Part 1: http://www.mapinc.org/drugnews/v00.n021.a01.html

Part 2: http://www.mapinc.org/drugnews/v00.n021.a02.html

Part 3: http://www.mapinc.org/drugnews/v00.n021.a03.html

Part 4: http://www.mapinc.org/drugnews/v00.n023.a01.html

Part 5: http://www.mapinc.org/drugnews/v00.n022.a02.html

Part 6: http://www.mapinc.org/drugnews/v00.n022.a01.html

Part 7: http://www.mapinc.org/drugnews/v00.n022.a03.html

METH OF OLD HAS MORPHED INTO EPIDEMIC PROPORTIONS

At the end of the century in which it was created, methamphetamine is
a new drug with an old name.

It's not the derivative of amphetamine that Japanese chemist A. Ogata
synthesized in 1919.

It's not the stimulant that Allied and Axis powers doled out to troops
in World War II to keep them alert during protracted combat, or even
what was legally prescribed for pilots during the Gulf War.

And it's not the meth that fueled the Summer of Love in San
Francisco's Haight-Asbury in 1968, which gave rise to the caution
"speed kills."

That meth is gone, its legal propagation halted by the federal
government because of widespread abuses by truck drivers trying to
stay awake during long hauls and homemakers eager for "mother's little
helper," as the Rolling Stones nicknamed uppers.

Meth has been listed as a Schedule II drug since Congress passed the
Controlled Substances Act of 1970. Physicians use it for overeating
disorders, narcolepsy, Parkinson's disease, Attention Deficit Disorder
and Attention Deficit Hyperactivity Disorder.

As occurs so often in this country, prohibition of a legal drug -- be
it alcohol, cocaine or meth -- forced it underground. When American
servicemen brought meth home to the West Coast from Japan after World
War II, the drug became a staple in San Diego. For years, it was
exclusively made and traded by the more violent motorcycle gangs.

No longer. After spreading north to the Canadian border, meth has
staked a claim to be a rival to, if not the baddest drug on the block
in the Southwest and Midwest. Cocaine and heroin still reign on the
East Coast, but meth has been detected in Georgia.

Just as troublesome is the expansion of illicit manufacturers. Meth
has become incredibly profitable for what law enforcement calls the
Mexican Organized Crime Families. They send meth into the United
States on supply routes as they've used for years for cocaine,
marijuana and heroin.

Increasingly, meth is made in back yards and, frequently, kitchens, in
mom-and-pop operations.

There appears to be no limit to creativity in meth recipes; they're
traded on the Internet and handed down among manufacturers, generation
to generation.

The most popular form of meth today -- d-meth -- is as close to 100
percent purity as ever dreamed possible. A. Ogata would be stunned by
how meth has morphed since it came to life in his lab 80 years ago

[sidebar]

TREATMENT PROGRAMS JUST AT THE STARTING POINT

Methamphetamine, as rapacious a drug as America has encountered, is
fast leaving treatment providers in the dust.

No well-established treatment protocol exists, so the 12-step approach
is pinch-hitting, albeit in a tweaked form to accommodate the drug's
idiosyncracies. As feverishly as researchers are working, they have
not developed a medication that does for meth addicts what methadone
does for heroin addicts -- allow them to maintain some semblance of a
normal life. A vaccine is also in the works.

Research on meth's complexities can't proceed fast enough. In
Washington state, the numbers are headed up.

Publicly funded treatment admissions for meth increased more than
1,000 percent from 1992 to the first half of 1998. In the same time,
admissions of adults citing meth as their primary drug increased 850
percent in King County.

In the meth game, King County is no Pierce County -- yet. Counties on
the western side of the mountains are bearing the greatest brunt of
the incursion. From 1993 through 1998, Pierce County experienced a
1,010 percent jump in treatment admissions, compared with 980 percent
in Thurston County, 880 percent in Lewis County and 740 percent in
Clark County.

There are two particularly worrisome trends: More and more users favor
injecting the drug over snorting, smoking or eating it. Injecting
drugs dramatically expands the population vulnerable to both Hepatitis
C and the HIV virus. And last year, the national Survey of Adolescent
Health Behaviors turned up the distressing finding that by the 12th
grade, nearly 12 percent of students reported past or present meth
use.

To Karol Kumpfer, who directs the U.S. Center for Drug Abuse
Prevention, gender parity in drugs is a result of the "Virginia Slims
effect." Probably because of their desire to be model-thin, girls
appear more susceptible to stimulant use than boys.

It's likely that meth is the first major drug in America to appeal
about as much to women as to men. Across the country, Kumpfer says,
females comprise 47 percent of the treatment admissions. Washington
apes that finding.

But in overall admissions, which cover treatment for alcohol and every
illicit drug, men here still predominate, with women comprising just
35 percent.

While meth is an equal seducer of the genders, it -- unlike cocaine --
appeals almost exclusively to whites.

To what depths do people sink before admitting that drugs have
overwhelmed their lives?

Meth brings about 60 percent of the clientele to Eastcenter Recovery
at Grays Harbor Community Hospital in Aberdeen. Over 15 years,
Charlotte Hunter, Eastcenter's director, has seen a wholesale
transformation from alcoholics and then crack addicts to a meth majority.

