Methamphetamine: New
Knowledge about the Epidemic,
the Neurobiology and Clinical
Issues
Richard A. Rawson, Ph.D, Professor
Integrated Substance Abuse Programs
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine
University of California at Los Angeles
www.uclaisap.org
rrawson@mednet.ucla.edu
Supported by:
National Institute on Drug Abuse (NIDA)
Pacific Southwest Technology Transfer Center (SAMHSA)
United Nations Office of Drugs and Crime
Methamphetamine

Methamphetamine is a powerful central
nervous system stimulant that strongly
activates multiple systems in the brain.
Methamphetamine is closely related
chemically to amphetamine, but the central
nervous system effects of
methamphetamine are greater.
Forms of Methamphetamine
Methamphetamine Powder
IDU Description: Beige/yellowy/off-white
powder
Base / Paste Methamphetamine
IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel,
moist, waxy
Crystalline Methamphetamine
IDU Description: White/clear
crystals/rocks; ‘crushed glass’ / ‘rock salt’
EPHEDRINE
H
H
C
C
OH
CH3
H
H
C
C
H
CH3
H
N
CH3
METHAMPHETAMINE
H
N
CH3
Scope of the Methamphetamine
Problem Worldwide


According to surveys and estimates by WHO
and UNODC, methamphetamine is the most
widely used illicit drug in the world except
for cannabis.
World wide it is estimated there are over 26
million regular users of
amphetamine/methamphetamine, as
compared to approximately 16 million heroin
users and 14 million cocaine users
Methamphetamine
The US Epidemic
Figure 1. Methamphetamine/Amphetamine Treatment
Admission Rate per 100,000 Population Aged 12 or Older:
1992-2002
Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).
The Eastward Spread of
Methamphetamine
Primary Amphetamine/Methamphetamine TEDS
Admission Rates: 1992
(per 100,000 aged 12 and over)
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine TEDS
Admission Rates: 1997
(per 100,000 aged 12 and over)
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 2003
(per 100,000 aged 12 and over)
Incomplete Data
< 5
5 - 59
60-126
127+
The Methamphetamine Epidemic:
Admissions/100,000: 1992-2003
It keeps going up
350
300
California
250
Hawaii
200
Iowa
150
Oregon
100
Washington
50
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
93
19
19
92
0
Figure 2. Methamphetamine/Amphetamine Treatment
Admissions, by Route of Administration: 1992-2002
Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).
National Association of Counties
(NACo) 2006 Survey of Sheriffs




Methamphetamine remains number one
drug problem
according to new survey of the nation’s
counties.
Legislation that restricts the sale of
precursors works.
The majority of meth currently being
abused is from outside of the state.
The full survey is available
at www.naco.org.
National Association on Counties
(NACo) 2006 Survey of Sheriffs






% Sheriffs ranking meth worst problem
100% in Calif, Hawaii, Idaho, Arizona, New Mexico,
Wyoming, Washington, Utah, Nevada
88% Oklahoma, Iowa 79%, Louisiana 75%
Nebraska 74%
64% Georgia
44% North Carolina
43% Alabama
National Association on Counties
(NACo) 2006 Survey of Sheriffs

Crimes related to meth continue to
grow during past year.
– 55% of law enforcement officials reported an
increase in robberies or burglaries in the last
year.
– 48 % reported an increase in domestic violence.
– 41 % reported an increase in simple assaults.
– 31% reported an increase in identity theft crime,
which is up from the 27 percent reported in
2005.
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
Anhydrous Ammonia Tank
Tips Officers to Possible
Meth Lab
5/4/04 Omaha, Neb. – A large
anhydrous ammonia tank
helped Sarpy County
Sheriff’s deputies bust
a suspected
methamphetamine
lab Tuesday.
SOURCE: TheOmahaChannel.com
Meth Epidemic; less
drama, more long term
risk/danger





