Abstract: Key findings:•Use of methamphetamine is increasing among two sentinel samples in Darwin, the Northern Territory. This increase is largely driven by an increase in use of crystal methamphetamine or ‘ice’. •Frequency of use has also increased among the group who regularly inject drugs, with half the sample reporting weekly or more frequent use in 2019•Smoking crystal methamphetamine is the most popular route of administration among the sample who regularly use ecstasy•There were no statistically significant differences in access to health services between those who use crystal methamphetamine weekly or more frequently and those who use it less than weekly.