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‘Your boyfriend's here, isn't he?' Kastrappis said.

There were so many sexual assaults by men high on ice in recent years, it's hard to know where to place Kastrappis. He wasn't a violent and manipulative rapist in the vein of Mohammed Kerbatieh. He was not an opportunistic lifetime criminal, like Dudley Aslett, Shane Martin or Michael Scott Wald, a 21-year-old Victorian who robbed, bashed and raped a seventeen-year-old boy one night in 2006 purely because he crossed paths with him on the street in Frankston. Ice did not, for Kastrappis, unleash a burst of sadism such as affected Lindsay Michael Hearn, a 30-year-old non-violent petty criminal from the Central Coast of NSW who impersonated a police officer and forced an autistic man to pull over on the F3 freeway in mid-2006, then kidnapped, robbed and raped him in a sexual crime that a judge said had ‘a degree of depravity and callousness . . . the likes of which I've not encountered before'. Nor was Kastrappis a vindictive sociopath like Canan Eken, the 28-year-old Sydney man who was jailed for fourteen years after ordering his flatmates to rape a young woman at his flat in Rosebery in 2004, as punishment for her not having sex with him. Eken, a schizophrenic, tried what sceptics were by the time of his sentencing in 2006 calling ‘the ice excuse', testifying that he became violent after smoking a gram a day for six months. District Court Judge Anthony Puckeridge would not have it: ‘By deliberately choosing to abuse illegal substances the prisoner should be treated as choosing the consequences of his behaviour,' he said.

There were so many sexual crimes triggered by crystal meth. But Andrew Kastrappis was different. He was unhinged and scared, and his sexual assault on Ms Matthews seemed less a result of a clear-headed plan than another facet of his general confusion. Rebuffed by her, redirecting his paranoia, he searched the unit for Ms Matthews's boyfriend (who wasn't there). Still apparently fearful, Kastrappis left the unit a short time later. Ms Matthews went to her boyfriend's home and phoned the police, who arrested Kastrappis the next morning. He hadn't left his unit.

In the South Australian Supreme Court the next year, two psychologists and the judge agreed with the defence's submission that Kastrappis was not guilty on the ground of mental incompetence. The finer points of the psychiatric reports differed—one diagnosed the incident as a first onset of bipolar disorder, another saw it as paranoid schizophrenia triggered by the ice and cannabis use, and another diagnosed a drug-induced psychosis—but the overall agreement was that Kastrappis was, for legal purposes, mentally ill at the time he entered Ms Matthews's flat. He was hearing voices telling him to go in, and was genuinely scared of the ‘trouble' that unknown men were going to cause. He was placed under a supervision order with a number of tight conditions, but wasn't considered to be a threat to the community; indeed, he stopped using ice and cannabis after the incident and, under a low dose of anti-psychotic medication, his mental health issues were held by the court to be ‘resolved'.

In March 2006, the United Nations' International Narcotics Board declared methamphetamine to be ‘a major drug pandemic'. At the same time, there was evidence in Australia that the drug was less used, and less of a threat, than it had been in five years. Is the current lull in methamphetamine use a dip in an inexorable increase, or the first sign of a cyclical abatement? It is too soon to know the truth, but one thing is sure: crystal methamphetamine has changed not only individual lives; it has changed Australian society. It has altered the public's disposition towards illicit drugs, and it has revolutionised the way a number of professions do their work. Hospitals, doctors' surgeries, rehab centres, ambulances and other paramedics, pharmacies, police and customs services, schools, prisons, sporting bodies, governments, the media and the criminal courts all conduct their business differently as a result of this drug.

So much change has happened in a remarkably short time. There will always be criticisms of institutions' slow reaction, but considering that this drug, in this form, only appeared in Australia a decade ago, the changes that have occurred are a testament to the suppleness and adaptability of our institutions.

Police in different states have dedicated clandestine laboratory squads now, with millions of dollars assigned to the specific task of locating and dismantling methamphetamine-making facilities and purpose-built trucks for reducing the harm to officers.

Police stations instruct officers in self-defence and restraint guidelines to deal specifically with suspects suffering ice-induced psychoses. In New South Wales and Victoria, programs have been developed allowing ice users to lecture police about the drug and attendant mental illnesses, to avoid attacks and shootings such as those which wounded Constable Elizabeth Roth and led to the death of ice user Gregory Rama Biggs.

Customs have new detection procedures targeted specifically at finding ice, and the Australian Federal Police allocates a large chunk of its resources to tracking ice importers in Australia and forging ties with Asian police in shutting down ice manufacturers and exporters there. Ice has been responsible for a greatly improved relationship between law enforcement officials across the region. Unlike counter-terrorism, combating crystal meth across borders has been politically and culturally uncontroversial.

The federal government has permeated every television-watching household with its ‘Tough On Drugs' advertisements showing a man throwing a bin at a window in a hospital ward, a son knocking over his mother, and a young girl scratching ulcers into her arms. Millions of tax dollars have been spent on illustrating for every parent and child the most extreme effects of crystal meth.

Higher courts have had to adjust the common law to take into account the horrific crimes catalysed by ice. The very notion of mental illness, in a criminal context, is undergoing a reassessment across Australia.

Local courts are changing their processes to deal with an explosion of defendants showing signs of mental illness. Self-control, even in courts, can be relied on less than ever. This is not simply a matter of more guards; programs are in place around the country to divert defendants away from prison and into treatment, with clinical nurse consultants assessing defendants' mental health needs now a fixture in the court system.

Hospitals have Psychiatric Emergency Care Centre rooms or other dedicated facilities to separate acute ice users from other patients and to treat the needs that are specific to users of the drug. Doctors' surgeries have been reconfigured with security as a paramount concern. No longer is the threat a junkie breaking in and raiding the medicine cabinet; it is an ice user attacking the doctor, or someone else, and tearing the place down.

