By Diana Mahoney, New England bureau. Share your thoughts and suggestions at clinicalpsychiatrynews@elsevier.com
In the war on drugs, methamphetamine is an insidious and tireless enemy.
According to statistics presented during a recent public Webcast addressing methamphetamine prevention sponsored by the U.S. Department of Justice (DOJ) Office of Community Oriented Policing Services, the Drug Enforcement Administration, and the Partnership for a Drug-Free America (PDFA), about 12 million Americans older than 12 years have tried methamphetamine, and 1.4 million Americans are addicted to it. Additionally, the results of a 2004 survey from the National Institute on Drug Abuse showed that more than 6% of high school seniors and more than 5% of 10th graders nationally reported lifetime use of the drug.
In a 2006 survey by the National Association of Counties (NAC), nearly half of the 500 participating counties reported that methamphetamine, or meth, is their primary drug problem. The results of separate NAC surveys reported in 2005 and 2006, respectively, showed that meth was the most commonly found drug in patients at public hospital emergency departments and demonstrated a significant increase in out-of-home placements for children because of parents' methamphetamine use or production.
Gains have been made on some battlefronts, but stubborn and unexpected obstacles hinder advances on others.
For example, the federal government has spent billions targeting the meth “super labs” in western states that are capable of producing huge quantities of the drug. Shutting down those facilities, however, has had little impact on the availability of meth. Rather, these actions pushed the large-scale production back into Mexico and have opened up more “business opportunities” for mom-and-pop meth labs that have been springing up across the country, particularly in the rural Midwest.
The super labs are a more important target. But the homespun labs, which account for more fires, explosions, child endangerment, and other problems, in many ways present a greater public health threat. Additionally, they make meth more accessible than ever to a wider range of people. And widespread access to the Internet has brought meth directly into people's living rooms by offering countless Web sites with detailed instructions for making meth.
The dangers of methamphetamine abuse extend beyond those associated with temporarily altering the consciousness of users. Meth stimulates central nervous system activity “by producing the mother of all dopamine releases,” according to Dr. Richard Rawson, associate director of the Integrated Substance Abuse Programs at the University of California, Los Angeles. Once the effect wears off, however, users “crash” and are often profoundly depressed, which triggers their desire for more meth to regain the high.
Side effects of the drug include irritability, insomnia, confusion, tremors, and aggressiveness. The increased dopamine production can induce psychosis, which may persist for months after the drug has been stopped. Meth also constricts blood vessels in the brain, leading to heart attacks, strokes, and potentially irreversible brain damage.
To put the brakes on meth abuse in the United States, the government recently passed a law called the Combat Methamphetamine Act, which provides legal pathways for targeting meth traffickers as well as a national standard for regulating meth precursors, including restrictions on the sale of over-the-counter medications containing pseudoephedrine.
Such efforts are positive, but community-level preventive interventions are needed that include local agencies, schools, parents, law enforcement, faith-based groups, and others with a vested interest in preventing meth use and intervening in meth abuse, according to Michael Townsend, director of the Methamphetamine Demand Reduction Program, a federally funded effort by the PDFA designed to reduce demand for the drug.
“Community partnerships are an effective approach to spreading this kind of word, and it's absolutely essential that the community get involved because [meth abuse] affects the whole community,” Mr. Townsend stated during the DOJ Webcast. Toward this end, the PDFA has developed a campaign called Meth 360, which has been piloted in several communities across the country. The approach relies on grassroots educational presentations delivered by teams made up of prevention, law enforcement, and treatment representatives.
“We call it Meth 360, because meth affects the whole community,” Mr. Townsend said. “It's important that everyone get involved at the local community level to give everyone a 360-degree view of the problem.”
After partnerships have been established, prevention approaches can be localized. The key is to “make sure that [the collaboration] is addressing your problem, and that the right people are at the table,” said Ron Glensor, deputy chief of the Reno, Nevada, police department, and one of the panelists participating in the DOJ Webcast. “And once you get to the table, be patient. Meth is not an easy problem to resolve, but you can make it better.”