Methamphetamine - MSNBC Special Report

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Methamphetamine - MSNBC Special Report

Part 1:  Meth's Deadly Buzz - The Hidden Drug Crisis

Part 2: Scourge of the Heartland - Meth Takes Root In Surprising Places

Part 3: Lab-busting in the Northwest - Stalking An Elusive Foe

Part 1: Meth's Deadly Buzz
The Hidden Drug Crisis

An MSNBC.com Special Report By Jon Bonné

In many ways, methamphetamine is the crack cocaine of the new millennium. Much like crack, which swept across the nation in the 1980s and ’90s, methamphetamine use has hit epidemic proportions in the past several years. Crack plagued inner cities and the black community; meth is thriving in cities like San Francisco, sweeping across the Midwest and headed east. It has quietly become America’s first major home-grown drug epidemic.

Meth is easy and cheap to produce, and unlike drugs such as marijuana and cocaine — much of which must be imported — meth is easily manufactured domestically with common household items such as batteries and cold medicine. There are retail and wholesale operators: Small-time meth cooks stash labs everywhere from mobile homes to car trunks, while Mexican organized crime has streamlined the high end of the industry in the past few years, supplying both finished product and the raw materials required for production, called “cooking” in the drug trade. What was once a regional West Coast problem can now be found in big cities and small towns alike.

“It covers the whole United States, right up into Maine,” says Joe Keefe, chief of operations for the Drug Enforcement Administration.

But unlike cocaine, or even crack — which provides a high of a couple hours at best — meth users can stay up for eight to 12 hours or more, depending how they ingest the drug: smoking, snorting, swallowing or injecting it.

Though meth has been around for decades, the latest crisis has spread among white, often poor, usually rural Americans. The drug is rampant in small communities with scant health facilities and few assistance options. “The thing that’s scary about this to me is that it’s hitting populations that have been previously unexposed and also have the least resources,” says addiction expert Dr. David Smith, founder of the Haight Ashbury Free Medical Clinic in San Francisco.

Meth remains remarkably affordable because the lasting high of the drug — which costs $20 to $60 or so for a quarter-gram, a bit more than cocaine — is achieved with small quantities, which is why it is called “the poor man’s cocaine.”

Traffickers usually move in small circles; cooks often exchange drugs or give them to friends. Because meth can be made in a backyard or a bathroom, families often pass around meth-cooking knowledge in an informal and ever-expanding web of connections.

“If your dad cooks meth in the house, that’s what you’re going to learn to do,” says Lt. Mel Williams of the Sioux City, Iowa, police department, which runs one of the nation’s few local training programs to handle meth.

SEARCH FOR SOLUTIONS

Communities across the country are struggling with ways to combat this drug epidemic. Some have opted for a hard-nosed approach — raids of clandestine meth labs, operations that require special equipment and training for police who must handle the toxic chemicals used in the cooking process. Others hope to stem the drug’s social impact and the rising health costs of a deadly addiction.

What remains clear is that officials find themselves frustrated, both with their slow progress and with an often contentious relationship with officials in Washington. Though federal authorities acknowledge the value of what Keefe calls a “holistic” approach, local authorities often feel burdened with the same stringent tactics that led to a prolonged fight against crack.

“Each year, they make more arrests, each year they seize more dope, they seize more guns, execute more search warrants,” says Capt. Peter Groetken, who heads Sioux City’s detective force. “It’s not stopping the flow of drugs.”

MSNBC.com has gone into communities struggling to cope with the meth crisis to get a first-hand look at the war on this drug. In this special package:

     We go to a drug clinic in San Francisco that has helped meth addicts since the city’s hippie culture of the 1960s.

     We follow along as police in Washington state bust meth cooks.

     We meet officials on the front lines of the meth battle in the Midwest, where the realities of this drug have created a new sort of pragmatism among even hard-nosed police and prosecutors.

     We introduce you to former addicts who describe how they got hooked on meth — and survived their addictions.

     We look at the drug’s physical and psychological effects, and how doctors bring users back from their jittery, paranoid trips.

Take a look inside America’s hidden drug epidemic.

Part 2: Scourge of the Heartland
Meth takes root in surprising places

By Jon Bonné
MSNBC

METH IS too big a problem for Monaghan’s office to ignore. With 80 percent of his drug cases involving meth, its impact has been significant enough to make him rethink conventional tactics. He freely admits that major advances in fighting the drug can only be accomplished with a balance between fighting supply and reducing demand. Those views pit him against many of his fellow federal officials, most notably former U.S. drug czar Gen. Barry McCaffrey.

