No indigenous ice epidemic yet, but it’s sure to arrive eventually

ALCOHOL is still the biggest problem for remote Aboriginal communities.

Unfortunately, ice is easy to produce and transport.

AROUND midday on Friday last week a body lay face up in the sun, sprawled across the verge outside a car dealership in central Cairns.

I stopped, as did three others. The man was indigenous, probably in his 40s but looking decades older and there was alcohol on his breath. He was not far from a creek-side camp where indigenous drinkers from Cairns and beyond gather, and he may simply have been very drunk — but how would you know? Homeless drinkers live in a risk-primed world and face accidents, violence, chronic ill health and the toxicity of any illicit substances that enterprising dealers can offload on pension day.

Moments later two policemen were on the scene, and while we waited for an ambulance one commented that they now had more business from ice than cannabis.

Though unstated, I’m sure that alcohol is still in front.

The next day, on the front page of The Weekend Australian, Marcia Langton was quoted in a story by Patricia Karvelas warning of an “epidemic of amphetamine use” in remote Aboriginal communities (“Langton warns of remote ice crisis”, October 25-26).

That column was really about welfare reform and Andrew Forrest’s Creating Parity report — big-picture stuff — and continued on page 4, below an article by Victoria Laurie (“Town waits to hear of grog’s terrible toll”) recapping the devastating impact of alcohol on the pregnancies of Aboriginal women at Fitzroy Crossing and the imminent release of research findings that were expected to place that small community among the world’s frontrunners in terms of proven cases of foetal alcohol syndrome and foetal alcohol spectrum disorder.

In my experience as a psychiatrist working in Aboriginal communities in Cape York, amphetamine use is uncommon, and though alcohol is prohibited in most of those communities it still ranks as the major proximate cause of misery and malaise, with cannabis not far behind.

Unfortunately, ice has too much going for it. With well-­developed distribution networks in rural Australia, it is relatively cheap, easily transported and can be cut to provide profit as it passes each set of hands. It’s easily used, highly addictive and, despite its well understood and devastating physical, mental health and social problems, it’s on the way.

Rewind a quarter-century. In the late 1980s I was in Fitzroy Crossing and the wider Kimberley gathering information from Aboriginal residents about alcohol use, including during pregnancy. While nobody envisaged the burden of harms that would follow, it was known that drinking during pregnancy was not uncommon.

During the next two decades data continued to accumulate, triggering a range of interventions across the country. While there may have been benefits, there is still a large population of children and young people who are afflicted, some of whom are themselves parents. And among the marginalised and disenfranchised in remote communities and town camps, pregnancies and the lives that will follow are still being ­compromised.

So, are there lessons from that slowly evolving catastrophe that may help us prepare for the arrival of the Ice Man? Well, there are things we can predict.

First, if it’s not there now, it’s coming — and will have its most immediate effects on youth and young adult males, spreading from towns and fringe camps to remote settings.

Second, those most at risk will already be disengaged from the social networks supporting healthy families and communities — children outside the home and school system, men who are unemployed or nominally enrolled in “training” that leads nowhere and those cycling through youth and criminal justice systems.

Third, an ice economy will develop that will further siphon sustenance funding from welfare-dependent families.

Fourth, there will be a rapid increase in service demands as a result of violence associated with intoxication and/or extortion, acute psychoses and the stress on families contending with the ­foregoing.

And fifth, a suite of programs and workers will be deployed through state and non-government organisation services to manage the epidemic.

No surprises that the groups at greatest risk are the same as for alcohol, self-harm and cannabis use, all of which have been labelled epidemics at various times. Perhaps the key lesson should be that while a new set of programs and providers (and colourful badged shirts) may help reduce the demands on health and social services, at best they will be a containment strategy. The damage unleashed by amphetamines will relate more to the social setting than the substance, and that setting remains much the same as the one that enabled those other epidemics to spiral out of control.

Those advocating national policies and programs across indigenous affairs — welfare reform, education, employment — are trying to transform that setting.

However, as Nicolas Rothwell notes in surveying that policy landscape over the past decade (“A decade after ATSIC was axed, Aborigines still have little to say”, Inquirer, September 27-28), there is an obvious conflict between “broadacre” approaches that adhere control to central authorities, and the capacity for communities to develop localised solutions — assuming more responsibility and control (about which there is much ­rhetoric).

There is no easy answer and it is unlikely that what proves to be an effective balance in Cape York will be the same as in Fitzroy Crossing. The challenge will be how to accommodate local circumstances and experience meaningfully while maintaining the reach and momentum to drive national gains.

Rothwell’s historical overview gives cause for caution rather than optimism. On the same page last weekend as the articles about FASD and the “ice crisis” is another about recent indigenous suicides in custody (“Hanged man in jail for burglary”).

Nearly a ­quarter-century since the Royal Commission into Aboriginal Deaths in Custody foregrounded underlying social disadvantage, the ultimate causes are the same.

And the man on the side of the road — as the ambulance arrived I reflected that he was lucky to be in a country with world-class emergency and health services — he’d be competently reviewed and probably back on the streets before nightfall.

Plus ca change …

Ernest Hunter is a medical practitioner in north Queensland.