WHERE TO GO FROM HERE

The Des Moines Register invited six experts in the fight against
methamphetamine to discuss what the state can do to ease the effects of the
rampant drug problem. The guests were state Rep. Clel Baudler; Marvin Van
Haaften, director of the governor's Office of Drug Control Policy; Janet
Zwick, director of the Iowa Division of Health Promotion, Prevention and
Addictive Behaviors; Mark Hine, an agent with the federal Drug Enforcement
Agency; Ken Carter, director of the Iowa Division of Narcotics Enforcement;
and Dr. Dennis Weis, medical director of the Powell Chemical Dependency
Center in Des Moines. This is an edited transcript of their discussion.

Q. The state government, local governments and federal government - no one
has any money. What are some realistic things that we can do to help lessen
the effects of meth?

Marvin Van Haaften: Kansas started a "Meth Watch" program for businesses.
It's an education program so that our Targets, our Wal-Marts, our retail
businesses can be educated as to what are the precursors - what's required
to manufacture methamphetamine. We have kind of started that with limited
staff and limited funding. We have met with the Iowa Grocers Association
and their lobbyists. We've met with the Iowa Retailers Association and
their lobbyists. They're interested in a kind of public-private
relationship and getting this going among their member grocers and member
businesspeople. When you educate convenience clerks as to what the
precursors for methamphetamine are, that results in some good information
coming in for law enforcement. And actually, I know of one case there was
one education at one convenience store, we ended up with about five meth
labs that we were able to shut down and do something about and get those
people in treatment, children out of those homes, all of that just because
of this educational approach. So it doesn't take a lot of money. It takes
commitment.

Dennis Weis: I've applied for and gotten involved in a national research
program with treatment and medication studies. I'm able to provide
treatment to a number of patients at no cost to them and gather some new
information, learning new things about meth. We've found out that many of
these patients do not tolerate being confined for long periods of time.
We're actually probably having just as good a result, if not better
results, treating them as outpatients a few times a week. And this is kind
of hard for a lot of the treatment industry to accept and understand right
away, but when you understand the dynamics of the addiction and the kind of
impairment that these individuals are left with for quite a period of time
after they stop using, it does make some sense. And that's a much more
cost-effective way of delivering treatment.

Q: Is there a feeling among some users of hopelessness, that they'll never
beat it?

Weis: I think so. The meth population in general is a different demographic
than for many of my other addictions. Most of the meth people - many of
them have never had a job a day in their life. They have multiple legal
problems. They have either primary or drug-induced psychiatric disorders,
and they're very tough to treat. And many of these patients we're seeing
now in the last five or six years, their parents were using meth and they
started using meth when they were little kids. They started getting it from
their parents. So they were born bathed in meth.

Mark Hine: It all starts with people who are using, because we tolerate
people who are using meth.

Q: How do we indicate that tolerance?

Hine: Users have to be held accountable in some way. And I think it's going
to be some kind of a radical solution. I'm not one of these people who say
enforcement is the answer. That's not the case. There's so many answers
that are out there. You just have to find one that's going to work for this
state.

Clel Baudler: When I look at this as a (former) law enforcement officer,
there's a big part of me that says interdiction and enforcement is what is
needed and needed more, and it's how we're going to look at these users.
Are they victims or are they perpetrators in a lawless activity? I do not
look at them as victims. When you talk about their children, that's who the
victims are. When they talk about their neighbors and the people that rent
them houses, they're the victims.

Last year I introduced a bill. Didn't get anywhere with it. We worked on it
throughout the summer again. It would limit the access of pseudoephedrine,
which is the main ingredient in any recipe you use. You have to have
ephedrine or pseudoephedrine to make meth. We're going to try to limit the
access of it somewhat, have ID, maybe even have a signature. And if we can
put it behind the counter, we feel that would help on the labs in rural
Iowa and even in urban Iowa. I think there's some allies out there for this
law this year.