“The general doesn’t think that money needs to be spent on demand reduction,” Monaghan says. “He’s just absolutely wrong.”

The federal government — including McCaffrey and his Office of National Drug Control Policy — haven’t quite ignored the demand side of the drug equation. In recent years, the general has done an about-face on strategy, acknowledging the need for reducing demand. But most federal drug policies are still rooted in the crack wars of the 1980s and ’90s — which led to jammed prisons and six of every 10 federal inmates doing time for drug crimes. Supply, as far as Washington is concerned, is still king.

Monaghan’s conversion, as it were, began in 1996 during a “road show” around the state. Officials in Nebraska — and in neighboring states — told him of meth’s skyrocketing appeal and expressed frustration that few local authorities were aware of the crisis in their midst.

“This is really the first rural explosion of a hard drug,” Monaghan says. “We spent a lot of time going around and saying, ‘Excuse me, we’ve got a meth problem here. Do you even know what meth is?’”

As Monaghan strategized, Congress passed the Methamphetamine Control Act of 1996, which toughened drug sentences and targeted drug supplies by attempting to stem the availability of ingredients such as ephedrine. The gap between Washington and the front line kept growing.

A NEW APPROACH

Mindful of that, Monaghan and other officials in Nebraska retooled the way they handled drug offenses.  Nebraska meth users and small-time dealers get different treatment from major dealers and traffickers. Violent offenders are targeted for harsh prosecution, but other offenders may be sentenced to treatment. Special courts set up to deal only with drugs seek the best solution for each case.

Monaghan’s office helps coordinate the efforts of a dozen or so local and state agencies. Those efforts allow his attorneys to target big fish — moving higher and higher up the meth supply chain while drug courts try to pry small-time offenders out of the system.

“It’s really therapeutic jurisprudence,” says Judy Barnes, who coordinates Omaha’s drug courts. “It’s a deal for them … but it’s also a deal for society.”

Another crucial component of the drug war has been education. Because the ingredients to make meth are readily available, officials put together a campaign to warn retailers about the potentially illicit uses of products. Posters remind store employees to watch for large purchases of everything from cold pills to drain cleaner.

Drug education messages left over from the crack era were retooled with less preachy messages and a tone more forthright than alarmist.  One memorable spot features a teen-age boy who appears to be dancing at a rave but is actually twitching on a bathroom floor in an apparent overdose. Broad themes that treated all drugs as equally harmful were rejected.

“Kids know that that’s not true,” says Nancy Martinez, who coordinates Monaghan’s local anti-drug efforts.

THE IDEA SPREADS

Other Midwestern officials — including some very hard-nosed law enforcement officers — are coming to share Monaghan’s views as they witness their communities in the midst of a quiet epidemic. Meth is growing exponentially more popular in the countryside, labs can be easily hidden in rural locations, ingredients are easy to get and, as Jerry Wells, executive director of the Koch Crime Institute in Topeka, Kan., points out: “We are in the middle of the country, so you can distribute to all four corners of the nation.”

This fact hasn’t gone unnoticed by the federal government, which designated Iowa, Kansas, Missouri, Nebraska and South Dakota as its High Intensity Drug Trafficking Area, or HIDTA, for the Midwest.  Those states, and surrounding ones like Oklahoma, are veined with major transportation routes for traffickers coming east from California and north from Mexico. The impact is clear in cities such as Des Moines, where 14 percent of the people arrested for any crime in 1999 tested positive for meth.

The Midwest’s meth problem has hit cities and small towns alike, from the streets of Kansas City to the meat-packing plants of rural Iowa — and regular use is increasing.

Yet each community’s problem is different. Missouri, Kansas and central Iowa primarily face problems with meth labs; Nebraska, South Dakota and western Iowa battle trafficking by Mexican drug gangs. Rural Missouri counties report a high incidence of intravenous meth use.

SIOUX CITY TAKES A STAND

Officials throughout the region have struggled to find a strategy that works. Sioux City, Iowa, about 100 miles north of Omaha straight up Interstate 29, is the hub of a regional economy driven by agriculture and meat packing. During the second half of the 1990s, the city of 84,000 also had become a nexus for meth trafficking, not only because the city had such a large target population but also because it sat at the intersection of three states — Iowa, Nebraska and South Dakota. It was a convenient layout for traffickers; crossing state lines to evade capture was simply a matter of crossing town.

