Transcript Substance Abuse

Substance Abuse
Bruce L. Houghton, MD
Division of General Medicine
Department of Internal Medicine
Creighton University School of
Medicine
Acknowledge
Dr. Nipper
Dr. Malin
Dr. Hunter
Dr. Siefert
Dr. Wilwerding
Cover
Heroin
Methamphetamine
Objectives
Describe the history of methamphetamine in the
Midwest
Discuss the pathophysiology of
methamphetamine’s effect on the brain in
addiction
Recognize common physical findings and
features of patients who use methamphetamine
Describe treatment options for acute
methamphetamine intoxication and
complications
HEROIN
Heroin (Definitions)
Opioids
– Natural and synthetic substances with morphine like
activity
Opiate
– subclass of opioids consisting of alkaloid compounds
extracted from opium
– Morphine and Codeine
Heroin
– Derivative of morphine
– Most commonly abused opiate
Opium derived from poppy plant
Used as early as
4000 BC
Morphine was purified
from opium in 19th
century
US Civil War heavy
use
Multiple ‘tonics’ and
patent medicines late
1800s
Heroin Use*
Use Peaked 1960s, decreased slightly in
1970s and 1980s and increased 1990s
2.4 million people used heroin at some
point during their lives
130,000 used sometime in last month
1998 National Household Survey on Drug Abuse
Treatment Episode Data Set
(TEDS) 2003
Admission based system
Facilities that receive federal or state
funding
Facilities that are licensed or certified by
the State substance abuse agency to
provide treatment
– Does NOT include all admissions to
substance abuse treatment
Methamphetamine Statistics
TEDS 2003
Five Substances of Abuse Accounted for
96% of all TEDS Admissions 2003
– Alcohol
– Opiates (primarily heroin)
– Marijuana/hashish
– Stimulants
(primarily Methamphetamine)
Increase from 2% in 1993
42%
18%
15%
7%
Heroin Street Names
Dope
Horse
Smack
Tar
Chemical name: diacetylmorphine
Heroin Routes of Administration
Snort (“snorting or sniffing”)
IV (“shooting up or mainlining”)
– Most overdoses
– Infection Risks
– “Skin Popping”
Smoke “Chasing the Dragon”
– More common in Asia
– “Once Upon a Time in America”
Purity
Often ‘cut’ with ASA or talc or sugar
powdered milk
May only be 10 to 40% pure on the street
Deaths occur with increased purity of the
heroin
Heroin History and Physical
Be direct
Amount of drug used
– Dependent patients use 2 to 6 times per day
When last used
Route of administration
Previous attempts at treatment
Problems from the drug
Other drugs (alcohol, benzos, stimulants)
Heroin Effects
Respiratory depression, aspiration,
pneumonitis, pulmonary edema
Decreased mental status, miotic pupils,
absent bowel sounds
HIV, Hepatitis, cellulitis, abscesses
Physical Exam
Track Marks (easily accessible veins)
– Breast veins, dorsal vein penis, axilla, under
fingernails, toes, fingers (to hide use)
Nasal Septum (snorting—perforation)
Cardiac murmur (endocarditis)
Cervical lymphadenopathy (HIV/AIDS)
Hepatic enlargement (hepatitis)
Intoxication Heroin
Naloxone
– Pure opioid antagonist
– 0.1 to 0.4 mg IV (or SQ or IM)
– May repeat if needed
Opioid Withdrawal
Opioid Withdrawal
Opioid Withdrawal
Methadone
– Tapering protocols available
– CANNOT be used by physician for
maintenance (outside of a licensed program)
– May use for MAX of 3 days while patient waits
to get into a program
– OK to use for pain control
– OK to use in acute hospital setting for
detoxification for ‘non opioid addiction’
admission (infection, etc)
Opioid Withdrawal
Clonidine
– alpha-2 adrenergic receptor agonist, reduces
catecholamine release in the sympathetic
nervous system and may decrease
withdrawal symptoms in patients taking low
doses of opioids
– Up to 1.2 mg per day in divided doses used
– 0.1 mg doses to 0.2 mg generally
Opioid Withdrawal
Rapid Detoxification
– Protocols with opioid antagonists such as
naloxone plus,clonidine with or without
adjunctive medications such as
benzodiazepines, antiemetics, and NSAIDs.
