METHAMPHETAMINE TREATMENT GUIDELINES

[Pages:145]METHAMPHETAMINE TREATMENT GUIDELINES

Methamphetamine

Treatment Guidelines

Practice Guidelines for Health Professionals

Second Edition

Jasmin Grigg Victoria Manning Shalini Arunogiri Isabelle Volpe Matthew Frei Vicky Phan Adam Rubenis Stephanie Dias Margret Petrie Michelle Sharkey Dan I Lubman

Copyright ? 2018 State of Victoria.

Second Edition printed 2018.

ISBN (print): 978-1-74001-028-3

ISBN (ebook): 978-1-74001-029-0

Copyright enquiries can be made to Turning Point, 110 Church St, Richmond, Victoria 3121, Australia

Published by Turning Point, funded by the Victorian Department of Health and Human Services. The views of the authors do not necessarily reflect the views and position of the Department of Health and Human Services.

The correct citation for this publication is: Grigg J., Manning V., Arunogiri S., Volpe I., Frei M., Phan V., Rubenis A., Dias S., Petrie M., Sharkey M. & Lubman D. I. (2018). Methamphetamine Treatment Guidelines: Practice Guidelines for Health Professionals (Second Edition). Richmond, Victoria: Turning Point.

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OVERVIEW

The Methamphetamine Treatment Guidelines have been developed by Turning Point to assist Victorian health professionals in the clinical management of methamphetamine use disorder and related presentations. These guidelines also aim to improve understanding of methamphetamine use disorder in health services and the community.

The first edition of these guidelines was published in 2007, and outlined acute and longer-term interventions for methamphetamine use problems available at the time. Recent changes in methamphetamine use patterns, from lower-purity powder to highpurity/potency crystal methamphetamine, has been accompanied by increases in methamphetamine-related harms and complex presentations. This shift, along with substantive changes to the diagnosis and classification of substance use disorders, has necessitated the revision of these guidelines.

The 2018 updated guidelines provide recommendations based on current evidence and best practice for the management of methamphetamine use disorder (chronic use and withdrawal). These guidelines include the management of acute and complex presentations, including behavioural disturbances, polydrug use, injecting methamphetamine use, cognitive impairment and comorbid mental health symptoms, as well as recommendations for reducing harm, working with specific populations, and supporting families and carers.

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ACKNOWLEDGEMENTS

This publication was made possible by the input of many people who willingly gave of their time and expertise. Their contributions, in the form of professional advice, suggestions and critical commentary, are greatly valued.

The authors would like to thank Professor Amanda Baker for permitting the inclusion of the Brief Intervention specifically developed and evaluated for clients who use methamphetamine.

In the revision of this resource, Turning Point acknowledges the considerable contribution of the authors of the previous version of these guidelines: Nicole Lee, Lisa Johns, Rebecca Jenkinson, Jennifer Johnston, Kieran Connolly, Kate Hall and Richard Cash. Turning Point also acknowledges the Clinical Expert Advisory Group who reviewed these guidelines during their original development: Amanda Baker, Catherine McGregor, Robin Fisher, Frances KayLambkin, Rebecca McKetin, Ingrid van Beek, Simon Ruth, Katherine Walsh and Sue White.

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CONTENTS

OVERVIEW ACKNOWLEDGEMENTS INTRODUCTION

What is amphetamine, and methamphetamine? Prevalence and patterns of methamphetamine use in Australia Properties and effects of methamphetamine

Impact of methamphetamine on the brain's reward system Methamphetamine dependence Methamphetamine withdrawal Harms associated with methamphetamine use

Methamphetamine and mental health Mood and anxiety symptoms Psychotic symptoms Risk of suicide

Methamphetamine and cognitive functioning Current evidence on stroke, cardiopathology and Parkinson's disease Barriers to accessing treatment PRINCIPLES OF TREATMENT

Working effectively with clients who use methamphetamine Stepped care Harm reduction approach TREATMENT MODALITIES AND SETTINGS Care and recovery coordination (case management) Withdrawal treatment settings Post-withdrawal treatment settings PRACTICE GUIDELINES

