. “It’s been two years now, and I relapse on her birthday.”
While he was talking, one of the others reached behind his head and pulled some tablets from the hood of his windcheater. “Olanzapine. I take this at night. Ten milligrams is enough to put me away without the horror dreams. I think it is an anti-psychotic. I can’t live without this. Sometimes I have been really crazy. You wouldn’t believe. Olanzapine – yeah, it’s a big one. Then, in the mornings, I do Pristiq. It’s a heavy-hitting antidepressant, and without these I’d be stuffed too.”
From one of the drug packets he unfolds a sheet containing warnings and potential side effects and begins to read it slowly. “Man, they say ice is bad,” he offers. “Get this: I can get chills, fever and increased sweating, confusion and trouble thinking and speaking, irregular pulse, changes to blood pressure, numbness, seizures, stiffness, mania, libido loss, no orgasm, loss of consciousness and blood vomiting. And that’s all meant to fix me up.”
The cocktail of drugs used to detox is imprecise. They react in unexpected ways. The boy in the windcheater told me about a friend who went into seizures, who was bent backwards in a cramp so extreme he needed to be lifted into the ambulance by three men. From there he was taken to intensive care – they said he required detox from the detox.
The boy drops his arms and walks towards the consulting room. He looks broken and weary.
Contact the key
“The key from a GP perspective,” Dr O’Donoghue explains as I leave, “is the frequency of face-to-face contact. The prescription drugs have a window of effectiveness that is measured in months, so from a GP perspective the visits need to be short, friendly and regular. The trust-based relationship is vital, and sometimes I am the only healthy person or only one of a few that remain constant through the recovery time. Once they get to this stage – self-admitting for help – almost everyone in their circle is as sick as they are. They all normalise to each other.”
A few days later I drive to Castlemaine in central Victoria to meet Dean Curtis. Dean is one of Victoria’s few behavioural therapists working exclusively with drug-addicted clients. His smiling blue eyes and enormous greying handlebar moustache suit his professional persona – the alchemist who helps people transform into their non-addictive self. For more than 20 years Dean has provided the structural support not able to be dispensed during a GP’s nine- to 15-minute window – bulk-billing under Medicare Level 1.
“Based on what I see, I think the medical profession is just too busy to have seen the extent of those users reported to be in the total ice user bell curve,” Curtis says. “Many GPs in the Loddon district are at peak load and are not taking new patients. In a worse case scenario – and if all the current predictions are correct – I don’t think anyone is prepared to deal with what might be coming. And they’re not prepared culturally or medically. The current GP capability to deal with ice might be 10 to 15 per cent at present. There has to be some serious change.”
We start talking about reasons, and about what he has seen. “One of the questions I ask myself is why there is a need for a drug-induced state in the richest country in the world. And one of my observations is that for many people it doesn’t seem to matter how much they have achieved or who they are – none of it is good enough. We have lost the ability to accept... Everybody has to have more and be better, and there are consequences arising from that.”
Curtis moves on to a comparison between alcohol and ice. “Some parts of the media have reported ice problems at ‘scourge’ and ‘epidemic levels’. Ice is being characterised in a biblical sense – I read one report where it was described as pure evil. Whereas drink has always been drink and it’s by far the biggest issue we have,” he says.
“Booze was last given media attention around Schoolies Week, and that was laced with a kind of cheap salaciousness. Young kids, booze and sex – the media love it. But the facts are, 15 people die every day from alcohol-related deaths in Australia. Fifteen every day. And there are more than 400 hospital admissions every day.
“I guess there is an economy around alcohol and the taxes from the sales cover the costs and the damage, and that allows us to normalise to it. It’s no longer news. I might be labelled a cynic, but there is no such tax on ice.”
I ask about the challenges of rehabilitating a patient who uses ice compared with one who presents with alcoholism. “Every time a patient uses methamphetamine, brain function is worn away. Each time the patient stops ice-using, their capacity to experience a sense of normal happiness is diminished, and their capacity to feel happiness is eroded. This drives behaviour back to use and it is the use that destroys parts of the brain.
“Think of a user progressively descending a set of stairs into a very dark basement. The recovery process from ice is incomparable to recovery from other drugs, especially alcohol. Pleasure and its relentless pursuit is the dominant imperative.”
Curtis describes an experiment where laboratory pigeons had wires inserted into their brains to allow stimulation of an orgasm sensation. Although they were provided with food, the birds were provided with choice – to eat or to stimulate a pleasure experience. Despite being aware of their hunger and their need to eat, they died from starvation.
Taking the train back from Drouin, I see a thin young woman who has missed her outer Metro stop. She runs up and down the carriage in panic, almost throwing herself at the windows, uncontrollably banging on them, her eyes like dinner plates, spilling over with fear. Her face is covered in sweat, her skin grey and her lips somewhere between purple and white. Pockmarked arms, pockmarked hands. She seems without love, without warmth, without the spirit to which we have learnt to assume we are all entitled.
“Get me out of here,” she screams. “Get me out of here. I just want to get off.”
This article was first published in the print edition of The Saturday Paper on May 9, 2015 as "Doctors treating the ice epidemic". Subscribe here.