Cocaine/Crack epidemic hit fast (in NYC 1986-87, as
well as other major east coast cities); overnight
emergency, tremendous media attention.
Big federal response (Reagan and Bush I). High
visibility deaths, stigmatization as a ghetto drug.
Dramatic decreases in indicators by early 1990s,
except in inner cites of east coast.
Crack epidemic: Rapid onset; Rapid decrease
Meth epidemic: Slow west to east spread. No
decrease in western cities. Use becomes endemic?
Methamphetamine: What
does it do?
Methamphetamine
Acute Physical Effects
- Increases
Heart rate
Blood pressure
Pupil size
time
Respiration
Sensory acuity
Energy
-Decreases
Appetite
Sleep
Reaction
Methamphetamine
Acute Psychological Effects

Increases
– Confidence
– Alertness
– Mood
– Sex drive
– Energy
– Talkativeness

Decreases
– Boredom
– Loneliness
– Timidity
Methamphetamine
Chronic Physical Effects
- Tremor
- Weakness
- Dry mouth
- Weight loss
- Cough
- Sinus infection
-
Sweating
Burned lips; sore nose
Oily skin/complexion
Headaches
Dental Problems
Anorexia
METH Use Leads to Severe Tooth
Decay
“METH Mouth”
Source: The New York Times, June 11, 20
Meth Use in Hawaii


The number of crystal methamphetaminerelated deaths has already doubled in Oahu in
the last five years.
"You've heard the stories about people on ice
who die in confrontations with police, but
most ice deaths happen quietly, sending
people to the morgue after their bodies just
can't keep up with the crystal meth in their
systems," Honolulu Chief Medical Examiner
Dr. Kanthi De Alwis said.
Meth Use in Hawaii








As of the middle of May, not even halfway through the
year, the city medical examiner's office already recorded
38 deaths connected to crystal methamphetamine. So,
we're well on the way to exceeding last year's total of 68.
Deaths:
2005 (mid-May) - 38 deaths
2004 - 68 deaths
2003 - 56 deaths
2002 - 62 deaths
2001 - 54 deaths
2000 - 34 deaths
Methamphetamine
Chronic Psychological
Effects
-
Confusion
Concentration
Hallucinations
Fatigue
Memory loss
Insomnia
-
Irritability
Paranoia
Panic reactions
Depression
Anger
Psychosis
Methamphetamine
Psychiatric Consequences







Paranoid reactions
Permanent memory loss
Depressive reactions
Hallucinations
Psychotic reactions
Panic disorders
Rapid addiction
MA Psychosis Inpatients from 4
Countries
No. of patients having
symptoms (%)
Psychotic symptom
Lifetime
Current
Persecutory delusion
Auditory hallucinations
Strange or unusual beliefs
Thought reading
Visual hallucinations
Delusion of reference
Thought insertion or made act
Negative psychotic symptoms
Disorganized speech
Disorganized or catatonic behavior
130 (77.4)
122 (72.6)
98 (58.3)
89 (53.0)
64 (38.1)
64 (38.1)
56 (33.3)
35
75
39
27
38
20
18
36
19
14
(20.8)
(44.6)
(23.2)
(16.1)
(22.6)
(11.9)
(10.7)
(21.4)
(11.3)
(8.3)
Srisurapanont et al., 2003
MA Psychosis

69 physically healthy, incarcerated Japanese
females with hx MA use
– 22 (31.8%) no psychosis
– 47 (68.2%) psychosis
19 resolved (mean=276.2±222.8 days)
 8 persistent (mean=17.6±10.5 months)
 20 flashbackers (mean=215.4±208.2 days to initial
resolution)

– 11 single flashback
– 9 Recurrent flashbacks
2001

Yui et al.,
Polymorphism in DAT Gene associated with MA
psychosis in Japanese
2003
Ujike et al.,
Source: Skidmore, S. (2006, April 21) Oregon Man
Survives 12 Nails to the Head. The Associated Press.
33-year-old man, high on
methamphetamine is brought to the ER
in Portland Oregon complaining of a
severe headache.