Ultrarapid Detoxification
– General anesthesia while given large doses of
naloxone to induce withdrawal and diuretic to
remove narcotics
Ultrarapid Detoxification
Serious complications
No benefit long term from other
detoxification protocols
Not recommended
How many have seen a patient with
methamphetamine problems?
Outpatient
Inpatient
Amphetamine History
Synthesized in 1887
1920’s used as a stimulant
1930’s abuse began
– Marketed as Benzedrine nasal inhaler
Used in WWII for combat fatigue and for
pilots
Footnotes
– Adolf Hitler reported to use amphetamines by
injection
– Japanese Kamikaze Pilots in WWII
– James Bond used Benzedrine in Ian Fleming novels
– Judy Garland given at an early age for weight control
– James Ellroy (author of LA Confidential) used
stimulants
– 1959 the FDA made it a prescription drug in the
United States
Wikipedia
How is “Meth” Made?
Methamphetamine is synthesized by
converting ephedrine or pseudoephedrine
into methamphetamine via a series of
steps usually involving additions of
phosphorous and iodine
Materials Needed
Iodine crystals
Red Phosphorous (may
replace with anhydrous
ammonia)
Pseudo-ephedrine or
ephedrine
Methanol
Toluene
Acetone
NaOH
Ice
Equipment Needed
2 L. Pyrex vessel
2 L. 2-neck round bottom
flask
Glass condenser (coil best)
Steam distillation splashhead
Pressure cooker and hot
plate
Buchner funnel & filter
paper
Glass stoppers & pvc tubing
Oil bath & thermometer
Synthesis Steps
Extract pseudo-ephedrine/ephedrine pills to
purify.
React with iodine + red P under heat
Change the pH to 14 with NaOH
Steam distill using pressure cooker as a steam
source
Extract the meth oily layer with toluene and
crystallize the pure methamphetamine
Should be done in hood behind safety glass!
CHARACTERISTICS
White
Odorless
Bitter-taste
Easily dissolves in water or alcohol
Equipment
Fits into a car trunk or closet
Recipes found on internet easily
Most ‘cookers’ learn from other cookers
– One reference cited an average cooker
teaches 10 other people over a year the
technique
Over 80% of Methamphetamine comes
from Mexico and other countries
Meth Lab Concerns
Social issues
– children
Contamination
– Law enforcement
Explosions
Meth Lab Concerns
Toxins
– Each pound of Meth produced yields 6 pounds of
toxic waste*
– Lye, acid, phosphorus in rivers/lakes
– Methamphetamine residue on house interior
Who is going to rent the house next?
Crime
– Booby traps in labs
– Trip wires, hidden sticks with nails or spikes, and light
switches or electrical appliances wired to explosive
devices
*Holton WC. Unlawful lab leftovers. Environ Health
Perspect. 2001;109:A576
Number of US methamphetamine lab incidents in 2004 from the
National Clandestine Laboratory Database. Total number was 17,033
A Meth cook found dead in a Southern California motel room, overcome by
phosphrine gas - created when red phosphorus is overheated.
METH Awareness And Prevention Project of South Dakota
METH Awareness And Prevention Project of South Dakota
METH Awareness And Prevention Project of South Dakota
METH Awareness And Prevention Project of South Dakota
METH Awareness And Prevention Project of South Dakota
Swat Team in Colorado
Removing a child from
A Meth House
Smurfs
Little gatherers in the cartoon
Pseudo-Smurfing
– The phenomenon of drug dealers crossing
state lines to buy pseudoephedrine -sometimes known as "pseudo smurfing"
– Cross state lines when OTC cold medication
laws passed in one state.