Flat-out desperation is the reason most give for seeking professional
help.

One 26-year-old mother who dropped to 82 pounds as a result of meth
was selling furniture to finance her $300-$500 weekly habit. "I was
too scared to ask my boyfriend for help," she said. "I finally left it
(the meth) where he could find it. He packed up the kids and left for
two hours. When he found it, that was the evidence I needed the help."

At 32, another mother recounted that she had done meth "five years
straight, pretty much every single day. It got to the point that
that's all I did. I lost my home, my car, myself."

A third Eastcenter patient wanted to slim down. After losing her
husband, house and antiques, the 47-year-old quit after a suicide
attempt. "I knew I was powerless over anything that was out there on
the street," the mother of two said.

For these women, the treatment standard is a 12-step program. Director
Hunter says anti-depressants are a mainstay in recovery, with
physicians prescribing them for three to five years after meth use
stops.

Because of the rapidity of meth's onslaught, providers are only
beginning to tailor treatment programs to the vagaries of meth addiction.

One approach touted by Dr. H. Westley Clark, who directs the U.S.
Center for Substance Abuse Treatment in Washington, D.C., is the
Matrix model developed in Los Angeles by Dr. Richard Rawson.

Over an intensive 24 weeks, the model employs a variety of strategies,
including relapse prevention, motivational interviewing,
psychoeducation and family therapy as well as the 12-step program.

What's so poignant about this approach, Rawson points out, is the need
for treatment specialists to "deliver information in small quantities
because patients do not remember due to damaged short-term-memory skill."

His admonition strikes home with the Eastcenter Recovery patients who
say their post-meth thinking is muddled and that they have suffered
memory loss.

It's no wonder that patients enter treatment willingly when they see
pictures of their brains post-meth. "Denial's really hard when you see
holes in your brain," says Dr. Daniel Amen, an addiction physician in
northern California.

Dr. Alex Stalcup has a bias against inpatient treatment for addicts in
his practice outside San Francisco. He claims 93 percent of meth
addicts will use again within six months of inpatient treatment.

"Meth doesn't lend itself to removing a person from the drug
environment, treating them and putting them back in," says Stalcup,
whose first experience in addiction medicine came when he ran the
Haight-Ashbury Free Clinic in San Francisco.

Environmental cuing is emblematic of meth use, he explains. Intense
cravings for the drug can come almost immediately from the most
improbable cues -- not just the people patients did the drug with, but
the room they did the drug in or songs popular at the time.

Fifty percent of treatment success comes from restructuring the
addict's lifestyle, Stalcup says. Once the patient has been stabilized
by the first three steps in recovery -- sleep, sleep, sleep -- and
drugs have been prescribed for possible mental illness or depression,
Stalcup dictates a daily regimen.

To someone whose life has been erratic, that routine can be as hard as
sleeping eight hours, exercising, eating three regularly spaced meals
and enjoying at least one positive social contact a day.

"A landmark day in recovery is not when they stop using drugs,"
Stalcup says. "It's when they start experiencing pleasure again."

[sidebar]

PROFILE OF METH USER

In 1996 the federal Office of National Drug Control Policy described
typical meth users in Washington state as white, high school-educated,
in their 20s and 30s and employed as blue-collar or service workers.

Three years later, that picture was replicated by statistics the P-I
drew from the state Division of Alcohol and Substance Abuse. Of those
seeking treatment from July 1998 to July 1999,

91 percent were white.

76 percent were between 21 and 40.

84.5 percent had no more than a high school education.

58 percent were unemployed, whether seeking work or
not.

Unlike most other illicit drugs, meth is as attractive to women as
men. From July 1998 to July 1999, women made up 45.5 percent of the
treatment population, according to a state DASA profile. The female
majority climbed as high as 65 percent in Lewis County; King County
matched the state average.

[sidebar]

THE DANGERS OF METH CANNOT BE UNDERSTATED

Karol Kumpfer witnessed methamphetamine's influence on its prey a
quarter of a century ago, when meth was being pushed by bikers, when
speed was its common name.

But Kumpfer, now director of the U.S. Center for Substance Abuse
Prevention in Washington, D.C., was unprepared for its transformation.
While evaluating an outpatient and residential treatment program in
northern California, she found herself staring at young women "who
looked like they had come from Auschwitz."

Their faces were pale, their eyes shrunken into their sockets; their
hair had fallen out.

"I was just shocked," Kumpfer said, explaining that the addicts, women
from average backgrounds, had met meth at parties or used it to lose
weight. "Heroin addicts at least eat, and they hold jobs."

Because of the zealous refinement of recipes, today's meth is as much
as six times as potent as the meth that the bikers sold, and flower
children bought, in the '60s.

Although scientific research on meth is in its infancy, treatment
guidelines issued this year by the U.S. Center for Substance Abuse
Treatment say "some of the most frightening research findings about
meth suggest that its prolonged use not only modifies behaviors but
literally changes the brain in fundamental and longlasting ways."

