The epidemiology of methamphetamine use and harm in Australia LOUISA DEGENHARDT 1 , AMANDA ROXBURGH 1 , EMMA BLACK 1 , RAIMONDO BRUNO 2 , GABRIELLE CAMPBELL 1 , STUART KINNER 3 , & JAMES FETHERSTON 4 1 National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, 2 School of Psychology, University of Tasmania, Tasmania, 3 Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Queensland, and 4 National Drug Research Institute, Curtin University of Technology, Western Australia Abstract Introduction and aims. There has been considerable media attention recently upon possible increases in methamphetamine use in Australia. Much of this debate has focused upon extreme cases of problematic crystal methamphetamine use, without reference to the broader population context. This paper provides data on methamphetamine use in Australia, and documents trends in methamphetamine-related harms. Design and Methods. Data used were from: (1) Australian Customs Service drug detections; (2) Australian Crime Commission drug seizure, arrest and clandestine laboratory detections data; (3) National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (4) data from the Illicit Drug Reporting System (IDRS) and Ecstasy and related Drug Reporting System (EDRS); and (5) data from NSW Emergency Department Information System, National Hospital Morbidity Database and Australian Bureau of Statistics causes of death databases. Results. There appears to have been an increase in both importation and local manufacture of meth/amphetamine. Population data show that meth/amphetamine use remains low and stable. However, clear increases in crystal methamphetamine use have occurred among sentinel groups of regular drug users. Frequent crystal use among regular injecting drug users is associated with earlier initiation to injecting, greater injection risk behaviours and more extensive criminal activity. In recent years, indicators of meth/amphetamine-related harm have stabilised, following steady increases in earlier years. Discussion and Conclusions. Some methamphetamine users experience significant problems related to their use; harms are particularly prevalent among regular IDU. Methamphetamine users, however, are a diverse group, and strategies need to be appropriately targeted towards different kinds of users. [Degenhardt L, Roxburgh A, Black E, Bruno R, Campbell G, Kinner S, Fetherston J. The epidemiology of methamphetamine use and harm in Australia. Drug Alcohol Rev 2008;27:243–252] Key words: drug-related harm, injecting drug use, monitoring systems, methamphetamine, mortality, opioids, overdose. Introduction The use of methamphetamine has become the focus of increasing attention world-wide [1], due perhaps to increases in both the scale of production and harms related to use. There is a growing literature on the harms associated with regular methamphetamine use, including mental and physical health problems [2 – 7], dependence [6], violent and aggressive behaviour [8], involvement in criminal activity [9], injecting and sexual risk [10,11] and, in some cases, death [12,13]. In Australia, as a result of legislative controls introduced in the early 1990s on precursor chemicals for amphetamine sulphate [14], the proportion of amphetamine seizures that were methamphetamine steadily increased, until methamphetamine comprised 91% of 2000/01 amphetamine seizures [15] (for the remainder of the paper we use the term methamphe- tamine more broadly in relation to use and harms, and the term meth/amphetamine to refer to data sources that do not differentiate between amphetamine and Received 24 July 2007; accepted for publication 28 November 2007. Louisa Degenhardt, National Drug and Alcohol Research Centre University of New South Wales, New South Wales, Australia, Amanda Roxburgh, National Drug and Alcohol Research Centre University of New South Wales, New South Wales, Australia, Emma Black, National Drug and Alcohol Research Centre University of New South Wales, New South Wales, Australia, Raimondo Bruno, School of Psychology, University of Tasmania, Tasmania, Gabrielle Campbell, National Drug and Alcohol Research Centre University of New South Wales, New South Wales, Australia, Stuart Kinner, Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Queensland, Australia, James Fetherston, National Drug Research Institute Curtin University of Technology, Western Australia. Correspondence to Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, 2052 Australia. Tel: 61 (0) 2 9385 0333. Fax: 61 (0) 2 9385 0222. E-mail: l.degenhardt@unsw.edu.au Drug and Alcohol Review (May 2008), 27, 243 – 252 ISSN 0959-5236 print/ISSN 1465-3362 online/08/030243–10 ª Australasian Professional Society on Alcohol and other Drugs DOI: 10.1080/09595230801950572