Legislation about OTC ‘Cold
Medicine’
NEBRASKA
Products containing pseudoephedrine
must be behind store counters or in locked
cabinets; purchases limited to 1,440
milligrams, or 48 adult doses, in any 24hour period, unless a doctor prescribes
more
Took effect in September 2005
Legislation about OTC ‘Cold
Medicine’
IOWA
Products containing pseudoephedrine
must be sold only by licensed
pharmacists; purchases limited to 7,500
milligrams in a 30-day period, unless
doctor calls for more; buyer must show ID
and sign logbook
Took effect in May, 2005
Legislation about OTC ‘Cold
Medicine’
FEDERAL
The recently reauthorized USA Patriot Act
creates a nationwide requirement for
buyers of pseudoephedrine to show
identification and sign a logbook
Beginning Sept. 30th 2006
OWH story March 20th, 2006
"It's one of the few laws in my 22 years in law
enforcement that I've seen make an impact so
quick…"
Iowa has seen an 80 percent decrease in labs,
and in Pottawattamie, Mills and Harrison
Counties, the number has dropped 27 percent,
Nebraska reported a 70 percent decrease in the
first four months after its law took effect.
– Terry LeMaster, unit supervisor for the Southwest
Iowa Narcotics Task Force.
80% of Meth comes from I-80 from
large labs Mexico and in California
A ditch in
Mexico with boxes of
Cold Medicine from a
Methamphetamine Lab
Anhydrous Ammonia
How to Decrease Theft
Take delivery of tanks just before you expect to
use them and return them as soon afterward as
possible
Place tanks in easily observed areas
Bleed pressure and remove tank hoses when
not in use
– one hose contains enough ammonia to make a batch
of meth
If you own your own nurse tank, add a lock and
cover
http://extension.unl.edu/Meth/index.html
Profile of Methamphetamine Users
1.2 million used stimulants
– including 583,000 methamphetamine users
– Similar to 2003 data.
– (National Survey on Drug Use & Health)
NSDUH 2004 data
Methamphetamine Epidemics
1960s and 1990s
Worldwide Epidemic:
180 million people consuming drugs 1990s
– 29 million use amphetamine-type stimulants
– More than cocaine and opiates combined
– United Nations Office for Drug Control, Crime Prevention
(UNODCCP). World Drug Report 2000
Japan
After World War II, intravenous
Methamphetamine abuse reached
epidemic proportions.
This was due to the fact that the Japanese
military had large amounts of
Methamphetamine stock piled and after
the war, made it available to the public.
Japan
Annals NY Academy of Science
1025: 279-287 (2004)
Social and health concern for 50 years
Most popular illicit drug for the last 10
years
Annals NY Academy of Science1025: 279-287 (2004)
Methamphetamine Street Names
Speed
Meth
Chalk
Ice
Crystal
Crank
Glass
Poor Man’s Cocaine
Zip
Tina
Stove Top
Oz
Hillbilly Crack
Peanut Butter
Lemon drop
Cinnamon
Tick tick
Why is it called Crank?
Smuggled in crankcases of vehicles
Production History
– During the 1970’s and the 1980’s, the
biker gangs such as the Hell’s Angels
were responsible for 90% of the
methamphetamine produced in the
United States.
Distribution
This changed in the late 80’s because the
Mexican gangs/mafia began
manufacturing Meth in Mexico and
smuggling it into the U.S.
The biker gangs then began purchasing
Meth from Mexico because it was cheaper
and easier than manufacturing their own.
