Corrections and Substance Abuse Training METHAMPHETAMINE Edited by Rand L. Kannenberg, M.A., CCM, LAC, CCS Copyright 2008 Rand L. Kannenberg

Part 1. Social Implications Screening, Assessment and Evaluation Prevention, Intervention and Treatment Part 2. Clinical Strategy The History of Methamphetamine Trends in Law Enforcement/Public Policy

Screening, Assessment and Evaluation

Prevention, Intervention and Treatment

Learner Objectives Identify and explain the chemical properties of methamphetamine. Describe the difference between methamphetamine and other stimulants. Summarize recent law enforcement trends regarding methamphetamine manufacturing and trafficking in the U.S. Increase knowledge and skill in assessment of methamphetamine abuse and dependence as well as methamphetamine induced psychosis, depression, mania and anxiety. Utilize effective treatment options for methamphetamine abuse and dependence. Administer written exercises and worksheets designed for the therapy and education of methamphetamine users.

Learner Objectives

Identify and explain the chemical properties of methamphetamine.

Describe the difference between methamphetamine and other stimulants.

Summarize recent law enforcement trends regarding methamphetamine manufacturing and trafficking in the U.S.

Increase knowledge and skill in assessment of methamphetamine abuse and dependence as well as methamphetamine induced psychosis, depression, mania and anxiety.

Utilize effective treatment options for methamphetamine abuse and dependence.

Administer written exercises and worksheets designed for the therapy and education of methamphetamine users.

History of Methamphetamine A derivative of amphetamine first developed by a pharmacologist in Japan in 1919. Used in the 1930s to treat asthma and narcolepsy as well as obesity. Methamphetamine Treatment Project, KCI: The Anti-Meth Site (formerly the Koch Crime Institute) Given to soldiers during war. Used under the name of “Pervitin” by Germany and its allies during World War II. Webster’s Dictionary DEA Number 1105. Classified as a Schedule II Narcotic, Controlled Substances Act (CSA), Title II, Comprehensive Drug Abuse Prevention and Control Act of 1970. Also known as “Desoxyn” and “D-desoxyephedrine.” Drug Enforcement Administration (DEA)

A derivative of amphetamine first developed by a pharmacologist in Japan in 1919.

Used in the 1930s to treat asthma and narcolepsy as well as obesity.

Methamphetamine Treatment Project, KCI: The Anti-Meth Site (formerly the Koch Crime Institute)

Given to soldiers during war. Used under the name of “Pervitin” by Germany and its allies during World War II.

Webster’s Dictionary

DEA Number 1105.

Classified as a Schedule II Narcotic, Controlled Substances Act (CSA), Title II, Comprehensive Drug Abuse Prevention and Control Act of 1970. Also known as “Desoxyn” and “D-desoxyephedrine.”

Drug Enforcement Administration (DEA)

In the 1960s manufactured illegally mostly by outlaw motorcycle gangs and used frequently by long distance truck drivers. It was usually DL-methamphetamine (dextro-levo-methamphetamine, a.k.a., “levo-methamphetamine”) using the phenyl-2-propanone (P-2-P) (also known as Phenylacetone) method. Methamphetamine with P-2-P was more toxic and less potent than the D-methamphetamine (dextro-methamphetamine) more commonly made since the late 1980s using across the counter cold medications (P-2-P became a Schedule II controlled substance in 1980). National Drug Intelligence Center (NDIC), National Institute on Drug Abuse (NIDA) Also smuggled from Taiwan and South Korea into Hawaii since the 1980s. Distribution spread to the U.S. mainland by 1990. KCI: The Anti-Meth Site

Methamphetamine as a Stimulant Has greater central nervous system affects than amphetamine. NIDA More effective than amphetamine. Lasts longer than amphetamine. More soluble in lipids (i.e., easily absorbed into the fatty tissue of the brain). Dextro is 3 to 4 times more potent than levo. NIDA Average purity decreased from 71.9% in 1994 to 40.1% in 2001. ONDCP Intentional fillers to dilute or cut the methamphetamine (with products that are similar in appearance, taste and/or action) include lactose, lidocaine, procaine (another local anesthetic), caffeine, quinine (anti-malarial drug) or sodium bicarbonate (aka, “baking soda”). NIDA

Has greater central nervous system affects than amphetamine.

NIDA

More effective than amphetamine.

Lasts longer than amphetamine.

More soluble in lipids (i.e., easily absorbed into the fatty tissue of the brain).

Dextro is 3 to 4 times more potent than levo.

NIDA

Average purity decreased from 71.9% in 1994 to 40.1% in 2001.

ONDCP

Intentional fillers to dilute or cut the methamphetamine (with products that are similar in appearance, taste and/or action) include lactose, lidocaine, procaine (another local anesthetic), caffeine, quinine (anti-malarial drug) or sodium bicarbonate (aka, “baking soda”).

