Background
It has been estimated that there are around 103,000 regular methamphetamine users in Australia, of whom approximately 73,000 are dependent on the drug. Heavy or dependent methamphetamine use is associated with a range of physical and mental health problems, such as psychosis, cardiovascular complaints, bruxism (teeth grinding and clenching) and sleep disturbances. People who inject methamphetamine are also at risk of contracting and transmitting blood-borne viruses. It is therefore likely that methamphetamine users have high levels of contact with the health sector. To date there has been little research examining health service utilisation among methamphetamine users in Australia, with most previous research in this area focussing on opioid and cocaine use.

Information on health service utilisation among methamphetamine users can improve our understanding of how methamphetamine use impacts on the health sector, the coverage of services for methamphetamine use, and factors affecting access to health services among this population. This type of information can ultimately aid the design of accessible treatment and other health care services for methamphetamine users.

The aim of the current study was to investigate patterns of health care utilisation among methamphetamine users. Specifically, we investigated the level of contact that methamphetamine users had with various health care services, both for general health care and methamphetamine-related problems. We also examined factors influencing health service utilisation, including patterns of drug use, sociodemographic characteristics, and disability in physical and mental functioning.

Method
Participants were 310 regular methamphetamine users from Sydney who were recruited through advertisements in newspapers, free press publications, needle and syringe programs and websites, as well as through word of mouth and referral from other research studies. Inclusion criteria for participation were having used methamphetamine at least monthly in the past year and being at least 16 years of age. A structured questionnaire was administered face-to-face by researchers at a mutually convenient location, such as cafes, parks and health centres. All participants were volunteers who completed informed consent and were reimbursed $30 for their participation.

Measures of health service utilisation were based on those used previously to assess drug treatment outcomes (Mattick et al., 2001; Shanahan et al., 2004) and included past year and past month utilisation of drug treatment services, hospitals, emergency and ambulance services, and general practitioners. Past month utilisation of other health professionals and purchasing of prescription medication was also measured. Additional information was collected on methamphetamine-related contact with drug treatment, hospital, emergency, and ambulances services, and also whether participants had received help for their methamphetamine use from a general practitioner.

Drug use measures included: (a) lifetime, past year and past month use of all major drug types; (b) frequency of drug use in the past month by drug type; (c) lifetime and past year injection of specific drug types and current frequency of injection; and (d) drug of choice.

Information was also obtained on the main method of methamphetamine administration and methamphetamine dependence in the past year. Methamphetamine dependence was defined as a score of four or greater on the Severity of Dependence Scale (Topp & Mattick, 1997).

Disability in physical and mental functioning was measured by the 12-item Short Form (SF-12, Ware, Kosinski, & Keller, 1996). Demographic factors measured included gender, age, language spoken at home, country of birth, income, level of high school education, tertiary education and employment status.

Results
Almost all participants (94%) had used at least one health service in the past year. The proportion of participants who had contact with general practitioners within the past month was particularly high relative to other health services (53% vs. 10% or less). It is noteworthy that 15% of participants had received help for their methamphetamine use from their general practitioner in the past year.

Specialised drug treatment agencies were the next most common health service used; however, only 10% of participants had received treatment specifically for methamphetamine use during the past year. The majority of drug treatment provided to methamphetamine users was for concurrent heroin use.

Almost one third of participants (31%) had been to an emergency department within the past year, one in five had used an ambulance service during this time, and 16% had been admitted to hospital. Almost one third (31%) of participants who had utilised these services within the past year indicated that methamphetamine was the main reason for their attendance.

Overall, health service utilisation among methamphetamine users was strongly related to injecting drug use, and particularly to the injection of heroin. After adjusting for disability in physical and mental functioning, heroin injectors were two to three times more likely than their non-heroin injecting counterparts to have utilised health care services. This trend was particularly pronounced for drug treatment, with heroin injectors being over five times more likely than non-heroin injectors to have attended drug treatment in the past year, and twice as likely to have received treatment for methamphetamine use in their lifetime.

Almost half of the sample (41%) had bought prescription medication in the previous month. Benzodiazepines were by far the most commonly purchased medication followed by antidepressants and narcotic analgesics. Unlike other types of health service utilisation, purchasing prescription medication was not related to heroin use, but was related to disability in mental functioning, older age, and higher income. Methamphetamine users on a low income (net weekly income less than AU$200) were half as likely to have purchased prescription medication relative to their more financial counterparts.

Conclusion
Methamphetamine users who participated in the current study reported high utilisation of health care services. Their level of general practitioner utilisation and purchasing of prescription medication was only slightly lower than that found among heroin users (Darke, Ross, Teesson, & Lynskey, 2003). Methamphetamine users also appeared to have high levels of contact with emergency departments relative to the general population, although their contact with ambulance, emergency and hospital services was lower than that previously observed among heroin users (Darke et al., 2003).

The current findings suggest that methamphetamine users who are concurrent heroin users have the greatest impact on the health sector in terms of their utilisation of general health care and specialised drug treatment services. The over-representation of heroin users attending health services is likely to reflect their greater need for health care, including specific urgent medical problems such as heroin overdose. However, higher drug treatment utilisation among heroin using participants in the current study is also likely to reflect the availability of services for opioid use in Sydney and the relative scarcity of services tailored to methamphetamine dependence.

Dependent methamphetamine users who are not concurrent heroin injectors are likely to be more difficult to access and engage in treatment or other health services because they have low levels of contact with the health system. Further research is needed to examine health care needs among this segment of the methamphetamine using population and the reasons why they do not access services. In the interim, general practitioners, and to a lesser extent emergency services, appear to be the most viable option for accessing and providing education and referral information to this population.

Citation: Kelly, E., McKetin, R. and McLaren, J. (2005) Health service utilisation among regular methamphetamine users, Sydney: National Drug and Alcohol Research Centre.