Treatment Episode Data Set
(TEDS) 2003
Admission based system
Facilities that receive federal or state
funding
Facilities that are licensed or certified by
the State substance abuse agency to
provide treatment
– Does NOT include all admissions to
substance abuse treatment
Methamphetamine Statistics
TEDS 2003
Five Substances of Abuse Accounted for
96% of all TEDS Admissions 2003
– Alcohol
– Opiates (primarily heroin)
– Marijuana/hashish
– Stimulants
(primarily Methamphetamine)
Increase from 2% in 1993
42%
18%
15%
7%
Treatment Episode Data Set
(TEDS) 2003
Average Age of Admission
–
–
–
–
Methamphetamine age 31 years
Marijuana 23 years
Cocaine (smoked 37 years) (non-smoked 34)
Heroin 36 years
Route of Methamphetamine administration
reported
– 56% smoking
– 22% injection
– 15% inhalation
Methamphetamine Statistics
TEDS 2003
Sex
– Male
55.3%
– Female 44.7%
Race
– White (non-Hispanic)
– Black (non-Hispanic)
– Hispanic origin
72.7%
2.6%
15.8%
Objectives
Describe the history of methamphetamine in the
Midwest
Discuss the pathophysiology of
methamphetamine’s effect on the brain in
addiction
Recognize common physical findings and
features of patients who use methamphetamine
Describe treatment options for acute
methamphetamine intoxication and
complications
Cocaine vs. Methamphetamine
Plant-Derived
50% removed from
the body in 1 hour
Duration 8 minutes
Man-made
50% removed from
the body in 12 hours
Duration 8 hours
Methamphetamine Forms and Time
to Effect
Intravenous
– 15 to 30 seconds
Smoked
– Immediate
Snorted
– 3 to 5 minutes
Ingested
– 15 to 20 minutes
Street Prices
Methamphetamine*
– One ‘hit’ (about a quarter gram) $25
Cocaine**
– $80 to $100 per gram
– One Rock $40
– *www.pbs.com
– **http://www.clarkprosecutor.org/index.htm
Methamphetamine and Brain
Chemistry
Nucleus
Accumbens
Stimulated
By
Dopamine
Major Reward
Center of the
Brain
Dopamine Receptors
Methamphetamine and Brain
Chemistry
Reuptake of Dopamine
Methamphetamine and Brain
Chemistry
Methamphetamine (and other
Stimulants) block reuptake of
Dopamine at the synapse.
HIGH LEVELS of dopamine persist
These PET scans
show that dopamine
receptor levels are
lower in
methamphetamine
abusers than
in control subjects.
High dopamine
receptor levels
appear red,
while low levels
appear
yellow/green.
Volkow
American Journal of Psychiatry
December 2001
Neurologic Effects of
Methamphetamine
“Rush” follows methamphetamine use
– Dopamine, serotonin, epinephrine
Increase levels of dopamine
– Inhibits reuptake and increase release at synapse
Nucleus Accumbens---stimulated by dopamine
– Major ‘reward’ center in the brain (addictive
behaviour)
Prolonged use results in chronically depressed
dopaminergic activity
Some recovery
Of dopamine
Activity possible
Volkow
The Journal of
Neuroscience
December 1, 2001
Objectives
Describe the history of methamphetamine in the
Midwest
Discuss the pathophysiology of
methamphetamine’s effect on the brain in
addiction
Recognize common physical findings and
features of patients who use methamphetamine
Describe treatment options for acute
methamphetamine intoxication and
complications
Mayo Clinic Proceedings
January 2006
Health Consequences
Daily use
Binge use
– 24 to 72 hours
– No sleep
– High risk sexual activity
Agitation, anxiety, acute paranoia
Mimic schizophrenia
Re-calibrate your clinical suspicion
“Tweaking”
Term for psychosis from
Methamphetamine
Sleep deprived
Extremely irritable and paranoid
Higher risk for violent behavior
– Especially if confronted
– User will sometimes ingest alcohol (which can
make violence more likely)
– National Drug Court Practitioner Fact Sheet, April 2000,
Vol. II, No. 2
Health Consequences (cont.)
Rapid weight loss
– Sympathomimetic effects
Skin lesions
– Obsessive/excessive picking and scratching
“Meth Mites” or “Meth Bugs”
– May become infected
Cellulitis
Abscesses
– MRSA infections reported
Clin Infect Dis 2005 May 15;40(10):1529-34
METH Awareness And Prevention Project of South Dakota
METH Awareness
And Prevention
Project of
South Dakota
Health Consequences (cont.)
Dental Decay
– Bruxism and clenching
– Soft drink use
– Dry mouth
– Residual product of methamphetamine
– Failure to floss
Drink of Choice
METH Awareness And Prevention Project of South Dakota
American Dental Association Website
Dr. Chris Heringlake, a dentist at the St. Cloud Correctional Facility in
Minnesota
Photo from NPR story online
American Dental Association Website
Health Consequences (cont.)