NIDA

Desoxyn ® by Ovation Chemically known as (S)-N,α-dimethylbenzeneethanamine hydrochloride, is a member of the amphetamine group of sympathomimetic amines (i.e., mimics effects of adrenaline). DESOXYN tablets contain 5 mg of methamphetamine hydrochloride for oral administration. Indications/Usage and Dosage/Administration: Attention-Deficit/Hyperactivity Disorder (ADHD) (20-25 mg daily in two divided doses). Used instead of Adderall (Amphetamine-Dextroamphetamine) or Ritalin (Methylphenidate) Exogenous Obesity (caused by overeating) for short-term only (a few weeks) (5 mg one half hour before each meal) Ovation Pharmaceuticals, Inc. (PDR)

Chemically known as (S)-N,α-dimethylbenzeneethanamine

hydrochloride, is a member of the amphetamine group of

sympathomimetic amines (i.e., mimics effects of adrenaline).

DESOXYN tablets contain 5 mg of methamphetamine hydrochloride

for oral administration.

Indications/Usage and Dosage/Administration:

Attention-Deficit/Hyperactivity Disorder (ADHD)

(20-25 mg daily in two divided doses). Used instead of Adderall (Amphetamine-Dextroamphetamine) or Ritalin (Methylphenidate)

Exogenous Obesity (caused by overeating) for short-term only (a few weeks)

(5 mg one half hour before each meal)

Ovation Pharmaceuticals, Inc.

Methamphetamine An extremely powerful and highly addictive “upper.” Made and sold as tablets, capsules, chunks, clear chunky crystals resembling frozen water, and powder. Can be swallowed, injected, snorted or smoked. Similar to adrenaline (the hormone epinephrine) chemically. Can be synthesized from ephedrine. Most common precursor (initial compound) is pseudoephedrine. Other dangerous chemicals are added to create a new drug. When ingested, bursts of dopamine are released in the brain. Desired effects are strong euphoria, heightened sense of well being, increased vigor, giddiness, sense of enhanced mental activity and performance, increased alertness, suppressed appetite, enhanced sensory awareness, and an increase in energy/alleviation of fatigue. CSAT, Methamphetamine Treatment Project, Newsweek, KCI: The Anti-Meth Site, Webster’s Dictionary, NIDA DEA

An extremely powerful and highly addictive “upper.”

Made and sold as tablets, capsules, chunks, clear chunky crystals resembling frozen water, and powder.

Can be swallowed, injected, snorted or smoked.

Similar to adrenaline (the hormone epinephrine) chemically. Can be synthesized from ephedrine.

Most common precursor (initial compound) is pseudoephedrine.

Other dangerous chemicals are added to create a new drug.

When ingested, bursts of dopamine are released in the brain.

Desired effects are strong euphoria, heightened sense of well being, increased vigor, giddiness, sense of enhanced mental activity and performance, increased alertness, suppressed appetite, enhanced sensory awareness, and an increase in energy/alleviation of fatigue.

CSAT, Methamphetamine Treatment Project, Newsweek, KCI: The Anti-Meth Site, Webster’s Dictionary, NIDA

Abbreviation MA

TERMS USED FOR THE FEELING OF MA INTOXICATION Ampin' Amped Bache Knock 2 Rock Bachin "BOB" as in discombobulated Buzzed Cranked Up Crank Whore Jamie Feelin Shitty Foiled Fried Gakked Gassing Geeked Geekin Gurped Heated Jacked Lit Ripped Pissed Pumped Psychosis KCI: The Anti-Meth Site Ring Dang Doo Rollin or Rollin Hard Scattered Schlep Heads Sketching Spin-Jo Speeding Sparked Spracked Spun Spun Monkey or Spun Turkey Stoked Talkie Twacked Tweeked Twisted Wide Open or Awake Wired Worked Wooop Chicken Zipper Zoomin

Ampin' Amped Bache Knock 2 Rock Bachin "BOB" as in discombobulated Buzzed Cranked Up Crank Whore Jamie Feelin Shitty Foiled Fried Gakked Gassing Geeked Geekin Gurped Heated Jacked Lit Ripped Pissed Pumped Psychosis

Nicknames for MA Users KCI: The Anti-Meth Site basehead battery bender cluckers, chicken-headed clucks crack heads crackies crankster or cranker doorknobers (Nova Scotia) fienda fiends fiendz gacked geek(ers) geekin geeter go go loser jibby jibby bear jibbhead loker or lokers neck creature shadow people sketchpad or schetchers skitzers sketchpads sketch cookie sketch monster spin doctors spinsters tweakers tweekin/the go wiggers

