Methamphetamine: New Knowledge about the Epidemic, the Neurobiology and Clinical Issues Richard A....

Methamphetamine: New Methamphetamine: New Knowledge about the Knowledge about the Epidemic, the Neurobiology Epidemic, the Neurobiology and Clinical Issuesand Clinical Issues

Richard A. Rawson, Ph.D, ProfessorRichard A. Rawson, Ph.D, ProfessorIntegrated Substance Abuse ProgramsIntegrated Substance Abuse ProgramsSemel Institute for Neuroscience and Human Semel Institute for Neuroscience and Human BehaviorBehaviorDavid Geffen School of MedicineDavid Geffen School of MedicineUniversity of California at Los AngelesUniversity of California at Los Angeleswww.uclaisap.orgwww.uclaisap.orgrrawson@[email protected]

Supported by:Supported by: National Institute on Drug Abuse (NIDA)National Institute on Drug Abuse (NIDA) Pacific Southwest Technology Transfer Center (SAMHSA)Pacific Southwest Technology Transfer Center (SAMHSA) United Nations Office of Drugs and CrimeUnited Nations Office of Drugs and Crime

MethamphetamineMethamphetamine

Methamphetamine is a powerful Methamphetamine is a powerful central nervous system stimulant that central nervous system stimulant that strongly activates multiple systems in strongly activates multiple systems in the brain. Methamphetamine is closely the brain. Methamphetamine is closely related chemically to amphetamine, related chemically to amphetamine, but the central nervous system effects but the central nervous system effects of methamphetamine are greaterof methamphetamine are greater..

Forms of MethamphetamineForms of Methamphetamine

Methamphetamine Powder

IDU Description: Beige/yellowy/off-white powder

Base / Paste Methamphetamine

IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy

Crystalline Methamphetamine

IDU Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’

EPHEDRINE

OH

CC

HHH

3CH 3CH

N

METHAMPHETAM INE

H

CC

HHH

3CH 3CH

N

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

World wide it is estimated there are over World wide it is estimated there are over 26 million regular users of 26 million regular users of amphetamine/methamphetamine, as amphetamine/methamphetamine, as compared to approximately 16 million compared to approximately 16 million heroin users and 14 million cocaine usersheroin users and 14 million cocaine users

Scope of the Methamphetamine Scope of the Methamphetamine Problem WorldwideProblem Worldwide


The US EpidemicThe US Epidemic

Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older:

1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

The Eastward Spread of The Eastward Spread of MethamphetamineMethamphetamine

Primary Amphetamine/Methamphetamine Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992TEDS Admission Rates: 1992(per 100,000 aged 12 and over)(per 100,000 aged 12 and over)

35 - 5812 - 35

< 12No data

> 58

< 12


35 - 5812 - 35

< 12No

data

> 58


127+< 5

5 - 5960-126

Incomplete Data

The Methamphetamine Epidemic:The Methamphetamine Epidemic:Admissions/100,000: 1992-2003Admissions/100,000: 1992-2003

0

50

100

150

200

250

300

350

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

California

Hawaii

I owa

Oregon

Washington

It keeps going up

Figure 2. Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

National Association of National Association of Counties (NACo) 2006 Survey of Counties (NACo) 2006 Survey of SheriffsSheriffs Methamphetamine remains number Methamphetamine remains number

one drug problemone drug problemaccording to new survey of the according to new survey of the nation’s counties.nation’s counties.

Legislation that restricts the sale of Legislation that restricts the sale of precursors works. precursors works.

The majority of meth currently being The majority of meth currently being abused is from outside of the state. abused is from outside of the state.

The full survey is available at The full survey is available at www.naco.orgwww.naco.org..

National Association on National Association on Counties (NACo) 2006 Survey of Counties (NACo) 2006 Survey of SheriffsSheriffs

% Sheriffs ranking meth worst problem% Sheriffs ranking meth worst problem 100% in Calif, Hawaii, Idaho, Arizona, New 100% in Calif, Hawaii, Idaho, Arizona, New

Mexico, Wyoming, Washington, Utah, NevadaMexico, Wyoming, Washington, Utah, Nevada 88% Oklahoma, Iowa 79%, Louisiana 75% 88% Oklahoma, Iowa 79%, Louisiana 75%

Nebraska 74%Nebraska 74% 64% Georgia64% Georgia 44% North Carolina44% North Carolina 43% Alabama 43% Alabama

National Association on National Association on Counties (NACo) 2006 Survey of Counties (NACo) 2006 Survey of SheriffsSheriffs Crimes related to meth continue to Crimes related to meth continue to

grow during past year.grow during past year.– 55% of law enforcement officials reported an 55% of law enforcement officials reported an

increase in robberies or burglaries in the last increase in robberies or burglaries in the last year.year.

– 48 % reported an increase in domestic 48 % reported an increase in domestic violence. violence.

– 41 % reported an increase in simple 41 % reported an increase in simple assaults.assaults.

– 31% reported an increase in identity theft 31% reported an increase in identity theft crime, which is up from the 27 percent crime, which is up from the 27 percent reported in 2005. reported in 2005.

Methamphetamine: A Growing Methamphetamine: A Growing Menace in Rural AmericaMenace in Rural America

In 1998, rural areas In 1998, rural areas nationwide reported nationwide reported 949 methamphetamine 949 methamphetamine labs. labs.

Last year, 9,385 were Last year, 9,385 were reported. reported.

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

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

Anhydrous Ammonia Anhydrous Ammonia Tank Tips Officers to Tank Tips Officers to Possible Meth LabPossible Meth Lab

5/4/04 Omaha, Neb. – A large

anhydrous ammonia tank

helped Sarpy County

Sheriff’s deputies bust

a suspected

methamphetamine

lab Tuesday.

SOURCE: TheOmahaChannel.com

Meth Epidemic; less Meth Epidemic; less drama, more long term drama, more long term risk/dangerrisk/danger Cocaine/Crack epidemic hit fast (in NYC 1986-87, Cocaine/Crack epidemic hit fast (in NYC 1986-87,

as well as other major east coast cities); overnight as well as other major east coast cities); overnight emergency, tremendous media attention.emergency, tremendous media attention.

Big federal response (Reagan and Bush I). High Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug.visibility deaths, stigmatization as a ghetto drug.

Dramatic decreases in indicators by early 1990s, Dramatic decreases in indicators by early 1990s, except in inner cites of east coast.except in inner cites of east coast.