Van Haaften: Six states already have purchase restrictions. And Kansas and
some of the states around us are considering them. We already in Iowa have
ephedrine as a Schedule Five (a restricted level of drug). Unless you take
anything that is used to make meth, which would be all of your cold
remedies, if you're really going to make a dent, you're going to have to do
the same as ephedrine and make it a Schedule Five. That's a bold move. But
I know that would be effective.

Q: Some Schedule Five drugs require a prescription. Would you need one to
get cold medicine?

Van Haaften: No. It would be much like codeine. You would go in, show your
ID, sign, and then you'd get it.

Q: And you think the merchants would go along with that, too?

Van Haaften: There's going to be a lot of opposition by merchants because
unless you have a pharmacy as part of your grocery chain, you're not going
to be able to sell cold medicine. The retailers know there's a problem and
want to cooperate, and that's why I started out my conversation with Meth
Watch, where there's an education program within the retail association. It
takes a little funding, and so we've been working with one of our senators.
But I think there's a real desire on the retailers to be educated and to do
something. That's a tough sell, but maybe we need to be bold.

Ken Carter: We have supported Mr. Van Haaften's project, particularly with
the retailers and petroleum marketers. We have had the opportunity to speak
to a number of groups and support Mr. Van Haaften's efforts. We're also at
lab sites in a process of collecting the receipts of where they purchased
the material. When we find repeated store receipts, particularly from the
same store, that will give us an opportunity to pay a visit in the future
to that particular place of business and just to present them with the
facts, that their store's being targeted for all of the ingredients that
we're finding at numerous lab sites and hopefully to remind them to be a
little more careful. We're finding this is a constant, constant thing to do
to re-educate people, in order to remind them. Ten years ago or seven years
ago when this really got going, particularly the meth lab situation, it was
very much in the news quite often, and we found the education level was
coming up and people were very much aware of it. Now I think it's
definitely on a slide downwards. Some people we have spoken to think: Is
there still a meth problem in Iowa?

Q: Do any others of you feel that people aren't aware of the scope of the
problem?

Van Haaften: There are quite a few Iowans that aren't aware that
pseudoephedrine is the key ingredient in making methamphetamine.

Baudler: I think a lot of people are aware that meth is in Iowa and that
it's a problem, but "it doesn't affect me." They don't realize that the
millions of dollars that we spend on enforcement, incarceration and
treatment is coming out of their pocket.

Hine: If you want to find out who knows the most about this, I think you've
got to go into the school systems in Iowa, because the teachers are well
aware of this situation. The effect is going to continue to happen for many
years, because this is a problem that involves families. If you go out and
talk to a lot of the counselors, I think they will tell you that most of
their clients are getting their meth from relatives. I hear this time and
time again, and when you ask them what is a relative, they'll say mom, dad,
brother, sister, aunt, uncle. It's not this real bad guy over here
somewhere. That's what makes the problem so difficult to attack.

Weis: I don't think that we've had the media attention and a lot of the
screaming and yelling and publicity that we had present seven or eight
years ago, so I think a portion of the population has sort of forgotten
about this or has accepted it.

I'm noticing over the past several years more and more that almost all of
my patients, the meth that they're using is being made by somebody locally.
There may still be a lot coming up from Mexico, but there's a lot being
made here locally now.

As with any addiction and any epidemic, we keep hoping it's going to burn
itself out. You know, the meth epidemic in the "70s burned itself out, and
everybody seemed to get the message that meth kills. That isn't working
anymore. This epidemic has been going on a long time, and I don't see any
end in sight because it's very easy to get.

Baudler: Doc, in your experience, how do people look at themselves, as
victims or as perpetrators?

Weis: I don't really see any of these people thinking of themselves as
victims. I really don't see that. They have a difficult time taking
responsibility, but we work at that very strenuously in accepting
consequences, those kinds of things. I think they need to take
responsibility for things that go beyond the line. Do they need to be
jailed or incarcerated simply because they have an addiction problem? I
don't think that's useful. But if they've committed crimes, yes.

One of the difficult things with meth is unlike any other addiction, 100
percent of people who become methamphetamine-dependent become dealers.
Usually within a week or two of getting onto to meth, they're giving it to
friends. They're becoming the dealer for somebody else. It's not like that
with any other drug.