Other MA Related Terminology Crank Craters - sores on your face caused by meth Tooter - the straw used to snort Paper - a quarter gram Teenager - 1/16 ounce Needles - called points, rigs, slammers Paraphernalia - medical supplies or utensils Tina Or Teena - name derives from the fact that meth is commonly bought in sixteenths of an ounce packages (aka "baggies") Eightball - (eighth of an ounce) = 3.5 grams (dealer absorbs the difference) KCI: The Anti-Meth Site

Crank Craters - sores on your face caused by meth

Tooter - the straw used to snort

Paper - a quarter gram

Teenager - 1/16 ounce

Needles - called points, rigs, slammers

Paraphernalia - medical supplies or utensils

Tina Or Teena - name derives from the fact that meth is commonly bought in sixteenths of an ounce packages (aka "baggies")

Eightball - (eighth of an ounce) = 3.5 grams (dealer absorbs the difference)

Cost of MA 1 ounce of MA=approximately 110 MA “hits” (uses) 1 ounce=28.35 grams 1 hit=1/4 gram KCI: The Anti-Meth Site 1/4 gram=250 mg (10 times daily dose of Desoxyn ® for ADHD) Average cost of ¼ gram of powdered MA is $10-50. Most common price nationally is $20 and many users will define ¼ gram as “$20.” Average cost of ice MA is $30-125. 32% of MA users report daily use. ONDCP

1 ounce of MA=approximately 110 MA “hits” (uses)

1 ounce=28.35 grams

1 hit=1/4 gram

KCI: The Anti-Meth Site

1/4 gram=250 mg

(10 times daily dose of Desoxyn ® for ADHD)

Average cost of ¼ gram of powdered MA is $10-50. Most common price nationally is $20 and many users will define ¼ gram as “$20.”

Average cost of ice MA is $30-125.

32% of MA users report daily use.

ONDCP

Effects of Route of Administration for Cocaine & MA Cook, 1991; Gold, 1997; Gold & Miller, 1997; Sowder & Beschner, 1993; NIDA; KCI: The Anti-Meth Site; DEA; ONDCP; Substance Abuse and Mental Health Services Administration (SAMHSA), North Carolina Governor’s Crime Commission (NCGCC) 45 to 90 minutes for cocaine/ 3 to 5 hours for MA No “rush” or “flash.” 10 to 30 minutes POWDER/PILL Usually white, but can also be yellow, red, brown or other colors. Usually, “low intensity users.” ORAL Swallowing pills, or putting on food or paper and eating it. Includes Yaba for MA (the Thai name for very small and brightly colored tablets with logos, mixed with caffeine, that look like MDMA or Ecstasy and are becoming popular within the rave scene). Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration

10 to 20 minutes for cocaine/ 2 to 4 hours for MA No “rush” or “flash.” 3 to 5 minutes POWDER Usually, “low intensity users.” INTRANASAL Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration

10 to 20 minutes for cocaine/ 4 to 6 hours for MA Following a 3 minute intense sensation called a “rush” or “flash.” 5 to 10 seconds SOLUTION Drug mixed with water and injected. Usually, “binge users” or “high intensity users.” INTRAVENOUS On a binge (aka, a “run”), user may inject 1 gram every 2 to 3 hours. Cocaine binges usually last no more than 72 hours. MA binges may last up to 1 week. “Tweaking” (delusional thinking and sometimes violence) follows the binge. “Crashing” (a phase that involves sleeping up to 3 days) follows the tweaking. Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration

5 to 20 minutes for crack/ 8 to 24 hours for ice Following a 3 minute intense sensation called a “rush” or “flash.” 5 to 10 seconds CRACK COCAINE/ ICE (MA) Rock form or clear chunky crystals. Usually, “binge users” or “high intensity users.” INHALATION Smoked in glass pipe, drug is heated and fumes are inhaled, or drug is sprinkled on tobacco or marijuana and smoked. Duration of “High” Onset of Action for Cocaine and MA Form of Drug Route of Administration

Other Differences Between Cocaine & MA COCAINE Plant-derived (obtained from coca leaves) Eliminated from the body in 1 hour Used as a local anesthetic in some surgical procedures MA Man-made Eliminated from the body in 12 hours Used for ADHD and obesity (as discussed earlier) NIDA

COCAINE

Plant-derived (obtained from coca leaves)

Eliminated from the body in 1 hour

Used as a local anesthetic in some surgical procedures

MA

Man-made

Eliminated from the body in 12 hours

Used for ADHD and obesity (as discussed earlier)