Crack epidemic: Rapid onset; Rapid decreaseCrack epidemic: Rapid onset; Rapid decrease Meth epidemic: Slow west to east spread. No Meth epidemic: Slow west to east spread. No

decrease in western cities. Use becomes decrease in western cities. Use becomes endemic?endemic?

Methamphetamine: Methamphetamine: What does it do?What does it do?

MethamphetamineMethamphetamineAcute Physical EffectsAcute Physical Effects

- - IncreasesIncreases --DecreasesDecreases

Heart rate Heart rate AppetiteAppetite

Blood pressure Blood pressure Sleep Sleep

Pupil size Pupil size Reaction Reaction timetime

RespirationRespiration

Sensory acuitySensory acuity

EnergyEnergy

MethamphetamineMethamphetamineAcute Psychological Acute Psychological EffectsEffects IncreasesIncreases

– Confidence Confidence – Alertness Alertness – MoodMood– Sex driveSex drive– EnergyEnergy– TalkativenesTalkativenes

ss

DecreasesDecreases – BoredomBoredom– LonelinessLoneliness– TimidityTimidity

MethamphetamineMethamphetamineChronic Physical EffectsChronic Physical Effects

-- Tremor Tremor - Sweating- Sweating- Weakness - Weakness - Burned lips; - Burned lips;

sore nosesore nose- Dry mouth - Dry mouth - Oily - Oily

skin/complexionskin/complexion- Weight loss - Weight loss - Headaches- Headaches- Cough - Cough - Dental Problems- Dental Problems- Sinus infection - Sinus infection - Anorexia- Anorexia

Source: The New York Times, June 11, 2005.Source: The New York Times, June 11, 2005.

“METH Mouth”“METH Mouth”

METH Use Leads to Severe Tooth Decay

Meth Use in HawaiiMeth Use in Hawaii The number of crystal methamphetamine-The number of crystal methamphetamine-

related deaths has already doubled in related deaths has already doubled in Oahu in the last five years.Oahu in the last five years.

"You've heard the stories about people on "You've heard the stories about people on ice who die in confrontations with police, ice who die in confrontations with police, but most ice deaths happen quietly, but most ice deaths happen quietly, sending people to the morgue after their sending people to the morgue after their bodies just can't keep up with the crystal bodies just can't keep up with the crystal meth in their systems," Honolulu Chief meth in their systems," Honolulu Chief Medical Examiner Dr. Kanthi De Alwis said.Medical Examiner Dr. Kanthi De Alwis said.

Meth Use in HawaiiMeth Use in Hawaii As of the middle of May, not even halfway through the As of the middle of May, not even halfway through the

year, the city medical examiner's office already year, the city medical examiner's office already recorded 38 deaths connected to crystal recorded 38 deaths connected to crystal methamphetamine. So, we're well on the way to methamphetamine. So, we're well on the way to exceeding last year's total of 68.exceeding last year's total of 68.

Deaths:Deaths: 2005 (mid-May) - 38 deaths 2005 (mid-May) - 38 deaths 2004 - 68 deaths 2004 - 68 deaths 2003 - 56 deaths 2003 - 56 deaths 2002 - 62 deaths 2002 - 62 deaths 2001 - 54 deaths 2001 - 54 deaths 2000 - 34 deaths2000 - 34 deaths

MethamphetamineMethamphetamineChronic Psychological Chronic Psychological EffectsEffects

- - Confusion - IrritabilityConfusion - Irritability

- Concentration - Paranoia- Concentration - Paranoia

- Hallucinations - Panic - Hallucinations - Panic reactionsreactions

- Fatigue - Depression- Fatigue - Depression

- Memory loss - Anger- Memory loss - Anger

- Insomnia - Psychosis- Insomnia - Psychosis

MethamphetamineMethamphetaminePsychiatric Psychiatric ConsequencesConsequences

Paranoid reactionsParanoid reactions Permanent memory lossPermanent memory loss Depressive reactionsDepressive reactions HallucinationsHallucinations Psychotic reactionsPsychotic reactions Panic disordersPanic disorders Rapid addictionRapid addiction

MA Psychosis Inpatients from 4 MA Psychosis Inpatients from 4 CountriesCountries

Psychotic symptomPsychotic symptom LifetimeLifetime CurrentCurrent

Persecutory delusionPersecutory delusion

Auditory hallucinationsAuditory hallucinations

Strange or unusual beliefsStrange or unusual beliefs

Thought readingThought reading

Visual hallucinationsVisual hallucinations

Delusion of referenceDelusion of reference

Thought insertion or made actThought insertion or made act

Negative psychotic symptomsNegative psychotic symptoms

Disorganized speechDisorganized speech

Disorganized or catatonic Disorganized or catatonic behaviorbehavior

130 (77.4)130 (77.4)

122 (72.6)122 (72.6)

98 (58.3)98 (58.3)

89 (53.0)89 (53.0)

64 (38.1)64 (38.1)

64 (38.1)64 (38.1)

56 (33.3)56 (33.3)

35 (20.8)35 (20.8)

75 (44.6)75 (44.6)

39 (23.2)39 (23.2)

27 (16.1)27 (16.1)

38 (22.6)38 (22.6)

20 (11.9)20 (11.9)

18 (10.7)18 (10.7)

36 (21.4)36 (21.4)

19 (11.3)19 (11.3)

14 (8.3)14 (8.3)

No. of patients having No. of patients having symptoms (%)symptoms (%)

Srisurapanont et al., 2003Srisurapanont et al., 2003

MA PsychosisMA Psychosis 69 physically healthy, incarcerated Japanese 69 physically healthy, incarcerated Japanese

females with hx MA usefemales with hx MA use– 22 (31.8%) no psychosis22 (31.8%) no psychosis– 47 (68.2%) psychosis47 (68.2%) psychosis

19 resolved (mean=276.219 resolved (mean=276.2±222.8 days)±222.8 days) 8 persistent (mean=17.6±10.5 months)8 persistent (mean=17.6±10.5 months) 20 flashbackers (mean=215.4±208.2 days to 20 flashbackers (mean=215.4±208.2 days to

initial resolution)initial resolution)– 11 single flashback11 single flashback– 9 Recurrent flashbacks9 Recurrent flashbacks Yui et Yui et

al., 2001al., 2001 Polymorphism in DAT Gene associated with MA Polymorphism in DAT Gene associated with MA

psychosis in Japanesepsychosis in Japanese Ujike et al., Ujike et al.,

20032003

Source: Skidmore, S. (2006, April 21) Oregon Man Source: Skidmore, S. (2006, April 21) Oregon Man Survives 12 Nails to the Head. Survives 12 Nails to the Head. TheThe Associated Associated PressPress. .

