How to manage acute methamphetamine intoxication

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How to Manage Acute Methamphetamine Intoxication

Crystal also known as ‘ice’, is a drug that speeds up the messages between the body and brain. It is often a purer form of methamphetamine and associated with more serious side effects, such as acute intoxication and long-term physical and mental health problems.
When a person is influenced by methamphetamine it can be confronting and challenging to manage. Some people who use methamphetamine may show aggressive behaviours while affected by the drug or when they are coming down.
For the safety of the person and those around them it is important that their symptoms are managed in a caring and supportive way. This fact page provides some practical tips for you and your service to approach these situations. These resources are recommended to be used with formal training and conversations within your service regarding the approach to take.

What is acute intoxication?

Acute intoxication with stimulants such as crystal methamphetamine, can involve a change in behaviour, including restlessness, pacing, repetitive sentences, body positioning that appears tense, and increased unpredictability. The acute effects of methamphetamine can depend on how much has been taken, any polysubstance use and the route of

It is important that a full assessment is undertaken to guide further management due to the ongoing possibility of adverse cardiovascular and cerebrovascular effects.

The aim of managing acute intoxication is to ensure the safety of everyone involved, whilst using strategies that are as least restrictive as possible to de-escalate behaviour. This means that it is essential that health workers, services and clinics have established clear procedures and ways of responding to clients who present in an agitated state.

How to Manage Acute Intoxication Events

People experiencing acute intoxication caused by methamphetamine should be treated with dignity, care, and respect. Listed below are steps to guide initial approaches to manage these situations. This includes de-escalation approaches (without medication), assessment and medication based options and suggested treatments.

For Aboriginal and Torres Strait Islander peoples, being mindful of specific cultural needs of patient care and alternative culturally appropriate management methods of acute incidents is important. Considering the presence of a support person, if appropriate, and seeking the advice of local members of the community regarding your planned approach is recommended.

De-escalate (before medications and sedation)
The Clinical Guidelines for Acute Presentations Related to Methamphetamine Use recommend the Assess, Gauge, Respond, Observe and Positive Reinforcement (AGRO+) method.
- Assess - what has caused the patient’s experience. Using open body language, reflective statements try to engage the patient in a calm manner to determine what has triggered their acute crisis.
- Gauge - how you are feeling. Consider how your feelings and approach is impacting the patient. How may this calm the situation or exacerbate the patient’s behaviour?
- Respond - to the patient experiences. From a safe distance, be patient focused but firm in the way you interact with the patient.
- Observe - the patient’s verbal and non-verbal behaviours. Are your de-escalation techniques
  working?
- Positive reinforcement -This may be something you say or do, such as giving them some water to drink. Do this when the patient is cooperating, the aim is to increase a desired behaviour.

Exclude other contributing factors or triggers
Where appropriate, rule out and consider factors other than methamphetamine use that could be the basis of the patients agitated behaviour and experience. This could include mental health disorders (acute psychosis), medical conditions (head injury), symptoms from the chronic use of other substances or polysubstance use.