In 1995, police Chief Joe Frisbie and other local officials set up their Tri-State Drug Task Force, which coordinates drug work between at least nine agencies from the local police to the Immigration and Naturalization Service. Task force members are federally deputized, which allows them to pursue drug crimes across state borders.

Though Mexican drug rings traffic much of the meth, other parts of Iowa struggle with small-time meth cooks. Most small cooks produce less than an ounce at a time, but the problem has grown exponentially. Iowa authorities uncovered two meth labs in 1994; by 1999, they found 803.

“For every one that learns to cook, they teach 10,” says Marti Reilly, one of the drug task force’s commanders. “It’s kind of the Amway pyramid thing.”

HELP ON THE LOCAL LEVEL

Since the meth war is especially difficult for small-town authorities, Sioux City decided to share its expertise. In a set of squat, undistinguished buildings on a dirt road behind the local airport, Frisbie’s department set up the Regional Training Center, one of a handful of training centers in the United States that teaches local law enforcement to deal with meth.

“If you look at San Diego, San Francisco or Portland, Ore., and they’re overwhelmed by what’s going on, what do you think is going on in Hinton, Iowa?” asks Lt. Mel Williams, who runs the center. “We need to provide them with those same safety and security training issues.”

A recent course list included “Identifying and Dealing with the Drug Impaired,” “Survival Spanish for Law Enforcement Officers” and “Examining Methamphetamine.” More than 5,000 officers in the region have trained in Sioux City already, and if they manage the funding, cops from around the country will have the opportunity.

“The biggest problem we’d had with this thing is no one’s ever done it before,” Frisbie says. “You have a lot of officers who don’t understand a lot of things about drugs.”

Frisbie is a cop’s cop; he’s tall and imposing, with broad features and well-trimmed gray hair. He leaves an unmistakable impression that he’s committed to a law-and-order approach. But like Monaghan, Frisbie and his deputies take a practical view on the fight against meth.

Part 3: Lab-busting in the Northwest
Stalking an elusive foe

By Jon Bonné
MSNBC

IN THE TOWN’S small courtroom, 20 officers are briefed by sheriff’s Deputy Scott Provost, a member of the sheriff’s meth lab team in Pierce County, whose 689,000 residents are spread out from working-class Tacoma to the desolate peaks of the Cascades. Team members review aerial photos and share details of how the bust will unfold

“Grandma has no idea what’s going on,” Provost says.

The officers don tactical assault gear — body armor, headsets and helmets — and prepare to head out. It’s the fifth lab discovered in Sumner this year, one police officer says, but only their first bust. “Most of them burn down,” he says.

A convoy of about a dozen vehicles winds its way across town to the bust site. Deputies leap out and shout “Police! Search warrant!” as they bust into the backyard shack where the suspect lives and surround Grandma’s house. The suspect appears taken by surprise and is quickly cuffed.

The deputies, along with local officers and DEA agents, fan out across the property, which is covered with overgrowth and littered with the hulks of rusting trucks and campers. They move through the high brush in a single file, alert for possible snipers or hidden evidence. The sheriff’s raid command center, a modified recreational vehicle with “Pierce County Clandestine Lab Team” painted on the side, pulls into the driveway to process whatever substances the deputies find.

A COSTLY CRISIS

Nowhere is the small-lab crisis as acute as in Washington state, which has the highest per-capita rate of lab busts in the nation. In 1990, authorities found 38 labs in the state; in 1999, that number had grown to 789. Of those busts, almost half were in Pierce County, believed to be the No. 2 county in the nation in meth lab busts.

Meth is fundamentally a homegrown problem. Though increasing amounts are imported by Mexican drug traffickers or produced in remote “superlabs,” the average producer in rural America is still the small-time cook — usually poor and white — with a dangerous, poorly constructed lab.

The growth of labs has ballooned because the process of making meth is comparatively simple. Meth’s key precursor ingredient is ephedrine or pseudoephedrine — basic ingredients in cold medicine. It can be extracted from over-the-counter pills and cooked down until it’s chemically transformed into the finished product. Thus, most meth starts out as cold pills on the shelf of a local convenience store, easy to find and cheap to buy.

Lab busts, on the other hand, can cost from $1,000 to $10,000 or more, not including costs to assess environmental hazards and do additional cleanup. In Pierce County, the cost for a single cleanup can run as high as $25,000.

Costs are steep because of the toxic nature of the cooking process. Ingredients such as toluene, a paint solvent; anhydrous ammonia, often used as fertilizer; and lithium from batteries can have potentially devastating ecological effects when leaked into soil or groundwater. Health-care workers face chemical exposure when treating meth cooks whose clothing is contaminated. 

