Epidemiology and public health Consequences of methamphetamine use in California's Central Valley

Methamphetamine use is an increasingly serious public health problem in California and other parts of the country. Despite sensationalistic media attention, however, very little is known about users of this clandestinely consumed drug. Employing methods known as Rapid Assessment and Response, the authors describe the epidemiology and public health implications of methamphetamine use in California's Central Valley, with a focus on Sacramento, which many social indicators suggest has been more severely affected by methamphetamine than any city in the nation. Data sources for this report include interviews with drug users, statistical reports, epidemiologic studies, and local informed expert opinion. In their social demography, methamphetamine users in the Central Valley are in marked contrast to those of coastal cities such as Seattle and San Francisco, being largely heterosexual, and of mixed racial/ethnic heritage. Three-quarters or more initiate their use of the drug while still in their teens, with more than a quarter beginning use before the age of 15. Many of these rapidly gravitate to regular use, and continue using well into their thirties. Methamphetamine users are at much higher risk of infection with HIV than opiate users, particularly if they inject. Partly because methamphetamine enhances libido, users of the drug typically also have many more sexual partners. Not surprisingly, data indicate that methamphetamine users are more likely than heroin users to be HIV-infected. Methamphetamine appears to be less of a street drug than heroin, complicating efforts at street outreach. However, because it is typically used in social settings, a social or diffusion approach to HIV prevention might be particularly promising.     

Crystal in Iran: methamphetamine or heroin kerack

In recent years, methamphetamine use has dramatically increased in Iran while there is a crucial misunderstanding about the colloquial words related to methamphetamine among health providers, policy makers, clinicians, scholars and people in the community. The word Crystal refers to methamphetamine in some parts of Iran while in some other parts of the country, Crystal refers to a high purity street-level heroin which is called Kerack and its abuse is epidemic. Methamphetamine and heroin Kerack are different drugs in Iran. Methamphetamine is a stimulant drug while heroin Kerack is an opioid. Health providers especially clinicians and emergency medicine specialists should consider colloquial words that Iranian drug users apply. Special training courses should be designed and implemented for clinicians in Iran to inform them about methamphetamine and its frequently used colloquial words in the community. This issue has important clinical and health implications.     

美沙酮维持治疗病人使用甲基苯丙胺兴奋剂情况调查

目的:了解美沙酮维持治疗病人合并使用甲基苯丙胺兴奋剂情况。方法:对2006年9月-2009年3月在重庆东华医院美沙酮门诊参加美沙酮维持治疗的550例病人中随机抽取170例进行甲基苯丙胺兴奋剂滥用情况问卷调查。结果:170例中合并使用甲基苯丙胺兴奋剂者98例,占被调查总人数的57.6%,其中偶尔合并使用者64例(65.3%),经常合并使用者21例(21.4%),每天合并使用者13例(13.3%)。满足好奇、同伴影响、空虚无聊、环境暗示是合并使用的常见原因。合并使用与未使用者相比较,前者规律服用美沙酮的比例偏低。结论:美沙酮维持治疗病人合并使用甲基苯丙胺兴奋剂较普遍,需引起重视。应对美沙酮维持治疗病人实施综合干预,减少多药滥用行为的发生。     

The relationship between crystalline methamphetamine use and methamphetamine dependence

BACKGROUND: The aim of the current study was to determine whether crystalline methamphetamine users are more dependent on methamphetamine than people who use other forms of the drug, and if so, whether this could be accounted for by their methamphetamine use history. METHOD: A structured face-to-face interview was used to assess drug use patterns and demographics among a convenience sample of 309 regular methamphetamine users from Sydney, Australia. Dependence on methamphetamine in the past year was measured using the Severity of Dependence Scale. The use of crystalline methamphetamine in the past year was confirmed using a photographic identification sheet. RESULTS: Participants who had used crystalline methamphetamine in the past year were significantly more likely to be dependent on methamphetamine than participants who took only other forms of methamphetamine during this time (61% versus 39%). Methamphetamine dependence was also associated with injecting or smoking methamphetamine (67% and 58%, respectively versus 30% for intranasal or oral use), using methamphetamine more than weekly (68% versus 34%), having used the drug for more than 5 years (61% versus 36%), and having used 'base' methamphetamine in the past year (59% versus 39%). Crystalline methamphetamine use remained significantly associated with methamphetamine dependence after adjusting for these patterns of methamphetamine use. CONCLUSIONS: Methamphetamine users who took crystalline methamphetamine in the past year were more likely to be dependent than methamphetamine users who had not taken the crystalline form of the drug during this time.     

