Recent warnings of a rise in crystal methamphetamine (“ice”) use in rural and remote Indigenous Australian communities should be heeded

To the Editor: Recent surveys indicate growing disquiet among health professionals nationally about the use of “ice” in some Indigenous communities,1 but with no clear evidence, as yet, of a feared general surge in its use.

During 2013 and 2014, we interviewed 304 key community leaders and service providers about alcohol controls in Queensland's rural and remote Indigenous communities. A number of these people offered diverging views about the use of amphetamine-type stimulants (ATS), including ice (Box). In parallel surveys in eight rural and remote communities, with participants recruited opportunistically, 953 community residents provided their views about trends in local drug use. Consistent with the information provided by the interviews, 393 residents (41%) asserted that new drugs were being used in their communities, 106 (11%) nominating ATS as the drugs involved, and 55 (6%) specifically nominating ice. A previous study2 indicated that no similar reports had appeared in surveys of alcohol, tobacco, cannabis and other substance use during the preceding 15 years in far north Queensland. The same applies to similar settings in Arnhem Land (Northern Territory), where few participants (< 1%) reported that they had ever tried any ATS, and none had used ice.3

It is of interest that cannabis appeared to have become endemic in around 4 years in Indigenous communities in both the NT4 and far north Queensland (A R C, unpublished data). Its widespread use followed a rapid rise from the late 1990s5 and early 2000s,4 enabled by locally embedded trafficking links with illicit drug suppliers outside the communities.5 Enforcement agencies have long held concerns that such links could also facilitate the marketing of ice. A similar, 4-year window of opportunity may, therefore, be all that is available to reduce the impacts of ice if demand for it emerges.

Effective prevention strategies and appropriate treatment approaches will require:

• improving community-level understanding of ice and its health and social consequences (Box);
• participatory research to better understand the resilience and protective factors that protect particular Indigenous individuals, families and groups from using ice, and to support the recovery of those who do use the drug;
• studies to determine the extent of the problem; and
• epidemiological studies to document current patterns and styles of ATS use, the precise nature of the substance used, and to monitor trends and patterns in the demand for novel substances such as ice among Indigenous Australians.

This will all require not only improved clinical capacity, but a sustained reinvestment in preventive services that have been seriously reduced in Queensland and elsewhere.