33-year-old man, high on 33-year-old man, high on methamphetamine is brought to the methamphetamine is brought to the ER in Portland Oregon complaining of ER in Portland Oregon complaining of a severe headache. a severe headache. Doctors did not see any Doctors did not see any immediate cause for the headache immediate cause for the headache and placed the patient in an exam and placed the patient in an exam room and ordered tests including room and ordered tests including X-rays to rule out head trauma.X-rays to rule out head trauma.

– The man at first claimed it was an accident, but The man at first claimed it was an accident, but he later admitted that it was a suicide attempt.he later admitted that it was a suicide attempt.

– The nails were removed, and the man survived The nails were removed, and the man survived without any serious permanent damage.without any serious permanent damage.

– He was eventually transferred to psychiatric He was eventually transferred to psychiatric care; he stayed for almost one month under care; he stayed for almost one month under court order but then left against doctors’ orderscourt order but then left against doctors’ orders

MSNBC-TV

A Major Reason People Take a Drug is they Like

What It Does to Their Brains

A Major Reason People Take a Drug is they Like

What It Does to Their Brains

00

5050

100100

150150

200200

00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Ou

tpu

t%

of

Bas

al D

A O

utp

ut

NAc shellNAc shell

EmptyEmpty

BoxBox FeedingFeeding

Source: Di Chiara et al.Source: Di Chiara et al.

FOODFOOD

100100

150150

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DA

Co

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ati

on

(%

Bas

elin

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% B

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MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

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1010

Co

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latio

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req

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SampleNumberSampleNumber

11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717

ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present

ScrScrFemale 2 PresentFemale 2 Present

ScrScr

Source: Fiorino and PhillipsSource: Fiorino and Phillips

SEXSEX

Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels

Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels

00

100100

200200

300300

400400

Time After CocaineTime After Cocaine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

DADADOPACDOPACHVAHVA

AccumbensAccumbensCOCAINECOCAINE

00

100100

150150

200200

250250

00 11 22 3 hr3 hr

Time After NicotineTime After Nicotine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Source: Shoblock and Sullivan; Di Chiara and Imperato

Effects of Drugs on Dopamine ReleaseEffects of Drugs on Dopamine Release

100

150

200

250

0 1 2 3 4hrTime After Ethanol

% o

f B

as

al

Re

lea

se

0.250.512.5

Accumbens

0

Dose (g/kg ip)

ETHANOLETHANOL

Time After Methamphetamine

% B

as

al

Re

lea

se

METHAMPHETAMINE

0 1 2 3hr

1500

1000

500

0

Accumbens

Prolonged Drug Use ChangesProlonged Drug Use Changesthe Brain In Fundamentalthe Brain In Fundamentaland Long-Lasting Waysand Long-Lasting Ways

What Can Imaging Tell What Can Imaging Tell Us?Us? In design of new medications – knowledge of In design of new medications – knowledge of

affected circuitry can point to chemical affected circuitry can point to chemical dysfunction that may be helped by medication.dysfunction that may be helped by medication.

In the design of behavioral treatments it can tell In the design of behavioral treatments it can tell you the types and severity of deficits and you the types and severity of deficits and dysfunctions in the brain and the timetable of dysfunctions in the brain and the timetable of their recovery (or not). This information can be their recovery (or not). This information can be helpful in guiding the behavioral targets for helpful in guiding the behavioral targets for treatment and the types and durations of treatment and the types and durations of treatment that can best accommodate the brain treatment that can best accommodate the brain recovery recovery

Brain imaging can show how much viable tissue Brain imaging can show how much viable tissue there is to work with. And, it can show the affect there is to work with. And, it can show the affect of treatment.of treatment.

Brain Function in Brain Function in Methamphetamine AbusersMethamphetamine Abusers

Do meth abusers show Do meth abusers show abnormalities in brain abnormalities in brain metabolites?metabolites?

Do brain metabolite abnormalities Do brain metabolite abnormalities relate to cognitive performance – relate to cognitive performance – such as selective attention?such as selective attention?

Does the brain recover following Does the brain recover following cessation of meth use?cessation of meth use?

Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

Decreased dopamine Decreased dopamine transporter binding in meth transporter binding in meth users resembles that inusers resembles that in Parkinson’s Disease Parkinson’s Disease patientspatients

%ID/cc

Control Methamphetamine PD

Partial Recovery of Brain Dopamine Transporters in Methamphetamine

(METH)Abuser After Protracted Abstinence

Normal Control METH Abuser(1 month detox)

METH Abuser(24 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Their Brains

have been

Re-Wired by Drug Use

Their Brains

have been

Re-Wired by Drug Use

Because…Because…

Control > MA

4

3

2

0

1

MA > Control

5

4

2

0

1

3


Cognitive and Memory Cognitive and Memory EffectsEffects

% I

mpair

ed

0

10

20

30

40

50

60

0

10

20

30

40

50

60ControlsMA Users

Learningand

Memory

Frequency of Impairment by Neuropsychological Domain

Attention/Psychomotor

Speed

WorkingMemory

Fluency Inhibition

Executive Systems Function

Defining Domains:Defining Domains: Executive Systems Executive Systems FunctioningFunctioning a.k.a. frontal lobe functioning.a.k.a. frontal lobe functioning. Deficits on executive tasks assoc. Deficits on executive tasks assoc.

w/:w/:– Poor judgment.Poor judgment.– Lack of insight.Lack of insight.– Poor strategy formation.Poor strategy formation.– Impulsivity.Impulsivity.– Reduced capacity to determine Reduced capacity to determine

consequences of actions.consequences of actions.

Brain Serotonin Transporter Density Brain Serotonin Transporter Density and Aggression in Abstinent and Aggression in Abstinent Methamphetamine AbusersMethamphetamine Abusers**

**

Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Density and Aggression in Abstinent Methamphetamine Density and Aggression in Abstinent Methamphetamine Abusers. Abusers. Arch Gen Psychiatry.Arch Gen Psychiatry. 2006;63:90-100. 2006;63:90-100.

Objective of StudyObjective of Study

Investigate the status of brain Investigate the status of brain serotonin neurons and their serotonin neurons and their possible relationship with clinical possible relationship with clinical characteristics in currently characteristics in currently abstinent methamphetamine abstinent methamphetamine abusers.abusers.

