Why do we need an Addiction supplement ... - Wiley Online Library

INTRODUCTION

Why do we need an Addiction supplement focused on methamphetamine? Richard A. Rawson1 & Timothy P. Condon2 Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA1 and National Institute on Drug Abuse, NIH, Bethesda, MD, USA2

ABSTRACT Methamphetamine is a substantial public health problem in many communities in the United States and in other parts of the world. In order to bring new knowledge about methamphetamine to policy makers, clinicians and researchers, this volume has compiled a set of articles containing new information about the drug and its effects. The articles contain information presented by researchers at two special methamphetamine meetings sponsored by the National Institute on Drug Abuse in 2005. Keywords

Epidemiology, methamphetamine, policy.

Correspondence to: Richard A. Rawson PhD, Professor, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, 1640 South Sepulveda Blvd, Suite 200, Los Angeles, California 90025–7535, USA. E-mail: [email protected]

INTRODUCTION Over the past decade (1995–2005), one of the fastest growing illicit drug problems in the world has been the use and abuse of methamphetamine. According to United Nations Office on Drugs and Crime (UNODC) estimates, approximately 26 million people used amphetamines in a 12-month period during 2003–04 [1]. In contrast, approximately 11 million people use heroin and 14 million use cocaine. World-wide, the only illicit drug that is used more often than amphetamines is cannabis [1]. At a recent meeting on methamphetamine held at the UNODC headquarters in Vienna, Austria, epidemiological reports from around the world documented that methamphetamine use is considered problematic in some parts of Europe (especially the Czech and Slovak Republics, Baltic region and Russia), in South-east Asia (especially Thailand and Malaysia), in the South Pacific (especially Indonesia and the Philippines), Australia and North America. In addition, recent reports have suggested rapid increases in methamphetamine use in the Republic of South Africa [2]. Statistics on the extent of the methamphetamine problem within the United States create a somewhat mixed picture. According to findings from the Substance Abuse and Mental Health Services Administration (SAMHSA)-funded National Survey on Drug Use and

R. A. Rawson & T. P. Condon declare no conflict of interests.

Health (NSDUH), methamphetamine use among the US population aged 12 years and older remained stable between 2002 and 2004 [3]. In 2004, an estimated 12 million people used methamphetamine at least once in their life-time, 1.4 million had used it in the previous year and 600 000 had used it in the previous 30 days. In 2004, an estimated 318 000 people used methamphetamine for the first time. This number has been stable at approximately 300 000 since 2002. Despite the fact that the number of new users, previous-year users and previous-month users remained stable, the number of previous-month users who met criteria for stimulant abuse or dependence increased from 63 000 in 2002 to 130 000 in 2004. Therefore, according to the NSDUH data, while the number of new users remains relatively stable, a higher percentage of those people who do use are developing significant clinical disorders as a result of their use. The NIDA-sponsored Monitoring the Future survey indicates that methamphetamine use has shown a substantial decline among 8th, 10th and 12th graders since 1999 [4]. Annual prevalence rates in 2005 were 1.8%, 2.9% and 2.5% among 8th, 10th and 12th graders, respectively. However, these survey data are in sharp contrast to treatment admission data within some treatment programs in California [5]. Treatment admission data for adults from SAMHSA has indicated that the percentage of individuals reporting methamphetamine as their primary drug of use has

© 2007 The Author(s) Journal compilation © 2007 Society for the Study of Addiction

Addiction, 102 (Suppl. 1), 1–4

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increased from 13 per 100 000 in 1993 to 56 per 100 000 in 2003 [6]. Another measure of the extent of the problem is the number of methamphetamine laboratory incidents (which includes laboratory, dumpsite and chemical and glassware seizures) reported by law enforcement personnel. This number increased from 7438 in 1999 to 17 170 in 2004 [7]. The methamphetamine problem in the United States has spread from the Western states to the Midwestern states and, most recently, to the South-eastern states over the past decade. At present, the only regions in the United States without substantial rates of methamphetamine use are the North-east and major urban centers in the East and Midwest. Recent media reports have suggested that even in some of these cities (e.g. New York), there is evidence of considerable methamphetamine use among some men who have sex with men [8]. As rates of methamphetamine use in the United States have risen over the past decade, an accompanying development is a major shift in the manner in which methamphetamine is ingested. In 1994, insufflation of methamphetamine powder (intranasal use) was the primary route of administration, with more than 40% of users reporting this method of administration [6]. By 2003, only 15% reported this method as their preferred route of administration, while 56% reported smoking as their preferred method of use [9]. (Over this period, injection use stayed relatively constant at between 22% and 29% of users [6].) Considerable clinical evidence suggests that routes of administration that produce more rapid onset of effects (injection and smoking) are associated with higher levels of negative health and behavioral consequences than routes that produce slower onset of effects (oral and intranasal) [10,11]. Therefore, the combination of increased methamphetamine availability, more methamphetamine use and more smoked methamphetamine have dramatically increased the impact of methamphetamine on the health-care, social service and criminal justice systems in the United States [12]. As clinicians, public health personnel and policy makers attempt to respond to the challenges of the expanded methamphetamine problem in the United States, interest in new knowledge about methamphetamine is high.