Rapid ‘aging effect’ seen in heavy
methamphetamine users
– Weight loss
– Skin lesions
– Dental decay
– Decline in overall appearance
Socioeconomic factors
General hygiene
MSNBC story from August 2005
Series of mug shots of a methamphetamine user
Over a 10 year period
FacesofMeth.us
Multnomah County Sheriff’s Department in
Oregon
Corrections Divisions Classification Unit,
Deputy Bret King
Mug shots and photos ‘before and after’
Eight Years of Meth Use
Objectives
Describe the history of methamphetamine in the
Midwest
Discuss the pathophysiology of
methamphetamine’s effect on the brain in
addiction
Recognize common physical findings and
features of patients who use methamphetamine
Describe treatment options for acute
methamphetamine intoxication and
complications
Mayo Clinic Proceedings
January 2006
Acute Presentation of
Methamphetamine Patient
Acute paranoia and agitation
Chest Pain
Trauma
Burns from explosion
Shock
Hyperthermia
– Rhabdomyolysis, acute renal failure
Selected Case Reports
Many case reports and series from Hawaii
– Cardiology cases
Methamphetamine toxicity secondary to
intravaginal body stuffing (Arizona)
– J Toxicol Clin Toxicol. 2004;42(7):987-9
Methamphetamine-associated shock with
intestinal infarction (Nebraska)
– MedGenMed. 2004 Dec 29;6(4):6
Delayed ischemic stroke associated with
methamphetamine use (Japan)
– J Emerg Med. 2005 Feb;28(2):165-7
Hierarchy of Strength of
Evidence for Treatment
Decisions
Cardiac
Chest pain
Tachycardia
Hypertension
Pulmonary edema
Dilated
cardiomyopathy
Endocarditis
Aortic dissection
Sudden Cardiac
Death
Cardiac Pathophysiology
High catecholamine state (similar to
cocaine)
– Norepinephrine and epinephrine
Coronary vasoconstriction
Hypertension
Tachycardia
Acute Therapy for Chest Pain with
Methamphetamine
Benzodiazepines
Calcium Channel Blockers for heart rate
IV Nitrates
– Maybe Nipride for hypertension?
AVOID BETA BLOCKERS
– Unopposed alpha constriction
– Similar to cocaine-associated MI therapy
– ?Labetalol?
Weak alpha and beta blocker???
Long Term Meth Use
Dilated Cardiomyopathy
ACEI or ARB
Standard therapy for CHF
*Avoid Beta Blockers if patient continues
to use Methamphetamine
Cardiomyopathy: “Tip of the
Iceberg”
Retrospective review of medical records of 21
crystal methamphetamine users.
RESULTS: Nineteen (84%) underwent
echocardiography with consistent findings of
dilated cardiomyopathy and global ventricular
dysfunction
Crystal methamphetamine-associated cardiomyopathy: tip of
the iceberg?
J Toxicol Clin Toxicol. 2003;41(7):981-6.
Department of Medicine, University of Hawaii, Honolulu,
Hawaii
Meth Patient Presentation
Hyperthermia
Rhabdomyolysis
Seizures
Paranoia/psychosis/agitation/antisocial
personality
CVA
Pulmonary from smoking
Infections
Much is supportive care and deal
with the complications
Head CT if altered mental status
CBC, Basic Metabolic Profile
CPK
– Rhabdomyolysis
– Troponin if cardiac damage concern
EKG
Pregnancy test
LOW threshold for
STD testing
Calm, quiet environment
Agitation from methamphetamine
BENZODIAZEPINES
BENZODIAZEPINES
BENZODIAZEPINES
BENZODIAZEPINES
Haloperidol
Methamphetamine and Burn Units
17,033 Meth Lab Seizures by Law
Enforcement in 2004
Increased costs and time in treating Meth
lab burn patients
– Require more sedation (withdrawals) and pain
medication than others
– More trauma from projectiles (glass, etc)
– Thermal and Chemical Burns
– JAMA October 26, 2005 Vol 94 No 16
Methamphetamine and Sexual Risk
Behavior
Men who have sex with men (MSM)
– Methamphetamine use 10 times higher than general
population
– High among both HIV-uninfected and HIV-infected
MSM
10% to 20% reporting recent methamphetamine use
–
–
–
–
Medscape Colfax 10 17 05
Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behavior
of HIV-positive men who have sex with men. J Subst Abuse. 2001;13:185-200.