Labs have become so small and so mobile that many cooks hole up in a motel or a cheap apartment, and cleanup costs are passed on to the property owner. Some meth cooks keep their children nearby, potentially exposing them to deadly chemical mixtures; the state’s Child Protective Services just requested $700,000 to hire social workers trained to deal with children who’ve grown up around meth.

“You might think of this as a kind of ecological problem,” says Michael Gorman, who helped run the Alcohol and Drug Abuse Institute at the University of Washington and studied meth for the National Institute on Drug Abuse. “I don’t think we really have the total picture here.”

TOXIC MESS

After the Sumner bust, deputies don airtight suits and masks to clear out the lab’s contents. On a tarp, they lay out rusted propane tanks, plastic buckets of chemicals and empty solvent cans.

Every liquid is tested to discover its ingredients, and each item is checked for fingerprints and documented. The suited deputies use radios to log the information with the command center.

Then the materials are destroyed. Propane tanks are taken to a remote shooting range and blown up; compounds are put in a landfill or incinerated; caustic ingredients are Ph-balanced to neutral.

“Judges don’t want that in their courtroom,” explains Sgt. David Perry, supervisor of the Pierce County narcotics unit.

A car pulls up. Grandma has arrived. Indeed, she tells officers she has no idea her grandson allegedly turned her backyard into a drug lab, and she sits crying in the car as a detective explains. She can’t return to her home that night, he informs her — not, in fact, until the health department has made a cleanup assessment and ensured that the property is safe. The process could take weeks, or even months.

Most lab sites are a shambles, largely because meth users have a hard time getting organized and staying focused. The drug also triggers paranoia and extreme sexual urges, and that accounts for other items found during busts.

“You’ll find the drugs, you’ll find the guns, you’ll find filth and you’ll find, a lot of times, pornography,” says Lt. James Chromey, who runs the Washington State Patrol’s Statewide Incident Response Team, or SIRT.

WORKING ON ‘CROOK TIME’

Pierce County has enough money to run its own meth team, but most of Washington state relies on Chromey and his SIRT officers to help clean up their meth problems. Their efforts are crucial in small towns like Sunnyside, a farm town of 12,000, nestled in the Yakima Valley just about halfway across the state, a region that produces some of the nation’s finest wine grapes. The town’s population — 50 percent Hispanic — demonstrates the confluence that often occurs in meth-prone areas: Working-class whites, who usually cook their own drugs or buy from a close-knit circle of acquaintances, mix with Hispanic workers among whom Mexican drug rings recruit local contacts. High-volume meth production coordinated by drug rings feeds ever-growing demand, while individual cooks remain on the industry’s ground floor.

“The local cooks,” Chromey says, “are Caucasian males, probably 25 to 35 … and unfortunately, most of them are using while they’re cooking. And they’re making mistakes.”

On a sunny September morning, Chromey and members of his team sit in a covert field office outside town and track several suspects. There appear to be no cooking mistakes this day, though an informant claims one alleged cook was complaining about frequent lab fires.

The officers spend hours waiting and tracking the suspects’ movements with the aid of a surveillance plane flying overhead and two patrol snipers who, before the day is over, will have spent 12 hours lying in the high desert nearby, watching the remote lab location.

At last, the snipers call in: The suspects have begun their cook at a lab in remote Bickleton, Wash., near the Oregon border. The officers’ convoy heads out on the 25-mile ride to Bickleton through the desolate Horse Heaven Hills, past miles of burnt scrub and desert. In such remote locations, local law enforcement is often hard-pressed to handle meth arrests and Chromey’s assistance is invaluable.

The caravan turns down a two-mile-long driveway. A run-down house sits amid piles of trash. In a nearby trailer, the cops find two suspects engrossed in their work. The third suspect, who is pregnant, is inside the house on the property and has one child with her — with five more expected home from school at any moment. The two alleged cooks are separated from the others; when sheriff’s deputies arrest them, they use thick rubber gloves and dress the two men in white protective suits.

The female suspect appears willing to cooperate and some of the officers allow her to point out where other materials may be kept. She is nervous and jumpy; several officers insist she is on a meth high

“This is pretty common,” Chromey says, surveying the scene. “Six kids living in this house, and she’s pregnant and she’s cooking meth.”

As authorities make arrangements with Child Protective Services to take custody of the children, Klickitat County Sheriff R.E. Kindler points out this is the fifth bust since June in the county, which has only 19,000 residents. Between 1990 and 1999, only seven labs were found.

Kindler looks around and sighs.