PHYSICAL AND MENTAL EFFECTS OF METHAMPHETAMINE Methamphetamine produces a euphoric ‘high’ or ‘rush’ that is almost instantaneous when the drug is smoked or injected [11]. The half-life of methamphetamine is approximately 8–12 hours, and it is during this time that the acute effects of methamphetamine occur. Immediate physiological changes associated with methamphet-

amine use are similar to those produced by the fightor-flight response: increased blood pressure, body temperature, heart rate and breathing. Even small doses can increase wakefulness, attention and physical activity and decrease fatigue and appetite. Negative physical effects typically include hypertension, tachycardia, headaches, cardiac arrhythmia and nausea. The psychological impact is manifested by increased anxiety; insomnia; aggression and violent tendencies; paranoia; and visual and auditory hallucinations. High doses can elevate body temperature to dangerous and sometimes lethal levels, causing convulsions, coma, stroke, vegetative states and even death. Prolonged use of methamphetamine frequently creates tolerance for the drug [11]. As tolerance occurs, users typically increase the methamphetamine dose and increase the frequency of use, which can lead to dependence on the drug. Long-term chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion and insomnia. These symptoms are the combined result of the direct effects of the drug plus the consequences associated with sleep deprivation, as abusers will often report days and even weeks of sleeplessness. Whether these reports are accurate or exaggerated, it is clear that the lack of quality sleep is profound. When in a state of prolonged methamphetamine use and sleep deprivation, users commonly experience a number of psychotic symptoms, including paranoia, auditory hallucinations, mood disturbances and delusions. One of the most regularly reported features is ‘formication’, the sensation of insects creeping on the skin. The paranoia brought on by methamphetamine can result in homicidal as well as suicidal thoughts. Methamphetamine can cause a variety of cardiovascular problems, including rapid and irregular heartbeat. Damage to small blood vessels in the brain can result in strokes. High doses of methamphetamine can produce potentially fatal hyperthermia. Chronic methamphetamine injection can result in endocarditis, severe infections and abscesses at injection sites. Methamphetamine smokers appear to be at elevated risk for chronic obstructive pulmonary disease and other respiratory problems. High-risk sexual behavior while under the effects of methamphetamine and injection use puts users, especially gay males, at greater risk of contracting and transmitting infectious diseases such as HIV, hepatitis B and C, other sexually transmitted infections and tuberculosis [14,15]. Effective treatment for methamphetamine-related drug disorders among men who have sex with men may be one of the most important strategies in reducing the spread of HIV and other associated communicable infections [16]. Among heterosexual injection methamphetamine users, hepatitis C



Introduction

rates of 44% have been reported [15]. Methamphetamine use (especially injection use) has also been highly associated with participation in illegal behaviors, such as crime and violence, which has resulted in increased incarcerations and other problems within the legal system [17]. The production of methamphetamine is also associated with significant health risks, such as clandestine laboboratory explosions, environmental fires and accidental poisoning [18,19]. Although there is still debate about the magnitude of the methamphetamine problem and whether or not it should be considered an ‘epidemic’, there is little question that in the United States and in much of the world, methamphetamine use creates substantial health and other social problems. New knowledge on the impact of this drug on individuals and communities is in great demand by policy makers and clinicians. As early as the 1970s, NIDA identified amphetaminerelated research as a major priority and began supporting studies of the neurochemical consequences of high-dose methamphetamine exposure in animal models in order to better understand its abuse potential. In December 1996, NIDA launched a comprehensive Methamphetamine Initiative, with the intent of stimulating research to fill gaps in the scientific knowledge about the pharmacology, toxicity, epidemiology, prevention and treatment of methamphetamine abuse, and to provide the latest available research information about methamphetamine to the public and health-care practitioners.

MEETINGS OF LEADING METHAMPHETAMINE RESEARCHERS During 2005, NIDA convened two meetings to review the research that had resulted from this decade-long initiative. These meetings brought together some of the leading researchers on methamphetamine in the United States. In May 2005 in Los Angeles, a group of 16 researchers presented new information from recent studies on a variety of topics related to methamphetamine. This meeting was followed in December by another meeting of 18 methamphetamine researchers held at a satellite meeting of the American College of Neuropsychopharmacology in Kona, Hawaii. The papers in this issue include the data presented at those meetings, along with other related findings.