Q: Why do you think that is?

Weis: It's the incredible availability. It's not a natural resource that
you've got to wait for a supply from Colombia. You can make it yourself.
You can look it up off the Internet in a few minutes.

Baudler: How many of the dealers become cookers?

Carter: We figure that each good cooker or reasonable cooker trains six to
10 others. And in turn they train six to 10 more people, and it just keeps
moving on.

Van Haaften: I need to say one positive thing. I was able to speak at the
Midwest Legislative Conference in Milwaukee, Wis. There are 13 states in
the conference. It was very clear to me that Iowa was taking the lead in
almost everything. I mentioned our drug-tax stamp, which was foreign to
quite a few of the legislators. And we pulled in over $4 million just
through that drug-tax stamp already. So Iowa is really doing a lot of
things right. Have we licked the problem? No. But many things are going
well here in Iowa.

Janet Zwick: I think we were much quicker to identify what was going on. A
lot of that was because we were all working together. We were quicker than
some of our other surrounding states to identify what was going on. We are
in the lead in doing some different things, trying different protocols, and
really identifying and working with everyone. If people are in treatment
for a longer length of time, if they have case management, if you are
really working with them, we have fairly good success rates. I think
oftentimes you hear out there that there's no success rate with
methamphetamine clients, and that's not true.

Baudler: How much did we spend on one of these clients, to keep them
straight for a year?

Zwick: When I look at an average cost of treatment, it is about $3,500 a
client compared to probably $25,000 a year to keep someone in prison.

Baudler: And that would be a year's treatment?

Zwick: That would be probably about six months, and again, that's a
continuum of care. Dennis made the comment that they're finding that these
people work much better in outpatient. They might start for a very short
period in residential or 24-hour care and then go into a less-intensive
outpatient.

Baudler: How do you most of your people come to you? They walk in, or
court-ordered?

Weis: Most of the people have legal issues. It's Corrections and the
Justice Department that get a lot of them to me. Others will come in
because a friend has done it, and they appear to be doing well.

Zwick: I'd say about 70 percent are referred in through the legal system.

Weis: Either that or the Department of Human Services when they take the
kids. That's how we get a lot of the parents.

Q: You don't hear too much anymore about prevention kinds of things in
terms of public awareness, do you?

Zwick: There are lots of teachable moments in schools, and there are lots
of times that you can just simply build prevention education into something
else that you're talking about. And I think ideally that would be the best
thing to happen.

Weis: What we've found in the treatment field is that one of the greatest
predictors of the future substance-abuse problems is how young you started
smoking cigarettes. The younger you are when you started smoking
cigarettes, the more likely you are to have a substance abuse problem.

Hine: The DEA has a strong demand-reduction program, and one of the most
important parts of my job is to go out and talk to kids in the schools.
When we go in there, we talk about education. Education is the No. 1 thing
we talk about with kids because it is the equalizer.

Q: Do you think kindergarten is too young to start education efforts?

Hine: I've talked to first-graders and second-graders and third-graders
because teachers will call and say, "Will you come and talk to them?" Any
kind of talking to kids is very helpful because sometimes they don't have
those conversations at home.

Zwick: You simply need to do it on their level. Obviously you aren't going
to go into a discussion with a kindergartner that you would with a
sixth-grader.

There are a couple of other pieces that I don't think any of us have talked
about, and one is a community coalition building. And when I use that term,
what I mean is you look at some of the changes that have happened with
tobacco as far as some of your smoke-free environment. And that really did
happen at a community-empowerment level. Another program that really is not
costly is a mentoring program. There has been a great deal going on with
mentoring within - I think it's the Iowa Health System - which is working
with the Iowa Mentoring Partnership and developing mentoring programs,
working with businesspeople, working with people within hospitals, and
actually having them do one-to-one mentoring with high-risk kids. Look at
the success rates of that. There is a decrease in school dropout and a
decrease in academic failure.

Q: What can the average Iowan do if they want to get involved?