Methamphetamine use,dependence and treatment access in rural and regional North Coast of New South Wales,Australia

Introduction and Aims. To identify the sociodemographic, health, drug use patterns, treatment coverage and barriers to treatment among regular methamphetamine users in rural and regional North Coast of New South Wales. Design and Methods. A structured questionnaire was used to measure sociodemographic factors, health and well‐being, drug use patterns, methamphetamine dependence, engagement in methamphetamine treatment and barriers to treatment. Participants were 140 regular methamphetamine users. Dependent and non‐dependent participants were compared to identify factors associated with dependence. Results. Participants were predominantly in their thirties, male and had low levels of education, high levels of unemployment and polydrug use. Participants who were dependent on methamphetamine (59%) were more likely to report impaired mental health and to have been diagnosed with depression, anxiety and drug‐induced psychosis. One quarter of dependent methamphetamine users had received treatment in the last year and half had ever received treatment. The main barriers to receiving treatment were a lack of perceived need or motivation to seek treatment and concerns about confidentiality. Discussion and Conclusions. Methamphetamine users living on the North Coast of New South Wales require treatment options tailored to address a complex array of physical and psychological problems. The findings highlight the need for psychiatric support and improved coordination between mental health and drug and alcohol services in rural and regional areas.[Wallace C, Galloway T, McKetin R, Kelly E, Leary J. Methamphetamine use, dependence and treatment access in rural and regional North Coast of New South Wales, Australia. Drug Alcohol Rev 2009]     

Analysis of methamphetamine in hair, nail, sweat, and saliva by mass fragmentography

A method for the detection and quantitation of methamphetamine and its major metabolite in hair, nails, sweat, and saliva from habitual users of methamphetamine by mass fragmentography has been developed. Hair and nail samples were washed with water and methanol to remove the external contamination, processed with 0.6M HCl, alkalinized, and extracted with CHCl3/isopropanol (3:1 v/v). Sweat and saliva samples were extracted with methanol. After trifluoroacetyl derivatization, the samples were analyzed by mass fragmentography. Methamphetamine and its major metabolite, amphetamine, were detected in hair, nail, and sweat samples, but methamphetamine alone was detected in saliva samples.     

Perceived risk of methamphetamine among Chinese methamphetamine users

BackgroundMethamphetamine use has grown considerably in China in recent years. Information about perceptions of risk on methamphetamine is important to facilitate health promotion efforts.MethodsUsing both survey data and qualitative interview data, the authors evaluate the perceived risk of methamphetamine use among Chinese users using a mixed-methods approach. Through Respondent Driven Sampling, the authors recruited a sample of 303 methamphetamine users in Changsha, China.ResultsA majority (59.1%) perceive that infrequent methamphetamine use poses no risk to the user, while 11.2% perceive at least moderate risk for light use. A majority (56.7%) perceived at least moderate risk associated with regular methamphetamine use. Most (82.2%) also perceive methamphetamine to be easily obtainable. A path model indicates that perceived risk shapes intentions to use and expectations of future use, as does perceived availability. Qualitatively, while addiction was the most common risk discussed by users, they differed on whether they perceived the drug addictive. Other concerns raised by interviewees included impaired cognition, mental health problems, physical harm, and social dysfunction.ConclusionWhile some users identify significant risks with methamphetamine, others do not perceive its use to be problematic. Collectively, these findings indicate that intervening upon perceptions of risk among Chinese methamphetamine users may be a means to influence intentions to use.     

Impulsivity and methamphetamine use

The purpose of this study was to explore the relationship between methamphetamine (meth) use and impulsivity in a sample of 385 HIV-negative heterosexually identified meth users. Participants who scored highest on a self-report measure of impulsivity were compared with those who scored lower in terms of background characteristics, meth use patterns, use of alcohol and other illicit drugs, sexual risk behavior, and psychiatric health variables. Methamphetamine users in the high impulsivity group were younger, less educated, used larger quantities of meth, were more likely to be binge users, had a larger number of sexual partners, engaged in more unprotected vaginal and oral sex, and scored higher on the Beck Depression Inventory as compared with those in the low impulsivity group. In a logistic regression analysis, Beck depression was the factor that best distinguished between meth users who scored high and those who scored low on impulsivity. Neurophysiological pathways that may underlie the relationship between impulsivity and meth use are discussed.     

Crystal methamphetamine-associated cardiomyopathy: tip of the iceberg?