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2 3 7 8 8 9 10 11 12 15 16 16 16 17 17 18 19 20 20 22 22 23 23 24 26 28

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PART I: ASSESSMENT Drug use assessment Assessing readiness for change Assessing risk of harm Mental health assessment Suicide and self-harm risk assessment Screening for psychosis Assessing risk of harm to others

PART II: MANAGEMENT OF ACUTE PRESENTATIONS Managing acute toxicity Managing acute psychotic symptoms Managing aggressive or agitated behaviour

PART III: MANAGEMENT OF METHAMPHETAMINE USE DISORDER WITHDRAWAL MANAGEMENT Withdrawal complications Supportive care Psychosocial approaches during methamphetamine withdrawal Pharmacotherapy for methamphetamine withdrawal Post-withdrawal support

MANAGEMENT OF CHRONIC USE (DEPENDENCE) Psychological and psychosocial interventions for chronic use Pharmacotherapy for chronic use

REDUCING HARMS Interventions to reduce harms Emerging risks: The Darknet Harm reduction tips for clients

PART IV: MANAGEMENT OF COMORBID/COMPLEX PRESENTATIONS Management of mood and anxiety symptoms Management of psychotic symptoms Pharmacotherapy for comorbid presentations When and how to refer to a mental health service

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29 30 31 31 32 33 34 34

36 37 38 38

40 40 42 42 43 43 45

46 46 49

52 53 55 56

58 59 60 61 65

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Management of cognitive impairment

67

Polydrug use

68

Injecting methamphetamine use

71

PART V: CONSIDERATIONS FOR SPECIAL POPULATIONS

74

Aboriginal and Torres Strait Islander people

74

People from culturally and linguistically diverse backgrounds

76

People who are homeless

77

People who identify as LGBTIQ+

79

Women who are pregnant or breastfeeding

81

People from remote populations

83

Young people

85

Older people

86

Occupational groups

88

PART VI: AFTERCARE AND SUPPORTING LONGER-TERM TREATMENT GOALS

90

The role of peer support

90

The role of peer education

92

The role of support people

92

Family/support people involvement in treatment

92

PART VII: MANAGING THE NEEDS OF FAMILY/SUPPORT PEOPLE

93

Interventions that respond to the needs of family/support people

94

FUTURE DIRECTIONS AND CONCLUSION

98

APPENDICES

100

Appendix A: Brief Psychological Intervention

100

CLINICAL RESOURCES

105

REFERENCES

128

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INTRODUCTION

In 2018, methamphetamine use remains a significant public health concern due to its high propensity for addiction, neurotoxic and neurocognitive effects, and the associated range of complex presentations that include acute mental health symptoms and behavioural disturbances. Methamphetamine use is an important contributor to the global burden of disease, and is associated with severe public health and social consequences including mortality, morbidity and criminality [1].

In Australia, methamphetamine is the second most commonly used illicit drug after cannabis [2]. Methamphetamine use occurs across the spectrum of society, though some groups (e.g. people who identify as LGBTIQ+, some occupational groups) have higher than average rates of use. While use of methamphetamine has remained relatively stable over the last decade and even declined in recent years, there has been a sharp increase in the proportion of those who are using high-potency crystal methamphetamine, or ice. Ice is now the main form of methamphetamine used, with a near three-fold increase from 22% in 2010 to 57% in 2016. In the same period, the purity of crystal methamphetamine has increased from less than 10% to more than 70%, and the proportion of individuals using weekly or more often has more than doubled from 9.3% in 2010, to 20% in 2016 [2].

These trends in use of high-purity/potency methamphetamine use have been accompanied by a visible pattern of more severe physical and psychological harms, which is having a significant impact on health service utilisation nationally, particularly emergency and psychiatric services [3]. At present, clinicians and health services are faced with a range of complex presentations of chronic methamphetamine use (dependence) and withdrawal. These cases are often complicated by polydrug use, mental health symptoms including psychosis, cognitive impairment, and acute behavioural disturbances.

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