Doctors did not see any immediate
cause for the headache and placed
the patient in an exam room and
ordered tests including X-rays to
rule out head trauma.

– The man at first claimed it was an accident, but he
later admitted that it was a suicide attempt.
– The nails were removed, and the man survived
without any serious permanent damage.
– He was eventually transferred to psychiatric care; he
stayed for almost one month under court order but
then left against doctors’ orders
MSNBC-TV
A Major Reason People
Take a Drug is they Like
What It Does to Their Brains
200
% of Basal DA Output
NAc shell
150
100
Empty
50
Box Feeding
200
150
100
15
10
5
0
0
0
60
120
Time (min)
180
ScrScr
BasFemale 1 Present
Sample 1 2 3 4 5 6 7 8
Number
Scr
Scr
Female 2 Present
9 10 11 12 13 14 15 16 17
Mounts
Intromissions
Ejaculations
Source: Di Chiara et al.
Source: Fiorino and Phillips
Copulation Frequency
DA Concentration (% Baseline)
Natural Rewards Elevate Dopamine
Levels
FOOD
SEX
Effects of Drugs on Dopamine Release
METHAMPHETAMINE
400
% of Basal Release
Accumbens
1000
500
COCAINE
DA
DOPAC
HVA
300
200
100
0
0
1
2
0
3hr
Time After Cocaine
% of Basal Release
Time After Methamphetamine
250
NICOTINE
200
Accumbens
Caudate
150
100
250
% of Basal Release
% Basal Release
1500
Accumbens
Accumbens
ETHANOL
Dose (g/kg ip)
200
0.25
0.5
1
2.5
150
100
0
0
1
2
3 hr
Time After Nicotine
0
0
1
2
3
Time After Ethanol
Source: Shoblock and Sullivan; Di Chiara and Imperato
4hr
Prolonged Drug Use Changes
the Brain In Fundamental
and Long-Lasting Ways
What Can Imaging Tell
Us?



In design of new medications – knowledge of
affected circuitry can point to chemical dysfunction
that may be helped by medication.
In the design of behavioral treatments it can tell
you the types and severity of deficits and
dysfunctions in the brain and the timetable of their
recovery (or not). This information can be helpful
in guiding the behavioral targets for treatment and
the types and durations of treatment that can best
accommodate the brain recovery
Brain imaging can show how much viable tissue
there is to work with. And, it can show the affect of
treatment.
Brain Function in
Methamphetamine Abusers



Do meth abusers show abnormalities
in brain metabolites?
Do brain metabolite abnormalities
relate to cognitive performance – such
as selective attention?
Does the brain recover following
cessation of meth use?
Decreased dopamine
transporter binding in meth
users resembles that in
Parkinson’s Disease patients
Control Methamphetamine PD
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.
Partial Recovery of Brain Dopamine
Transporters in Methamphetamine
(METH)
Abuser After Protracted Abstinence
3
0
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
Because…
Their Brains
have been
Re-Wired
by Drug Use
Control
> MA
4
3
2
1
0
MA >
Control
5
4
3
2
1
0
Methamphetamine
Cognitive and Memory Effects
Frequency of Impairment by Neuropsychological Domain
60
60
% Impaired
Controls
MA Users
50
50
40
40
30
30
20
20
10
10
0
Attention/
Psychomotor
Speed
Learning
and
Memory
Working
Memory
Fluency
Inhibition
Executive Systems Function
0
Defining Domains:
Executive Systems Functioning


a.k.a. frontal lobe functioning.
Deficits on executive tasks assoc. w/:
– Poor judgment.
– Lack of insight.
– Poor strategy formation.
– Impulsivity.
– Reduced capacity to determine
consequences of actions.
Brain Serotonin Transporter Density and
Aggression in Abstinent Methamphetamine
Abusers*
*
Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Density
and Aggression in Abstinent Methamphetamine Abusers. Arch Gen
Psychiatry. 2006;63:90-100.
Objective of Study

