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APA: Pure 'Ice' Fueling Methamphetamine Epidemic

By Michael Smith, MedPage Today Staff Writer May 24, 2006

TORONTO, May 24 — The rate of methamphetamine use in the U.S. is relatively stable, but—apparently paradoxically—admissions to treatment programs have skyrocketed.

And one reason for the increase may be the success of law enforcement programs in shutting down illegal domestic labs producing the drugs-opening the market to purer crystalline methamphetamine, or "ice," the American Psychiatric Association meeting here was told.

From 1993 and 2004, the number of admissions for treatment of substance abuse involving stimulant—most connected with methamphetamine—rose from 28,000 a year to about 150,000, said James Colliver, Ph.D., of the National Institute on Drug Abuse, during a symposium on the epidemic of methamphetamine abuse.

The figures are based on state numbers reported as part of the Treatment Episode Data Set (TEDS), collected by the Substance Abuse and Mental Health Services Administration.

But data from the National Survey on Drug Use and Health (NSDUH) and the University of Michigan's Monitoring the Future (MTF) study indicate that the rate of methamphetamine use remains roughly constant. At any time, about 5.1% of the adolescent and adult populations say they've used the drug at some time in their lives, about 0.6% say they've used the drug in the past year, and 0.3% say they've used it in the past month, he said.

"We do not see evidence of a big increase" in the number of users, he said in an interview. "So what's going on?"

In some ways, Dr. Colliver said, the prevalence and treatment data track together:

  • The state-by-state rates of both measures tend to be in lockstep. If a state has a high prevalence rate it also has a high treatment rate and vice versa. Interestingly, western states tend to be high, midwest and southern states are in the middle, while the northeast is low, he said.
  • Of the 300,000 people every year who reported using the drug in the previous month, the proportion who met criteria for abuse or dependence on any illicit drug has risen from 28% in 2002 to 59% in 2004. Over the same time, the proportion addicted to stimulants has gone from 10.5% to 22%.
  • And two slightly different measures of treatment numbers—one from NSDUH and one from TEDS—are "going up at the same rate and they're in the same ballpark," Dr. Colliver said.

Dr. Colliver noted that law enforcement data show that domestic methamphetamine production has declined, that seizures of illicit labs have fallen, and that more states are now tightly controlling the precursor chemicals needed to make the drug. At the same time, imports of methamphetamine from Mexico—purer than the domestic product—have increased.

Also, the route of administration of the drug has changed, he said: More users are now smoking the crystalline form—dubbed "ice"—and fewer are injecting it or inhaling it as a powder.

In 1993, he reported, only a few thousand of the 28,000 patients admitted for treatment said they smoked the drug. By 2003, the number was nearly 80,000 of the roughly 150,000 admissions, but all other routes of administration had remained roughly constant for several years.

"Smoking is a route of administration that delivers the drug very rapidly to the brain, producing greater reinforcement effects, which therefore may produce higher rates of dependence," he said.

The combination of purer offshore drugs and a tendency for users to smoke the substance may "be associated with greater rates of dependence and greater rates of presentation for treatment among a reasonably constant pool of users," Dr. Tolliver concluded.

Indeed, such a scenario appears to be the case in Hawaii, which is leading the epidemic, said Linda Chang, M.D., of the University of Hawaii, who studies the neurological effects of the drugs in adults and children. "We get almost pharmaceutical grade drugs and we think that's why it's so toxic," Dr. Chang said.

"Because the drug is neurotoxic, if you're getting more, it can cause more damage to the system," she said in an interview.