In 2009/10, there were 51 methamphetamine-related hospitalisations for 50 patients within the Hunter New England Health district.

By 2016/17, that figure climbed to 957 hospitalisations for 743 patients, a more than 1700 per cent increase on patient admissions.

Comparatively, South Western Sydney lower health district rose from 38 methamphetamine-related hospitalisations for 32 patients in 2009/10, to 928 hospitalisations for 657 patients in 2016/17. South Eastern Sydney lower health district’s figures rose from 127 hospitalisations in 2009/10, to 1183 in 2016/17.

Related: 10 years on ice.

But the figures could actually be much higher, Professor Adrian Dunlop, Hunter New England Health director of Drug and Alcohol Clinical Services, said.

“The challenge with looking at the hospital data is that many people come in and out of hospital, and they may have a substance problem, but unless you ask them specifically, you don’t often know,” he said.

“For example, between one-in-six and maybe as high as one-in-three people are currently drinking more alcohol than they should be, and a significant proportion of that has been the reason for their presentation to hospital. They may have fallen, gotten into a fight, etc.

“But it would turn up in a hospital file as a fractured wrist or leg, or whatever they have done to themselves.

“Unless someone specifically asks them, we are probably under-counting.

“There is a lot of amphetamine use that never ends up being coded.”

But Professor Dunlop said the Hunter’s numbers were likely higher due to the skill of the clinicians working within the region’s drug and alcohol services.

“One of the things that is different about Hunter New England is that we have the Mental Health and Substance use ward at Mater Mental Health,” he said.

“And because they are arguably better at recognising use in the people they are admitting, it is more likely to be recorded, so you will see more of those separations when you look at Hunter New England data.

“Could it be that there is more amphetamine use here? That question is really hard to answer.”

Related: Violent and unpredictable.

Dr Marcia Fogarty, the executive director of Hunter New England Mental Health, said methamphetamine – particularly “ice” – was common in the region’s emergency departments.

“For the past three years, I think every emergency department in NSW has noticed it,” she said.

Sometimes, people would come in psychotic on ice – crystal meth – and need to be safely restrained or sedated.

“Other times, the person seemingly sitting there quietly will suddenly turn around and launch themselves across the room and start punching someone because they think they are laughing at them,” she said.

“There is certainly a sub-group of people that can be quite violent on it, and they can be very difficult for our staff to manage.

“The police bring people on ice in, and they are kicking and struggling and they are handcuffed. Then they take the handcuffs off, and we have to manage them.

“In those cases, all we can do is sedate with medication and try to manage people as safely as we can so they don’t hurt themselves, or hurt anyone else. We do get staff injuries in our emergency departments and our acute mental health ward.”

Dr Fogarty said patients on “quieter” drugs, like opiates or cannabis, usually did not want to “fight”. People with alcohol intoxication were typically predictable, and generally uncoordinated.

“But ice seems to power people up, and it makes them very accurate,” she said.

“They’ll start hitting or kicking someone, and they will continue.

“The things that stop you taking that extra step and hurting someone, that internal control we all have, is temporarily switched off. It’s a nasty drug for that.”

Dr Fogarty said while heroin and ecstacy were in regional centres, they were more prevalent in larger city populations, such as Sydney.

“Whereas with ice, it is the first time I’ve really seen a drug sweep through a country town and be cheap, and readily available. I’m thinking the Dungogs, Singletons, Muswellbrooks and the Walchas. We’ve had patients coming in from everywhere.”

Dr Fogarty said there was no doubt our region had a problem with ice, but “no bigger than anywhere else”.

“It is very common right across NSW,” she said.