Symptoms of MA Use Inability to sleep Loss of appetite and weight, thin/gaunt Increased sensitivity to noise Agitation, restlessness, irritability, aggressiveness Dizziness Confusion, impaired judgment Diarrhea and gastrointestinal complaints Difficulty breathing Headaches Tremors or seizures Nausea and vomiting Numbness Profuse sweating, often with chills Muscle cramping, pain and tenderness Dehydration Low magnesium level, low potassium level Stale urine smell due to ammonia constituents used to manufacture MA Dilated pupils Chest pain Increased or decreased heart rate Increased blood pressure (>= 140/90) Fever or hyperthermia (life-threatening above 104 °F) Impaired speech and language Mania Psychosis with hallucinations and delusions Anxiety, panic, fear of impending doom Depression and suicidal ideation Poor hygiene and body malodor Missing teeth, bleeding gums, infected gums, dental caries/decay/cavities (dry mouth/removed enamel/teeth grinding) Skin aging and damage (dryness, roughness, wrinkles, broken veins) Dermatitis around the mouth from smoking hydrochloride salt (from hydrochloric acid and amine) Skin ulceration and infection (as a result of picking at imaginary bugs under the skin), acne or sores Hair loss (from repetitious pulling) SAMHSA, KCI: The Anti-Meth Site, NAADAC News, CSAT, Texas Alcohol and Drug Testing Service, Inc., NIDA

Inability to sleep

Loss of appetite and weight, thin/gaunt

Increased sensitivity to noise

Agitation, restlessness, irritability, aggressiveness

Dizziness

Confusion, impaired judgment

Diarrhea and gastrointestinal complaints

Difficulty breathing

Headaches

Tremors or seizures

Nausea and vomiting

Numbness

Profuse sweating, often with chills

Muscle cramping, pain and tenderness

Dehydration

Low magnesium level, low potassium level

Stale urine smell due to ammonia constituents used to manufacture MA

Dilated pupils

Chest pain

Increased or decreased heart rate

Increased blood pressure (>= 140/90)

Fever or hyperthermia (life-threatening above 104 °F)

Impaired speech and language

Mania

Psychosis with hallucinations and delusions

Anxiety, panic, fear of impending doom

Depression and suicidal ideation

Poor hygiene and body malodor

Missing teeth, bleeding gums, infected gums, dental caries/decay/cavities (dry mouth/removed enamel/teeth grinding)

Skin aging and damage (dryness, roughness, wrinkles, broken veins)

Dermatitis around the mouth from smoking hydrochloride salt (from hydrochloric acid and amine)

Skin ulceration and infection (as a result of picking at imaginary bugs under the skin), acne or sores

Hair loss (from repetitious pulling)

ABC Channel 7 News Denver

Oregon Narcotics Enforcement Association

The News & Observer/Associated Press

If “tweaking” (a term also applied to using alcohol while on MA) the users’ eyes will involuntarily jerk back and forth when they look out at the corner of their eyes (i.e., a horizontal-gaze nystagmus). An overdose of MA may result in heart attack or stroke and high body temperature. Presence of paraphernalia such as razor blades, mirrors, straws for snorting. Presence of paraphernalia such as syringes, heated spoons, surgical tubing for injecting.

If “tweaking” (a term also applied to using alcohol while on MA) the users’ eyes will involuntarily jerk back and forth when they look out at the corner of their eyes (i.e., a horizontal-gaze nystagmus).

An overdose of MA may result in heart attack or stroke and high body temperature.

Presence of paraphernalia such as

razor blades, mirrors, straws for

snorting.

Presence of paraphernalia such as syringes, heated spoons, surgical

tubing for injecting.

Other Ways to Reduce the Risk of Violence with MA Users Identify yourself and use the client’s name. Use a space that is quiet, subdued and not too confining. Remove any objects from the room that could in any way be used as weapons. Make certain that the client does not have any weapons. Do not let the client get between the interviewer and the door, however, the client should also have an easy exit. Acknowledge agitation and distress. Tolerate repetition. Remain nonconfrontational. Reinforce any progress made. Have a show of force ready as needed. Notify others that their assistance may be required and have a plan. Have physical and chemical restraints ready as needed. CSAT

Identify yourself and use the client’s name.

Use a space that is quiet, subdued and not too confining.

Remove any objects from the room that could in any way be used as weapons.

Make certain that the client does not have any weapons.

Do not let the client get between the interviewer and the door, however, the client should also have an easy exit.

Acknowledge agitation and distress. Tolerate repetition.

Remain nonconfrontational. Reinforce any progress made.

Have a show of force ready as needed. Notify others that their assistance may be required and have a plan.

Have physical and chemical restraints ready as needed.

CSAT

MA, HIV & Hepatitis B & C IV MA users may get infections and sores at injection site IV MA users may get infections of heart lining and valves IV MA users who share needles may contract HIV, hepatitis B and hepatitis C IV MA use is increasingly common in gay clubs in New York City and elsewhere in the U.S. KCI: The Anti-Meth Site, NIDA

IV MA users may get infections and sores at injection site

IV MA users may get infections of heart lining and valves

IV MA users who share needles may contract HIV, hepatitis B and hepatitis C

IV MA use is increasingly common in gay clubs in New York City and elsewhere in the U.S.

