Scattered (27 page)

For Beaver Hudson, the turning point came with a patient he saw at St Vincent's in 2004. The ‘Incredible Hulks' and other ‘meth freaks', as they were now nicknamed, were flowing through the hospital at an ever-greater rate—meth-related admissions rising from 200 to 1600 per year between 1999 and 2004—and with ever-stranger stories.

‘A 24-year-old man had been using it for weeks on end, and he was hearing voices telling him his wife was having an affair. So he began using a webcam to spy on her,' Hudson recalls.

St Vincent's emergency care director Gordian Fulde was shocked, telling reporters at the time: ‘I have been emergency department director here for 25 years and nothing has scared me as much as these people. We see people who are totally disinhibited, totally violent and out of control.'

The problem was not isolated to inner-city Sydney hospitals like St Vincent's. NDARC research published in the
Medical
Journal of Australia
showed that national hospital databases recorded a fivefold upswing in drug-induced psychotic episodes between 1999 and 2004. Across the nation, 3190 meth users were taken to hospital for mental and behaviour disorders in the years 2003 and 2004. Demographically, the main driver of the increase was ice being injected by older users, in their thirties. A study released simultaneously, by Royal Perth Hospital's registrar in emergency medicine, Suzanne Gray, found that 20 per cent of all amphetamine-related presentations at the hospital had required police assistance. ‘A third of patients required sedation, which correlated with a high pre-hospital, nursing, medical and security load to manage these patients safely,' Dr Gray said. Gordian Fulde said: ‘The fact that Perth Hospital is having the same problem that we are in the east underscores that it really is a problem Australia-wide.'

At St Vincent's, Beaver Hudson had been observing the change up close—‘The long-term users were very hard to differentiate from paranoid schizophrenics. The bad dental care, the terrible skin, the frightening ageing effects, are all similar'—but there was one patient who stood out.

‘There was a woman presenting here, totally manic. We thought she had a bipolar disorder. She was scattered. She was very concerned about her partner. She said she'd broken up with him because he was in a bikie gang. She'd heard a click on the phone when she was using it, and was sure it was bugged. She wouldn't use her mobile. She got to the point where she was so scared she'd only make phone calls from a call box on the street corner. She said when she looked up from the call box, she saw someone in an apartment taking photographs of her.

‘I was thinking, “This poor woman, being menaced by a bikie gang” . . . She said she'd spent $25 000 having her apartment swept for bugs. I was sucked in.'

Then one day, Hudson asked her, ‘How much speed do you use?'

The patient said, ‘A little bit now and then.'

‘Do you inject?'

She said, ‘Not much. About two or three times a day.'

Hudson said the penny dropped. ‘I thought, Oh my god, she's not bipolar, she's having another form of speed psychosis I haven't seen before. She was articulate, rational, credible. Her delusion was totally systematised. I was sucked in. But this was what it was doing to people.'

Health workers at St Vincent's were not alone in making such observations. In the Victorian health system, patients asking to be treated for methamphetamine-related disorders doubled between 2001 and 2004. A psychiatrist at Royal Perth Hospital, Dr Nigel Armstrong, said his hospital's emergency department had become a ‘de facto psychiatric clinic', requiring extra psychiatric staff. This was on top of the police involvement noted at the same hospital by Suzanne Gray. ‘Clinically, we see a lot of people in [emergency] with drug-induced pathology and the ones that give us the most grief are those with amphetamine-induced psychoses because we have to find [secure] beds for them,' Armstrong said.

North of Sydney, violent patients were putting hospital staff at risk. In four Hunter region hospitals in 2005, there were 94 aggressive incidents, including 50 assaults, 54 cases involving verbal aggression and fourteen bullying or intimidation. On 32 occasions, a staff member had needed to press an alarm signifying a ‘code black' emergency, where help was needed to subdue a patient.

John Hunter Hospital clinical services and nursing director Chris Kewley said that staff had to deal with potentially aggressive patients on drugs such as ice on a daily basis.

‘There is absolutely no doubt that the violence we experience through the front door is related largely to the social issues, such as the high use of substances, ice and the other common drugs out there,' he said.