Stall R, Paul JP, Greenwood G et al. Alcohol use, drug use and alcohol-related problems among men who have
sex with men: the Urban Men's Health Study. Addiction. 2001;96:1589-1601.
Morin SF, Steward WT, Charlebois ED, et al. Predicting HIV Transmission Risk Among HIV-Infected Men Who
Have Sex With Men: Findings From the Healthy Living Project. J Acquir Immune Defic Syndr. 2005;40:226-235.
Methamphetamine and Sexual Risk
Behavior
Circuit parties (weekend-long dance party
events) attended by MSM participants
– 43% reported methamphetamine use in a
72-hour period
Medscape Colfax 10 17 05
Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual
transmission risk behavior of HIV-positive men who have sex with men. J Subst Abuse.
2001;13:185-200.
Stall R, Paul JP, Greenwood G et al. Alcohol use, drug use and alcohol-related
problems among men who have sex with men: the Urban Men's Health Study.
Addiction. 2001;96:1589-1601.
Morin SF, Steward WT, Charlebois ED, et al. Predicting HIV Transmission Risk Among
HIV-Infected Men Who Have Sex With Men: Findings From the Healthy Living Project. J
Acquir Immune Defic Syndr. 2005;40:226-235.
The context of sexual risk behavior
among heterosexual
methamphetamine users
Descriptive study (interviews)
Explored context of sexual risk behavior in
HIV-negative, heterosexual meth-using
men and women
– Drug use history
– Motivation for drug use
– Relationship types
– Social-sexual context of meth use
– Addict Behav. 2004 Jun;29(4):807-10
Sample Characteristics
San Diego, CA
139 HIV-negative heterosexual meth users
Majority were male, Caucasian, highschool educated, never married,
unemployed, and living with other adults
Average age 38.6 years
29% reported having one or more STDs in
the past 2 months
– *This may be why patients present to access
healthcare system*
The context of sexual risk behavior
among heterosexual
methamphetamine users
Primary motivations for current meth use
– Get high, get more energy, and to party
Participants reported an average number of 9.4
sex partners over 2 months
Mean number of unprotected sexual acts over
a 2-month period
– Vaginal 21.5
– Anal
6.3
– Oral
41.7
– Addict Behav. 2004 Jun;29(4):807-10
Methamphetamine and HIV
Methamphetamine use is independently
associated with HIV infection
– Even after controlling for
Sexual partners
Unprotected sex
– Colfax G. Confronting the methamphetamine epidemic:
an HIV prevention priority. Program and abstracts of the
2005 CDC HIV Prevention Conference. Atlanta, Georgia;
June 12-15, 2005.
Methamphetamine and HIV
Adherence to Antiretroviral Therapy (ART)
– Probably the largest risk factor---emergence of
resistance
Methamphetamine increases replication of feline
immunodeficiency virus (related to HIV)
– ?clinical significance but interesting
Neurotoxicity of methamphetamine and HIV are
synergistic (may both affect dopamine receptors)
– Medscape Colfax G 10 17 05
Methamphetamine and Sexual
Activity
“...sexual episodes during which
methamphetamine is used are far more likely to
be associated with high-risk sexual behavior
compared with episodes during which
methamphetamine is not used…”
Medscape Colfax G 10 17 05
Colfax G, Vittinghoff E, Husnik MJ, et al. Substance use and
sexual risk: a participant- and episode-level analysis among
a cohort of men who have sex with men. Am J Epidemiol.
2004;159:1002-10
Methamphetamine and STDs
Increased risk-taking with methamphetamine
use
Condom breakage with methamphetamine use
Aggressive sex with more fissures, bleeding
Immunosuppressive factors
Changes in blood flow with methamphetamine
use
– Medscape Colfax G 10 17 05
Meth and HIV
www.lifeormeth.com
Meth makes users feel
hypersexual and uninhibited,
heightened orgasm
L.A., 2004: 1 out of 3 HIV+
men reported using meth
% of HIV+ men using meth
has tripled since 2001
Meth Withdrawal?
Mixed evidence....