BACKGROUND: Crystal methamphetamine has become a drug of widespread use. Previous reports describe myocardial infarction, pulmonary edema, and aortic dissection related to methamphetamine use. Cardiomyopathy due to methamphetamine exposure has been rarely described. METHODS: We identified 1640 patients admitted in a 4-yr period with a primary or secondary diagnosis of cardiomyopathy. We excluded patients with known cause of cardiomyopathy other than substance abuse. We found 120 patients had a diagnosis of substance abuse, including 21 patients with methamphetamine use. We retrospectively reviewed the medical records of these 21 crystal methamphetamine users. RESULTS: Nineteen (84%) underwent echocardiography with consistent findings of dilated cardiomyopathy and global ventricular dysfunction. Of five who had a nuclear myocardial perfusion study, none had evidence of ischemia or infarct. Of six who underwent cardiac catheterization, only one had evidence of coronary stenosis. CONCLUSION: Methamphetamine use appears to produce cardiomyopathy in some users. The pathogenesis is probably similar to that of cocaine and catecholamine-induced cardiomyopathy. Cellular, animal, and clinical data support the link between methamphetamine exposure and myocardial pathology.     

Methamphetamine and cocaine users: differences in characteristics and treatment retention

The use of methamphetamine and cocaine have both produced significant public health problems during the past two decades. Although these powerful psychostimulants have many common acute and chronic effects, there are some important differences in who uses these drugs and the consequences of their use. This article reports on two large cohorts of treatment-seeking cocaine and methamphetamine users who entered treatment at the same facility over the same four-year period of time. Patterns of use differed significantly. Cocaine users have more episodic use patterns, spend more money on purchasing their drugs, and use alcohol more heavily. Methamphetamine users include a higher proportion of women, more frequently use on a daily basis, use marijuana more often, and experience more severe medical and psychiatric consequences. Despite the differences in the stimulant drug effects and consequences, the treatment response to a multicomponent, outpatient program is very similar.     

Status of methamphetamine users 2-5 years after outpatient treatment

Increasing numbers of methamphetamine users sought treatment during the decade of the 1990s. Little is known about the post treatment status of methamphetamine users who enter treatment. The data presented in this paper describe the outcome status of a group of a convenience sample of 114 methamphetamine users from a total group of 500 methamphetamine users who were treated 2-5 years prior to a follow up interview. Since the sample was not randomly selected, no specific treatment outcome attribution is possible. Methamphetamine use and other drug use of the follow up sample was substantially reduced from pretreatment levels. In general, the follow up status of the sample was much improved as compared to before treatment. However, headaches and depression were reported at a similar rate at follow up as had been reported at treatment admission.     

The impact of methamphetamine use on subjective well-being in an Internet survey: preliminary findings

Methamphetamine is one of the most widely used stimulants worldwide. Common reasons for use of the drug include efforts to improve or enhance one's life and to uplift one's mood. Nevertheless, acute effects of the drug lead to temporary improvements in mood followed by negative affect. The purpose of the present study was to expand on the current literature and examine other aspects of mood and satisfaction with life in methamphetamine users. Over 6000 adults completed an Internet survey and reported on depression, apathy, satisfaction with life, happiness, and subjective well-being, in addition to measures of methamphetamine use. We compared those who had used methamphetamine at least once within the past year (N = 610) to those who had never used (N = 6063). Methamphetamine use accounted for significant variance in depression, apathy, satisfaction with life, happiness, and subjective well-being even when alcohol and other drugs served as covariates. Methamphetamine use may decrease one's subjective well-being instead of enhancing it, which is contradictory to the perceptions of many users. Increasing awareness about methamphetamine's negative impact on mood and life satisfaction might help decrease prevalence of the drug's use and associated troubles.     

Psychological differences between binge and chronic methamphetamine using gay and bisexual men

Methamphetamine use among gay and bisexual men in New York City continues to pervade the psychological and physical well being of those who engage in its use. While the behavioral and contextual factors associated with methamphetamine use have been examined, there is a paucity of literature examining the psychological and psychosocial correlates associated with varying levels of addiction to the substance. We assessed these correlates among 49 methamphetamine-using gay and bisexual men in New York City. Findings suggest that "Chronic" users report higher levels of avoidant coping and are more likely to use methamphetamine to avoid unpleasant emotions, to avoid physical pain, and to engage in pleasant times with others than those who are "Binge" users. While previous research demonstrates the value of treatment approaches that consider the synergy of mental health, drug use, and sexual-risk taking, our findings suggest the importance of identifying the frequency and current progression of methamphetamine use when addressing the psychological meanings it has for the individual user.     

Methamphetamine use and HIV risk among substance-abusing offenders in California

Recent epidemiological surveys of illicit substance use show a particularly high prevalence of methamphetamine use in the western and southwestern United States-most notably California. Moreover, in their analysis of 1995 Drug Use Forecasting data, Anglin and colleagues (1998) found that methamphetamine was a preferred substance among California arrestees. The present study uses data from 807 state prison inmates in California (32% of whom reported using methamphetamine prior to incarceration) to examine the associations between methamphetamine use and HIV risk behaviors. Methamphetamine users in this sample were significantly more likely than nonusers to have injected drugs during the six months prior to their current incarceration. Among injectors, however, injection-related risks (such as dirty needles and needle sharing, etc.) were not significantly associated with methamphetamine use. However, past six-month sex-related risks were dramatically higher for methamphetamine users. These patterns persisted even after controlling for background differences between the two groups. The results of this study underscore the importance of addressing the higher sex-related HIV/AIDS risk among methamphetamine users undergoing prison-based drug treatment.     

