Methamphetamine: A 2005 Update Richard A. Rawson, Ph.D.UCLA Integrated Substance Abuse ProgramsLos Angeles, Californiarrawson@mednet.ucla.edu

Speed It is methamphetamine powder ranging in color from white, yellow, orange, pink, or brown. Color variations are due to differences in chemicals used to produce it and the expertise of the cooker. Other names: shabu, crystal, crystal meth, crank, tina, yaba

IceHigh purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

According to surveys and estimates by WHO and UNDCP, methamphetamine is the most widely used illicit drug in the world except for cannabis.

World wide it is estimated there are over 42 million regular users of methamphetamine, as compared to approximately 15 million heroin users and 10 million cocaine usersScope of the Methamphetamine Problem Worldwide

IHS-Wide RPMS PCC Outpatient Encounters for Amphetamine Related Visit by Calendar Year

The Eastward Spread of Methamphetamine

Methamphetamine: A Growing Menace in Rural AmericaIn 1998, rural areas nationwide reported 949 methamphetamine labs.

Last year, 9,385 were reported.

This year, 4,589 rural labs had been reported as of July 26.

Source: El Paso Intelligence Center (EPIC), U.S. DEA

Stove Top LabsThe active ingredient in making methamphetamine is ephedrine or pseudoephedrine, commonly found in over the counter cold remedies.

Meth Lab SeizuresA small percentage of labs seized are labeled Super Labs and are capable of producing over 10 lbs per batch. Super Labs are operated by Mexican National Drug Trafficking Organizations (MNDTOs), and supply the majority of meth to the market.

Clandestine Meth Lab Equipment

A Major Reason People Take a Drug is they Like What It Does to Their Brains

Methamphetamine abusers have abnormal brain activity

Natural Rewards Elevate Dopamine Levels

Methamphetamine AddictionThe brains of people addicted to Methamphetamine aredifferent than those ofnon-addicts

CocaineMethamphetamine*Cocaine and Methamphetamine Effects Compared

Prolonged Drug Use Changesthe Brain In Fundamentaland Long-Lasting Ways

Sample Characteristics305 Adolescents (13-18 years old)

Average Age ~ 16yrs old (sd=1.138)

Gender: 70.2% Males

Ethnicity: 55.3% White & 33.1% Latino

Age Distribution

Ethnic Identification

Drug Use History (Ever Used?)N=272

Drug Use History (Ever Used)*Missing responses

Drug Use by Gender

Drug Use by Age*P

Drug Use by Ethnicity*P

Parental & Peer FactorsFamily dysfunction was high for both groups.64.3% reported parental drug use.60.2% had divorced or separated parents.40% lived in single-headed households (mothers only).

Involvement with drug-using peers was high (65.9%).

Social Problems by Drug Use

Psychological Distress by Drug Use*P

Treatment Response by Drug Use

Overall Treatment Response

Drug Use at DischargeMore than 50% of the sample reported using drugs or alcohol in the previous 30 days at discharge.

50% reported using their Drug of choice20% reported using alcohol15% reported using other drugs (not DOC)

Women and Meth

Meth and Women: Typical gender ratio of heroin users in treatment : 3 men to 1 womanTypical gender ratio of cocaine users in treatment : 2 men to 1 womanTypical gender ratio of methamphetamine users in treatment : 1 man to 1 woman *

*among large clinical research populations

Drug Use by Gender

Self-Reported Reasons for Starting Methamphetamine Use

Self-Reported Reasons for Starting Methamphetamine Use

My sexual drive is increased by the use of (Rawson et al., 2002)

My sexual pleasure is enhanced by the use of (Rawson et al., 2002)

My sexual performance is improved by the use of (Rawson et al., 2002)

CSAT Methamphetamine Treatment Project: Cross-Site Sample Description1,016 clientsAverage age was 32.8 years55% female60% Caucasian12.2 years of education on average16% currently married31% awaiting charges, trial, or sentencing

Methamphetamine Use HistoryAvg. years of lifetime use:7.54

Avg. days used in past 30:11.53

Percent that usually smoked:65%

Violence Issues in Lifetime78% experienced violence39% experienced sexual abuse81% experienced one or the other36% experienced both

Psychological Issues in Lifetime60% depressed56% anxiety45% memory problems43% violence control problems34% suicidal thoughts32% received medication9% memory problems

Gender Differences in Violence History

Gender Differences in Partner Violence

Gender Differences in Sexual Abuse History

Analyses reveal that a history of physical or sexual violence (controlling for gender) is significantly related to a number of negative outcomes.

These results suggest the importance of understanding client background factors before they enter treatment.