KCI: The Anti-Meth Site, NIDA

MA Use During Pregnancy May result in the following damage to the infant: Premature labor and delivery Detachment of the placenta Low birth weight Neurological damage “ Worm Heart” (Transposition of the Great Vessels) (i.e., backward with holes) Birth defects Tremors Excessive crying Withdrawal Dysphoria (“unpleasant mental and emotional state”) Agitation Lethargy Behavioral disorders Attention-Deficit/Hyperactivity Disorder Greater Dallas Council on Alcohol and Drug Abuse (GDCADA), KCI: The Anti-Meth Site, PDR

May result in the following damage to the infant:

Premature labor and delivery

Detachment of the placenta

Low birth weight

Neurological damage

“ Worm Heart” (Transposition of the Great Vessels) (i.e., backward with holes)

Birth defects

Tremors

Excessive crying

Withdrawal

Dysphoria (“unpleasant mental and emotional state”)

Agitation

Lethargy

Behavioral disorders

Attention-Deficit/Hyperactivity Disorder

Emergency Department Mentions of MA 1994-2002 MA that was recorded during an ED Visit that “was induced by or related to the use of drug(s).” Has fluctuated over the years. Lowest 1999 10,447 Highest 2002 17,696 (nearly 170% increase) ONDCP

MA that was recorded during an ED Visit that “was induced by or related to the use of drug(s).” Has fluctuated over the years.

Lowest 1999 10,447

Highest 2002 17,696

(nearly 170% increase)

METHAMPHETAMINE SEMINAR MANUAL ADDENDUM Copyright 2008 Rand L. Kannenberg A single therapeutic dose of amphetamine or methamphetamine can produce a positive urine for 12 to 24 hours, depending upon urinary pH and individual metabolic differences. High-dose abusers may continue to generate positive urine specimens for 2 to 4 days after last use (and sometimes longer). The following compounds DO cross-react (i.e., the compounds are detected and a positive for amphetamines or methamphetamine should result) with the methods of most immunoassay tests (the initial drug screening that uses antibodies to detect the presence of a compound) performed in laboratory urine toxicology: Methylenedioxyamphetamine (MDA) 2,5-dimethoxy-4-methylamphetamine hydrochloride (DOM) 3,4-Methylen-Dioxy-n-Ethylamphetamin (MDE) 3,4-methylenedioxy-n-methylamphetamine (MDMA) “Ecstasy” The following prescription medications containing d- amphetamine or racemic d,l- amphetamine (i.e., equal amounts of d- and l- amphetamine): Adderall® Benzedrine® Biphetamine® Dexedrine® Durophet® Obetrol® The following prescription medication containing d- methamphetamine: Desoxyn® Vicks Inhaler® (the only over-the-counter medication that contains either d- or l- methamphetamine or amphetamine). It contains l- methamphetamine, however, there is a possibility that a laboratory positive result could be reported for l- methamphetamine and/or l -amphetamine. T here may be a slight amount of d-methamphetamine present as a contaminant in the Vicks Inhaler®.

METHAMPHETAMINE SEMINAR MANUAL ADDENDUM Copyright 2008 Rand L. Kannenberg The following compounds DO cross-react (i.e., the compounds are detected and a so called, “false positive” for amphetamines or methamphetamine may result) with the methods of most immunoassay tests (the initial drug screening that uses antibodies to detect the presence of a compound) performed in laboratory urine toxicology: Benzylamine (Aminotoluene) Bupropion (Wellbutrin) Cyclohexylamine (Hexahydroaniline) Fenfluramine (Pondimin) Fluoxetine (Prozac) Isometheptene (Paracetamol) Isoxsuprine Labetalol Mephentennine Methoxyphenamine 5-methoxytryptamine (Melatonin) Meloprolol Mexiletine (Mexitil®) Nicotine Nylidrin Ofloxacin (Floxin®) Pefloxacin Phenethylamine Phenmetrazine (Preludin)

Phentermine (Adipex-P, Fastin, Obenix, Oby-Trim) Phenyltoloxamine Propylhexedrine Ranitidine (Zantac) Sertraline (Zoloft) Timolol Tryptamine Tyramine Gas Chromatography/Mass Spectrometry (GC/MS) should be used to confirm (identify and quantify) a presumptive positive initial drug screen result. GC/MS measures the specific amount (if any) of amphetamines or methamphetamine present in urine samples by detecting specific metabolites. Sources: CSAP Technical Report-15 ( http://www.health.org/workplace/report15/mro-man.aspx ) LabCorp Occupational Testing ( http://www.labcorp.com ) Rapid Response Lab, Exempla Lutheran Medical Center, Wheat Ridge, CO 80033

“ Biggest Drug Problem” Based on Drug Related Arrests in 2005 According to 500 Law Enforcement Agencies in 45 States National Association of Counties (NACo)

Total Arrests in U.S. Counties MA Related 75% of all counties report that 40 to 50% of total arrests made in the last five years are MA related . NACo

75%

of all counties report that

40 to 50% of total arrests made in the last five years are MA related .

