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Methamphetamine: New Knowledge and Effective Treatment Approaches

Methamphetamine: New Knowledge and Effective Treatment Approaches. Thomas Freese, PhD Beth Rutkowski, MPH. Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs Alhambra, CA February 10, 2006. Speed.

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Methamphetamine: New Knowledge and Effective Treatment Approaches

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  1. Methamphetamine: New Knowledge and Effective Treatment Approaches Thomas Freese, PhD Beth Rutkowski, MPH Pacific Southwest Addiction Technology Transfer Center UCLA Integrated Substance Abuse Programs Alhambra, CA February 10, 2006

  2. Speed • It is methamphetamine powder ranging in color from white, yellow, orange, pink, or brown. • Color variations are due to differences in chemicals used to produce it and the expertise of the cooker. • Other names: shabu, crystal, crystal meth, crank, tina, yaba

  3. Ice High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

  4. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

  5. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over) < 12 SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

  6. Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2002(per 100,000 aged 12 and over) < 12 35 -58 200 or more 150-199 100-149 12 - 35 58-99 SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

  7. Percentage of Arrestees Testing Positive for Methamphetamine - 2002 San Jose Salt Lake City Portland SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring Program (ADAM), 2003.

  8. IHS-Wide RPMS PCC Outpatient Encounters for Amphetamine Related Visit by Calendar Year

  9. Trends in LA County Treatment Admissions by Primary Substance of Abuse SOURCE: ADP, California Alcohol and Drug Data System, 2005.

  10. Poison Control Center Calls for Major Substances of Abuse: 2000-2004 Los Angeles County SOURCE: California Poison Control System, 2004.

  11. DAWN Major Substances of Abuse: Los Angeles County, CY 2004 N=8,982 SOURCE: DAWN, OAS, SAMHSA, updated 4/13-14/2005.

  12. NFLIS Illicit Drug Items: LA County, Jan-Dec 2004 N=53,972 SOURCE: DEA, National Forensic Laboratory Information System (NFLIS), 2004.

  13. Methamphetamine in Los Angeles County

  14. Methamphetamine Lab Equipment

  15. SOURCE: www.stopdrugs.org

  16. Methamphetamine: A Growing Menace in Rural America • In 1998, rural areas nationwide reported 949 methamphetamine labs. • Last year, 9,385 were reported. • This year, 4,589 rural labs had been reported as of July 26. • Source: El Paso Intelligence Center (EPIC), U.S. DEA

  17. Lab Seizure Locations • Most common meth lab facilities were single-family houses, followed by apartments, mobile homes, vehicles in traffic stops, garages, trailers, motels/hotels, businesses, desert, and storage.

  18. Toxic Effects of Methamphetamine • Manufacturing • Abuse • Fetal exposure

  19. Clandestine Meth Lab

  20. Clandestine Meth Lab

  21. Drug Endangered Children

  22. High Incidence of Domestic Violence in MA-Abusing Homes • Threatening notes • Dangerous & stressful environment for children

  23. Children • Children who live in and around the area of the meth lab become exposed to the drug and its toxic precursors and byproducts. • 80-90% of children found in homes where there are meth labs test positive for exposure to meth. Some are as young as 19 months old. 

  24. Children • Children can test positive for methamphetamine by: • Having inhaled fumes during the manufacturing process • Coming into direct contact with the drug • Through second-hand smoke.

  25. Children • Hundreds of children are neglected by parents who are meth cooks. Nationally, over 20% of the seized meth labs in 2002 had children present. • In Washington State, the counties of Grays Harbor, Spokane, Thurston, and Klickitat all reported that children were found at half the labs seized in 2002. In Lewis County, children were found at 60-70 %, and in Clark-Skamania, 35%.

  26. Children • In 2002, a total of 142 children were present at lab seizures in Riverside and San Bernardino Counties. • Most children reported as being present during a seizure were school age.

  27. Children • Social workers now accompany law enforcement during lab seizures with children involved. • Parents are often charged with second-degree criminal mistreatment, along with manufacturing charges. • Allowing children to live in a toxic environment where additional risks of explosion and fire are high is considered to be neglect at best to child abuse.

  28. Children are not small adults! • Different diet • Growing & developing rapidly • Higher metabolic & respiratory rate • Developing nervous system • Unusual habits (hand-to-mouth behaviors; close to floor, contact with many surfaces, at risk for all poisonings) • Biologic & developmental vulnerability

  29. DEC RESPONSE TEAM • CORE TEAM MEMBERS: • LAW ENFORCEMENT (24/7) • CHILD PROTECTIVE SERVICES (24/7) • DISTRICT ATTORNEY’S OFFICE (24/7) • MEDICAL PERSONNEL (24/7) • “AUXILIARY” TEAM MEMBERS: • MENTAL HEALTH & THERAPEUTIC PERSONNEL FOR CHILDREN • ENVIRONMENTAL SERVICES, FIRE, & PUBLIC HEALTH • DRUG TREATMENT PROVIDERS FOR PARENTS AND FAMILY MEMBERS

  30. WWW.NATIONALDEC.ORG

  31. Methamphetamine Addiction The brains of people addicted to Methamphetamine are different than those of non-addicts

  32. FOOD SEX 200 200 NAc shell 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 Scr Scr Scr Scr 0 60 120 180 Bas Female 1 Present Female 2 Present Mounts Time (min) Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Natural Rewards Elevate Dopamine Levels

  33. Effects of Drugs on Dopamine Levels COCAINE AMPHETAMINE Accumbens 1100 Accumbens 400 1000 900 DA 800 DA 300 DOPAC 700 DOPAC % of Basal Release HVA HVA 600 % of Basal Release 500 200 400 300 100 200 100 0 0 0 1 2 3 4 5 hr Time After Amphetamine Time After Cocaine MORPHINE NICOTINE 250 Accumbens 250 Dose (mg/kg) 200 Accumbens 0.5 200 Caudate 1.0 2.5 % of Basal Release 150 % of Basal Release 10 150 100 0 1 2 3 hr 100 0 1 2 3 4 5 hr 0 0 0 1 2 3 4 5hr Time After Nicotine Time After Morphine Source: Di Chiara and Imperato

  34. PET Scan of Long-Term Impact of Methamphetamine on the Brain

  35. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients %ID/cc 0.030 0.015 0.000 Control Meth PD Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

  36. 2.0 Motor Activity 1.8 1.6 1.4 (Bmax/Kd) Dopamine Transporter 1.2 1.0 7 8 9 10 11 12 13 Normal Control Time Gait (seconds) 2 Memory 1.8 1.6 1.4 Dopamine Transporter Bmax/Kd 1.2 1 16 14 12 10 8 6 4 Methamphetamine Abuser Delayed Recall p < 0.0002 (words remembered) Dopamine Transporters in Methamphetamine Abusers

  37. Cognitive Impairment in Individuals Currently Using Methamphetamine Sara Simon, Ph.D. VA MDRU Matrix Institute on Addictions LAARC

  38. Differences between Stimulant and Comparison Groups on tests requiring perceptual speed

  39. Memory Difference between Stimulant and Comparison Groups

  40. Longitudinal Memory Performance number correct test

  41. Control > MA 4 3 2 1 0

  42. 5 4 3 2 1 0 MA > Control

  43. DA Receptor Levels and Response to MP unpleasant response High Dopamine Transporters Low Dopamine Transporters pleasant response 2.5 0 Subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasant

  44. How much does the brain heal?

  45. PET Scan of Long-Term Meth Brain Damage

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