At St Vincent's, Hudson had long been concerned about violence against staff, and frustrated at the restrictions on staff either protecting themselves or otherwise improving the situation.

‘We couldn't punch back,' he says, almost ruefully. ‘And we can't put up a Closed sign. But we could reject them from admission, or make them wait, or deny them pain relief. That turned out to be the way.'

St Vincent's decided on a radical policy of zero tolerance.

‘Rather than medicalise that [violent] behaviour, we'd ask for the police to come,' Hudson says. ‘If people were being violent, that was a police problem. It got around in the community that if you went to St Vincent's and acted that way, you were handed to the police. People don't like the men in blue. They want help, but if they realised they were going to be strong-armed out, they started to behave a bit better.'

And in October 2005, St Vincent's opened a new facility in Hudson's department: the Psychiatric Emergency Care Centre (PECC), a six-bed facility specifically for non-acute drug-affected patients.

Dr Peter McGeorge, director of mental health services at St Vincent's, said PECC would accept patients who would usually have to sit in the emergency department while the broken legs and car accident victims were given priority.

‘What tends to happen at present is they get discharged without being sorted out as well as they could be,' he said. ‘So they'll get a better quality of management and they're not occupying space that could be used by others.'

The PECC rooms are spartan, without anything that can be seriously damaged if patients lash out. The beds don't have sharp edges and there is extra padding on hard surfaces. Duress alarms alert security staff, who sit next door. Each PECC room is monitored on closed-circuit TV. Almost immediately, 90 per cent of methamphetamine cases were put into the PECC rooms until the drug's effects wore off.

The following year, at Gorman House at St Vincent's and at John Hunter, twenty-bed detoxification wards were established to treat a problem that was not yet abating. Nurses at the James Fletcher Hospital in Newcastle had briefly refused to admit any more patients suffering from drug psychoses, so hard were they to handle. Other hospitals around the country, whether by setting up new units or re-purposing old ones, were learning that patients affected by ice needed a unique kind of treatment. South Australian hospitals, discovering that a quarter of all intoxicated emergency patients were on methamphetamine, segregated these patients from others in designated ‘quiet rooms' away from public areas. The Royal Children's Hospital in Melbourne used special rooms, which were empty but for a foam mattress, for young patients affected by drugs or alcohol, and Melbourne's St Vincent's Hospital had since 2002 been using ‘behavioural assessment rooms' to calm psychotic and other hard-to-handle patients. At the Gold Coast Hospital, where as many as five medical staff were needed at once to restrain patients having psychotic episodes on ice, specially designed rooms with foam furniture and reinforced walls were used from mid-2006.

David Spain, the deputy director of the hospital's emergency department, said: ‘We have furniture which is made out of foam so they can't throw it at people or at windows or the doors. There's usually a chair and bed we have in there. The walls have been reinforced because they continually were smashed by fists or feet.

‘I've been here 25 years. We used to see drug-induced psychosis very rarely when I first graduated. They used to be a very small percentage but now 30 to 50 per cent of the people who present through the emergency department with psychiatric illness have drug-related problems. So it has been a dramatic and unexpected upswing.'

Along with the Pharmacy Guild's Project STOP, the hospitals' initiatives were Australia's first concerted institutional response to the ice problem. Later, ambulance and paramedic services were to follow the same course, introducing ice-specific guidelines for officers, including the administration of the sedative Midazolam for ice-psychotics from September 2006.

‘This Midazolam is great stuff,' one ambulance paramedic told the
Australian
. ‘All we need now is a better delivery system . . . like a shotgun. Daktari-style tranquilliser darts.'

Gallows humour aside, no longer was it acceptable to fob off crystal meth as the same old drug as speed. It wasn't, and it never had been.

The criminal justice system, meanwhile, was having to make its own adjustments.

Real drug education is street drug education. Users get to know the effects of a drug before anyone else does, and the mythology of excess spreads quickly. In 2003 and 2004, the horror stories of ice hadn't been broadcast to the extent that they have now; consequently, ice users didn't often know what they were fooling with. When those incautious users were petty criminals, their crimes were soon far from petty.

