Crystal Meth Use on the Rise, Community Cooperation Needed March 2, 2020 Dr. Heather Logan, Physician, Addiction and Mental Health Services, Fredericton area Addiction is a complex disease with various causes. Treatment of substance use disorders is most effective when experts from various disciplines treat patients depending on the substance patients are using. Patients often present with existing mental health issues and significant past trauma and must be properly diagnosed and treated to effectively support their recovery. I have been working full time at Addiction and Mental Health since 2008. Working with patients with substance use disorder is incredibly rewarding. The patients are resilient, and I’m pleased to see that many people recover, move on to pursue education, steady employment, and to obtain stable housing. We also work with individuals who struggle and face many barriers within our current system. Up until about three years ago we did not see a great deal of crystal meth here in Fredericton. The use has increased steadily over this time and has presented a significant treatment challenge. Acutely intoxicated patients can become aggressive and violent. It is important to provide safety for staff working with these patients and a safe and calm environment to help decrease their agitation. About 30 per cent of methamphetamine abusers develop a drug-induced psychosis. The majority resolves within a week after they stop using the drug. There are best practices in dealing with acute meth intoxication and drug induced psychosis. Unfortunately, evidence-based medications for treating methamphetamine use disorder remain elusive. This is an active area of research with a number of prescription stimulants studied but no dedicated pharmacological treatments have been widely successful in helping people quit the highly addictive drug. Individuals using crystal meth tend to be erratic and disorganized. They may not know the date or time and it is very difficult for them to attend appointments for things like counseling. Outreach services are necessary to really service this marginalized patient population and currently not for profit organizations are doing a better job of that with few resources. It is critical for people using crystal meth to have treatment available as quickly as possible. The longer patients use drugs the less likely it is that their brains will recover fully. When crystal meth patients stop using the drug, they experience profound fatigue and depression. It is difficult for them to accomplish basic tasks; they describe their brains as being like “mush” and their memory is poor. Addiction and Mental Health services does not exist in a bubble. Bureaucracy is the biggest challenge to treating patients with substance use disorder. Addressing crystal meth use in our communities requires cooperation between community partners including Addiction and Mental Health, Social Development, Public Safety, local law enforcement and acute care facilities as well as non-profit community organizations such as Community Action Group on homelessness, the emergency shelters and AIDS NB to name a few. The social determinants of health significantly impact patients in their recovery. These include income, education, culture, personal health practices and support networks. Patients who use crystal meth and successfully stop need a great deal of support. Those that do not relapse generally have stable housing and the ability to afford their medications. It is incredibly frustrating to be treating patients who struggle with any substance use disorder when they have no access to medications required to support their recovery. And it is important to recognize that no matter how many rehab beds that we create in this province, discharging individuals to the street with no discharge plan and no access to safe housing ultimately leads to resumption of drug use in the clear majority of cases. Obviously here in New Brunswick we are working with limited resources and any improvements to the system can be difficult to implement due to cost. Failing to adequately treat these individuals can result in significant costs as well, including the cost to the criminal justice system, and within the health care system itself. The cost of monthly medication for patients is much less than the cost of a one-night admission to hospital. Without addressing these issues patients will continue to suffer and ultimately our communities are less safe. All levels of government need to come together to ensure the basic needs are available for vulnerable populations. Dr. Heather Logan has been a full-time physician at Fredericton Addiction and Mental Health Services since 2009. She has been a methadone prescriber since 2006. She graduated from Dalhousie University Medical School in 2001. She has special interests in smoking cessation, trauma and substance abuse, and concurrent disorder treatment. She has a Certificate of Added Competence in Addiction Medicine from the College of Family Physicians of Canada.