WAR ON 'ICE' HEATS UP IN HAWAII

Federal Funds Will Help Local Researchers Study A Devastating Addiction

Hawaii, the "crystal meth capital of the country," is one of six sites
selected for a national study of treatments for crystal methamphetamine
(ice) addiction, says Dr. William Haning III, University of Hawaii
psychiatry professor.

Psychiatrists participating in the study hope to develop a treatment program
and research structure that could support a clinic for ice addicts as a
spinoff, Haning said.

Haning and Dr. Barry Carlton, also a UH psychiatry professor and chief of
psychiatry at Queen's Medical Center, are principal investigators of the
Pacific Addiction Center, a program of the John A. Burns Medical School and
Queen's.

The National Institute of Drug Abuse is funding a series of studies that
probably will amount to $350,000 in the first five years, Haning said.

Other sites in the study, coordinated by the University of California-Los
Angeles, are Costa Mesa and San Diego, Calif.; Des Moines, Iowa; Kansas
City, Kan.; and San Antonio. Rural areas are included because they are
ice-manufacturing centers.

Haning said the study grew out of a 1999 ice addiction treatment think tank
to which he was invited in Washington, D.C.

The major question was about what medications already on the shelf can be
used to treat addicts, he said. Preliminary research suggested some will
work, he said. "We just don't know how well they will work."

The Honolulu study began with a behavioral trial in August last year, using
"talk therapy" to characterize ice withdrawal symptoms and establish a
foundation for research with medications, Haning said.

Each site hopes to have 30 voluntary participants, each involved for about
two months, Haning said. They are being drawn from Queen's emergency room,
clinics or referrals from doctors and families, but recruitment is slow
because of rigorous criteria, he said.

Expenses will be defrayed for participants, and they will receive free
health screenings, treatments and referrals to specialists if medical
problems are detected.

More than half of all psychiatric admissions to Queen's involve
methamphetamine, Haning said, pointing out it is a growing health epidemic.

Usage in Hawaii has been estimated as high as 20 percent of the population
but more realistically is 10 percent to 15 percent, he said. Those presently
dependent on ice probably are in the 1 to 2 percent range, he said.

Ice is cheaper than marijuana now, said Carlton.

"For the cost of a movie, you can get high for a day and destroy your brain
at the same time. That's actually the problem of kids."

Haning, medical school associate dean of graduate medical education and
faculty affairs, said methamphetamine began in the United States as an oral
tablet for therapeutic purposes and is still "a very good drug" for
attention deficit hyperactivity syndrome.

But when the drug is used intravenously or by inhaling it "to enhance
euphoric qualities," people are inclined to use it compulsively and
progressively, he said.

He described how crystal meth spread from an intravenous epidemic in San
Francisco to a nasal inhalation epidemic in San Diego. It became a
"performance drug ... for bored, hard-working people to get through the
day," he said.

In the first years, ice users may have a lower risk for accidents because
they are more attentive, so they justify it as being "therapeutic," Haning
said.

As they ramp up the dosage, however, they are at risk for developing
psychiatric symptoms and medical problems, the psychiatrists said.

Illusions are the most common effect, followed by delusions and
hallucinations, Haning said. What distinguishes crystal meth hallucinations
is the subjects' feeling that something is touching them, like ants crawling
on their skin, he said.

"You'll see some addicts with lots of gouges and scratches on the face and
arms. They call it an 'ice rash.' But ultimately it's because they sense
something is there and they're trying to carve it out of their arms or
faces. It can be gruesome." Additionally, Carlton said they are "seeing
20-year-olds with 60-year-old hearts" and some addicts with ice-induced
cardiac arrhythmia. Muscle also is destroyed, which can damage the kidneys,
he said.

Ice also gets rid of chemicals that control mood and stability of the brain,
and users coming off a high become overwhelmingly depressed, he said.
Overstimulation causes paranoia and continued overstimulation "changes the
brain to say, 'I need it, I need it, I need it,'" he said.

Criminal acts may occur with loss of restraint and inhibitions, Carlton
said. Those doing crimes may argue that they were not intoxicated at the
time, but the effects that reduce inhibitions last beyond intoxication, he
said.

People who stop using crystal meth can return to normal, but if they even
walk past or meet a person where they usually got their drugs, the brain
tells them to "use, use, use" and the cycle starts over again, Carlton said.

The craving is also place-dependent, the psychiatrists pointed out. Haning
said he had a student who spent months in recovery and got into Narcotics
Anonymous. Taking the message to other addicts, he went to see a buddy with
whom he used to smoke ice.

"An ice pipe was sitting on the coffee table. He goes with a copy of
Narcotics Anonymous in hand, his head full of NA recovery, going up against
someone willing to stop using, and before the hour was over, both were using
ice because of the cue sitting there on the table," Haning said.

Participants will receive either a medication or a placebo (substitute) in a
double-blind study, and the psychiatrists will meet with them three times a
week for three hours a night. Sequential studies may go on five to 10 years,
Haning said.