Acknowledgements The research upon which this report is based was supported by NIDA contract numbers: CTO: N01DA-0–8804 (Thomas Newton, PI) and MDS: N01DA-3–8824 (Walter Ling, PI).

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References 1. United Nations Office of Drugs and Crime (UNODC). 2005 World Drug Report. Vienna, Austria: UNODC; 2005. 2. Parry C., Meyers B., Puddeman A. Drug policy for methamphetamine use urgently needed. South African Med Journal 2004; 99: 964–5. 3. Substance Abuse and Mental Health Services Administration Office of Applied Studies. The NSDUH Report: Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005. 4. Johnston L. D., O’Malley P. M., Bachman J. G., Schulenberg J. E. Monitoring the Future. National Results on Adolescent Drug Use: Overview of Key Findings, 2005. NIH Publication no. 06–5882. Bethesda, MD: National Institute on Drug Abuse; 2006. 5. Rawson R. A., Gonzales R. G., Obert J. L., McCann M. J., Brethen P. Methamphetamine use among treatmentseeking adolescents in Southern California: participant characteristics and treatment Response. J Subst Abuse Treat 2005; 29: 67–74. 6. Substance Abuse and Mental Health Services Administration, Office of Applied Studies (SAMHSA/OAS). The DASIS Report: Trends in Methamphetamine/Amphetamine Admissions to Treatment: 1993–2003. Issue 9. Rockville, MD: SAMHSA/OAS; 2006. Available at: http://oas.samhsa.gov/ 2k6/methTx/methTX.pdf (accessed 1 July 2006). 7. Drug Enforcement Administration. El Paso Intelligence Center’s National Clandestine Laboratory Seizure System. Maps of Methamphetamine Lab Seizures. Available at: http://www.dea.gov/concern/map_lab_seizures.html. 8. Jacobs A. Battling HIV where sex meets crystal meth. New York Times 21 February 2006 (accessed 1 July 2006). 9. Substance Abuse and Mental Health Services Administration, Office of Applied Studies (SAMHSA/OAS). Treatment Episode Data Set (TEDS). Highlights—2003. National Admissions to Substance Abuse Treatment Services. DASIS series: S-27. DHHS Publication no. (SMA) 05–4043. Rockville, MD: SAMHSA/OAS; 2005. 10. Domier C. P., Simon S. L., Rawson R. A., Huber A., Ling W. A comparison of injecting and non-injecting MA users. J Psychoact Drugs 2002; 32: 229–32. 11. Matsumoto T., Kamijo A., Miyakawa T., Endo K., Yabana T., Kishimoto H. et al. Methamphetamine in Japan: the consequences of methamphetamine abuse as a function of route of administration. Addiction 2002; 97: 809. 12. National Association of Counties (NOCA). The Meth Epidemic in America: Two Surveys of U.S. Counties: the Criminal Effect of Meth on Communities; the Impact of Meth on Children. Washington, DC: NOCA; 2006. 13. Jaffe J. A., Ling W., Rawson R. A. Amphetamines. In: Sadock B. J., Sadock V. A., editors. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Baltimore, MD: Lippincott; 2005, p. 1188–200. 14. Frosch D., Shoptaw S., Huber A., Rawson R. A., Ling W. Sexual HIV risk among gay and bisexual male methamphetamine abusers. J Subst Abuse Treat 1996; 13: 483–6. 15. Gonzales R. G. Marinelli, Casey, PM, Shoptaw, S, Ang, A, Rawson, RA. Hepatitis C virus infection among methamphetamine dependent individuals in outpatient treatment. J Subst Abuse Treat 31: 195–202. 16. Shoptaw S., Reback C. J., Peck J. A., Yang X., RotheramFuller E., Larkins S. et al. Behavioral treatment approaches



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for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend 2005; 78: 125–34. 17. Farabee D., Prendergast M., Cartier L. Methamphetamine use and HIV risk among substance-abusing offenders in California. J Psychoact Drugs 2002; 34: 295–300.

18. Danks R. R., Wibbenmeyer L. A., Faucher L. D., Sihler K. C., Kealey G. P., Chang P. et al. Methamphetamine-associated burn injuries: a retrospective analysis. J Burn Care Rehabil 2004; 25: 425–9. 19. Wermuth L. Methamphetamine use: hazards and social influences. J Drug Educ 2000; 30: 423–33.