Hooked in the Haight
Life, death or prison

By Jon Bonné
MSNBC

SAN FRANCISCO —  The irony was that Mark Miller didn’t do drugs. Miller, “better known as Miss Miller” as he’ll tell you, came to San Francisco to pursue a career as a dancer. It wasn’t until he was in his late 20s that he first tried ecstasy.  “I actually snubbed people who did drugs and alcohol,” he says.

“It made me feel confident, self-assured,” he says. “Then it took on a whole new meaning to me. I became a partier.”

He haunted the clubs of San Francisco, his nights filled with drugs like ecstasy, meth and GHB, and with dancing and sex. The next day, he would often do another hit of speed to recover. Within two years, Miller had become a porn actor, a stripper and a male prostitute.

“I was a person of great promiscuity,” he recalls — one reason he ultimately became HIV-positive.

Miller began to try new ways to do meth, at first snorting and smoking, then taking it anally. His addiction grew, and he was thrown out of his apartment and ended up on the streets, searching to string along his high.

“One time, I was up seven days on speed,” he remembers. “I was out in public fondling myself.” San Francisco police found him and took him to the hospital.

“I woke up the next day thinking I was having a dream,” he says, “when I was living it.”

Even then, Miller kept using meth “every way imaginable.” By the fall of 1999, he was going through two quarter-grams a day. Finally, he learned to inject himself with the drug — and realized he needed help.

“That moment was a moment of clarity to me,” he remembers, “where I said, ‘Enough. Please, God, help me. I’m dying.’”

ONE CITY’S LEGACY

Though meth has spread rapidly through rural America, it remains a crisis in urban centers, especially on the West Coast. Like other big cities in the West, San Francisco has a major meth problem. Seen as early as 1978 in the city’s gay bathhouses, it could keep users up for days on end and enhance sexual pleasure. With the onset of AIDS, it was a popular but sometimes deadly pleasure and a major factor in the transmission of HIV, hepatitis B and C and syphilis.

“If you’re at a party where a lot of people are injecting, when you put your needle down, someone else may pick it up,” says psychologist Michael Siever, who founded the Stonewall Project, which offers meth counseling to the city’s gay community.

The city’s meth roots stretch decades. In 1967, a 28-year-old doctor named David Smith who was living in the Haight Ashbury neighborhood was shocked to find that plans for the Summer of Love gathering included no contingency to help any of the expected 100,000 stoned kids with medical problems from bad trips to bad hygiene. Fresh out of medical school, Smith and other young doctors organized the Haight Ashbury Free Medical Clinic, which offered free services to the flower children and hippies who came to its door.

Haight Ashbury also had other visitors that summer, the Hell’s Angels, who had a fondness for a drug then called crank or speed.

“It was the ‘make love, not war’ era, so the view was that psychedelic drugs were a route to non-violence,” Smith recalls. “And then all of a sudden, you started seeing speed and violence and rip-offs, psychosis and craziness.”

Smith and his team decided to step in. But it was too late for Haight Ashbury. Speed had come to stay in San Francisco.

“Speed had destroyed the dream that was the Summer of Love,” Smith says.

HELPING HAND FOR ADDICTS

Some 33 years later, the clinic still helps meth addicts by offering medical care and residential recovery programs. The staff believes in harm reduction, which encourages addicts to use clean needles and condoms during sex. As Dr. Joseph Elson, the clinic’s medical director, explains: “We tend to be honest and not judgmental.”

Addicts’ medical problems are manifest — from alarming weight loss (meth users often forget to eat) to skin infections and abscesses from poor hygiene. Many users also suffer mental problems, including paranoia and depression. Addicts may develop meth psychosis, which requires acute detox: several days in isolation to leach the drug out of the body, often accompanied by drugs to help with tweaking, the spastic reflexes that often accompany paranoia on the way down from a meth high.

“What they basically need to do is to hibernate,” Elson says. ”[We tell them,] ‘Here’s a couple valium. Go and hibernate for a day or two.’”

Coming down is difficult because meth can take users to the height of euphoria and sexual frenzy. The typical high lasts 12 hours or longer and some users will sometimes stay up for days, chaining themselves along with hit after hit. Others will use meth to suppress appetite or to help them work long hours, hence the drug’s growing popularity in Silicon Valley.

That’s why Stephanie Lujan tried meth. Growing up in New Mexico, she managed a fast-food restaurant and occasionally smoked pot. Her friends got her started on a tempting new drug. The initial rush was “this very intense surge of electric energy through the body,” she recalls. “It felt as though your mind was moving faster.

