Should we be considering free ‘ice pipe’ distribution in Australia?

There has been much public discussion of late, regarding methamphetamine in Australia.  While much of the focus has been on the acute adverse effects of intoxication and concerns regarding public amenity and safety, little has been written about how we can innovatively address methamphetamine harms.  In this article I examine the idea of free ice pipe distribution and the potential benefits that it might offer.

Ice Pipes – where are we now?

Amendments made to the Drugs, Poisons and Controlled Substance Act 1981, several years ago made it illegal to sell or display for sale ‘ice pipes’ in Victoria.  Under the legislation an ice pipe is defined as a device:

a)      capable of being used or intended for use or designed for the  introduction, or for introducing, into the body of a person the drug  of dependence methylamphetamine, by means of smoking or inhaling of smoke or fumes resulting from the heating or burning of methylamphetamine in a crystalline form; or

b)      that is intended to be used as a device referred to in paragraph (a) but that is not capable of being so used because it needs adjustment, modification or addition.

(Source: Drugs, Poisons and Controlled Substance Act 1981, Victoria, Australia)

The introduction of this legislation has seen no meaningful impact in reducing the number of people smoking methamphetamine in Victoria, nor is there any evidence that it has assisted in reducing drug related harms.

According to the Ecstasy and Related Drugs Reporting System 2012 survey (Sindich et.al 2013), Victoria reports the highest prevalence of recent use (any use in the preceding 6 months) of methamphetamine, when compared with other states and territories. Comparison of EDRS data over time demonstrates that since 2010 reported recent use (any use in the preceding 6 months) across Australia has been slowly increasing, with the increase of recent use of ice (crystal methamphetamine) accounting for the greater part of this trend, in deference to recent use of speed (powder methamphetamine) or base.  According to Sindich et.al (2013), 88% of people reporting crystal methamphetamine use identifying smoking as the route of administration.

In short, despite the assumed goal of this amendment to reduce the smoking of methamphetamine, it continues largely unabated.

Should we be heading in the completely opposite direction?

While the prohibition of the sale of ice pipes seems to be largely ineffective in reducing either methamphetamine use or the harms associated with it, this legislation may well stand in the way of the development of potential harm reduction initiatives.

According to Hunter et.al (2012), the sharing of smoking equipment amongst people who smoke methamphetamine poses a potential risk of blood born virus transmission.  People who frequently smoke methamphetamine can develop cuts and/or burns to their lips and mouth.  It has been hypothesized that these open wounds in conjunction with pipe sharing pose a risk of blood born virus transmission (Strike et.al, 2006).  Additionally in a news article celebrating the successes of the pilot pipe distribution program conducted in Vancouver targeting people who smoke crack cocaine, pipe sharing has been associated with outbreaks of pneumococcal disease.

The implementation of similar programs in Australia that provide for pipe distribution to people who smoke methamphetamine may pose some benefits in reducing the transmission of infection, but there is an additional benefit that may be accrued.

According to Kenny et.al (2011), the number of people presenting for treatment for methamphetamine use remains quite low, despite the prevalence of use.  As has been demonstrated by Australia’s adoption of needle syringe programs in the 1980’s and the  development of the Medically Supervised Injecting Centre in Sydney which commenced in 2001, low threshold harm reduction initiatives can be a crucial interface between marginalised groups of people who use drugs and health and alcohol and other drug treatment services.  If people who use methamphetamine are not coming to us, then we need to be more proactive at meeting them where they are at.  Ice pipe distribution programs could provide this opportunity.

Summary

Current laws pertaining to ice pipes in Victoria seek to limit access to smoking equipment designed to be used to smoke methamphetamine.  There is no evidence to support the notion that these restrictions have reduced the prevalence of use of methamphetamine or smoking as a route of administration.  These restrictions may however exacerbate harm, or at the very least impede pursuit of an innovative approach to harm reduction, addressing the needs of people who smoke methamphetamine.

References

Hunter, C., Strike, C., Barnaby, L., Busch, A., Marshall, C., Shepherd, S. & Hopkins, S. (2012). Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play? Harm reduction journal, 9(1), 1-9.

Kenny, P., Harney, A., Lee, N. and Pennay, A (2011) Treatment utilization and barriers to treatment: Results of a survey of dependent methamphetamine users in ‘Substance Abuse Treatment, Prevention, and Policy’ Vol: 6, No: 3

State Government of Victoria,  Drugs, Poisons and Controlled Substance Act 1981, Victoria, Australia http://www.austlii.edu.au/au/legis/vic/consol_act/dpacsa1981422/ accessed 11th October 2013

Strike C, Leonard L, Millson M, Anstice S, Berkeley N, Medd E. (2006) Ontario needle exchange programs: Best practice recommendations. Toronto: Ontario Needle Exchange Coordinating Committee.

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