No physical manifestations of a withdrawal
syndrome is recognized by experts at this time
Rather, appears majority of symptoms are psychiatric
and emotional…
Depression
Anxiety
Fatigue
Paranoia
Aggression
Intense drug cravings
Treatment
One of the most
difficult drugs to
maintain abstinence
Only at the 5yr clean
and sober point does
the relapse rate drop
near zero
Psychiatric Issues
Psychiatric disorders accompany
methamphetamine abuse (preexist the
methamphetamine use)
– Rule more than the exception
– Poor impulse control
– Childhood trauma
Mayo Clinic Proceedings
January 2006
Treatment
Paroxetine shown to decrease
methamphetamine cravings in an eightweek study
– An exploratory study: the use of paroxetine for
methamphetamine craving.
J Psychoactive Drugs. 2002 JulSep;34(3):301-4.
Treatment
No pharmacologic options available to assist
for meth abstinence as no single agent has
been proven efficacious in clinical studies
Some studies with buproprion show ↓craving
Antidepressants, antipsychotics, and
anxiolytics are utilized wide-spread for both
acute intoxication and residual psychiatric
sequelae
Treatment
Psychotherapies are best
option:
- Cognitive-behavioral
- Recovery Support
Groups
- 12 Step programs
United States Drug Abuse
Awareness
If a US drug abuse epidemic fails to
include a major east coast city, can it
be called an epidemic?
– J Addict Dis. 2002;21(1):1-4
Rawson RA, Simon SL, Ling W
Editorial
Epidemic?
If a tree falls in a forest and no one is there
to hear it, does it make a sound?
If a US drug abuse epidemic fails to
include a major east coast city, can it be
called an epidemic?
Methamphetamine
Treatment
Admission
Rates
Per 100,000
RED 50+
Grey 10 to 50
Green less than 10
Office of
National
Drug
Policy
Control
Why the Slow Recognition of
Methamphetamine Epidemic?
National News Media
– Greater attention to East Coast public health
concerns
Hawaii and California are a ‘long way’ from
Washington, DC
Saturday Night Live
“Good Morning Meth” Skit
November 12th, 2005
How many of you saw this episode?
A single death is a tragedy; a
million deaths is a statistic.
– Joseph Stalin
– Georgian Soviet politician (1879 - 1953)
Questions or Comments?
Thank you for your
attention
Online Resources
http://www.whitehousedrugpolicy.gov/
www.methresources.gov
http://www.samhsa.gov/
http://www.facingthedragon.org
Online Resources
www.drugabuse.gov
http://www.mappsd.org
National Institute on Drug Abuse
http://www.nida.nih.gov/MethAlert/MethAle
rt.html
METH Awareness And
Prevention Project of South
Dakota
MAPP-SD
http://www.mappsd.org/Index.htm
Methamphetamine and Addiction
www.drugabuse.gov
http://www.drugabuse.gov/pubs/teaching/T
eaching4.html
Recommended Sources
M. Holley, M.D.
M. Holley, M.D.
Recommended Websites
For the health care professional:
nida.nih.gov
- covers each drug of abuse
- contains several links to more specific sites
- recently published articles
For the patient:
Crystalrecovery.com
Mamasite.net
Methamphetamineaddiction.com
http://www.oas.samhsa.gov/nsduh/2k4nsd
uh/2k4results/2k4results.htm#5.1
Methamphetamine Statistics
TEDS 2003
Proportion of admissions increase from
2% (1993) to 7% (2003)
Criminal Justice System as Source of
Referral to Treatment Program
– Primary marijuana (57%)
– PCP
(52%)
– Methamphetamine (51%)
Methamphetamine and Omaha
World Herald stories
There are 4448 hits on the word
methamphetamine in our archive since
1983.
– Ann Walding-Phillips
Researcher
LibraryLink
– Omaha World-Herald
809 hits over the last 2 years
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http://www.decodog.com/default.html
Meth Lab Clean-up
http://www.hhs.state.ne.us/enh/riskasse/exposchem.htm
“There is currently no official federal guidance or
regulations on how to clean up a former meth lab for
reoccupation. Utilizing an environmental company
trained in hazardous substance removal and cleanup is
the safest way to deal with the property but may be cost
prohibitive. Often property owners choose to remove and
cleanup a former meth lab themselves. These guidelines
are designed to assist with the cleanup.”