Those Who Have Experienced Violence Have Higher Scores on the BSI and the BDI

Those Who Have Experienced Violence Have Higher Average Composite Scores on the ASI

Those Who Experienced Violence Were More Likely to Have Psychological Issues on the ASI

ImplicationsPhysical and sexual violence is related to psychological problems and drug use pattern differencesDifferent types of traumas may have different outcomes and may affect people in different waysA history of trauma may be related to treatment engagement and outcome

Behavior Symptom Inventory (BSI) Scores at Baseline

Beck Depression Inventory (BDI) Scores at Baseline

Drug Endangered Children in California: Methamphetamine Use and Manufacture Nena Messina, Ph.D., Patricia Marinelli-Casey, Ph.D., Richard Rawson, Ph.D.UCLA Integrated Substance Abuse Programs

ChildrenInquisitive nature of young children makes them more prone to accidentally consuming toxic chemicals that are sometimes kept in unmarked containers in the refrigerator.

ChildrenHundreds of children are neglected by parents who are meth cooks. Nationally, over 20% of the seized meth labs in 2002 had children present.

In Washington State, the counties of Grays Harbor, Spokane, Thurston, and Klickitat all reported that children were found at half the labs seized in 2002. In Lewis County, children were found at 60-70 %, and in Clark-Skamania, 35%.

ChildrenChildren who live in and around the area of the meth lab become exposed to the drug and its toxic precursors and byproducts.

80-90% of children found in homes where there are meth labs test positive for exposure to meth. Some are as young as 19 months old.

ChildrenChildren can test positive for methamphetamine by:

Having inhaled fumes during the manufacturing process Coming into direct contact with the drugThrough second-hand smoke.

ChildrenHundreds of children are neglected by parents who are meth cooks. Nationally, over 20% of the seized meth labs in 2002 had children present.

In Washington State, the counties of Grays Harbor, Spokane, Thurston, and Klickitat all reported that children were found at half the labs seized in 2002. In Lewis County, children were found at 60-70 %, and in Clark-Skamania, 35%.

ChildrenIn 2002, a total of 142 children were present at lab seizures in Riverside and San Bernardino Counties.

Most children reported as being present during a seizure were school age.

ChildrenChildren are uniquely susceptible to neurological contamination in the environment because their brains are still developing.

Lead poisoning is an example of what the child is exposed to in these meth labs. A small amount of lead that may not affect an adult can cause neurological damage in a child.

Children are not small adults!Different dietGrowing & developing rapidlyHigher metabolic & respiratory rateDeveloping nervous systemUnusual habits (hand-to-mouth behaviors; close to floor, contact with many surfaces, at risk for all poisonings)Biologic & developmental vulnerability

Drug Endangered Children Response TeamsMulti-Need Families; Multi-Need IndividualsMulti-Disciplinary ApproachSpirit of CooperationSharing of InformationCase Coordination for Best Family and Individual Outcome Why the Team Concept Is Needed and Works...

CORE TEAM MEMBERS:LAW ENFORCEMENT (24/7)CHILD PROTECTIVE SERVICES (24/7)DISTRICT ATTORNEYS OFFICE (24/7)MEDICAL PERSONNEL (24/7)

AUXILIARY TEAM MEMBERS:MENTAL HEALTH & THERAPEUTIC PERSONNEL FOR CHILDRENENVIRONMENTAL SERVICES, FIRE, & PUBLIC HEALTHDRUG TREATMENT PROVIDERS FOR PARENTS AND FAMILY MEMBERSDEC RESPONSE TEAM

States with DEC Response TeamsDEC Team``No DECDEC Resource Center, 2001

States Having Received DEC Training from CaliforniaDEC TrainingNo TrainingDEC Resource Center, 2001

Methamphetamine Treatment

Contingency ManagementMatrix Model

Investigating the use of contingency management to treat methamphetamine abuseContingency management is arguably the most effective behavioral strategy for treating other types of drug abuse.

Human laboratory investigations (Roll, Newton, Chudzynski & Fong, under review) suggest that methamphetamine use is amenable to modification via the presentation of alternative sources of reinforcement.

Combined data from several pilot studies (Roll, Huber, et al., in press; Roll & Shoptaw, in pressAll studies provided vouchers with specified monetary values for the provision of urine samples which indicated no recent methamphetamine use.Urines were collected under direct observation.Vouchers could be exchanged for goods or services that were congruent with developing a drug free lifestyle.

All trials were 12 weeks in duration and collected urine sample three times/week.

All trials had a cognitive behavioral psychosocial platform that was administered by trained clinicians and delivered three times/week.