In layman's language, meth rewires the brain, and while recovery may
be possible, the brain won't be the same. Cocaine, by contrast,
doesn't stay long in the brain because it almost completely
metabolizes in the body.

Any physician with more than a passing acquaintance with meth, and
certainly West Coast physicians who specialize in addiction medicine,
describe the drug in the most graphic of terms. Their assessments have
been shaped by firsthand experience trying to return meth addicts to
some semblance of normalcy.

As a trauma surgeon at Mercy Hospital in San Diego, where meth first
gained a foothold in the United States, Dr. Michael Sise believes that
meth "carries a prognosis that is worse than many cancers."

A clinical neuroscientist who specializes in nuclear brain imaging in
northern California, Dr. Daniel Amen, ranks meth's addictive character
second only to heroin's. But he says it's far more dangerous to users
- -- and the people around them -- because of the paranoia and psychosis
that inevitably follow. "Our scans basically show that these people
are dealing with a defective brain," Amen said.

In Bellingham, Dr. Greg Hipskind observes that because meth decreases
the blood flow to the brain, "it dumbs you down."

This drug is very adept -- but eventually way too adept -- at what it
does.

Meth messages the brain's pleasure center to release more dopamine and
endorphins, two natural chemicals that make people feel good.

An extra helping of these chemicals makes people feel more confident,
lose weight, work quicker at a myriad of tasks and enjoy sex more.

But what's initially so enticing about meth becomes intolerable. The
rate of addiction is breathtaking: Over six months of use, 94 percent
of those who smoke meth become addicted, as do 72 percent who snort
it. That compares with 14 percent who inject heroin and 8 percent who
smoke marijuana.

(Therapeutic doses for diseases such as Parkinson's and narcolepsy may
be up to 50 mg a day. Meth is being abused when someone uses between
250 mg or more, and during a binge, it is not uncommon for some to use
up to 1,000 mg every two or three hours.)

Meth is all about extremes.

Eager to slim down? That's what the earlier version of meth was
prescribed for in the '50s and '60s. Today's more potent form can
emaciate people. One Tacoma addict interviewed by the P-I, a woman of
average height, dropped to 80 pounds while she was pregnant.
High-intensity users can shed 50 to 100 pounds.

Lust for mind-numbing sex? Meth will produce it -- at first. That is
why it is so popular at "raves" in nightclubs or in the gay bath
houses in Seattle.

Eventually the drug inhibits sexual functioning in both sexes. The
consequences cited in the guidelines from the Center for Substance
Abuse Treatment, include men developing breasts, losing interest in
sex and experiencing impotence, and women developing menstrual
problems, infertility and difficulty achieving orgasm.

One of meth's most alluring qualities is extra energy. At the extreme,
meth facilitates behavior that is persistent, repetitive and
compulsive. The federal treatment guidelines describe these activities
as stereotypical of meth use: "vacuuming the same part of the floor
over and over, popping knuckles, picking at scabs, or taking apart and
reassembling mechanical devices."

Daily, Dr. Alex Stalcup, an addiction physician in Concord, Calif.,
treats people who have gone without sleep for as long as 10 days. The
record-holder was a woman up 21 days. "Politely put, she was crazier
than a barn owl," he says.

Obviously that patient had not been able to restrict her meth use to
recreation. In jargon, she was bingeing.

During the roller-coaster ride, the user continues to chase -- but can
never recapture -- the intensity of the initial euphoric sensation.
Over three to 15 days, he will help himself to more and more meth. He
typically favors smoking or injecting it over snorting or drinking it
dissolved in liquid (usually alcohol), because the payoff is so much
faster and stronger.

Aggression and paranoia set in in the tweaking stage, which can
persist 24 hours. (Afterwards, the body must collapse, so the user
sleeps for one to three days.)

The only thing more dangerous than a tweaker is a tweaker in the
company of others, notably those who are weaker. The Pierce County
Sheriff's Department has documented the intersection of meth labs and
domestic violence in the area surrounding McChord Air Force Base.
Tweakers, with extreme sleep deprivation, need no provocation to lash
out. They exist in their own world during this phase of the binge.

In his San Diego emergency room, Sise repairs the handiwork of
tweakers far too often. He's stitched together the heart of a woman
stabbed by the meth dealer who stole her money, removed a blood clot
from the gangrenous leg of a young binger. He told a woman her
daughter died of a gunshot wound suffered during an argument with her
meth-using boyfriend.

People steeped in the culture of meth, be they police officers or
treatment providers, say when they hear of an abnormally violent act,
their first thought is meth. Two years ago an Arizona man repeatedly
stabbed his 14-year-old son, then decapitated him and threw his head
out the window of a van. The man, now serving a 30-year sentence, had
been convinced the devil was inside the van.

Meth abusers die at higher rates from suicide, traffic accidents and
murder, and commonly succumb to overdoses or malnutrition.

Ron Jackson, director of Seattle's Evergreen Treatment Center for
heroin addiction, paints the difference:

"People on heroin are basically going to leave you alone unless
they're desperate for money. Somebody loaded on meth is going to be
much more dangerous."