Results Results 1.1. Serotonin transporter density in global Serotonin transporter density in global

brain regions was significantly lower in brain regions was significantly lower in methamphetamine abusersmethamphetamine abusers

• Suggests that abuse of methamphetamine Suggests that abuse of methamphetamine leads to a global and severe reduction in leads to a global and severe reduction in the density of human brain serotonin the density of human brain serotonin transporterstransporters

2.2. Values of serotonin transporter density Values of serotonin transporter density in widely distributed brain regions were in widely distributed brain regions were found to negatively correlate with the found to negatively correlate with the duration of methamphetamine use.duration of methamphetamine use.

• Suggests that the longer Suggests that the longer methamphetamine is used, the more methamphetamine is used, the more severe the decrease in serotonin severe the decrease in serotonin transporter density.transporter density.

Results (Continued)Results (Continued)

3.3. Magnitude of aggression in methamphetamine Magnitude of aggression in methamphetamine abusers increased significantly with decreasing abusers increased significantly with decreasing serotonin transporter densities in some brain serotonin transporter densities in some brain regions.regions.

• Bitofrontal cortex, anterior cingulate, temporal cortexBitofrontal cortex, anterior cingulate, temporal cortex

4.4. No correlation between a representative measure No correlation between a representative measure of serotonin transporter density and the duration of serotonin transporter density and the duration of methamphetamine abstinence. Individuals of methamphetamine abstinence. Individuals abstinent for > 1 year still had a substantial abstinent for > 1 year still had a substantial decrease in serotonin transporter density.decrease in serotonin transporter density.

• Suggests reductions in the density of the serotonin Suggests reductions in the density of the serotonin transporter in the brain could persist long after transporter in the brain could persist long after methamphetamine use ceases.methamphetamine use ceases.

Methamphetamine Use, Self-Reported Methamphetamine Use, Self-Reported Violent Crime, and Recidivism Among Violent Crime, and Recidivism Among Offenders in California Who Abuse Offenders in California Who Abuse Substances Substances **

Cartier J, Farabee D, Prendergast M. Methamphetamine Use, Cartier J, Farabee D, Prendergast M. Methamphetamine Use, Self-Reported Violent Crime, and Recidivism Among Offenders Self-Reported Violent Crime, and Recidivism Among Offenders in California Who Abuse Substances. in California Who Abuse Substances. Journal of Interpersonal Journal of Interpersonal Violence.Violence. 2006;21:435-445. 2006;21:435-445.

Objective of StudyObjective of Study

Examine the associations Examine the associations between methamphetamine (MA) between methamphetamine (MA) use and three measures of use and three measures of criminal behavior: (a) self-criminal behavior: (a) self-reported violent criminal reported violent criminal behavior, (b) return to prison for a behavior, (b) return to prison for a violent offense, and (c) return to violent offense, and (c) return to prison for any reason.prison for any reason.

MethodsMethods

ParticipantsParticipants– 808 low- to medium-level inmates808 low- to medium-level inmates

Clear history of substance abuseClear history of substance abuse Within 12 months of releaseWithin 12 months of release Half the sample entering an in-prison Half the sample entering an in-prison

substance abuse (SA) program and the substance abuse (SA) program and the other half from a neighboring prison other half from a neighboring prison that offered no formal SA treatmentthat offered no formal SA treatment

Matched by age, ethnicity, sex offender Matched by age, ethnicity, sex offender status, and commitment offensestatus, and commitment offense

Methods ContinuedMethods Continued

• Baseline and 12-Month Follow-Up Baseline and 12-Month Follow-Up InterviewsInterviews Modified versions of criminal justice Modified versions of criminal justice

treatment evaluation forms developed by treatment evaluation forms developed by researchers at Texas Christian Universityresearchers at Texas Christian University

Sections on sociodemographic Sections on sociodemographic background, family and peer relations, background, family and peer relations, health and psychological status, criminal health and psychological status, criminal involvement, in-depth drug-use history, involvement, in-depth drug-use history, and an AIDS-risk assessmentand an AIDS-risk assessment

ResultsResults

Those who used MA (81.6%) were Those who used MA (81.6%) were significantly more likely than significantly more likely than those who did not use MA (53.9%) those who did not use MA (53.9%) to have been returned to custody to have been returned to custody for any reason or to report for any reason or to report committing any violent acts in the committing any violent acts in the 30 days prior to follow-up (23.6% 30 days prior to follow-up (23.6% vs. 6.8%, respectively)vs. 6.8%, respectively)

Results ContinuedResults Continued

After controlling for drug trade After controlling for drug trade involvement, MA use was still involvement, MA use was still significantly predictive of self-significantly predictive of self-reported violent crime and reported violent crime and general recidivismgeneral recidivism

Implications of ResultsImplications of Results

• These findings suggest that These findings suggest that offenders who use MA may differ offenders who use MA may differ significantly from their peers who do significantly from their peers who do not use MA and may require more not use MA and may require more intensive treatment interventions intensive treatment interventions and parole supervision than other and parole supervision than other types of offenders who use drugstypes of offenders who use drugs

Methamphetamine Abuse, HIV Methamphetamine Abuse, HIV Infection Causes Changes in Brain Infection Causes Changes in Brain StructureStructureJernigan,T, et al American Jnl of Psychiatry Aug Jernigan,T, et al American Jnl of Psychiatry Aug 20052005 Methamphetamine abuse and HIV infection Methamphetamine abuse and HIV infection

cause significant alterations in the size of cause significant alterations in the size of certain brain structures, and in both cases certain brain structures, and in both cases the changes may be associated with the changes may be associated with impaired cognitive functions, such as impaired cognitive functions, such as difficulties in learning new information, difficulties in learning new information, solving problems, maintaining attention and solving problems, maintaining attention and quickly processing information.quickly processing information.

Co-occurring methamphetamine abuse and Co-occurring methamphetamine abuse and HIV infection appears to result in greater HIV infection appears to result in greater impairment than each condition alone impairment than each condition alone

Methamphetamine Abuse, HIV Methamphetamine Abuse, HIV Infection Causes Changes in Brain Infection Causes Changes in Brain StructureStructureJernigan,T, et al American Jnl of Psychiatry Aug Jernigan,T, et al American Jnl of Psychiatry Aug 20052005 Brain scans to analyze structural volume changes Brain scans to analyze structural volume changes

in 103 adults divided among four populations: in 103 adults divided among four populations: methamphetamine abusers who were HIV-methamphetamine abusers who were HIV-positive; methamphetamine abusers who were positive; methamphetamine abusers who were HIV-negative; nonabusers who were HIV-positive; HIV-negative; nonabusers who were HIV-positive; and nonabusers who were HIV-negative. and nonabusers who were HIV-negative.

