I have not long returned from a visit to Australia, where I attended an interesting conference on methamphetamine. We haven't seen much use in the UK yet, and I wonder whether the Fleet Street prophets of doom will be right with their gloomy predictions - my suspicion is that "Ice" will not become the problem here that it has been in Oz, South East Asia or California - why? well fascinatingly the demographics and the harms with Ice are very similar to Crack - in Australia there is little Crack because there are no traditional smuggling routes and cocaine there is very expensive - in the UK our patients have pretty much open access to Crack or amphetamine and market forces have directed the vast majority of stimulant use to Crack. It is my belief that if we had similar access to methamphetamine, then the amphetamine users might opt for it, but the Crack users would stick with their rocks - but that is just my theory.
Another interesting Australian experience which again arises from traditional smuggling routes is that their heroin is the white water soluble product that is processed in SE Asia and China - so their injecting users are spared the task of cooking up their smack with citric etc as our patients do with the brown Afghan product.
Some Australian commentators have been critical of British heroin treatment, citing low methadone doses and not enough supervision - and I was interested by the comments of one Australian drugs worker who described her country's habit of putting people on daily supervised consumption for ever with virtually no other support, and herding them all into centralised dosing clinics as "a sheepdip" - an interesting antipodean metaphor!