Participants 112 treatment-seeking methamphetamine users (29 CBT and 83 CBT + Contingency Management)

mean age was 31.4 (sem 0.8) years. 62.7% were Caucasian,30.1% were Hispanic, 2.4% were African American, 2.4% were American Indian, and 2.4% were Pacific Islander44.8% were employed full time22.9% were married

Cm Amph

9.55.81.30.9

14101.20.98

CM (n=55)

Standard care (n=69)

Number of samples

mean meth neg

Slow Esc. + Bonus86

Slow Esc.63

De-Esc + Bonus86

Standard25

Means

% relapsing following 4-wks of abstinence

mean abs

192.4

92

Mean number of abstinences

Mean number of abstinences

Sheet1

MeansSEMs

Mean number of abstinences

CM192.4

Control92

MeansSEM

Slow Esc. + Bonus86

Slow Esc.63

De-Esc + Bonus86

Standard25

Sheet2

Sheet3

Cm Amph

9.55.81.30.9

14101.20.98

CM (n=55)

Standard care (n=69)

Number of samples

mean meth neg

Slow Esc. + Bonus86

Slow Esc.63

De-Esc + Bonus86

Standard25

Means

% relapsing following 4-wks of abstinence

mean abs

41

1.11.1

Mean number of abstinences

Mean weeks of consecutive abstinence

Sheet1

MeansSEMs

Mean number of abstinences

CM41

Control1.11.1

MeansSEM

Slow Esc. + Bonus86

Slow Esc.63

De-Esc + Bonus86

Standard25

Sheet2

Sheet3

CTN 006 methamphetamine data(Roll, et al.,in prep.)Used the variable magnitude of reinforcement procedure developed by Petry. 113 methamphetamine abusing individuals were part of the larger trial.Received the chance to win prizes for the provision of stimulant negative urine samples.

Methamphetamine Outcomes from CTN 006

Cm Amph

9.55.81.30.9

14101.20.98

CM (n=55)

Standard care (n=69)

Number of samples

Sheet1

MeansSEMs

LDA# Negative UrineLDA# Negative UrineUrines

CM (n=55)9.5141.31.2

Standard care (n=69)5.8100.90.98

Sheet2

Sheet3

Project Structure:Study SitesBillings, MTHonolulu, HISan Mateo, CA (2)San Diego, CAConcord, CACosta Mesa, CAHayward, CA Coordinating CenterUCLA Integrated Substance Abuse ProgramsSteering CommitteeScientific Advisory BoardCommunity Advisory Board

Baseline Demographics

Gender Distribution of Participants

Sample Description

Ethnic Identification of Participants

Route of Methamphetamine Administration

Changes from Baseline to Treatment-end

Days of Methamphetamine Use in Past 30 (ASI)Possible is 0-30; tpaired=20.90; p-value

Beck Depression Inventory (BDI) Total ScoresPossible is 0-63; tpaired=16.87; p-value

BSI Scores (mean)1Possible, all scores, is 0-4; *all p-values

Positive Symptom Total (PST) from Brief Symptom Inventory (BSI)Possible is 0-53; tpaired=14.33; p-value

Mean Number of Weeks in Treatment

Mean Number of UAs that were MA-free during treatment

Figure 4. Percent completing treatment, by group

x2=4.68, p=0.031

This completer measure is computed by comparing the last visit ever seen to the length of the treatment assigned.If the last visit seen is equal to the treatment length, the participant is a completer. If the last visit ever seen is less than the treatment length, the participant is not a completer.

Figure 6. Participant self-report of MA use (number of days during the past 30) at enrollment, discharge, and 6-month follow-up, by treatment condition

Overall Repeated measures analyses:The effect of TIME is wildly significant; F=124.43, p

Methamphetamine

Route of Administration

Route of Methamphetamine Administration

Route of Administration by SiteP

Craving by RouteP

Drop Rates by RouteP

Treatment Length by RouteP

Treatment Completion by RouteP

MA-Free Samples by RouteP

BSI Psychiatric Symptoms by RouteP

Depression Symptoms by RouteP

Psychopathology and RouteIDUs > likely to have a psychiatric disability.

IDUs > likely to have prior hospitalizations for psychiatric problems.

Methamphetamine

Methamphetamine User Tx Response vs Cocaine User Tx Response

Medical and Psychiatric SymptomsMore MA users experienced headaches (p

Medical and Psychiatric SymptomsHallucinations were reported by one-third of MA users and one quarter of cocaine users (p

Medical and Psychiatric Symptoms*p

Treatment Length by Stimulant Users

Response to TreatmentThere is no difference in the amount or type of treatment received.The two groups were retained in treatment for the same duration, and the survival curves are nearly identical.

Methamphetamine and cocaine users participated similarly in the program.

Treatment outcomes, as measured by urine toxicology results, does NOT vary significantly between methamphetamine and cocaine users.

Hepatitis C by RouteP