Investigate the status of brain
serotonin neurons and their possible
relationship with clinical characteristics
in currently abstinent
methamphetamine abusers.
Results
1.
•
2.
•
Serotonin transporter density in global brain
regions was significantly lower in
methamphetamine abusers
Suggests that abuse of methamphetamine leads
to a global and severe reduction in the density
of human brain serotonin transporters
Values of serotonin transporter density in
widely distributed brain regions were found
to negatively correlate with the duration of
methamphetamine use.
Suggests that the longer methamphetamine is
used, the more severe the decrease in serotonin
transporter density.
Results (Continued)
Magnitude of aggression in methamphetamine
abusers increased significantly with decreasing
serotonin transporter densities in some brain
regions.
3.
•
Bitofrontal cortex, anterior cingulate, temporal cortex
No correlation between a representative measure
of serotonin transporter density and the duration
of methamphetamine abstinence. Individuals
abstinent for > 1 year still had a substantial
decrease in serotonin transporter density.
4.
•
Suggests reductions in the density of the serotonin
transporter in the brain could persist long after
methamphetamine use ceases.
Methamphetamine Use, Self-Reported
Violent Crime, and Recidivism Among
Offenders in California Who Abuse
Substances *
Cartier J, Farabee D, Prendergast M. Methamphetamine Use, SelfReported Violent Crime, and Recidivism Among Offenders in California
Who Abuse Substances. Journal of Interpersonal Violence.
2006;21:435-445.
Objective of Study

Examine the associations between
methamphetamine (MA) use and three
measures of criminal behavior: (a)
self-reported violent criminal behavior,
(b) return to prison for a violent
offense, and (c) return to prison for
any reason.
Methods

Participants
– 808 low- to medium-level inmates
Clear history of substance abuse
 Within 12 months of release
 Half the sample entering an in-prison
substance abuse (SA) program and the other
half from a neighboring prison that offered no
formal SA treatment
 Matched by age, ethnicity, sex offender
status, and commitment offense

Methods Continued
• Baseline and 12-Month Follow-Up
Interviews
Modified versions of criminal justice treatment
evaluation forms developed by researchers at
Texas Christian University
 Sections on sociodemographic background,
family and peer relations, health and
psychological status, criminal involvement, indepth drug-use history, and an AIDS-risk
assessment

Results

Those who used MA (81.6%) were
significantly more likely than those
who did not use MA (53.9%) to have
been returned to custody for any
reason or to report committing any
violent acts in the 30 days prior to
follow-up (23.6% vs. 6.8%,
respectively)
Results Continued

After controlling for drug trade
involvement, MA use was still
significantly predictive of self-reported
violent crime and general recidivism
Implications of Results
• These findings suggest that offenders
who use MA may differ significantly from
their peers who do not use MA and may
require more intensive treatment
interventions and parole supervision than
other types of offenders who use drugs
Methamphetamine Abuse, HIV Infection
Causes Changes in Brain Structure
Jernigan,T, et al American Jnl of Psychiatry Aug 2005


Methamphetamine abuse and HIV infection cause
significant alterations in the size of certain brain
structures, and in both cases the changes may be
associated with impaired cognitive functions, such
as difficulties in learning new information, solving
problems, maintaining attention and quickly
processing information.
Co-occurring methamphetamine abuse and HIV
infection appears to result in greater impairment
than each condition alone
Methamphetamine Abuse, HIV Infection
Causes Changes in Brain Structure
Jernigan,T, et al American Jnl of Psychiatry Aug 2005


Brain scans to analyze structural volume changes in
103 adults divided among four populations:
methamphetamine abusers who were HIV-positive;
methamphetamine abusers who were HIV-negative;
nonabusers who were HIV-positive; and
nonabusers who were HIV-negative.
They also assessed the ability to think and reason
using a detailed battery of tests that examined
speed of information processing, attention/working
memory, learning and delayed recall,
abstraction/executive functioning, verbal fluency,
and motor functioning.
Methamphetamine Abuse, HIV Infection
Causes Changes in Brain Structure
Jernigan,T, et al American Jnl of Psychiatry Aug 2005