They also assessedThey also assessed the ability to think and the ability to think and reason using a detailed battery of tests that reason using a detailed battery of tests that examined speed of information processing, examined speed of information processing, attention/working memory, learning and delayed attention/working memory, learning and delayed recall, abstraction/executive functioning, verbal recall, abstraction/executive functioning, verbal fluency, and motor functioning.fluency, and motor functioning.

Methamphetamine Abuse, HIV Methamphetamine Abuse, HIV Infection Causes Changes in Brain Infection Causes Changes in Brain StructureStructureJernigan,T, et al American Jnl of Psychiatry Aug Jernigan,T, et al American Jnl of Psychiatry Aug 20052005 Methamphetamine abuse is associated with changes Methamphetamine abuse is associated with changes

in the the brain’s parietal cortex (which helps people in the the brain’s parietal cortex (which helps people to understand and pay attention to what’s going on to understand and pay attention to what’s going on around them) and basal ganglia (linked to motor around them) and basal ganglia (linked to motor function and motivation). function and motivation).

The degree of change in the parietal cortex was The degree of change in the parietal cortex was associated with worse cognitive function associated with worse cognitive function

HIV infection is associated with prominent volume HIV infection is associated with prominent volume losses in the cerebral cortex (involved in higher losses in the cerebral cortex (involved in higher thought, reasoning, and memory), basal ganglia, and thought, reasoning, and memory), basal ganglia, and hippocampus (involved in memory and learning hippocampus (involved in memory and learning

Methamphetamine Abuse, HIV Methamphetamine Abuse, HIV Infection Causes Changes in Brain Infection Causes Changes in Brain StructureStructureJernigan,T, et al American Jnl of Psychiatry Aug Jernigan,T, et al American Jnl of Psychiatry Aug 20052005 ““In HIV-infected people, the cognitive In HIV-infected people, the cognitive

impairments are associated with decreased impairments are associated with decreased employment and vocational abilities, difficulties employment and vocational abilities, difficulties with medication management, impaired driving with medication management, impaired driving performance, and problems with general performance, and problems with general activities of daily living, such as managing activities of daily living, such as managing

money,”money,” ““The impact of methamphetamine could The impact of methamphetamine could

potentially affect treatment and relapse potentially affect treatment and relapse prevention efforts, as well as things like money prevention efforts, as well as things like money management and driving performance.”management and driving performance.”

Methamphetamine Abuse, HIV Methamphetamine Abuse, HIV Infection Causes Changes in Brain Infection Causes Changes in Brain StructureStructureJernigan,T, et al American Jnl of Psychiatry Aug Jernigan,T, et al American Jnl of Psychiatry Aug 20052005 Younger methamphetamine abusers showed Younger methamphetamine abusers showed

larger effects in some brain regions. larger effects in some brain regions. Among HIV-infected individuals, the researchers Among HIV-infected individuals, the researchers

noted a direct association between the severity noted a direct association between the severity of the infection and greater loss of brain matter. of the infection and greater loss of brain matter.

In methamphetamine abusers who are also HIV-In methamphetamine abusers who are also HIV-positive, decreased volumes are correlated with positive, decreased volumes are correlated with increased cognitive impairment in one brain increased cognitive impairment in one brain region, the hippocampus. region, the hippocampus.

ChildrenChildren Children who live in and around the Children who live in and around the

area of the meth lab become exposed area of the meth lab become exposed to the drug and its toxic precursors to the drug and its toxic precursors and by-products.and by-products.

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

ChildrenChildren

Children can test positive for Children can test positive for methamphetamine by:methamphetamine by:– Having inhaled fumes during the Having inhaled fumes during the

manufacturing process manufacturing process – Coming into direct contact with the Coming into direct contact with the

drugdrug– Through second-hand smokeThrough second-hand smoke

ChildrenChildren

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

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

ChildrenChildren

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

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

ChildrenChildren Social workers now accompany law Social workers now accompany law

enforcement during lab seizures with children enforcement during lab seizures with children involved. involved.

– Parents are often charged with second-degree Parents are often charged with second-degree criminal mistreatment, along with manufacturing criminal mistreatment, along with manufacturing charges. charges.

– Allowing children to live in a toxic environment Allowing children to live in a toxic environment where additional risks of explosion and fire are high where additional risks of explosion and fire are high is considered to be neglect at best to child abuse.is considered to be neglect at best to child abuse.

Children are Children are notnot small adults! small adults! Different dietDifferent diet Growing & developing rapidlyGrowing & developing rapidly Higher metabolic & respiratory rateHigher metabolic & respiratory rate Developing nervous systemDeveloping nervous system Unusual habits (hand-to-mouth behaviors; Unusual habits (hand-to-mouth behaviors;

close to floor, contact with many close to floor, contact with many surfaces, at risk for all poisonings)surfaces, at risk for all poisonings)

Biologic & developmental vulnerabilityBiologic & developmental vulnerability

Prenatal Meth Prenatal Meth ExposureExposure Preliminary findings on infants exposed Preliminary findings on infants exposed

prenatally to methamphetamine (MA) prenatally to methamphetamine (MA) and nonexposed infants suggest…and nonexposed infants suggest…– Prenatal exposure to MA is associated with an Prenatal exposure to MA is associated with an

increase in SGA (small for gestational size).increase in SGA (small for gestational size).– Neurobehavioral deficits at birth were Neurobehavioral deficits at birth were

identified in NNNS (Neonatal Intensive Care identified in NNNS (Neonatal Intensive Care Unit Network Neurobehavioral Scale) Unit Network Neurobehavioral Scale) neurobehavior, including dose response neurobehavior, including dose response relationships and acoustical analysis of the relationships and acoustical analysis of the infant’s cry. Lester et al 2005infant’s cry. Lester et al 2005

Methamphetamine Methamphetamine and Sex: Connection and Sex: Connection in Heterosexualsin Heterosexuals

Q.2:Q.2: My sexual drive is My sexual drive is increasedincreased by the use of … by the use of …

18.120.5

43.9

70.655.3

11.1

85.3

55.6

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"

opiates alcohol cocaine meth

Primary Drug of Abuse

malefemale

Q.4: My sexual performance is Q.4: My sexual performance is improvedimproved by the by the use of …use of …

19.115.9

24.432.4

18.411.1

58.8 61.1

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.6: My sexual pleasure is Q.6: My sexual pleasure is enhancedenhanced by the by the use of …use of …

16.018.224.4

38.244.7

11.1

73.5 66.7

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.8: My use of … has made me become Q.8: My use of … has made me become obsessedobsessed with sex and/or made my sex drive with sex and/or made my sex drive abnormally abnormally highhigh..

