Methamphetamine: Issues, Concerns

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MethamphetamineIssues, Concerns Solutions
Bob Dewbury Tracy Flaherty-WillmottAFM
Winnipeg(204) 944-6235
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Agenda

• Intro to AFM resources and philosophy
• Whats Going On Out There?
• Meth 101
• What it is
• How it affects the brain and body
• Why its popular
• The associated dangers
• Withdrawal Recovery Issues

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AFM Youth Services

• Who to Refer
• Any young person (12-19th birthday) whose
  alcohol, other drug or gambling involvement is of
  concern.
• Services We Offer
• Our goal is to provide youth clients with the
  information, skills and opportunities to
  successfully address their concerns about alcohol
  and other drug use, or gambling involvement, and
  any related problems.
• Intake Assessment, 1-1 Counselling, Group
  Counseling, Parent Intervention Program
• How to Refer
• In Winnipeg - Phone [phone] and ask to speak to
  an Intake Counsellor.
• Office located at 200 Osborne Street North,
  across from Memorial Park. Parking is available
  on Colony Street.
• In Rural Areas consult www.afm.mb.ca contains
  contact numbers for all AFM offices province wide

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The Public Messages

• "No one ever tries Meth just once

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Best Practices in Prevention/Education

• Comprehensive
• Factual Encourage Critical Thinking
• Recognize Complexities
• Balanced Approach Avoid Minimizing Maximizing
• Facilitative Style
• Non-Judgemental/Use of Empathy
• Make Room for Hope

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Why Kids Experiment/Continue to Use

• Glassers Basic Needs
• TO SURVIVE
• TO BELONG
• TO HAVE POWER
• TO BE FREE
• TO HAVE FUN

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Does drug use a drug problem?
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Substances Used by MB Students(2004 Survey)

• Alcohol 73
• (80 in Senior Grades)
• Cannabis 33
• (42 in Senior 4)
• Statistics for Senior High
• Mushrooms 12
• Meth 3
• Club Drugs (Ecstasy 2.6) 3
• Cocaine/Crack 5
• Other Stimulants 3
• Other Hallucinogens 3
• Inhalants 3

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Trends in Alcohol Consumption(2004)

• 73 of students (Grade 7-S4) drank alcohol in
  the past year
• Less than 10 of students get drunk on a weekly
  basis
• 52 of males 51 of females began drinking
  before the age of 15
• Binge Drinking 25 of students drink more than
  5 drinks about once per month
• Hazardous Drinking About 15 drink 8 or more
  drinks at least once per month

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Impaired Driving Statistics(2004)

• 19 of male students and 14 of female students
  have driven within one hour of consuming 2 or
  more drinks
• 20 of males and 15 of the females over the age
  of 16 have driven under the influence of THC this
  last year
• Over half of Grade 12 students have been a
  passenger in a car with someone who has been
  drinking
• Almost half of Grade 12 students have been a
  passenger in a car with a driver who has been
  smoking cannabis

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Harm Reduction Messages

• Is it appropriate for the audience?
• Generally not appropriate for non-involved kids
• Get youth to generate them
• What does safer drinking look like?

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Marijauna Trends

• Next to alcohol, cannabis is the next most widely
  used drug.
• 2.3 of those surveyed are using THC 2-3 x/month
• 2.7 are using 2-3 x/week and 1.9 are using
  daily
• 69.9 of those surveyed have never tried
  cannabis

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AFM Meth Stats

• AFM Adult Clients
• 2002 2003 4
• 2003- 2004 4.7
• AFM Youth Clients who had tried meth
• 2002 - 2003 14
• 2003 2004 15.5
• 2004 2005 18.5
• Compass Stats
• 2001-2002 1 meth as drug of choice
• 2004-2005 11 meth as drug of choice
• 28 had used meth before

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West to East Movement for Meth Use in Canada

• Alberta, Saskatchewan and Manitoba have all seen
  increase in use and related issues
• The largest numbers of users appear in BC
• The Toronto Star reports that, Meth is starting
  to replace crack as the DOC in the downtown
  core.
• This west to east movement is similar for most
  drugs.

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Meth and Women

• First drug in history that females likely to have
  a problem with use as much a males (approx. 50/50
  typical 31 ratio with other substances)
• Why is this?

