Dear Ida

Over the past few months my flat mate’s ice use has increased dramatically. We used to smoke a few points together on a Friday night before we went out clubbing, and then inject another point on Saturday morning before hitting the day clubs. However in the last few months she has started to inject exclusively and her use has changed from strictly weekend to nearly daily. So far she hasn’t fucked up on paying her half of the rent, however it seems to be affecting her work as she is taking more and more days off.

I don’t have a problem with her using, but I think the amount she’s using might be getting to her. She’s often moody, flying off the handle at what she thinks are personal criticisms (they aren’t, she’s just imagining it all). She’s also been talking about ‘conspiracies’ at work and thinks that her co-workers are hatching a plot to get her fired. Basically she seems to read things into conversations which just aren’t there. She also makes some weird connections between things which happen naturally in order to ‘prove’ her paranoia (e.g. the post arrives in the afternoon rather than the morning so she thinks this proves people are intercepting her mail).

I’ve heard that ice causes psychosis and I’m worried that she might have developed it. Can you tell me the symptoms of ice induced psychosis and how it’s cured? Any advice and info you could give me would be much appreciated!!

Confused about Dazed

Dear Confused about Dazed

From what you describe, it sounds as though you are correct in thinking your friend is experiencing psychosis. However it sounds as though she is lucky to have a friend like you to watch her back, as it can certainly be difficult to support someone who is suffering symptoms of psychosis.

Psychosis refers to a mental state where a person’s perception of reality is irrational, abnormal or inaccurate to the point of being bizarre. Classic signs of psychosis include hearing or seeing things which aren’t really there, with delusions manifesting as feelings of grandeur, paranoia, persecution, aggression or invincibility. Amphetamine psychosis can also include aural and/or visual hallucinations. A person undergoing psychosis may not be aware of their behavior and as a result their ability to perform basic social functions may be affected.

Amphetamine related psychosis can happen when several factors coincide. Usually these factors include: taking too much of the drug (which results in excessive dopamine and serotonin activity in particular pathways of the brain); chronic sleep deprivation; and the body lacking the necessary nutrients obtained from food. Although amphetamine psychosis can occur with a single large dose, it can also occur at low doses if use is continual. The method of amphetamine administration is irrelevant; a person can develop psychosis whether they inject, smoke, shaft or snort the substance. Once psychosis has occurred, it is very likely it will reoccur every time a person uses amphetamines. In most cases psychosis will go away once all the residual amphetamine related chemicals have left the body and a person discontinues with amphetamine use.

If you are with a friend who you think may be experiencing psychosis, it is important to keep yourself safe. By keeping out of harm’s way you will be in a better position to help your pal. Take your friend to a quiet, safe place, away from other people and anything which might aggravate them. Talk to your friend gently and try to distract or occupy them with another activity. Try to discourage them from using more amphetamines as this may exacerbate the situation and won’t actually make them feel any better. If your friend is showing sings of an amphetamine overdose (e.g. restlessness, tremors, rapid breathing, confusion, hallucinations, panic, aggressiveness, nausea, vomiting, diarrhea, an irregular heartbeat, and/or seizures) ring an ambulance immediately. The ambos are only interested in saving lives and they won’t call police to the scene of an overdose unless they fear they will be subject to violence or a death has taken place. Once your friend has come down, talk to them about their behavior and discuss strategies for avoiding the same situation in the future.

The only way to avoid amphetamine related psychosis is to not use amphetamines, however for some people this is not always a realistic option. If you are using crystal and think you may be at risk of developing psychosis there are a few basic tactics you can adapt to your lifestyle which may help to minimise the risk of it developing. 1- Try to use with people you know and trust. 2- Use in places you feel safe. 3- Try not to draw unwanted behavior to yourself when in public (and try not to carry drugs on you when you are in public). 4- Have a break between binges (i.e. wait until you’ve come down before using more.) 5- Make sure you eat regularly (if you can’t eat solids, drink fruit or protein shakes). 6- Get regular sleep (remember a short nap is better than no nap at all).

Dear Ida

For the past couple of years I’ve been thinking about undergoing hep C treatment. I’ve been sourcing all the info available at my local NSP and I’ve been reading up on what to expect from treatment in terms of side effects and my chances of actually overcoming the virus. I feel as though I have a pretty good grasp of the whole process, however I read somewhere that women undergoing treatment aren’t supposed to get pregnant and that men undergoing treatment aren’t supposed to get a woman pregnant. I can understand that for women there’s the possibility of chemicals from the antiretroviral drugs being passed onto the baby in the womb, but why does a man have to agree to it? It seems a bit illogical to me.

Signed How will Interferon interfere?

Dear How will Interferon interfere

As you may know, hep C positive people in Australia are entitled to one free course of antiretroviral treatment. In order to qualify for free hep C treatment with combination therapy, there are several criteria patients must fulfill: you must be over 18 years of age; you must have tested positive to hep C; you must have active hep C (tested with a PCR test); you must have a liver function test which indicates liver disease and/or damage (i.e. raised ALT levels); you must not previously have received free treatment; you must not be pregnant/ breast feeding or have a partner pregnant to you; and you must agree to use contraception with your partner, with both partners taking precautions to prevent pregnancy.

Although it may seem harsh there are actually good reasons for not allowing persons considering treatment to become pregnant. One of the active drugs used in combination therapy (pegylated interferon and ribavirin) has suspected links to birth defects. As amounts of combination therapy drugs remain in the semen of men undergoing treatment, there is the possibility that residues of these drugs could contribute to birth defects should the man impregnate a woman.

When considering the health of a new born child, it pays to be over-cautious. Thus both men and women who have undergone hep C treatment with combination therapy are advised to wait at least six months after finishing combination treatment before getting pregnant. Similarly women who are pregnant or are breastfeeding a baby are advised to wait for several months after finishing breastfeeding before beginning treatment.

Dear Ida

I’m prescribed morphine pills for pain relief. Although I am prescribed them for oral use, I prefer to inject them. Am I breaking any law by injecting them?

From Muddled Morph User

Dear Muddled Morph User

This is not strictly a black and white issue under the law. The key here is that a prescription extends not only to the drug but to the method of administration. That is, the doctor prescribes a drug to be taken in a certain way, as the method of administration can affect the effectiveness of the drug. Even though S8 drugs may be obtained legally they are still subject to regulation and law — even beyond the chemist door. Injecting a ‘prohibited’ drug, in this case an S8 drug (e.g. morphine, oxycodone and methadone) which is prescribed exclusively for oral use, can get you in trouble both with your doctor and the medical authorities. Although this is a matter of law you would be unlucky to be charged with a criminal offence — e.g. self-administration — but you are likely to have your script cancelled or restricted to daily pick-ups and so on.

However unlikely, it is possible to be charged with self administration of drugs prescribed to yourself if they are taken in a manner other than prescribed by your doctor — i.e. if you inject them.

Remember giving away (or selling) your medications is a criminal offence and not likely to be ignored by a doctor or the police.

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