Other Crimes Resulting from MA 70% of counties report increase in robberies or burglaries because of MA 62% of counties report increase in domestic violence because of MA 53% of counties report increase in simple assaults because of MA 27% of counties report increase in identity thefts because of MA NACo

70% of counties report increase in robberies or burglaries because of MA

62% of counties report increase in domestic violence because of MA

53% of counties report increase in simple assaults because of MA

27% of counties report increase in identity thefts because of MA

“ Super Labs” in Mexico (i.e., capable of producing in excess of 10 pounds of MA in 24 hours) and Chemicals from Canada 20 Mexican MA trafficking organizations have been identified in the Midwest and West. These Mexican cartels entered the market in 1994. In 2005, Mexican super labs now dominate the trade (between 70-80% of MA used in the U.S.). The remaining 20-30% is made by motor cycle gangs, other independent lab operators or individuals in so-called, “small toxic labs,” “mom and pop labs” or “Beavis and Butt-Head labs” in this country. Mexican super labs commonly use methylsulfonylmethane (MSM), a legal dietary supplement for horses and humans, to cut the MA. Pseudoephedrine is often shipped from Canada to Mexico to be used in the super labs. Ephedra plants are also being imported from Asia to the U.S. and Mexico. DEA, ONDCP, NCGCC

20 Mexican MA trafficking organizations have been identified in the Midwest and West.

These Mexican cartels entered the market in 1994.

In 2005, Mexican super labs now dominate the trade (between 70-80% of MA used in the U.S.). The remaining 20-30% is made by motor cycle gangs, other independent lab operators or individuals in so-called, “small toxic labs,” “mom and pop labs” or “Beavis and Butt-Head labs” in this country.

Mexican super labs commonly use methylsulfonylmethane (MSM), a legal dietary supplement for horses and humans, to cut the MA.

Pseudoephedrine is often shipped from Canada to Mexico to be used in the super labs.

Ephedra plants are also being imported from Asia to the U.S. and Mexico.

MA Labs: Health & Environment Concerns The chemicals used in MA labs are volatile and flammable. The by-products created in MA labs are toxic acids and gases. According to the Hazardous Substances Emergency Events Surveillance (HSEES), MA related events have a higher percentage of persons with injuries than non MA events. The most common complaints from first responders exposed to the chemicals and by-products in MA labs are: respiratory and eye irritations, headaches, dizziness, nausea and shortness of breath. ONDCP Fumes in a MA user’s clothing or hair can make others ill. Avoid close contact in a poorly ventilated area with a MA user. Always wear gloves if touching the skin or belongings of MA users.

The chemicals used in MA labs are volatile and flammable. The by-products created in MA labs are toxic acids and gases. According to the Hazardous Substances Emergency Events Surveillance (HSEES), MA related events have a higher percentage of persons with injuries than non MA events.

The most common complaints from first responders exposed to the chemicals and by-products in MA labs are:

respiratory and eye irritations,

headaches,

dizziness,

nausea and

shortness of breath.

ONDCP

Fumes in a MA user’s clothing or hair can make others ill.

Avoid close contact in a poorly ventilated area with a MA user.

Always wear gloves if touching the skin or belongings of MA users.

Amphetamine-Like (MA) Intoxication APA A. Recent use of MA. B. Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of MA. C. Two (or more) of the following, developing during, or shortly after, use of MA: tachycardia (resting heart rate of over 100 beats per minute) or bradycardia (heart rate of under 60 beats per minute) Pupillary dilation Elevated or lowered blood pressure Perspiration or chills Nausea or vomiting Evidence of weight loss Psychomotor (thought and physical movements) agitation or retardation Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias (irregular heart contraction) Confusion, seizures, dyskinesias (bad or abnormal movements), dystonias (involuntary, sustained muscle contractions), or coma D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: With Perceptual Disturbance: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions (distortion of a sensory perception) occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of MA-Induced Psychotic Disorder, With Hallucinations, should be considered.

A. Recent use of MA.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of MA.

C. Two (or more) of the following, developing during, or shortly after, use of MA:

tachycardia (resting heart rate of over 100 beats per minute) or bradycardia (heart rate of under 60 beats per minute)

Pupillary dilation

Elevated or lowered blood pressure

Perspiration or chills

Nausea or vomiting

Evidence of weight loss

Psychomotor (thought and physical movements) agitation or retardation

Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias (irregular heart contraction)

Confusion, seizures, dyskinesias (bad or abnormal movements), dystonias (involuntary, sustained muscle contractions), or coma

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Specify if:

With Perceptual Disturbance: This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions (distortion of a sensory perception) occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of MA-Induced Psychotic Disorder, With Hallucinations, should be considered.