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A Brief History1887 -1945 (SourcePatricia
Case, Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)

• 1887 Amphetamine first synthesized in
  Germany
• 1919 Methamphetamine synthesized in Japan
• 1927 Amphetamine used as a substitute for
  ephedrine
• 1932 Benzedrine (amphetamine) in OTC nasal
  inhalers
• 1935 Benzedrine tablets available by
  prescription
• 1937 Benzedrine used to treat 39 other
  conditions
• 1937 Gorell recommends Benzedrine for
  fatigued doctors
• 1938 First published report of
  amphetamine addiction
• 1938 First description of amphetamine
  psychosis
• 1940 Eggleston there is not much danger
  of addiction
• 1940-45 Critical wartime period as all sides
  go to battle on amphetamines

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Medical Advance Benzedrine1930s Wonder Drug
(SourcePatricia Case, Sc.D.Harvard Medical
School, 1st National Conference on
Methamphetamine, HIV and Hepatitis, 2005)
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Wartime Benzedrine (SourcePatricia Case,
Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)
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Benzedrine Goes Bad 1950 -1959 (SourcePatricia
Case, Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)
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Selling Speed 1950 -1965 (SourcePatricia Case,
Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)
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The Hidden Agenda Housework (SourcePatricia
Case, Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)
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Methamphetamine Goes Bad 1962-1969
(SourcePatricia Case, Sc.D.Harvard Medical
School, 1st National Conference on
Methamphetamine, HIV and Hepatitis, 2005)
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Outbreak Emergence 1970 1975 (or so)
(SourcePatricia Case, Sc.D.Harvard Medical
School, 1st National Conference on
Methamphetamine, HIV and Hepatitis, 2005)
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Meditation on the Future (SourcePatricia Case,
Sc.D.Harvard Medical School, 1st National
Conference on Methamphetamine, HIV and Hepatitis,
2005)

• What will happen with ProVigil, approved in 1998
  and now used extensively by the military in Iraq?

Drug keeps pilots awake By Peter Mucha, Inquirer
Staff Writer A much-ballyhooed anti-drowsiness
drug made by West Chester-based Cephalon Inc. is
taking off as the Air Force's new
"go-pill. Provigil, also known by its generic
name, modafinil, has been used more than 150
times this year by bomber crews to ward off
sleepiness on missions of more than 12 hours.
2005 Projected Sales 400 million
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What is Methamphetamine?

• A synthetic stimulant that affects the brain and
  the body
• Can be smoked, snorted, swallowed or injected
• Is highly addictive
• Often made in clandestine labs from inexpensive
  over-the-counter ingredients
• Street names include meth, crystal, crystal meth,
  ice, crank, chalk, tina, jib, speed, etc., etc.

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Meth
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Costs in Winnipeg 2005

• Cocaine
• 25.00 per ¼ gram (crack)
• 80.00 per gram (powder)
• Meth
• 10.00 per point (1/10th gram)

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Search of person in Agassiz results in .7g of
CRYSTAL METH
AUGUST 2005
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Cost Effectiveness

• 40 worth of crack high 5-10 minutes
• 20 worth of cocaine high 20-30 minutes
• 10 Methamphetamine high for 6 hours or more

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Meth vs. Cocaine

• Meth
• Man-made
• 50 of the drug removed from the body in 12 hours
• Potential fall into addiction quicker
• Domestic untrained cooks or superlabs

• Cocaine/Crack
• Plant derived
• 50 of the drug removed from the body in 1 hour
• Slide to compulsive use quicker with crack
• Imported links to organized crime gang
  activity

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Why is Meth becoming more popular

• Available Accessible
• Inexpensive in comparison to other drugs
• Weight loss
• The duration of the high
• Increased energy, alertness, confidence and sex
  drive
• Often connected with certain lifestyles, scenes
  or activities

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Dangers Affiliated with Meth

• Potential for dependent involvement
• Potential for rapid physical emotional
  decline/risks
• Potential for violence assaults, gunshots,
  stabbings, suicide
• Clandestine labs environmental risks
• Untrained cooks, unpredictable drug effects
• Need for improved treatment resources/approaches
  to meet specific needs
• Traditionally, rural communities are at high risk
• How are these dangers the same or different re
  Cocaine/Crack??

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Meth is Addictive

• Natural rewards elevate dopamine
• Higher rush associated with stronger cravings
• Smoking shooting meth gives very big rush in
  5-7 seconds.

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Instantly Addictive?

• Only 4.6 of Americans who any lifetime use of
  methamphetamine, used meth in the last month
  (1999 Survey)
• 6.4 of Canadians had used amphetamines of any
  kind Less than 1 of those had used in the last
  year (2004 Canadian Addiction Survey) (The Meth
  Epidemic that Isnt. Dan Gardener, The Ottawa
  Citizen, Friday, July 7, 2006)

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LEVELS OF INVOLVEMENT

• Non Involvement
• Irregular Involvement
• Regular Involvement
• Harmful Involvement
• Dependant Involvement

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Methamphetamine Ingredients

• Each of these ingredients are/may be added to the
  process of chemically altering pseudo-ephedrine
  (removing one oxygen molecule)
• They are added to accelerate the chemical process

