Crystal Meth

1. Crystal Meth S. Pirzada Sattar, MD Director of Addiction Psychiatry Fellowship Creighton University School of Medicine Medical Director, Substance Abuse Treatment Programs, VA Health System, Nebraska and Western Iowa

2. Worst Drug to hit America “A ferociously addictive drug that is spreading… it’s hard to imagine overstating the magnitude of the meth problem.” -U.S. Drug Czar Barry McCaffrey Source-A Madness Called Meth

3. History of Meth * First created in Germany in 1887 * Used widely during WWII by the Nazi and Japanese armies * Japanese kamikaze pilots were documented to be high on meth * Major challenge in post war Japan * Biker gangs in California after WWII began to distribute meth Source-Nebraska State Patrol

4. Prevalance data for the Native American Population: • Geographic variation between Native American Population’s drug use pattern (NLAES).1 • Limited data • Males up to 50%2 • Females up to 35%2 • NA Adolescents 16% attempted suicide3

5. Nebraska Teenage Drinking Stats * Ranked 9th for teenage binge drinking * Over 1/2 of Nebraska teens reported that they currently use alcohol - 6th in the nation * 3rd among teenagers that reported driving after drinking * 2nd in teens that reported riding with a drinking driver Source-2003 National Youth Risk Behavior Survey

6. Nebraska Teenage Drinking * 7 out of 10 teens who drink obtained alcohol from an adult * 38% drank with an adult present * Over 1/5 drank at home with the permission of a parent Source-Nebraska Risk & Protective Factor Student Survey By Nebraska HHS

7. Risk Factors for Youth Four domains of human interaction: *Family *Individual/Peers *Schools *Community Bonding - Positive Social and Relationship Skills - Positive involvement - Affirmative Recognition Major transition periods

8. What is meth? Source: NIDA Research Report –1998

9. What does meth look like? • Typically an odorless powder that dissolves quickly in water • Another form of meth is clear chunky crystals referred to as crystal meth or ice • May be in the form of small brightly colored tablets, referred to as YABA

10. * Injected How is meth used? * Snorted * Smoked * Orally

11. * Speed Commonly known as: * Chalk * Crystal * Crank * Glass * Ice

12. Meth Causes… ~ Increased alertness ~ Decreased appetite ~ A distorted sense of well-being ~ Effects that can last 8 to 24 hours

13. Psychotic behavior Paranoia Aggression Anxiety Fatigue Depression Delusions Mood Swings Confusion Insomnia Hallucinations Stroke Brain damage, similar to Alzheimer’s disease Weight loss Death Behavior Changes Health Changes Source-Congressional Research Sites

14. Effects of Meth on Teeth Source-Make Smart Choices website

15. Effects of Meth on the BrainDead spots in brain tissue appear to be brown mush

16. Light colored spots on brain scan areas of dead tissue similar to the brain of an Alzheimer’s patient is creating a “Swiss Cheese” brain incapable of normal function

17. Researchers have reported that the dopamine producing cells in the brain can be damaged after prolonged exposure of relatively low levels of methamphetamine.

18. What are the consequences of meth use?

19. Meth labs • Meth labs use so many toxic solvents/ create toxic waste, HAZMAT trained specialists are needed to decontaminate/dismantle • In 40% of meth lab seizures, children were present in the home at the time of the raid.

20. Ingredients in Meth * Over the counter drugs containing pseudoephedrine * Iodine * Anhydrous ammonia * Starter fluid or de-icer * Drain cleaner * Lithium batteries * Muriatic/Hydrochloric acid

21. Odor Cat Urine Ammonia Ether Acetone Items to look for: Large number of blister packs Red or brown stained coffee filters Cookware/jars What are signs of a meth lab? Source-Congressional Research Sites

22. Other signs of a meth lab • Little or no traffic during the day • Never putting out the trash • Covered windows • Smoking outside • Unemployed but seems to have plenty of cash

23. Methamphetamine:Synthesis • “Pour and run” • Ephedrine reduction method • Boil pills in red phosphorous and iodine • Convert ephedrine to MAP with lye, HCl, or hydrogen sulfide • Add hydrocarbon solvent • Filter precipitate • Pour byproduct down the drain • “Dry cook” with anhydrous ammonia

24. Methamphetamine:Synthesis • Manufacture possible with ephedrine/ pseudoephredrine • Found in cold medicines • Found in diet pills • Many pharmacies restrict bulk purchase of these drugs

25. Methamphetamine:Synthesis • Can be synthesized with common household products • Generates 5-7 pounds of hazardous waste per pound of drug • $70 of ingredients can create drugs with $2000 street value • But you can die trying to make it.

26. Meth production • Three categories of chemicals for production • Solvents • Corrosives • Metals/Salts

27. Methamphetamine:Synthesis • Toluene: paint thinner • Methanol: gas tank anti-freeze ("Heet“) • Ethyl Ether: starting fluid • Anhydrous ammonia: farmer’s co-ops • Hydrochloric acid: hardware stores • Sodium hydroxide: "Drano" or Red Devil Lye • Sulfuric acid: battery acid or drain cleaners • Iodine crystals: iodine crystals or tincture of iodine • Red phosphorous: striker plates, road flares • Lithium: camera batteries

28. Source: U. S. Drug Enforcement Administration

29. Environmental Effects of Meth * Meth production leaves behind 5-6 lbs of toxic waste per 1 lb of meth produced. * Toxic by-products contaminate sites where meth is produced posing serious health and environmental hazards to those nearby. * The average cost to clean up one meth lab often exceeds $4,000. Source-Nebraska State Patrol

30. Impacts on Families • Dangers of children being exposed to toxic fumes • Increase in child abuse and neglect cases • Increased risk for substance abuse among children in later life • A rise in domestic disputes

31. Costs related to drug epidemic * 8% of Nebraska’s budget, over $291 million, is spent on substance abuse related costs * 91% of that amount is spent on burdens to public programs through Medicaid and welfare programs * 6% goes for regulation and compliance * 3% goes for prevention (These amounts don’t include local and federal costs) Source-National Center on Addiction and Substance Abuse study

32. Meth affects You… • Each meth addict commits several crimes each year to support his/her habit. • The percentage of federal sentences for meth related drug convictions in Nebraska is five times the national average. Source-National Drug Intelligence Center

33. Special Native American Concerns • Meth, a growing concern on reservations • Jurisdictional issues

34. Treatment • Non-Pharmacotherapy • Pharmacotherapy

35. Treatment • Individual Therapy • Group Therapy • Self-help Groups • Structured Living • Treatment of Ongoing Medical Problems • Treatment of Ongoing Psychiatric Problems

36. Role of Spirituality • Spirituality promotes treatment adherence • Spirituality promotes mental health • Spirituality promotes decreased use

37. Role of Culture • Spirituality promotes treatment adherence • Spirituality promotes mental health • Spirituality promotes decreased use

38. Hidden Dangers • Meth lab operators are now discarding waste materials in ditches and other remote areas of our community. • Leaders of scouts, 4-H, church organizations, and Adopt-A-Highway and Keep Nebraska Beautiful groups should be made aware of potential dangers.