Amphetamine-Like (MA)-Induced Psychotic Disorder APA A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced. B. There is evidence from the history, physical examination, or laboratory findings of either 1) or 2): the symptoms in Criterion A developed during, or within a month of, MA Intoxication or Withdrawal Medication use is etiologically related to the disturbance C. The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Psychotic Disorder (e.g., a history of recurrent non-substance-related episodes). D. The disturbance does not occur exclusively during the course of a delirium. Note: This diagnosis should be made instead of a diagnosis of MA Intoxication or MA Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. Specify if predominated by delusions or hallucinations: With Delusions With Hallucinations Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome: With Onset During Intoxication With Onset During Withdrawal

A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced.

B. There is evidence from the history, physical examination, or laboratory findings of either 1) or 2):

the symptoms in Criterion A developed during, or within a month of, MA Intoxication or Withdrawal

Medication use is etiologically related to the disturbance

C. The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Psychotic Disorder (e.g., a history of recurrent non-substance-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

Note: This diagnosis should be made instead of a diagnosis of MA Intoxication or MA Withdrawal only when the symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.

Specify if predominated by delusions or hallucinations:

With Delusions

With Hallucinations

Specify if criteria are met for and if the symptoms develop during intoxication or withdrawal syndrome:

With Onset During Intoxication

With Onset During Withdrawal

Amphetamine-Like (MA) Withdrawal APA A. Cessation of (or reduction in) MA use that has been heavy and prolonged. B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A: Fatigue Vivid, unpleasant dreams Insomnia or hypersomnia (an excessive amount of sleepiness) Increased appetite Psychomotor retardation or agitation C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

A. Cessation of (or reduction in) MA use that has been heavy and prolonged.

B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A:

Fatigue

Vivid, unpleasant dreams

Insomnia or hypersomnia (an excessive amount of sleepiness)

Increased appetite

Psychomotor retardation or agitation

C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

MA Resources MAMa (Mothers Against Meth-Amphetamine) www.mamasite.net Crystal Meth Anonymous (CMA) www.crystalmeth.org Other Resources New D.A.R.E. (Drug Abuse Resistance Education) www.dare.com

MAMa

(Mothers Against Meth-Amphetamine)

www.mamasite.net

Crystal Meth Anonymous

(CMA)

www.crystalmeth.org

Other Resources

New D.A.R.E.

(Drug Abuse Resistance Education)

www.dare.com

MA and Recovery “ Wall” period lasts 6 to 8 months for casual users and 2 to 3 years for regular users. During this extended time of 6 months to 3 years, people in recovery from MA commonly have: depression difficulty with decision making, concentration and memory lack of pleasure in daily activities Meth-addiction.com

“ Wall” period lasts 6 to 8 months for casual users and 2 to 3 years for regular users.

During this extended time of 6 months to 3 years, people in recovery from MA commonly have:

depression

difficulty with decision making, concentration and memory

lack of pleasure in daily activities

Meth-addiction.com

MA Users and Relapse 98% of MA users entering outpatient treatment have already relapsed at least one time. 50-70% of MA users relapse in the first 30 days of attempted recovery. Methamphetamine.org

98% of MA users entering outpatient treatment have already relapsed at least one time.

50-70% of MA users relapse in the first 30 days of attempted recovery.

Methamphetamine.org

MA Treatment MTP (Methamphetamine Treatment Project) UCLA Integrated Substance Abuse Programs (ISAP) Matrix Institute on Addictions Matrix Model (aka, “neurobehavioral model”) 8, 16 & 24 Week Protocols for MA Use Disorders Now Free at: http://www.health.org SAMHSA and Center for Substance Abuse Treatment (CSAT)

MTP

(Methamphetamine Treatment Project)

UCLA Integrated Substance Abuse Programs (ISAP)

Matrix Institute on Addictions

Matrix Model (aka, “neurobehavioral model”)

8, 16 & 24 Week Protocols for MA Use Disorders

Now Free at:

http://www.health.org

Cognitive Behavioral Treatment Teaching options and alternatives. communication decision making problem solving Practicing the newly learned skills. Graduating only once able to demonstrate change. Success is equal to change.

Teaching options and alternatives.

communication

decision making

problem solving

Practicing the newly learned skills.

Graduating only once able to demonstrate change.

Success is equal to change.