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Methamphetamine Ingredients

• Whatever method a cook chooses to use, he cannot
  make meth without the ephedrine or
  pseudoehpedrine.
• They are to meth what flour is to bread THE
  essential ingredient

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Essential Meth Ingredients

• Ephedra a natural stimulant found in shrub like
  plant ma huang, which grows naturally in India or
  China. The dried plant has been used medicinally
  for centuries. The active ingredient (one per
  cent) is ephedrine.
• Ephedrine an alkoloid from the leaves of the ma
  hung plant. Used as bronchial decongestant and
  stimulant. Also found in many weight loss
  products
• (Source Winnipeg Free Press, Sunday Dec. 11,
  2005)

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Essential Meth Ingredients

• Pseudoephedrine Synthetic variety of ephedrine,
  but less potent. Used in many over-the-counter
  cold medications, such as nasal decongestants
  Sudafed, Actifed and Contact. Also acts as a
  central nervous system stimulant. Sometimes
  abused by athletes before a competition to
  stimulate heart rate and brain activity.
• (Source Winnipeg Free Press, Sunday Dec. 11,
  2005)

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Phenylephrine Sudafed

• Sudafed adding new lines of decongestants that
  use phenylephrine instead of pseudoephedrine.
• A decongestant-only phenylephrine product,
  Sudafed PE to be on shelves in January.
• (Source Drugmakers take action to foil meth
  cooks,Donna Leinwand, USA TODAY

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Manitoba Meth Watch Program

• Moving cold medications behind counter tracking
  sales
• Oklahoma restrictions resulted in 90 reduction
  in mom pop labs
• Oklahoma - Affected supply for 6 months street
  supply returned increased potency

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Remember

• A persons experience with any drug can vary.
  Things that may have an impact on that experience
  can include but are not limited to the amount
  and strength of the drug consumed, the setting in
  which it is used, a persons mood or expectations
  prior to using, gender, overall health, as well
  as a persons past experience with that drug.

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Meth Use Overdose

• Toxic reactions can occur at low levels
• As low as 50 milligrams of pure meth for
  non-tolerant user (half a point)
• Metabolic rates vary form person to person,
  strength of the drug will vary from batch to
  batch
• There is no defined safe level of use due to
  unpredictability of each batch
• Sign of OD include high fever, convulsions,
  cardiovascular collapse

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How meth affects the body brain

• While under the influence
• Alertness, Talkative, Increased Energy, Quick
  Movements
• Increased heart rate, blood pressure, breathing
  rate, body temperature
• Feelings of euphoria, power, energy, excitement,
  confidence
• Increased sensory acuity and sex drive
• Dilated pupils, no need to eat or sleep
• Feelings of anxiety, paranoia aggression
  possible
• Tweaking behaviours, possible hallucinations
  resulting injuries
• High from the drug may last 6-24 hours
• Potential to use in binge pattern

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Fetal Toxicity from Meth Abuse

• Early effects
• - fetal death
• - small for gestational age
• Late effects
• learning disability
• poor social adjustment

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WHAT HAPPENS WHEN METH THE BRAINGET
TOGETHER???
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Dopamine Transmission

• Dopamine
• Crystal Meth

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Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body
Dopamine Gives a sense of reward and pleasure Associated with body movement Too little dopamine causes paralysis or Parkinsons-like tremors and rigidity. Too much dopamine and a person can become paranoid, hear voices, and have irrational, bizarre thinking METHAMPHETAMINE USE REASONS, RISKS, AND PRACTICAL INTERVENTIONSNeva Chauppette, Psy.D. (1st National Conference on Methamphetamine, HIV and Hepatitis, August 2006)
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Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body
Serotonin Plays a role in depression, sex, and regulating body temperature Involved with many emotional disorders like schizophrenia, phobias, super-aggressive states, and obsessive-compulsive behavior It is involved in sleep and sensory perception. Too much serotonin can make it difficult (or impossible) to have an orgasm METHAMPHETAMINE USE REASONS, RISKS, AND PRACTICAL INTERVENTIONSNeva Chauppette, Psy.D. (1st National Conference on Methamphetamine, HIV and Hepatitis, August 2006)
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Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body Three Neurotransmitters Play A Big Part In How Crystal Meth Affects The Mind Body
Norepinephrine Increases alertness and concentration Helps kill pain and regulate blood pressure Basic instincts like hunger, thirst, and sex can be triggered by norepinephrine Too much contributes to impotence METHAMPHETAMINE USE REASONS, RISKS, AND PRACTICAL INTERVENTIONSNeva Chauppette, Psy.D. (1st National Conference on Methamphetamine, HIV and Hepatitis, August 2006)
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Methamphetamine Binge Use

• Methamphetamine has a 9-12 hour half-life, which
  means that weekend warriors can start on Thursday
  and dose five times and make it to Sunday
  evening. (Steven Shoptaw, UCLA Integrated
  Substance Abuse Programs)

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BINGE USE
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Withdrawal Issues The Brain Without Meth

• What is significant about the impact of Meth use
  on the brain?