Methamphetamine abuse is associated with changes in the
the brain’s parietal cortex (which helps people to understand
and pay attention to what’s going on around them) and basal
ganglia (linked to motor function and motivation).
The degree of change in the parietal cortex was associated
with worse cognitive function
HIV infection is associated with prominent volume losses in
the cerebral cortex (involved in higher thought, reasoning,
and memory), basal ganglia, and hippocampus (involved in
memory and learning
Methamphetamine Abuse, HIV Infection
Causes Changes in Brain Structure
Jernigan,T, et al American Jnl of Psychiatry Aug 2005

“In HIV-infected people, the cognitive impairments
are associated with decreased employment and
vocational abilities, difficulties with medication
management, impaired driving performance, and
problems with general activities of daily living, such
as managing money,”

“The impact of methamphetamine could potentially
affect treatment and relapse prevention efforts, as
well as things like money management and driving
performance.”
Methamphetamine Abuse, HIV Infection
Causes Changes in Brain Structure
Jernigan,T, et al American Jnl of Psychiatry Aug 2005



Younger methamphetamine abusers showed larger
effects in some brain regions.
Among HIV-infected individuals, the researchers
noted a direct association between the severity of
the infection and greater loss of brain matter.
In methamphetamine abusers who are also HIVpositive, decreased volumes are correlated with
increased cognitive impairment in one brain region,
the hippocampus.
Children


Children who live in and around the area of
the meth lab become exposed to the drug
and its toxic precursors and by-products.
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.
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
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%.
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.
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
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
Prenatal Meth Exposure

Preliminary findings on infants exposed
prenatally to methamphetamine (MA) and
nonexposed infants suggest…
– Prenatal exposure to MA is associated with an
increase in SGA (small for gestational size).
– Neurobehavioral deficits at birth were identified
in NNNS (Neonatal Intensive Care Unit Network
Neurobehavioral Scale) neurobehavior, including
dose response relationships and acoustical
analysis of the infant’s cry.
Lester et al 2005
Methamphetamine and
Sex: Connection in
Heterosexuals
Percent Responding
"Yes"
Q.2: My sexual drive is increased by the use of …
100
90
80
70
60
50
40
30
20
10
0
85.3
70.6
55.3
55.6
43.9
18.120.5
opiates
male
female
11.1
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.4: My sexual performance is improved by the use of
…
100
90
80
70
60
50
40
30
20
10
0
58.8 61.1
19.1
15.9
opiates
32.4
24.4
alcohol
male
female
18.4
11.1
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.6: My sexual pleasure is enhanced by the use of
…
100
90
80
70
60
50
40
30
20
10
0
73.5
16.018.2
opiates
38.2
24.4
66.7
44.7
male
female
11.1
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.8: My use of … has made me become obsessed
with sex and/or made my sex drive abnormally
high.
100
90
80
70
60
50
40
30
20
10
0
76.5
55.3
44.4
3.2
6.8
opiates
19.514.7
alcohol
male
female
11.1
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.10: I am more likely to have sex (e.g.,
intercourse, oral sex, masturbation, etc.) when
using …
100
90
80
70
60
50
40
30
20
10
0
79.4
65.8
41.5
61.1
50.0
male
female
27.8
7.411.4
opiates
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.12: I am more likely to practice “risky” sex under
the influence of … (e.g., not use condoms, be less
careful about who you choose as a sex partner,
etc.)
100
90
80
70
60
50
40
30
20
10
0
48.8
35.3
52.9
55.6
male
female
16.7
4.36.8
opiates
57.9
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.13: I have become involved in sex acts that are
unusual for me when I am under the influence of …
(e.g., marathon masturbation, go to “peep” shows,
cross-dress, voyeurism, expose yourself, etc.)
100
90
80
70
60
50
40
30
20
10
0
52.9
52.6
1.1
4.5 12.2
opiates
20.6
alcohol
44.4
male
female
16.7
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.16: Sexual fantasies or desires have
previously “triggered” my use of …
100
90
80
70
60
50
40
30
20
10
0
47.4
26.8 32.4
11.1
5.3 4.5
opiates
41.238.9
alcohol
cocaine
Primary Drug of Abuse
meth
male
female
Percent Responding
"Yes"
Q.19: My sexual behavior under the influence of …
has caused me to feel sexually perverted or
abnormal.
100
90
80
70
60
50
40
30
20
10
0
52.9
47.4
33.3
3.22.3
opiates
14.6
5.9
alcohol
11.1
cocaine
Primary Drug of Abuse
meth
male
female
Female Methamphetamine Users:
Social Characteristics and Sexual
Risk Behavior
Semple SJ, Grant I, Patterson TL
Women and Health
Vol. 40(3), 2004
Demographics (n=98)

