Crystal meth: the chilling effect of 'ice' on emergency care provision
As users of crystal meth, or 'ice', become more common in Australia, it can place a substantial drain on resources in the emergency department (ED)
As users of crystal meth, or 'ice', become more common in Australia, it can place a substantial drain on resources in the emergency department (ED).
The doors to the emergency department (ED) open and a 23-year-old man arrives by ambulance, shackled to a stretcher. He is in a psychotic state; loud, combative and abusive. As he yells and swears, other patients become anxious and frightened while nursing staff are on edge.
Code black is called. Staff are placed on standby. Sedative medication is drawn up.
This is the reality faced by ED staff in metropolitan and rural areas across Australia as a result of increasing abuse of crystalline methamphetamine.
When it comes to dealing with the effects of the drug, ED staff are on the front line. Patients and their erratic, abusive behaviour can have a profound effect and be a substantial drain on resources.
Crystal meth, commonly referred to as 'ice', is a highly addictive, illicit substance that is usually smoked or injected. It is becoming more widely used, with more than 2% of the Australian population admitting to using it in the past year (Australian Medical Association Ltd 2016).
Patients can present handcuffed by police or shackled to stretchers. They are often psychotic, anxious, paranoid and displaying super-human strength. They are agitated, verbally aggressive and unpredictable and rarely comply with staff requests. They lack insight and shout profanities and their behaviour is a major disruption.
Some such patients present with family members to the triage nurse but usually they arrive with a member of the emergency services, who notify ED staff that they are on their way.
When patients arrive by ambulance or with police, a code black is announced over the intercom. This denotes a person threatening or attempting to harm themselves or others, and can be instigated by any staff member. In response, security personnel, hospital attendants, the nursing coordinator, doctors and nursing staff arrive to secure the patient and restrain them physically, chemically or mechanically.
Ice users present to EDs and use other hospital resources more often than any other type of drug user (Marshall et al 2012), and managing one patient draws huge resources. For this reason, some nurses resent the time-consuming, labour-intensive care they have to provide in such cases and believe their efforts could be spent better on patient presentations that are not self-inflicted.
However, society stigmatises addiction, and ice users can detect when they are being judged and their behaviour can worsen as a result (Bartlett et al 2013). Through greater education, ED nurses could come to realise they are best placed in the health system to offer empathy and support.
To ensure a safe ED when caring for patients who are addicted to crystal meth:
● Communicate with open-ended questions. Speak in clear, plain language and maintain arm’s length distance at all times.
● Revise mandatory working practices including training and education for all staff.
● Arrange regular hospital in-service education sessions by qualified allied health professionals in conjunction with drug and alcohol services.
● Ensure management plans are in place and can be found easily at triage when known frequent users present.
- Australian Medical Association Ltd (2016) AMA position statement: methamphetamine – 2015.
- Bartlett R, Brown L, Shattell M et al (2013) Harm reduction: compassionate care of persons with addictions. MEDSURG Nursing. 22, 6, 349-358.
- Marshall BDL, Grafstein E, Buxton JA et al (2012) Frequent methamphetamine injection predicts emergency department utilisation among street-involved youth. Public Health. 126, 1, 47-53.
About the author
Marcus Dixon is a nurse at the North West Regional Hospital, Tasmania, Australia