CB and IM, two young men from New South Wales, hadn't learnt yet. The consequences of their lack of education were tragic. CB had grown up in Murrurundi, the eldest of four children, and then in the Taree–Wingham area. He suffered from a reading disability that left him four or five years behind his schoolmates. Victimised, he found a ready recourse and sanctuary in drugs.

He was expelled from Chatham High School, in Taree, for possession of cannabis when he was in year seven. Through his early teens, CB was expelled from a further two high schools for disruptive behaviour, truancy and using drugs and alcohol.

When CB was around fifteen, his father noticed that he had some unexplained funds. CB said that he had been sexually molested by a male friend of the family, who had given him hush money. A fight ensued, and CB left home. His father seemed to take the side of the family friend, who accused CB of making his story up. It was at this point that the teenager graduated from alcohol and cannabis to harder drugs, including amphetamines. At sixteen, when he left home, he set off on a six-year collection of criminal convictions, mainly for stealing, break and enter, and larceny.

CB's parents tried their best, but he was even less controllable after he left home, showing no sign of being able to live independently or hold a job. Several times his parents received calls from hospitals saying CB had been admitted for psychotic or suicidal incidents. He would be put in a hospital room where he would sing and dance one minute, and rage the next, smashing the walls with his hands. At his lowest, he would moan that he wished he had never been born. He tried to hang himself in 2000, when he was eighteen. His parents didn't know with any certainty where he slept at night.

IM was a year older than CB, having been born in 1981 at Blacktown Hospital in Sydney's west. IM's father, a migrant from former Yugoslavia, was frequently unemployed and a violent alcoholic who beat his three children, of whom IM was the youngest. Like CB, IM was sexually abused by a male family friend; when he told his father about it, his father beat him, refusing to believe it. IM was placed in foster care as a young child, but at the age of seven was returned to his family when they moved from Sydney to the Newcastle area.

Nothing much improved for IM. He had no attention for his lessons and wagged school more often than not. The only time he received consistent schooling was while he was in juvenile detention centres. When he was eleven, his abuser tried to rape him in bushland but was interrupted by two passers-by. IM said he was happy to be sent away from his family, ‘to get away from the abuse'.

At twelve, IM left school and began supporting himself through crime. Over the next decade he picked up convictions for armed robbery, common assault, malicious damage, stealing cars, damaging property, break and enter, larceny, intimidating behaviour and assault occasioning actual bodily harm.

Like CB, IM used cannabis and alcohol from an early age and harder drugs from around thirteen. Heroin was his favourite; he said it made him ‘a nicer person'. After a prison stint in 2001, he became an addict, using as much as a gram a day.

On the mid-north coast of New South Wales, crystal meth was known as ‘gas'. IM had first taken gas at fourteen, and continued to use it whenever it was available. Unlike heroin, which brought him down with terrible flu-like withdrawal symptoms within a couple of days, gas would keep him up for two weeks at a time before he crashed. But he saw it as a nastier drug than heroin. The gas, he would tell a health worker, ‘eats me away'. He would forget meals, and become malnourished. He was also beset by a dark and violent paranoia.

This was a particular problem in his home life. From about the age of fourteen, IM had a girlfriend. Around 2003 they had a son. He alternated periods of loving-kindness with terrible neglect. For ten years he had suffered flashbacks to the sexual abuse, resulting in nightmares, poor sleep, anxiety, an inability to trust people, and a sense of despair about his future that amounted to depression.

IM and CB had a lot in common. Given their shared backgrounds, it was natural for the pair to become friends. They did crime together and drugs together. As horrendous as their lives may appear from the outside, to themselves they were cowboys, good-time guys who loved to get high and go out stealing. It was their way of life. The roller-coaster of moods was something they, like most drug users, accepted. In a terrible way, there is a stoic resilience to the addict's life, a way of absorbing fate, and a discipline, knowing the ups and downs are tied to, and may be alleviated by, the use of a drug.