“I felt like I was superhuman because I would think more, I could accomplish more.”

Lujan, now 31 and a counselor who helps run one of the clinic’s residential treatment programs, described the elaborate ritual she and her friends would perform when they did meth. Upon scoring a bag, she and her friends would admire the size of the “rocks,” clumps of powdered meth, and would chop the rocks into lines of powder with a razor blade, much like cocaine. For up to an hour, they would play intensely with their drugs, cutting and recutting lines of meth to snort. “I very much enjoyed doing that,” she says.

They would get high and chatter for hours, quickly jumping from conversation to conversation. If she had to work, the meth would give her extra energy. The drug’s economics — cheaper than cocaine — only added to its appeal.

“I was like, ‘Oh my God, you get more bang for your buck,’” Lujan recalls. “Why would you do something that costs more and doesn’t last as long?”

Even for moderate users, meth has a steep addiction curve: It’s remarkably easy to get hooked and painfully hard to get off it. Almost as soon as the high begins, users start to fear the crash, especially the tweaking and paranoia. When a user finally comes down, his or her surroundings seem bleak. As Lujan describes it: “The world was black and dark and I was totally depressed.”

FEAR OF THE CRASH

Users coming down usually experience depression and a profound sense of anhedonia, the complete lack of emotional sensation.

Users undergo intensive counseling in one-on-one and group sessions. The first step, called “early recovery,” is about helping addicts learn how to stay clean and rebuild their lives.

“A lot of what we get into here is, ‘How do I have social relationships? How do I have sex without doing speed?’” DiDomenico says.

Users also must learn to deal with powerful “triggers” that can start a craving — anything from a specific street corner to a particular friend or a bit of drug paraphernalia.

“A lot of times, people can get triggered at support meetings when they hear stories about using,” says Dr. Robert Hood, a clinic psychiatrist.

Intensive therapy usually lasts about six months, but an addict may need more casual group counseling for several years.

Of course, in rare cases, getting off meth can be simpler than that. Lujan kicked her meth habit after the third time she overdosed on it.

“I got so sick that I have not had a craving for it since,” she says.

Mark Miller’s recovery began in 1999. He was clean for nine months before having a relapse. Miller went back into treatment and by late 2000, at age 36, he had been clean again for almost three months, working at Gold’s Gym and exercising every day. He takes antidepressant medication, attends church on Sunday and goes to recovery group meetings almost daily. He is learning to cope with his HIV status, and hopes within a year to be back out auditioning for dancing roles in musicals.

Much of the recovery process, he says, has been about realizing what meth covered up in his life. Among other things, he would use it to have copious amounts of sex, and he used sex as a way to avoid other problems.

“Intimacy is one of my biggest fears,” he admits. “I feel insecure because I don’t feel worthy of anything in this world.”

Miller acknowledges he could easily feel sorry for himself, but he says part of the healing process has been learning to cope with how his life has turned out.

“I don’t have to be a crybaby about it,” he offers, defiantly.

Part 4: Beating An Addiction To Methamhetamine
Researchers Zero In 
On Brain Effects & Treatment Approaches

By Julia Sommerfeld
MSNBC

UNTIL a few years ago, methamphetamine was considered a regional problem. Largely confined to the West Coast and Southwest, it was off the radar of federal drug offices in Washington, D.C. But as the drug swept into rural Midwestern communities in the mid-1990s, catching hospitals and treatment centers unprepared for its devastating effects, steps were taken to gain a better understanding of meth’s toll on the body.

GETTING HOOKED

Methamphetamine, like cocaine, is a powerful stimulant. It produces physiological changes similar to the fight-or-flight response — it boosts heart rate, respiration, blood pressure and body temperature. Some people use it for the brief, intense “rush” it produces when smoked or injected. Others use it for functional reasons — as an appetite suppressant to lose weight or as an energy-booster to enable them to work more. When snorted or taken orally it doesn’t produce an intense “rush” but rather a “high” that can last more than 12 hours.

Both cocaine and meth boost brain levels of the neurotransmitter dopamine, which causes feelings of euphoria and increased energy, but go about it in different ways. Cocaine doesn’t directly stimulate the release of dopamine; it prevents the normal recycling of the chemical messenger once it’s released. Meth goes a step further — it actually gets into the nerve cell where it causes the excessive release of dopamine. Meth users can quickly become addicted to the spike in dopamine.

Abuse of methamphetamine is linked to several serious medical complications such as heart damage, stroke and psychosis. But perhaps the most frightening side effect is long-term neurological damage unlike anything seen with heroin or cocaine.