Ethnicity
–
–
–
–
–

44% Caucasian
33% African American
16% Latina
2% Native American
5% Other
Education
– 96% had less than a college education

Marital Status
– 54% had never been married

Employment
– 77% were unemployed
Demographics

Psychiatric Health Status
– 38% reported having a psychiatric diagnosis
53% depression
 17% bipolar
 14% schizophrenia


Patterns of Use
– 83% smoked

Context of Meth Use
– Meth was used primarily with either a friend
(95%) or a sexual partner (84%).

Social and Legal Problems
– 36% reported having a felony conviction.
Sexual Partners of Meth-Using Women


On average women had 7.8 sexual partners in a
two-month period (SD=10.7, range 1-74).
84% had casual partners during the past two
months.
– 90% of all casual partners were reported to be meth
users.

31% had an anonymous partner in the past two
months.
– 76% of anonymous sex partners were meth users.

No spouses or live-in partners were reported to
be HIV-positive.
Sexual Risk Behavior



Participants engaged in an average of 79.2 sex
acts over a two-month period.
Most sexual activity was unprotected. The
average number of unprotected and protected sex
acts over the two-month period was 70.3 and 8.8,
respectively.
In terms of unprotected sex:
– 56% of all vaginal sex acts were unprotected
– 83% of all anal sex acts were unprotected
– 98% of all oral sex acts were unprotected
Methamphetamine Use and HIV
Risk Behaviors Among
Heterosexual Men -- Preliminary
Results from Five Northern
California Counties, December
2001-November 2003
CS Krawczyk, et al., 2006,
The Body
(http://www.thebody.com/cdc/straights_meth.html#tab2)
Recent Versus Never Meth Use*
100
Recent Meth
No Meth Use
90
80
70
60
50
40
30
20
10
0
Female
Partner
Anal with
Female
Casual
Female
Partner
Multiple
Parters
IDU Partner
Sex for
Drugs or $
Injection-Related HIV Risk


Injected in the Past 6
Months:
– MA Users: 37.1%
– Non-MA Users: 11.1%
Of these-– 24% used “dirty”
syringes
– 30% shared cookers,
rinse water, etc.
Men-Who-Have-Sex-With-Men


"The difference between sex with crystal and sex
without it is like the difference between
Technicolor and black-and-white," one man told
me at Tina's Café in San Francisco. “Once you
have sex with crystal, it's hard to imagine having
it any other way.” New Yorker Magazine, New
York.
“Crystal tells your brain to go back and get more,
more, more. The logical side of your mind is
saying, 'I can't keep doing this,' but you are still
on your way to the dealer's house.” New Yorker
Magazine, New York.


