Methamphetamine use: hazards and social influences

Use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s in the United States, concentrated in the west, midwest, and south. The use and trade of methamphetamine was facilitated by a fairly simple production process and the involvement of numerous small entrepreneurs as well as drug-trafficking syndicates. National data from the 1994 Drug Abuse Warning network revealed that for the period from 1991 to 1994 methamphetamine use among short-stay hospital patients more than tripled, and methamphetamine-related deaths reported by medical examiner offices nearly tripled. In addition, the Treatment Episode Data Set revealed a 43 percent increase in treatment-program admissions in which clients identified methamphetamine as the primary drug of abuse. Nonetheless, methamphetamine use did not become widespread in the U.S. population. Low-income and unemployed young white men continue to be the group most likely to use methamphetamine, but by the mid-1990s the drug had increased in popularity in more diverse populations and regions. Economic and social pressures experienced by a broad array of Americans may partially explain expanded methamphetamine use; for example, depressed economic conditions in rural and semi-rural areas have contributed to methamphetamine's appeal as a source of income. A "war against drugs" approach has characterized the policy response, with increased criminal justice penalties. A public health approach is recommended, including prevention campaigns, harm-reduction outreach and treatment approaches, and pharmacologic and abstinence-based drug treatment approaches.     

An Exploratory Investigation of Treatment Strategies for Black,Gay, Bisexual,and Heterosexual Men-Who-Have-Sex- With-Men Who Use Methamphetamine

Research has repeatedly indicated a strong relation between methamphetamine use and risky sex leading to HIV-seroconversion. Despite the high prevalence of HIV among Black gay, bisexual, and other men-who-have-sex-with-men (BMSM) and the strong association between methamphetamine use and HIV-seroconversion, treatment research on methamphetamine use and HIV-risk behaviors among BMSM is limited. The goal of this exploratory study was to investigate treatment strategies for BMSM that may be used to inform methamphetamine treatment programs tailored for BMSM. Data was collected on a sample of HIV-negative and HIV-positive gay, bisexual, and heterosexual BMSM (N = 52) in New York City. Participants were asked to discuss methamphetamine treatment strategies they believed would be successful in treating their own methamphetamine abuse and that of other BMSM who use methamphetamine. Results indicated four treatment areas salient for BMSM seeking treatment for methamphetamine used disorders: (a) outreach/recruitment strategies, (b) therapist qualities, (c) group characteristics, and (d) intervention elements themselves. Findings gathered here and through literature review underscore the importance of adapting evidence-based methamphetamine treatment strategies to include culturally-relevant treatment strategies that address the specific needs of BMSM who use methamphetamine.     

The Impact of Methamphetamine Use on Parenting

SUMMARY

Children whose parents abuse substances are often exposed to chaotic and neglectful lifestyles. Because of the increase in methamphetamine abuse, especially by females of child-bearing age, it is important to understand how the use of this drug impacts parenting. In this qualitative study, ten parents being treated for methamphetamine abuse were interviewed. Results indicated that while using, parents utilized a polarized style of parenting and specific drug management strategies, allowed exposure to violence, created upheaval in their children's daily living structure, and felt ambivalence when discussing these effects on children. Implications for social work practice include early intervention focusing on strengthening parenting skills.     

Life Events and Sexual Risk Among HIV-Negative,Heterosexual, Methamphetamine Users

Identifying psychosocial factors associated with sexual risk behavior among methamphetamine users is essential to enhancing HIV and sexually transmitted infection prevention. This study examined the relationship between positive and negative life events and sexual risk behavior in a sample of 100 HIV-negative, heterosexually identified, methamphetamine-using men and women. Negative life event categories included death of a significant other, negative health event involving self or significant other, and child custody or visitation issues. Categories of positive life events included birth or pregnancy involving self or significant other, a positive relationship event, and a positive life change. Multivariate analyses demonstrated that negative life events were positively associated with total number of unprotected sex acts, whereas positive life events were not associated with sexual risk taking. Also, amount of methamphetamine used did not moderate the relationship between life events and sexual risk behavior. These data support future research to identify underlying mechanisms that link negative life events to sexual risk taking in this high-risk population.     

Briefly Noted

Researchers have found that mirtazapine, in addition to counseling for substance use, reduced methamphetamine use and some HIV risk behaviors in cisgender men and transgender women who have sex with men. Mirtazapine, an antidepressant also known as Remeron, showed benefits after treatment ended, even if patients didn't always take their medication or took less than they were supposed to. The study follows a previous study of mirtazapine finding reductions in methamphetamine use and sexual risk behaviors among men who have sex with men. “Effects of mirtazapine for methamphetamine use disorder among cisgender men and transgender women who have sex with men: A placebo‐controlled randomized clinical trial” was published in JAMA Psychiatry online last week by Phillip Coffin, M.D. and colleagues. The RCT took place over a course of 24 weeks from 2013 to 2017 in San Francisco. Main outcomes measured were urine tests for methamphetamine and sexual risk behaviors, with sleep, methamphetamine craving, dependence severity, and adverse events also assessed. Sexual risk behaviors included number of sexual partners, and frequency of condomless anal sex. Participants assigned to mirtazapine also had reductions in depressive symptoms.     