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Initial Crash Withdrawal (2 days 2 weeks)

• Exhaustion
• Confusion poor concentration
• Hallucinations
• Fatigue Insomnia
• Memory loss, esp. verbal
• Paranoia
• Irritability
• Depression (Anhedonia)
• Potential for Anger Aggression
• Potential for Psychosis (1 of users)
• Intense Cravings

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Psychological Distress Compared to other drug
users - Meth users are more depressed, more
suicidal, and have more psychopathology
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Meth Withdrawal is associated with

• Impaired Memory
• Impaired manipulation of information
• Impaired impulse control
• Impaired vigilance
• Impaired decision making
• Increased depression
• Increased craving
• Because of these factors intervention needs to be
  directive and clear in early recovery

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Effect of Meth on the BrainDopamine

• Research has shown that as much as 50 of the
  dopamine producing cells in the brain can be
  functionally changed after prolonged exposure to
  relatively low levels of meth.
• Research has also found that serotonin-containing
  nerve cells can also be changed.

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What do you know about Alcohol?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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Attitudes about Binge Drinking?
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What do you know about Marijuana?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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What do you know about Mushrooms?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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What do you know about Cocaine?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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What do you know about Ecstasy?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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What do you know about Meth?

• How is it used?
• What are short-term effects?
• What are long-term effects?
• What are other risks?

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WithdrawalWhat Caregivers Can Do To Help

• Help them get plenty of sleep
• Plenty of fluids healthy foods
• Low stimulation environment
• Seek to be non-confrontational, especially in
  early withdrawal
• Remind them that their body and brain need time
  to heal
• Connect then with helping professionals address
  mental health concerns as they arise
• Ensure safe housing to avoid triggers
• Encourage physical activity and involvement in
  spiritual and cultural activities
• Consult a physician for medical concerns

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Potential Long Term Effects

• Chronic Depression Inability to Experience
  Pleasure
• Malnutrition vitamin deficiencies
• Jaw Teeth Problems (particularly if smoked)
• Damage to heart, lungs, liver, kidneys nerve
  cells
• Users are more likely to die from long term
  health problems than a meth overdose
• Insomnia
• Panic reactions
• Speech thought disturbances
• Memory Loss
• Possibility of Psychosis
• Episodic Cravings, especially when Triggered

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Signs of a Problem

• Socially
• Unexplained absences (AWOLs)
• Change in peer group
• Legal issues
• Loss of interest in regular activities/hobbies
• Withdrawn from peers, secretive
• Money problems
• Frequent change of address

• Emotional Indicators
• Depression
• Mood swings
• Aggression/violence
• Preoccupied with substances
• Cravings for the substance
• Physical Indicators
• Weight loss
• Exhaustion, lethargy
• Appears run down, ill
• Skin conditions welts, acne
• Secondary infections
• Unexplained injuries accidents
• Cravings for substance

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CRAFFT Questions (Knight et al, 2002)

• C
• R
• A
• F
• F
• T

• Have you ever ridden in a CAR driven by some
  (including yourself) who was high or had been
  using alcohol or drugs?
• Do you ever use alcohol or drugs to RELAX, feel
  better about yourself, or fit in?
• Do you ever use alcohol/drugs while you are by
  yourself, ALONE?
• Do your FAMILY or FRIENDS ever tell you that you
  should cut down on your drinking or drug use?
• DO you ever FORGET things you did while using
  alcohol or drugs?
• Have you gotten into TROUBLE while you were using
  alcohol or drugs?
• 2 endorsements red flag

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Penny Wood and Son

• Clean for two years and four months
• Recently married and wanting to open a half way
  house
• Some permanent damage to lungs (chronic cough)
• Some damage to kidneys and bowels
• (Source Cobblestones Rare Story of a Woman
  who conquered Meth. Manitoba Magazine,
  Holiday/Winter Issue, pg. 18)

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AFM Resources Prevention

• www.afm.mb.ca search for all library resources
  this would include books, videos, articles
• MAAW Kit also found on Website, should be coming
  to a school near you via the mail
  www.afm.mb.ca/maaw/
• Also on website The Basics found under Learn
  Much More/Alcohol and other drugs set of
  printable pamphlets
• Recommended Videos for Sr.1-4
• General AOD Info What is your Drug IQ? (Gr. 6
  Sr. 4, 17 min)
• Alcohol Binge Drinking Blowout
• Marijuana The Mirror that Magnifies
• Ecstasy Nothing to Rave About
• Methamphetamine The Rush to the Crash

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Wrap-up Questions