3.26.8

19.514.7

55.3

11.1

76.5

44.4

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.10: I am Q.10: I am more likelymore likely to have sex ( to have sex (e.ge.g., ., intercourse, oral sex, masturbation, intercourse, oral sex, masturbation, etcetc.) .) when using …when using …

7.411.4

41.550.0

65.8

27.8

79.4

61.1

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.12: I am Q.12: I am more likelymore likely to practice “risky” sex to practice “risky” sex under the influence of … (under the influence of … (e.ge.g., not use ., not use condoms, be less careful about who you condoms, be less careful about who you choose as a sex partner, choose as a sex partner, etcetc.).)

4.36.8

48.8

35.3

57.9

16.7

52.955.6

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.13: I have become involved in sex acts that Q.13: I have become involved in sex acts that are are unusualunusual for me when I am under the for me when I am under the influence of … (influence of … (e.ge.g., marathon masturbation, go ., marathon masturbation, go to “peep” shows, cross-dress, voyeurism, to “peep” shows, cross-dress, voyeurism, expose yourself, expose yourself, etcetc.).)

1.14.5 12.2

20.6

52.6

16.7

52.9 44.4

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.16: Sexual fantasies or desires have Q.16: Sexual fantasies or desires have previously “triggered” my use of …previously “triggered” my use of …

5.3 4.5

26.8 32.4

47.4

11.1

41.238.9

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Q.19: My sexual behavior under the Q.19: My sexual behavior under the influence of … has caused me to feel influence of … has caused me to feel sexually sexually pervertedperverted or or abnormalabnormal..

3.22.3

14.65.9

47.4

11.1

52.9

33.3

0102030405060708090

100

Per

cent

Res

pond

ing

"Yes

"



malefemale

Female Methamphetamine Female Methamphetamine Users: Social Characteristics Users: Social Characteristics and Sexual Risk Behaviorand Sexual Risk Behavior

Semple SJ, Grant I, Patterson TLSemple SJ, Grant I, Patterson TLWomen and HealthWomen and HealthVol. 40(3), 2004Vol. 40(3), 2004

Demographics (n=98)Demographics (n=98) EthnicityEthnicity

– 44% Caucasian44% Caucasian– 33% African American33% African American– 16% Latina16% Latina– 2% Native American2% Native American– 5% Other5% Other

EducationEducation– 96% had less than a college education96% had less than a college education

Marital StatusMarital Status– 54% had never been married54% had never been married

EmploymentEmployment– 77% were unemployed77% were unemployed

DemographicsDemographics Psychiatric Health StatusPsychiatric Health Status

– 38% reported having a psychiatric diagnosis38% reported having a psychiatric diagnosis 53% depression53% depression 17% bipolar17% bipolar 14% schizophrenia14% schizophrenia

Patterns of UsePatterns of Use– 83% smoked83% smoked

Context of Meth UseContext of Meth Use– Meth was used primarily with either a friend Meth was used primarily with either a friend

(95%) or a sexual partner (84%).(95%) or a sexual partner (84%). Social and Legal ProblemsSocial and Legal Problems

– 36% reported having a felony conviction.36% reported having a felony conviction.

Sexual Partners of Meth-Using Sexual Partners of Meth-Using WomenWomen On average women had 7.8 sexual partners in On average women had 7.8 sexual partners in

a two-month period (SD=10.7, range 1-74).a two-month period (SD=10.7, range 1-74). 84% had casual partners during the past two 84% had casual partners during the past two

months.months.– 90% of all casual partners were reported to be 90% of all casual partners were reported to be

meth users.meth users. 31% had an anonymous partner in the past 31% had an anonymous partner in the past

two months.two months.– 76% of anonymous sex partners were meth users.76% of anonymous sex partners were meth users.

No spouses or live-in partners were reported to No spouses or live-in partners were reported to be HIV-positive.be HIV-positive.

Sexual Risk BehaviorSexual Risk Behavior Participants engaged in an average of 79.2 sex Participants engaged in an average of 79.2 sex

acts over a two-month period.acts over a two-month period.

Most sexual activity was unprotected. The Most sexual activity was unprotected. The average number of unprotected and protected average number of unprotected and protected sex acts over the two-month period was 70.3 sex acts over the two-month period was 70.3 and 8.8, respectively.and 8.8, respectively.

In terms of In terms of unprotected sexunprotected sex::– 56% of all vaginal sex acts were unprotected56% of all vaginal sex acts were unprotected– 83% of all anal sex acts were unprotected 83% of all anal sex acts were unprotected – 98% of all oral sex acts were unprotected98% of all oral sex acts were unprotected

Methamphetamine Use and Methamphetamine Use and HIV Risk Behaviors Among HIV Risk Behaviors Among Heterosexual Men -- Heterosexual Men -- Preliminary Results from Five Preliminary Results from Five Northern California Counties, Northern California Counties, December 2001-November December 2001-November 2003 2003

CS Krawczyk, et al., 2006,The Body

(http://www.thebody.com/cdc/straights_meth.html#tab2)

0

10

20

30

40

50

60

70

80

90

100

FemalePartner

Anal withFemale

CasualFemalePartner

MultipleParters

IDU Partner Sex forDrugs or $

Recent Meth No Meth Use

Recent Versus Never Meth Recent Versus Never Meth Use*Use*

Injection-Related HIV Injection-Related HIV Risk Risk

Injected in the Past 6 Injected in the Past 6 Months:Months:– MA Users: 37.1%MA Users: 37.1%– Non-MA Users: 11.1%Non-MA Users: 11.1%

Of these--Of these--– 24% used “dirty” 24% used “dirty”

syringessyringes– 30% shared cookers, 30% shared cookers,

rinse water, etc.rinse water, etc.