“The more I used it, the more I needed it. At one
point, I broke into my own house to try and steal
furniture.” New Yorker Magazine, New York.
"On the Internet, you can be whoever you want to
be. Smoke some crystal, get online, and there is
nothing you won't or cannot do." New Yorker
Magazine, New York.
More about HIV+ Meth-Using
MSM

The following data is based on a small
qualitative study:
– Participants snorted meth for 9.4 years
– Used to “party,” “to get high,” and “to
escape”
– Got high and looked for sex partners
– Used meth with other MSMs but not with
heterosexual meth users.
SOURCE: Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87.
Other Data on Meth-Using MSM

The following data is based on a
sample of 90 HIV+ meth-using MSM:
– 46% identified as “binge” users
– Average binge lasted 5.6 days
– Binge users reported significantly more
social difficulties, sexual risk behaviors,
and mental and physical health problems
SOURCE: Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87.
Crystal Methamphetamine
Use By Latino Men



Newly diagnosed HIV-positive Latino
men who have sex with men were
almost 9 times more likely to report
crystal use than HIV-negative men
Crystal use was highest among Latinos
(20%)
Crystal was associated with a higher
prevalence of unprotected anal sex
and with newly diagnosed HIV
Sex-Related HIV Risk
(Odd Ratios of MA Users vs. Non-MA Users)
1.5
Traded Sex for
Money/Drugs
2.5
Unprotected Sex
w/ Non-Partner
4.8
Unprotected Sex
w/ IDU
0
1
2
3
4
5
In Los Angeles
County, heroin
injectors at low
risk; gay male
meth users at
extreme risk
% HIV Positive
Drug Abuse Problem or
Public Health Problem
70
60
50
40
30
20
10
0
MMT-LAC Her-LAC
MethHWD
Meth-RC
LAC HIV Epi (1999-2004); UCLA/ISAP (1998-2004)
Weekend Warriers:
How It Works.
Sun
Mon Tues Wed Thur
s
Fri
$50 - $75 for the weekend (excluding cover charges)
Sat
Intervention:
Prevention and
Treatment Approaches
Methamphetamine and HIV in MSM:
A Time-to-Response Association?
100
90%
Percent HIV+
80
62%
60
41%
40
20
0
26%
8%
Probability
Sample*
Recreational
User**
Chronic Non
Treatment***
Outpatient
Psychosoc****
Residential****
* Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep,
*** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data
Substance Abuse
Treatment
Sex Risks Reduced with
Treatment: UARI Past 30
Days
3.5
3
2.5
CBT
CM
CBT+CM
GCBT
2
1.5
1
0.5
2(3)=6.75, p<.01
12
-M
os
os
M
6-
ks
-W
16
ks
-W
12
W
ks
8-
W
ks
4-
Ba
se
l
in
e
0
Methamphetamine
Women’s Issues
Craving
Adolescents
A
nx
Pa
ie
ra
ty
no
id
Id
ea
tio
n
Ps
yc
ho
tic
is
m
Ph
ob
ic
Ho
st
ili
ty
1.40
An
xi
et
y
So
m
O
at
bs
iz
es
at
io
si
ve
n
In
Co
te
m
rp
pu
er
ls
so
iv
na
e
lS
en
si
tiv
ity
De
pr
es
si
on
Mean BSI Score
Behavior Symptom Inventory (BSI)
Scores at Baseline
1.60
all significant at p< .001
Female
1.20
Male
1.00
0.80
0.60
0.40
0.20
0.00
Beck Depression Inventory (BDI)
Scores at Baseline
20.00
p < .001
18.00
Mean BDI Score
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00
Female
Male
Self-Reported Reasons for Starting
Methamphetamine Use
40%
35%
*p< .001
Male
30%
Female
25%
20%
15%
10%
5%
0%
*to lose weight
*to relieve depression
Percent Using by Route
Route of Methamphetamine
Administration
64
70
60
50
40
30
20
24
11
10
0
Route of Administration
intranasal (IN)
smoke (SM)
inject (IDU)
Craving by Route
% No Craving at baseline
70
60
50
40
30
IN
SM
IDU
20
10
0
P<.05
Length in Treatment (wks)
Treatment Length by Route
10
9
8
7
6
5
4
IN
SM
IDU
3
2
1
0
P<.05
MA-Free Samples by Route
% of MA-free UA (3 wks)
0.7
0.6
0.5
0.4
0.3
IN
SM
IDU
0.2
0.1
0
P<.05
Hepatitis C by Route
% Prevelance
50
45
40
35
30
25
20
15
10
5
0
44
21.05
15
IN (n=38)
SM (n=202)
IDU (n=72)
Total (n=314)
10
P<.05
BSI Psychiatric Symptoms by
Route
30
25
20
BL PST
TX-End PST
6-Mo PST
12-Mo PST
15
10
5
0
IN
SM
Positive Symptom Total (PST)
IDU
P<.05