References Center for Substance Abuse Treatment (CSAT). Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series, Number 33. DHHS Publication No. (SMA) 99-3296. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999. Cook, 1991; Gold, 1997; Gold & Miller, 1997; Sowder & Beschner, 1993. Center for Substance Abuse Treatment (CSAT). Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series, Number 33. DHHS Publication No. (SMA) 99-3296. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999. Criminal Justice Addiction Services, 7475 W. 5th Ave., #150F, Lakewood, CO 80226-1673. Denver’s ABC 7. Retrieved October 2005 on the World Wide Web at http://www.thedenverchannel.com. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). (1994). Washington, DC: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision). (2000). Washington, DC: American Psychiatric Association. Drug Abuse Warning Network (DAWN). Retrieved October 2005 on the World Wide Web at http://www.dawninfo.samhsa.gov. Drug Enforcement Administration (DEA). Retrieved October 2005 on the World Wide Web at http://www.usdoj.gov/dea. Gorski, Terence T. & Kelley, John M. (1999). Relapse Prevention Workbook for Chemically Dependent Criminal Offenders. Technical Assistance Publication (TAP) Series, Number 19. DHHS Publication No. (SMA) 99-3340. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999. Greater Dallas Council on Alcohol & Drug Abuse ( GDCADA). Retrieved October 2005 on the World Wide Web at http://www.gdcada.org. Jefferson, David J, “America’s Most Dangerous Drug,” Newsweek Society , 8 August 2005. Retrieved October 2005 on the World Wide Web at http://www.msnbc.msn.com. Kannenberg, Rand L. (2003). Case Management Handbook for Clinicians . Eau Claire, WI: PESI HealthCare, LLC.

References Kannenberg, Rand L. (2002). Sociotherapy for Sociopaths: Resocial Group. A Group Treatment Curriculum for Adults with Antisocial Behavior and Substance Abuse . Eau Claire, WI: PESI HealthCare, LLC. KCI: The Anti-Meth Site. (Formerly the Koch Crime Institute.) Retrieved October 2005 on the World Wide Web at http:// www.kci.org . Levin, M. (Director). (1996). Prisoners of the War on Drugs [Film]. Home Box Office, Inc. Meth Addiction.com. Retrieved October 2005 on the World Wide Web at http://www.meth-addiction.com. Methamphetamine Treatment Project (MTP). Methamphetamine.org. Retrieved October 2005 on the World Wide Web at http://www.methamphetamine.org. Monitoring the Future Survey, National Institute on Drug Abuse, National Institutes of Health, DHHS. Retrieved October 2005 on the World Wide Web at http://www.drugabuse.gov. Moreno, J.L. (1934). Who Shall Survive? A New Approach to the Problem of Human Interrelations . Washington, DC: Nervous and Mental Disease Publishing Company. Multnomah County Sheriff's Office/Oregon Narcotics Association. Retrieved October 2005 on the World Wide Web at http:// www.facesofmeth.us . NAADAC News. (Vol. 15, No. 3, August 2005). The Association for Addiction Professionals. National Association of Counties (NACo). Retrieved October 2005 on the World Wide Web at http:// www.naco.org . National Drug Intelligence Center (NDIC). Retrieved October 2005 on the World Wide Web at http:// www.usdoj.gov/ndic . National Institute on Drug Abuse (NIDA). Retrieved October 2005 on the World Wide Web at http:// www.nida.nih.gov. North Carolina Governor’s Crime Commission (NCGCC). Retrieved October 2005 on the World Wide Web at http:// www. gcc.state.nc.us. NSDUH (formerly known as the National Household Survey on Drug Abuse). Retrieved October 2005 on the World Wide Web at http:// www.samhsa.gov .

References Office of National Drug Control Policy (ONDCP). Retrieved October 2005 on the World Wide Web at http:// www.whitehousedrugpolicy.gov . Ovation Pharmaceuticals. Retrieved October 2005 on the World Wide Web at http:// www.ovationpharma.com. Physicians’ Desk Reference® (PDR®). (6th ed.). (2003). New York: Pocket Books. Reilly PM, Shopshire MS, Durazzo TC, and Campbell TA. Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook. DHHS Pub. No. (SMA) 05-4009. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2002, reprinted 2003 and 2005. Sternberg, Patricia, & Garcia, Antonia (1990). Sociodrama: Who’s in Your Shoes . New York: Praeger Paperback. Stop Meth. Retrieved October 2005 on the World Wide Web at http:// www.stopmeth.com . Substance Abuse and Mental Health Services Administration (SAMHSA ). Retrieved October 2005 on the World Wide Web at http:// www.samhsa.gov. Substance Abuse and Mental Health Services Administration. (2005). Results from the 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-28, DHHS Publication No. SMA 05-4062). Rockville, MD. Texas Alcohol and Drug Testing Service, Inc. (TADTS). Retrieved October 2005 on the World Wide Web at http:// www.texasdrugtest.com .The News & Observer (AP). Retrieved October 2005 on the World Wide Web at http:// www.newsobserver.com . The United States Pharmacopeial Convention Inc. (USP). Retrieved October 2005 on the World Wide Web at http://www.usp.org. U.S. Food and Drug Administration (FDA). Retrieved October 2005 on the World Wide Web at http:// www.fda.gov . Webster’s Dictionary. (2005). Boston: Houghton Mifflin Company.