Men-Who-Have-Sex-With-Men-Who-Have-Sex-With-MenMen

"The difference between sex with crystal "The difference between sex with crystal and sex without it is like the difference and sex without it is like the difference between Technicolor and black-and-white," between Technicolor and black-and-white," one man told me at Tina's Café in San one man told me at Tina's Café in San Francisco. “Once you have sex with crystal, Francisco. “Once you have sex with crystal, it's hard to imagine having it any other it's hard to imagine having it any other way.” way.” New Yorker Magazine, New YorkNew Yorker Magazine, New York..

““Crystal tells your brain to go back and get Crystal tells your brain to go back and get more, more, more. The logical side of your more, more, more. The logical side of your mind is saying, 'I can't keep doing this,' but mind is saying, 'I can't keep doing this,' but you are still on your way to the dealer's you are still on your way to the dealer's house.” house.” New Yorker Magazine, New YorkNew Yorker Magazine, New York..

““The more I used it, the more I needed it. At The more I used it, the more I needed it. At one point, I broke into my own house to try one point, I broke into my own house to try and steal furniture.” and steal furniture.” New Yorker Magazine, New Yorker Magazine, New YorkNew York..

"On the Internet, you can be whoever you "On the Internet, you can be whoever you want to be. Smoke some crystal, get online, want to be. Smoke some crystal, get online, and there is nothing you won't or cannot and there is nothing you won't or cannot do." do." New Yorker Magazine, New YorkNew Yorker Magazine, New York..

More about HIV+ Meth-More about HIV+ Meth-Using MSMUsing MSM

The following data is based on a The following data is based on a small qualitative study:small qualitative study:– Participants snorted meth for 9.4 Participants snorted meth for 9.4

yearsyears– Used to “party,” “to get high,” and Used to “party,” “to get high,” and

“to escape”“to escape”– Got high and looked for sex partnersGot high and looked for sex partners– Used meth with other MSMs but not Used meth with other MSMs but not

with heterosexual meth users.with heterosexual meth users.

SOURCE: Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87.

Other Data on Meth-Using Other Data on Meth-Using MSMMSM

The following data is based on a The following data is based on a sample of 90 HIV+ meth-using sample of 90 HIV+ meth-using MSM:MSM:– 46% identified as “binge” users46% identified as “binge” users– Average binge lasted 5.6 daysAverage binge lasted 5.6 days– Binge users reported significantly Binge users reported significantly

more social difficulties, sexual risk more social difficulties, sexual risk behaviors, and mental and physical behaviors, and mental and physical health problemshealth problems

SOURCE: Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87.

Crystal Crystal Methamphetamine Use Methamphetamine Use By Latino MenBy Latino Men Newly diagnosed HIV-positive Latino Newly diagnosed HIV-positive Latino

men who have sex with men were men who have sex with men were almost 9 times more likely to report almost 9 times more likely to report crystal use than HIV-negative mencrystal use than HIV-negative men

Crystal use was highest among Crystal use was highest among Latinos (20%)Latinos (20%)

Crystal was associated with a higher Crystal was associated with a higher prevalence of unprotected anal sex prevalence of unprotected anal sex and with newly diagnosed HIVand with newly diagnosed HIV

Sex-Related HIV Risk Sex-Related HIV Risk (Odd Ratios of MA Users vs. Non-MA Users)(Odd Ratios of MA Users vs. Non-MA Users)

0 1 2 3 4 5

Unprotected Sexw/ IDU

Unprotected Sexw/ Non-Partner

Traded Sex forMoney/Drugs

1.5

2.5

4.8

Drug Abuse Problem Drug Abuse Problem or Public Health or Public Health ProblemProblem

In Los Angeles In Los Angeles County, heroin County, heroin injectors at low injectors at low risk; gay male risk; gay male meth users at meth users at extreme riskextreme risk

010203040506070

% H

IV P

osit

ive

MMT-LAC Her-LAC Meth-HWD

Meth-RC

LAC HIV Epi (1999-2004); UCLA/ISAP (1998-2004)

Weekend Warriers: Weekend Warriers: How It Works.How It Works.

SunSun MonMon TuesTues WedWedss

ThurThur FriFri SatSat

$50 - $75 for the weekend (excluding cover charges)

Intervention: Intervention: Prevention and Prevention and Treatment ApproachesTreatment Approaches

Methamphetamine and HIV in MSM: Methamphetamine and HIV in MSM: A Time-to-Response Association? A Time-to-Response Association?

8%

26%

41%

62%

90%

0

20

40

60

80

100

Per

cen

t H

IV+

ProbabilitySample*

RecreationalUser**

Chronic NonTreatment***

OutpatientPsychosoc****

Residential****

* Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep, *** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data

Substance Abuse Substance Abuse TreatmentTreatment

Sex Risks Reduced Sex Risks Reduced with Treatment: UARI with Treatment: UARI Past 30 DaysPast 30 Days

0

0.5

1

1.5

2

2.5

3

3.5

CBTCMCBT+CMGCBT

2(3)=6.75, p<.01

Methamphetamine Methamphetamine

Women’s IssuesWomen’s Issues

CravingCraving

AdolescentsAdolescents

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Somat

izatio

n

Obsess

ive-

Compul

sive

Inte

rper

sonal

Sen

sitiv

ity

Depre

ssio

n

Anxiet

y

Hostili

ty

Phobic

Anx

iety

Paran

oid Id

eatio

n

Psych

otic

ism

all significant at p< .001

Mea

n B

SI

Sco

re

Female

Male

Behavior Symptom Inventory (BSI) Scores at Baseline

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

20.00

Female Male

p < .001

Me

an

BD

I Sc

ore

Beck Depression Inventory (BDI) Scores at Baseline

0%

5%

10%

15%

20%

25%

30%

35%

40%

*to lose weight *to relieve depression

*p< .001

Male

Female

Self-Reported Reasons for Starting Methamphetamine Use

Route of Route of Methamphetamine Methamphetamine AdministrationAdministration

24

11

64

0

10

20

30

40

50

60

70

Route of Administration

Perc

ent

Usi

ng b

y R

oute

intranasal (IN)smoke (SM)inject (IDU)

Craving by RouteCraving by Route

0

10

20

30

40

50

60

70%

No

Cra

vin

g a

t b

aseli

ne

IN

SM

IDU

P<.05

Treatment Length by Treatment Length by RouteRoute

0

1

2

3

4

5

6

7

8

9

10L

en

gth

in

Tre

atm

en

t (w

ks)

IN

SM

IDU

P<.05

MA-Free Samples by MA-Free Samples by RouteRoute

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7%

of

MA

-fre

e U

A (

3 w

ks)

