About three months ago a guy we'll call Michael was prescribed a stimulant medication for his ADHD. He takes it three times a week, on and off, and he gets the bugs. They appear when he stays still for too long or is exposed to heavy light and sound. He knows they're not real, but the only thing he can do is try to ignore them.
The drug was called Vyvanse and it contains dextroamphetamine, an amphetamine that was used by the US Air Force in WW2 as a "go-pill" for fighter pilots. The night it first happened, Michael had downed a 30mg dose and gone to bed. After a while he started to get a pulsating, tingling feeling moving across his skin like something was crawling over his body
He'd had the feeling before but this time he panicked. He ripped off his sheets and started looking for bugs. At first he couldn't find anything, but when he looked closer he found a small translucent bug about a millimetre in length. Then more. Then they were everywhere, some darker than others like the static on a television screen.
"After a while I gave up," he said. "I was tired and just lay in bed. The crawling continued and I took about an hour to fall asleep. I would wake up several times during the night and feel a nasty itch, so I knew they were still there. This continued for three days at the same intensity."
Michael let it go for a week before he had someone check his bed to make sure he wasn't crazy. When they found nothing, he didn't believe them and in his search for answers, he ended up online where he learned about a psychosis called Ekbom's syndrome. Ekbom's or "delusional parasitosis" is a rare form of neurosis where someone genuinely believes they are being swarmed with bugs. To avoid this feeling Micahel went back to the doctor and was prescribed a meth-based medication. He still gets the bugs but tries to ignore them.
On the street, Ekbom's is more commonly known as ice bugs or meth mites, and is associated with hardcore ice users. But not everyone with Ekbom's uses ice, and not everyone on ice gets the bugs. When writing this article I spent days trying to find a local user who had experienced bugs and finally gave up. Eventually I turned to the net which is how I found Michael, who lives in California. According to Jack Nagle, a past addict who works as the National intake and assessment manager at Dayhab, a rehab clinic specialising in ice addiction about half an hour east of the Melbourne CBD, this isn't surprising at all. He personally sees how rare bugs are, and even when he was a gaunt, thieving addict he never got the bugs.
These days he's four years and four months sober. His job is to get addicts into treatment, but every time an anti-ice scare campaign hits national television, such as a recent Australian government initiative showing a woman digging her fingernails into her skin, things get a little bit harder.
"It prevents people from seeking help," he said. "Because a lot of people come here and talk to me and they think they don't have a problem because they don't have the bugs. They still have a job. They still have a family. They may have mental health issues, but they don't think they have a problem."
When someone gets the bugs, understanding how it happens can be complicated. Dr Nicole Lee, an Associate Professor at the National Centre for Education and Training on Addiction at Flinders University, told VICE that only those doing a lot of meth, around five times a week for at least six to eight months are at risk. Yet beyond this pattern, doctors can only hazard a guess at what's going on in the brain.
Dr Lee explained that it possibly has something to do with the way dopamine works on the pre-frontal cortex and the limbic system within the brain. Ordinarily, these two areas "talk" to each other as they work to analyse everything that happens in a person's environment. They also run on dopamine, which gets released every time a person does something nice. Anything left over gets recycled and used again the next time around.
"What we know from other forms of psychosis is that high levels of dopamine increase psychotic symptoms," Dr Lee said.
Dr Lee said ice floods the brain with dopamine while blocking its ability to recycle the leftovers. There are no exact figures, but estimates are that ice increases dopamine to 1200 times baseline levels and sustained use over a long period breaks the system, killing the conversation between the two parts of the brain.
Numbers on how common Ekbom's actually is among ice users is hard to come by. The same goes for stats on those who are most at risk, but based on those who move through his clinic Jack Nagle believes women are more likely to get the bugs. At the very least, he said they are more likely to develop some kind of obsessive skin picking disorder, which he puts down to society's obsession with beauty.
"They look at a pimple or a blemish on their arm or face and they start picking at it and they don't realise what they're doing," he said. It is a theory that seems to be supported by at least one study cited in a review of the medical literature of Ekbom's more broadly, which found women were more at risk.
Whatever the case, both Dr Lee and Jack stress that very few ice users ever get the bugs and using them as a measure of addiction either individually or as scare tactics in a fear campaign is stupid and harmful. Hyperbole only makes first-time ice users tune out of any conversation about the potential health impact, while at the other end, getting addicts to admit they're addicts is already hard enough without holding up a select group of hardcore users as a false standard. Addiction, as Jack likes to tell those at his clinic, is not just drug taking but a way of being.
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