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Report of the Special Commission of Inquiry into crystal methamphetamine and other amphetamine-type stimulants 1 Table of Contents Chapter 1. An introduction to amphetamine-type stimulants ....................................... 10 Introduction .............................................................................................................. 10 Common types of illicit ATS and their effects ....................................................... 10 Amphetamine ............................................................................................................. 10 Methamphetamine ..................................................................................................... 10 Crystal methamphetamine ......................................................................................... 11 MDMA ........................................................................................................................ 11 How ATS affect the brain ........................................................................................ 13 Dopamine .................................................................................................................. 14 Serotonin ................................................................................................................... 15 Noradrenaline ............................................................................................................ 15 Intoxication ............................................................................................................... 15 Neurotoxicity ............................................................................................................ 17 The ‘come-down’ or ‘crash’ and withdrawal .......................................................... 17 How ATS are used ................................................................................................... 19 Some ATS have medical uses ................................................................................... 19 Not all ATS use is harmful ......................................................................................... 19 Dependence and ATS use ......................................................................................... 20 The harms associated with ATS use ...................................................................... 21 Harms to users .......................................................................................................... 22 Harms to others ......................................................................................................... 29 References ............................................................................................................... 34 Chapter 2. A history of drug use and policy in NSW ...................................................... 41 Introduction .............................................................................................................. 41 Lessons from history .............................................................................................. 41 People have always used psychoactive substances ................................................. 41 Different drugs have been of concern at different times in history ............................. 42 Early attempts to prohibit drugs led to unintended consequences ............................. 43 Illicit drugs including ATS have not always been illegal ............................................. 44 Australia’s response to drugs has been heavily influenced by an international punitive approach ...................................................................................................... 45 Social perceptions of drug use led to stigma and more punitive laws ........................ 46 The ‘war on drugs’ and a shift towards a harm minimisation approach ..................... 47 Australia led the world by moving towards harm minimisation ................................... 49 Compassion has been an element of drug policy since the 1999 NSW Drug Summit....................................................................................................................... 50 Progress has stalled since the Drug Summit ........................................................ 51 NSW developments ................................................................................................... 51 National developments .............................................................................................. 52 Previous inquiries ...................................................................................................... 53 Conclusion ............................................................................................................... 57 References ............................................................................................................... 59 2 Report of the Special Commission of Inquiry into crystal methamphetamine and other amphetamine-type stimulants Chapter 3. Trauma and other social determinants of amphetamine-type stimulant use ..................................................................................................................... 65 Introduction .............................................................................................................. 65 ATS use occurs across all parts of the community .............................................. 65 The link between ATS use and broader social determinants of health ............... 66 Trauma is linked to drug use .................................................................................. 67 Trauma in childhood .................................................................................................. 68 Trauma in adulthood .................................................................................................. 69 Implications for policy and service responses ..................................................... 69 Services need to be integrated, holistic and address a person’s full range of needs ......................................................................................................................... 69 Services working with people who use drugs must be trauma informed .................... 70 NSW Government response should be trauma informed ........................................... 71 References ............................................................................................................... 73 Chapter 4. Current drug policy, funding and governance ............................................. 75 Introduction .............................................................................................................. 75 Why government seeks to respond to AOD use ................................................... 75 Government drug policies change over time ........................................................ 76 Current national policy framework: the National Drug Strategy ......................... 77 National Drug Strategy priorities for attention ............................................................ 78 The pillars of the National Drug Strategy ................................................................... 79 National Ice Action Strategy 2015 .............................................................................. 81 Current NSW policy framework .............................................................................. 82 Current legal framework .......................................................................................... 83 Commonwealth legal framework ................................................................................ 83 NSW legal framework ................................................................................................ 84 Governance .............................................................................................................. 87 Intergovernmental AOD governance mechanisms..................................................... 87 NSW AOD governance mechanisms ......................................................................... 87 Funding ..................................................................................................................... 88 Funding of targeted AOD health responses ............................................................... 89 Funding of targeted AOD justice responses ......................................................... 92 References ............................................................................................................... 93 Chapter 5. The spectrum of amphetamine-type stimulant use and implications for policy and services ..................................................................................................... 97 Introduction .............................................................................................................. 97 Drug use occurs across a spectrum ...................................................................... 97 Types of ATS use ..................................................................................................... 98 People who do not use drugs .................................................................................... 98 Experimental use ....................................................................................................... 98 Recreational use ........................................................................................................ 99 Situational