IN

SM

IDU

P<.05

Hepatitis C by RouteHepatitis C by Route

21.05

10

44

15

0

5

10

15

20

25

30

35

40

45

50%

Pre

vela

nce

IN (n=38)

SM (n=202)

IDU (n=72)

Total (n=314)

P<.05

BSI Psychiatric Symptoms by BSI Psychiatric Symptoms by RouteRoute

0

5

10

15

20

25

30

IN SM IDU

BL PST

TX-End PST

6-Mo PST

12-Mo PST

P<.05Positive Symptom Total (PST)

Adolescent Meth Abuse Adolescent Meth Abuse Treatment AdmissionsTreatment Admissions

Matrix Matrix (Boys)(Boys) (Girls) (Girls)– 2002 2002 16%16% 63%63%– 2003 2003 25%25% 67%67%– 2004 2004 22%22% 69%69%

Phoenix Phoenix (Boys)(Boys)– 2002 2002 25%25% 43%43%– 2003 2003 23%23% 51%51%– 2004 2004 27%27% 53%53%

Sample CharacteristicsSample Characteristics

305 Adolescents305 Adolescents (13-18 years old) (13-18 years old)

Average AgeAverage Age ~ 16yrs old (sd=1.138) ~ 16yrs old (sd=1.138)

GenderGender: 70.2% Males: 70.2% Males

EthnicityEthnicity: 55.3% White & 33.1% Latino: 55.3% White & 33.1% Latino

Ethnic IdentificationEthnic Identification55.3

33.1

7.63 1

0

10

20

30

40

50

60

Per

cent

Ethnicity

Drug of ChoiceDrug of Choice: N=305: N=305MethamphetamineMethamphetamine 74 (24.3%)74 (24.3%)PotPot 149 (48.9%)149 (48.9%)AlcoholAlcohol 24 (7.9%)24 (7.9%)Methamphetamine & PotMethamphetamine & Pot 9 (3%)9 (3%)Methamphetamine & Methamphetamine & AlcoholAlcohol 6 (2%)6 (2%)

Pot & AlcoholPot & Alcohol 26 (8.5%)26 (8.5%)CocaineCocaine 6 (2%)6 (2%)Opiates (Heroin)Opiates (Heroin) 3 (1%)3 (1%)OtherOther 8 (2.6%)8 (2.6%)

Drug Use by GenderDrug Use by Gender

14.9

63.7

85.1

36.3

0

10

20

30

40

50

60

70

80

90

Meth Other

Males

Females

Treatment History Treatment History by Drug Useby Drug Use

Total Total (N=275*)(N=275*)*30 Missing*30 Missing

% %

CompletedCompleted% Not % Not

CompleteCompletedd

139 139

(50.5%)(50.5%)136 136

(49.5%)(49.5%)

METHMETH(n=85)(n=85)

3737

(43.5%)(43.5%)46 46

(54.1%)(54.1%)

OTHEROTHER(n=190)(n=190) 102 (53.7%)102 (53.7%)

8888

(46.3%)(46.3%)

Legal ProblemsLegal Problems

Missing Data*Missing Data* Total Total (n=268)(n=268)

OTHEROTHER(n=189)*(n=189)*

METH METH USERS USERS (n=79)(n=79)

**Illegal Behaviors Illegal Behaviors

ArrestArrestProbationProbationJuvenile HallJuvenile Hall

177 177 (66.0%)(66.0%)

124 124 (65.6%)(65.6%)

53 53 (67.1%)(67.1%)

Psychological DistressPsychological DistressMissing Data*Missing Data*

TotalTotal % Yes% Yes(n=275)(n=275)

OTHEROTHER(n=196)(n=196)

METH METH USERS USERS (n=79)(n=79)

Depression*Depression* 128128 (46.5%)(46.5%)

83 83 (42.6%)(42.6%)

4545(57.7%)(57.7%)

SuicidalitySuicidality Attempted SuicideAttempted SuicideDoes not want to Does not want to live live Like to injure Like to injure yourselfyourself

7272 (26.2%)(26.2%)

48 48 (24.5%)(24.5%)

24 24 (30.8%)(30.8%)

Psychopathology*Psychopathology*Paranoid FeelingsParanoid FeelingsLosing MindLosing MindHearing VoicesHearing Voices

87 87 (31.6%)(31.6%)

53 53 (27.0%)(27.0%)

34 34 (43.0%)(43.0%)

P<.05

Do meth users stop on Do meth users stop on their own?their own? Meth use via intranasal or oral routes Meth use via intranasal or oral routes maymay

D/C meth on their ownD/C meth on their own Oral and intranasal use until a decade agoOral and intranasal use until a decade ago Meth users take 7-10 years to enter RxMeth users take 7-10 years to enter Rx Large majority now smoke or inject. They Large majority now smoke or inject. They

don’t stop on their own. don’t stop on their own. These users are now entering AOD system. These users are now entering AOD system.

Treatment demand is and will expand.Treatment demand is and will expand. Many meth users show up in primary care Many meth users show up in primary care

and mental health systems and mental health systems


ResearchResearch

Meth vs Cocaine: Do Users Meth vs Cocaine: Do Users Switch ?Switch ?

Meth users: White, Mexican/Central American, Meth users: White, Mexican/Central American, Rural, SuburbanRural, Suburban

Coke users: African-American, Caribbean, Coke users: African-American, Caribbean, UrbanUrban

Each group stigmatizes the otherEach group stigmatizes the other Evidence of “switching” minimal, but no prior Evidence of “switching” minimal, but no prior

experience with major shifts in availability.experience with major shifts in availability. The cocaine to meth “switch” more likely than The cocaine to meth “switch” more likely than

the reverse, since meth is less expensive, lasts the reverse, since meth is less expensive, lasts longer and supplies are easier to establish and longer and supplies are easier to establish and maintain.maintain.

Current Status of Meth Current Status of Meth ResearchResearch Brain imaging research is impressive, Brain imaging research is impressive,

valuable and quite well developed programsvaluable and quite well developed programs Research on meth and kids in labs neededResearch on meth and kids in labs needed Research on meth and adolescent treatment Research on meth and adolescent treatment

neededneeded Treatment research developing slowlyTreatment research developing slowly

– No medications available and moving No medications available and moving ahead slowlyahead slowly

– Few studies of behavioral treatmentsFew studies of behavioral treatments

Thank youThank you

[email protected]@mednet.ucla.edu

www.uclaisap.orgwww.uclaisap.org

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