While high levels of dopamine in the brain usually cause feelings of pleasure, too much can produce aggressiveness, irritability and schizophrenic-like behavior.

“Meth has more long-term, serious effects on the brain than cocaine,” said Dr. Nora Volkow, senior scientist at Brookhaven National Laboratories in Upton, N.Y., who has studied the effects of both cocaine and methamphetamine on the brain for 15 years.

THE BRAIN ON METH

Using brain-imaging techniques, scientists have discovered that the brains of former chronic users show a significant decrease in the number of dopamine transporters, a crucial component of a functional dopamine system.

The most recent development comes from Volkow who, along with Dr. Linda Chang, collected the first data on what this decline in dopamine transporters means. They performed brain scans on 15 detoxified, former meth users and found a 24-percent loss in the normal number of dopamine transporters. This loss of transporters was linked to slowness in motor skills and poorer performance on verbal and memory tasks.

“We found the subjects with the most profound changes in the transporters were the ones with the most functional disturbances,” said Volkow, whose research will be published in the American Journal of Psychiatry in March. “This is the first time anybody has reported that these neuron losses are functionally significant. It’s not just that you lose brain cells and you keep living happily ever after; it translates into a disruption in your performance.”

Common Signs Of Methamphetamine Abuse

     Agitation, excited speech, decreased appetite, increased physical activity, dilated pupils, and nausea and vomiting.

     Occasional episodes of sudden and violent behavior, intense paranoia, visual and auditory hallucinations, and bouts of insomnia.

     A tendency to compulsively clean and groom and repetitively disassemble and sort objects.

Source: National Institute on Drug Abuse

“We need to look more at how and why it’s having these long-term effects and whether in fact they are permanent,” said Timothy Condon, associate director for science policy at the National Institute on Drug Abuse (NIDA). “As we unravel more about what functional changes are a result of those brain changes, they will impact how you go about treating someone.”

Douglas Anglin, director of the UCLA Drug Abuse Research Center and co-principal investigator of the Methamphetamine Treatment Project, a group that studies addiction therapies, said: “This takes us beyond the model of drug treatment to one of brain damage.”

But Dr. David Smith, founder and president of the Haight Ashbury Free Clinics in San Francisco, wants to draw attention away from methamphetamine’s neurological impact.  “Focusing on the brain damage caused by meth is counterproductive to recovery.  It makes people pessimistic about whether their brains are going to heal. In treatment, we offer a message of hope, and we have had many meth users who have achieved full recovery.”

BEHAVIORAL TREATMENT

Meth addiction gained a reputation as being untreatable when the drug began to spread into small communities in the Midwest. “These rural areas had not been very affected by cocaine or heroin so when they had to start dealing with meth users they had no idea what to do with them,” said Richard Rawson, executive director of the Matrix Institute, a non-profit addiction research organization in Los Angeles, and co-principal investigator at the Methamphetamine Treatment Project along with Anglin. “Patients were coming in psychotic, so you started hearing these horror stories that meth was untreatable. For those of us who’ve been dealing with heroin and crack users, it was more manageable.”

Though not impossible, meth addiction is a difficult disorder to treat, according to Anglin. “There’s not severe physical withdrawal with methamphetamine, but rather a feeling of anhedonia, an inability to experience pleasure, that can last for months and which leads to a lot of relapse at six months,” he said. The anhedonia appears to correspond with the period when the brain is recovering and producing abnormally low levels of dopamine.

“When you think of treatment of drugs like methamphetamine, you have to think of it like fixing a broken leg — treatment provides a structure to allow their brain chemistry to return to normal. Their brain is out of tune, it’s not working very well, and it takes a while to recover,” Rawson said.

Unlike heroin addicts, who can be weaned off the substance with methadone, there are no pharmacological treatments for meth. The only currently available treatment is behavioral therapy.

The Matrix model, a method of outpatient cognitive-behavioral therapy backed by the Center for Substance Abuse Treatment (CSAT), a division of the federal Substance Abuse and Mental Health Services Administration, is the only program with evidence of effectiveness for methamphetamine addiction.

The model, which was first developed in the 1980s as a cocaine treatment under a NIDA grant, serves as the primary treatment protocol for a network of clinics in Southern California.

The basic elements of the four- to six-month approach (a two-month approach is also being developed) consist of a minimum of three group or individual therapy sessions per week, where patients are coached through their recovery. They are taught about their addiction and trained to manage cravings and avoid risky activities, like drinking alcohol, that could trigger relapse. The method also uses family therapy, urine testing and 12-step activities.