Socio-demographic factors associated with methamphetamine treatment contact among dependent methamphetamine users in Sydney, Australia

Australia has a sizable population of dependent methamphetamine users, the majority of whom do not receive treatment for their drug use. The aim of the current study was to identify socio-demographic factors related to not having received treatment for methamphetamine use among dependent users of the drug in Sydney, Australia. A cross-sectional survey of methamphetamine users in Sydney was used to identify a sample of dependent methamphetamine users (n = 173). Dependence was defined as a score of four or greater on the Severity of Dependence Scale. Dependent methamphetamine users who had received treatment for their methamphetamine use (n = 57) were compared with those who had never received treatment for their methamphetamine use (n = 116) on socio-demographic characteristics and drug use. After adjusting for severity of methamphetamine dependence, socio-demographic factors that were predictive of not having received methamphetamine treatment included being female, being born outside Australia and being in full-time employment. Methamphetamine smokers were less likely to receive treatment than people who took the drug via other routes of administration, while primary heroin users who were concurrently dependent on methamphetamine were unlikely to receive treatment for their methamphetamine use. Further research is needed to understand the barriers to receiving methamphetamine treatment among these subgroups of dependent methamphetamine users. [McKetin R, Kelly E. Socio-demographic factors associated with methamphetamine treatment contact among dependent methamphetamine users in Sydney, Australia. Drug Alcohol Rev 2007;26:161 - 168]     

Methamphetamine use among Australian workers and its implications for prevention

Introduction and Aims. Little attention has been directed to the use of methamphetamine among Australian workers. To address this, a study was conducted that examined drug consumption patterns of the Australian work-force. Design and Method. A secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data was undertaken that focused on methamphetamine use among those in paid employment. Results. Methamphetamine use in the past 12 months was reported by 4.0% of workers compared to 2.2% of respondents not in the paid work-force. A larger proportion of male (4.8%) than female workers (3.0%) used methamphetamine. The highest prevalence occurred among 18 - 29-year-old workers (11.2%; males: 12.6%; females: 9.4%), and among workers in hospitality (9.5%), construction (5.4%) and transport (5.4%) industries and among tradespeople (6.5%). Significantly more methamphetamine users reported absenteeism compared to users of other illicit drugs and non-drug users. Among respondents reporting methamphetamine use, 13.4% reported absenteeism due to illicit drug use, while 56.8% reported absenteeism due to any illness or injury. Significantly more methamphetamine users (32.9%) reported going to work under the influence than users of other illicit drugs. Compared to users of other illicit drugs, methamphetamine users were also significantly more likely to drive a car, operate heavy machinery or abuse someone while under the influence. Discussion and Conclusions. The specific details of the profile of workers using methamphetamine and the impact it has on work performance allows for the development of targeted interventions and tailored prevention strategies previously not possible. [Roche AM, Pidd K, Bywood P, Freeman F. Methamphetamine use among Australian workers and its implications for prevention. Drug Alcohol Rev 2008;27:334-341]     

Patterns of methamphetamine use and symptoms of depression among young adults in northern Thailand

Introduction

Depression often co-occurs with amphetamine type stimulant use and can negatively impact drug treatment outcomes. Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options.

Methods

Methamphetamine users aged 18–25 years were enrolled in a 12-month randomized behavioral trial in Thailand. Questionnaires were administered every 3 months and included information on substance use and depressive symptoms. Pattern of methamphetamine use during follow-up was characterized into four groups: early cessation, late cessation, relapse and persistent use. Multinomial logistic regression was used to determine the impact of baseline depressive symptoms (CES-D score and % ≥22) on patterns of methamphetamine use during follow-up. Linear and logistic regression was used to determine the impact of patterns of methamphetamine use on depressive symptoms at the end of the trial.

Results

No association was found between baseline depressive symptoms and subsequent patterns of methamphetamine use. A significant relationship was found between patterns of methamphetamine use and ensuing depressive symptoms, with those achieving cessation experiencing lower levels of depressive symptoms.

Discussion

Many symptoms of depression may resolve with cessation or reduction in methamphetamine use. Clinical and community-based efforts that facilitate drug users’ attempts to stop using drugs should be supported as they may contribute to positive cessation outcomes and help to improve overall mental health.