Adolescent Meth Abuse Treatment
Admissions
Matrix
(Boys)
(Girls)
– 2002
– 2003
– 2004

Phoenix
– 2002
– 2003
– 2004
16%
25%
22%
63%
67%
69%
(Boys)
25%
23%
27%
43%
51%
53%
Sample Characteristics
305 Adolescents (13-18 years old)
Average Age ~ 16yrs old (sd=1.138)
Gender: 70.2% Males
Ethnicity: 55.3% White & 33.1% Latino
Ethnic Identification
60
55.3
Percent
50
40
33.1
30
20
3
1
n
ia
As
O
7.6
10
0
er
th
k
ac
Bl
te
hi
o
tin
La
W
Ethnicity
Drug of Choice: N=305
Methamphetamine
Pot
Alcohol
Methamphetamine & Pot
Methamphetamine & Alcohol
Pot & Alcohol
Cocaine
Opiates (Heroin)
Other
74 (24.3%)
149 (48.9%)
24 (7.9%)
9 (3%)
6 (2%)
26 (8.5%)
6 (2%)
3 (1%)
8 (2.6%)
Drug Use by Gender
90
85.1
80
70
63.7
60
50
36.3
40
30
20
14.9
10
0
Meth
Other
Males
Females
Treatment History
by Drug Use
Total
(N=275*)
*30 Missing
METH
(n=85)
OTHER
(n=190)
%
Completed
% Not
Completed
139
(50.5%)
136
(49.5%)
37
(43.5%)
46
(54.1%)
102 (53.7%)
88
(46.3%)
Legal Problems
Missing Data*
Total
(n=268)
METH
OTHER
USERS
(n=189)* (n=79)*
Illegal Behaviors
Arrest
Probation
Juvenile Hall
177
(66.0%)
124
(65.6%)
53
(67.1%)
Psychological Distress
Missing Data*
Depression*
Suicidality
Attempted Suicide
Does not want to live
Like to injure
yourself
Psychopathology*
Paranoid Feelings
Losing Mind
Hearing Voices
P<.05
Total
% Yes
(n=275)
OTHER
(n=196)
128
(46.5%)
83
(42.6%)
(n=79)
45
(57.7%)
72
(26.2%)
48
(24.5%)
24
(30.8%)
87
(31.6%)
53
(27.0%)
34
(43.0%)
METH
USERS
Do meth users stop on
their own?






Meth use via intranasal or oral routes may
D/C meth on their own
Oral and intranasal use until a decade ago
Meth users take 7-10 years to enter Rx
Large majority now smoke or inject. They
don’t stop on their own.
These users are now entering AOD system.
Treatment demand is and will expand.
Many meth users show up in primary care
and mental health systems
Methamphetamine
Research
Meth vs Cocaine: Do Users
Switch ?





Meth users: White, Mexican/Central American,
Rural, Suburban
Coke users: African-American, Caribbean, Urban
Each group stigmatizes the other
Evidence of “switching” minimal, but no prior
experience with major shifts in availability.
The cocaine to meth “switch” more likely than the
reverse, since meth is less expensive, lasts longer
and supplies are easier to establish and maintain.
Current Status of Meth
Research




Brain imaging research is impressive, valuable and
quite well developed programs
Research on meth and kids in labs needed
Research on meth and adolescent treatment
needed
Treatment research developing slowly
– No medications available and moving ahead
slowly
– Few studies of behavioral treatments
Thank you
rrawson@mednet.ucla.edu
www.uclaisap.org