“We have data from treating several thousand patients [with the Matrix model],” Rawson said. “Treatment of meth addiction appears approximately equal to cocaine treatment. Treatment is about 50 percent to 60 percent drug-free at the end of one year.” That’s superior to recovery after behavioral therapy for heroin addiction (without the use of methadone), but not as good as recovery from alcoholism, according to Rawson. No nationwide statistics on the overall effectiveness of treatment for meth addiction exist, but as the Matrix model is a particularly vigorous, well-studied approach, it’s likely this success rate is higher than average, Rawson noted.

The model is currently being compared to seven other outpatient treatment methods in the first large clinical trial of behavioral treatments for meth addiction. The 800-patient randomized study is being conducted by the Methamphetamine Treatment Project, an organization funded by CSAT in an effort to identify the most effective treatment strategies for meth addiction. CSAT will use the results to issue its national treatment guidelines.

The other treatment approaches being evaluated vary in length (from one month to six months), intensity (from one hour per week to 13), population (two are for women only, and racial makeup varies across centers) and emphasis. All of the programs are based on the underlying assumption that addiction is a chronic disease. Some emphasize life skills such as assertiveness; others focus on spirituality; others on family support. Some are strictly regimented programs; others are more flexible to a patient’s individual needs.

Though the large clinical trial is not evaluating any inpatient treatments, some methamphetamine users do enter 28-day residential programs focused on detoxification and self-help strategies. Originally developed for the treatment of alcoholism in the 1980s, these programs have become a catchall for abusers of various substances. Additionally, other, more long-term residential programs (usually about six months) designed primarily for heroin users referred by the criminal justice system are now being used by meth addicts. CSAT cites a lack of empirical evidence for these programs for stimulant users; however, some experts cite supporting clinical experiences with short-term and long-term residential programs for certain subsets of meth abusers.

IN THE PIPELINE

In an effort to expand treatment options, NIDA set up a program last year to develop pharmacological approaches to meth addiction.

“In our pipeline right now, we have about 10 compounds in various stages of clinical trials, most of them very early on, for methamphetamine addiction,” Condon said. “They’re all classic medications used in other areas of medicine that we’re testing as anti-methamphetamine agents.”

Among the drugs being tested: calcium-channel blockers, a class of drugs used to treat high blood pressure that may inhibit the excessive release of neurotransmitters and reduce the “reward” of using methamphetamine; the anti-nausea drug Zofran, which has been shown to work against relapse in alcoholics; tyrosine, an amino acid that’s a precursor of dopamine and may increase production of the neurotransmitter; and several antidepressants.

Antidepressant medications are currently prescribed for some meth addicts to combat the depressive symptoms frequently seen in withdrawal, but they are now being studied as treatments to reduce relapse based on their ability to boost levels of neurotransmitters associated with pleasure, which are abnormally low in people who have stopped using meth.

Research is currently being planned on the anti-smoking/antidepressant drug bupropion, also known as Zyban and Wellbutrin.

Scientists also plan to test medications that may be able to reverse some of the neurological damage and cognitive impairment caused by methamphetamine use. Experts say one of the most promising is selegiline, a treatment approved for some symptoms of Parkinson’s disease. Selegiline has neuroprotective effects and has been shown to reduce HIV-related cognitive deficits. Studies on vitamin E, which is thought to boost natural protective chemicals in the brain, are also planned.

In addition, NIDA is funding research on the development of an antidote for methamphetamine that would be used in overdose situations. The hope is that a compound could leach meth out of the tissues, decreasing concentrations of the drug in the body. Theoretically, this would reduce the duration of the high and some of the adverse effects. However, such a treatment is years away from being tested in people, according to NIDA.

But as researchers churn away on potential treatments of the future, thousands of people are addicted to methamphetamine right now and aren’t taking advantage of the available behavioral treatments, said CSAT director Dr. Westley Clark.

A survey of primary care doctors suggests many of them are reluctant to talk with their patients about drug abuse. The findings, published recently in the Archives of Internal Medicine, showed that about one-third of the 1,080 doctors surveyed said they don’t routinely ask new patients if they use drugs, and 15 percent said they do not generally suggest interventions for drug-abusing patients.

Resources Mentioned In this Report

Haight Ashbury Free Clinics

Matrix Institute

Methamphetamine Treatment Project

National Institute on Drug Abuse (NIDA)

Other Articles On Methamphetamine
(Go To Site Map For Other Drugs Of Abuse)

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