Zwick: There are a number of things. I'll give an example: It was really
interesting when we were having very high tobacco sales to youth, and when
people found out that their corner grocery store was selling to youths,
they would go into the grocer and they would say, "I really don't like
shopping here. You are selling to youth. You are breaking the law." And it
really did start to make a change. I think that same type of thing can
happen with selling the precursors.

Van Haaften: What really strikes me - and I have five children of my own
and nine grandchildren - parents who talk to their children and warn them
about the dangers of drug abuse, those kids are 50 percent less likely to
experiment with drugs, and that's basically what we're trying to apply to
grandparents now, too, to get "Power of Grandparents" brochures out there.
You'll find many children are actually being raised by their grandparents
because of problems their parents run into. That brochure is going to be
available quite soon from the Partnership for a Drug Free Iowa. As sheriff,
I've taken many kids to detention that were on drugs, because of whatever
acting-out they did, sometimes quite violent. And what always struck me is
many times they did not have a good relationship with their parents, but,
boy, they wanted to please Grandpa or Grandma.

Hine: Every component is critical. You have to have consequences for people
who are involved in doing this kind of behavior. And at the same time,
individuals who are using it, you have to help them. And we have to get the
message out prevention-wise as well.

Q: What does your fight against meth mean to you personally?

Baudler: I spent 321/2 years on the State Patrol. When I came on, we still
thought of marijuana as hemp, something you cut. You didn't grow, and you
didn't smoke. And we went through the do-your-own-thing period. "If it
feels good, do it" - the speed, everything on down the line. But I don't
think that I've seen anything to compare to methamphetamine or to LSD. The
violence and bloodshed and the destruction to the family unit with
methamphetamine has been much greater, and it's something that I don't
believe we should back off from.

Zwick: I've been in the field for over 30 years. It isn't just a job to me
or I wouldn't be in the field. I have really seen it as a challenge.
Recovery doesn't always happen. There are relapses, but when it does happen
- - when people are able to get out of the cycle, when they become employed,
they start making more money, they're no longer arrested and you really see
a change in their lifestyle, all of that's been worth it.

Hine: I was born and raised in Iowa. I spent 15 years working for DEA on
the East Coast, and I always talked to people about Iowa and said we don't
have the drug problem they had. And I came back here, and I couldn't
believe the drug problem that was here. But you realize that you do make a
difference. You get done with a sentencing, and you have a parent come up
to you, and they say, "Are you Mark Hine?" And you're not sure what you're
going to get when they ask you that question, but nine times out of 10,
it's: "You saved my child's life, and I want to thank you for that, for the
job that you're doing."

Weis: We see people come into treatment with a variety of substance-abuse
problems. Many of our alcoholic patients still have marriages. They still
have jobs. They still have a number of things in their life. But
methamphetamine, when they come in, they're starting at the absolutely rock
bottom, and they're not likable. When I see these people begin to heal,
begin to recover, their brains begin to function better, they start to
become likable people. And the ones that got into recovery that we followed
up a year or two years later have had some phenomenal successes. I've got
two or three of these people that have their own businesses. One has gone
out and got a master's degree. And so that's very dramatic. The difference
between their addicted state and their recovery state is more dramatic than
really anything I've seen with other substances.

Carter: I've passed my 28th year in state drug enforcement, and I've been
fortunate, or unfortunate, to go through the evolution of what's been
described - through the marijuana, the LSD, the cocaine, the crack cocaine,
and now we're into meth. But the challenge is trying to see into the
future, what's coming. If methamphetamine ever does go away, what is next
on the horizon? People realize that we're doing the best we can. We're
trying. We're up for the challenge. We're trying to beat it head-on as
quickly as it evolves.

Van Haaften: When I was a sheriff, I could sit with Dad and Mom and arrange
for the involuntary commitment, perhaps, of their 17-year-old. Those kids,
they're adults now, and they still hunt me up on the street or shake my
hand. I joined just a little small mission church in Knoxville, and two of
the kids that I sent up on 25-year manufacture-of-meth charges, they're now
church members. There are people who do get over this, and there are people
who are cured. One of those young people is working with our youth leader
with about 200 youth. He's been there. He's done it. So those are powerful
people that can really make a change.