Rehab and detox centres, as well as having tailored therapeutic programs for ice users, now have family rooms to protect the children and spouses of recovering users.

Project STOP has changed the way pharmacists do their business, as have legislative changes to cut down on pseudo-ephedrine sales. A by-product of this has affected all Australians suffering a cold or flu: they can no longer buy apparently harmless medicines over the counter, and for many this has incurred a degree of suffering.

Treatment options still lag—there is no accepted or widely used pharmacological treatment for methamphetamine addiction. Methadone is entrenched in the treatment regime for heroin addicts, but there is still no methadone-equivalent for ice users. Behavioural therapy is still the most common approach to ice users, but there are currently about 15 000 treatment episodes a year taking place in Australia, fewer than half of the National Drug Strategy's target of treating 70 per cent of dependent users. While most heroin addicts know of the methadone option, even if they don't take it up, the lack of a recognised pharmacological treatment for methamphetamine addiction is seen as an influential factor in keeping heavy users away from treatment. A decade since Alex Wodak thought of prescribed dexamphetamine as a way of countering withdrawal, there is no proven pharmacotherapy for meth users. Most health professionals involved with ice say that the consequences of this will be felt in the long term: the debilitating depression, anxiety and other mental illnesses resulting from crystal methamphetamine use are a long way from being known.

Nicole Lee has surveyed treatment outcomes for the past eight years at the Melbourne clinic Turning Point. She says that the ‘natural history' for meth users is to go from first use to regular use within a year, to suffer from mental health problems, or dependence, or a criminal act within another year, but for a staggering five years to then go by before the user seeks treatment.

‘There are lots of reasons for this,' she says. ‘They're reluctant to attend treatment programs that are geared for opiate users. They don't see themselves as having that kind of hard-drug problem, and don't want to be hanging around waiting rooms with heroin users. Also, they tend to want a response on the same day, immediately, and if we don't give them that we lose them.'

The most effective treatment, when it happens, is a combination of cognitive behaviour therapy and drug Modafinil, which is still being trialled. Dr Lee says Modafinil is a drug to counter narcolepsy, a ‘wakefulness-promoting drug'; ‘It lifts the user's mood during withdrawal,' she says, ‘though we don't know exactly how it works.'

Dr Lee thinks the time bomb on methamphetamine use is not psychosis but depression. ‘Only 10 percent of users experience psychosis, but 60 to 80 percent experience depression,' she says. ‘It's a quiet disorder, and the user often doesn't link it to drug use, especially when they've stopped. But a debilitating depression can go on for years and years.'

In 2007, the Australian Federal Police devised a Drug Harm Index showing the economic impact of drugs on the country. The DHI measures, retrospectively, costs of violent and nonviolent crime, the drain on police resources and ambulance and hospital services, and the burden on courts and prisons.

Per kilogram produced, heroin is still the most expensive, costing the country $550 000. This has halved since 2003.

Methamphetamine costs Australia $284 000 per kilo, the DHI found. In 2003, its cost was $80 000 a kilo. (The effects of cannabis, incidentally, cost the public $13 000 a kilo.)

The AFP assistant commissioner Mike Phelan told a parliamentary committee that the DHI for methamphetamine had trebled because of ‘the increased number of interactions with the health system, people having to go to hospital, and it's also the crime that goes with that—drug-taking, the burglaries, break-ins.' There was also the cost of road accidents, lost work days and family break-ups.

The DHI is one attempt to quantify the unquantifiable but longest-lasting and truest cost of a drug. How do you assess the price that is paid by families when one member becomes an ice user? How do you measure the effect on the thousands of children growing up in houses where their parents are addicted to a drug? In 2007, according to a National Council on Drugs study, there were an estimated 14 000 children whose parents used crystal meth at least once a month. How can the impact ever be quantified?

There is, at the very least, a body count. Users who have committed serious crimes have had their lives depleted by years in jail. Damien Peters, Mohammed Kerbatieh, Dudley Aslett and his acolytes, Dimitrios Kyriakidis, Lindsay Hearn, Sally Brennan, Matthew Gagalowicz, Darren Blackburn, Novica Jakimov, Ersen Cicekdag, David Khuu, Justin De Gruchy, Canan Eken, Todd Bookham and the fatal young friends, IM and CB in Newcastle and B and C in Collie, have gone to jail after what they did on ice, some for the rest of their lives. There are too many to count, and they multiply when the imprisoned traffickers and manufacturers are added in.

Australia's prisons bear a certain burden, as do the mental health facilities that have looked after the ‘innocent criminals' such as Trent Jennings and Andrew Kastrappis.

Among their victims, life will never be the same, due to a purely random crossing of paths with ice. The Marlows of the Central Coast pharmacy, whom I interviewed in 2007, were still traumatised. Jennifer Marlow could not recall Dudley Aslett's attack in detail, and her husband Paul said they had altered their routine of locking up the newsagency at night because of Jennifer's ongoing fear. Peter Sutherland of the Tuggerah NAB, Constable Elizabeth Roth, Karen Fairbairn, Andrew Hennessey and John Pestana of the West Australian rest stop, unnamed and uncountable victims of sexual attacks—these people must live with their memories of terror springing out of nowhere. Emad Youssef, Giuseppe Vitale, Kelly Hodge, Andre Akai, Graham Band, Eliza Davis and many others didn't survive the ice age. Garry Sansom, Ricky Smith and Gavin Atkin were involved in the drug trade, but nobody except their killers could ever conceive of the idea that they deserved to die or that their families deserved to go on living with such painful memories. Somewhere there is a memorial for the deceased victims of ice-related violence, and it is one that stretches out to the horizon and beyond.