Methamphetamine and the changing face of child welfare: practice principles for child welfare workers

Methamphetamine use and production is changing child welfare practice. Methamphetamine is a significant public health threat (National Institute of Justice, 1999) reaching epidemic proportions (Anglin, Burke, Perrochet, Stamper, & Dawud-Nouris, 2000). The manufacturing of methamphetamine is a serious problem for the child welfare system, yet child welfare has not addressed the needs of children living in homes where methamphetamine is manufactured (U.S. Department of Justice, 2002; DOJ, 2003; Altshuler, 2005). This article presents key issues for child welfare workers related to the use, production, and effects of methamphetamine on children and families, and identifies practice principles for child welfare workers in order to ensure safety for victims, parents, and workers themselves.     

Pharmaceutical Intimacy: Sex,Death, and Methamphetamine

ABSTRACT

In this article, I draw from ethnographic work conducted among residents of an “in-house” drug and alcohol treatment center in Baltimore, Maryland, to discuss the relationships born of pharmaceutical (ab)use. By looking in close detail at the autobiographical accounts of one man in treatment for addiction to methamphetamine, I attempt to chart the way life and death are at times brought into close proximity, and at others wedged firmly apart, by such things as love and avoidance. My concern is with the ethics of care that emerge through the so-called “small events” in everyday relations; that so often define a life or a relationship as falling under the category “normal” or “pathological.” I ask how such things as the known demands placed on the body by the need to maintain or avoid relations, whether pharmaceutically mediated or not, come to bear on the decision to “let die” or the resurgence of moral worlds. I end by discussing the different aspects of relatedness revealed by the dependencies and alliances formed by the kinship between pharmaceuticals and humans.

In compliance with current ethical research standards, the names of all informants have been changed to assure their anonymity.     

Community reactions to campaigns addressing crystal methamphetamine use among gay and bisexual men in New York City

Crystal methamphetamine (aka "crystal meth") use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed.     

Prevention of methamphetamine abuse: can existing evidence inform community prevention?

Little research exists on effective strategies to prevent methamphetamine production, distribution, sales, use, and harm. As a result, prevention practitioners (especially at the local level) have little guidance in selecting potentially effective strategies. This article presents a general causal model of methamphetamine use and harms that reflects the available findings from either research specific to methamphetamine or from alcohol and other illegal drugs, and suggests prevention approaches and strategies that communities might use based upon research evidence and experience. Community methamphetamine prevention can use the public health and safety perspective applied to other substance abuse prevention. Analyses of the complex system of intermediate variables that interact to affect methamphetamine use and harms suggest that multiple reinforcing prevention interventions may have the greatest potential effectiveness.     

Outcomes from a homegrown HIV prevention program for extremely high-risk,substance-using men who have sex with men with multiple health disparities

ABSTRACT

From February 2010 through December 2014, 585 substance-using men who have sex with men (MSM) were enrolled into a “homegrown” risk reduction intervention. Participants evidenced significant iterative factor reductions in the odds of substance use including alcohol (AOR = 0.79) and marijuana (AOR = 0.78; both p ≤ 0.05) and marginally significant reductions in the odds of methamphetamine use (AOR = 0.83; p ≤ 0.07). Participants also evidenced significant reductions in sexual risks including the odds of reporting drug/alcohol use before or during sex (AOR = 0.80) and of condomless anal intercourse (AOR = 0.72; all significant at p ≤ 0.05). Results demonstrate that the homegrown intervention was effective at reducing HIV risk behaviors among high-risk MSM.     

Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York city and Los Angeles

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxy-methamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.     

Community Reactions to a Syphilis Prevention Campaign for Gay and Bisexual Men in Los Angeles County

“Stop the Sores” (STS), a humor-based syphilis prevention campaign, was implemented in response to increasing syphilis prevalence among gay and bisexual men in Los Angeles County. In 2004, 564 men completed surveys measuring exposure and reactions to the campaign and syphilis testing. Mean age was 39, and men of color comprised a significant proportion of the sample (46.8%). Most men reported being HIV-negative (79.3%). Overall, 7.8% of the sample reported ever having syphilis; HIV-positive men were six times more likely to report this. Over one half of the sample (58.5%) reported exposure to the campaign. Men reporting any recent unprotected anal sex were twice more likely (than those who did not) to see the campaign. Men of color were twice more likely than White men to report wanting to speak to their friends about it. Finally, 39.1% of men exposed to the campaign reported being tested for syphilis as a result. Factors related to higher likelihood to test for syphilis included HIV seropositive status, any recent unprotected anal insertive sex, recent use of methamphetamine, recent use of “poppers,” and recent use of erectile dysfunction drugs. Although STS was somewhat effective, outreach efforts to particular subgroups may need to increase.     

Research with Gay Drug Users and the Interface with HIV

Abstract

Studying the co-occurrence of drug use and sexual risk behaviors among gay men poses special challenges for research. The importance of conducting such research, however, is underscored by current trends in the gay community, including increases in methamphetamine and club drug use. This increase has been associated with high-risk behavior for the transmission of HIV and other diseases (e.g., hepatitis B and hepatitis C). The author describes methodological issues related to initiating and conducting research among gay male drug users, and discusses how such research can guide more effective prevention, treatment, and policy initiatives related to drug abuse and HIV/AIDS.     

Exploring the prevalence and correlates of methamphetamine use: findings from Sacramento's ADAM program

Anecdotal reports have suggested that the use and abuse of methamphetamine is increasing in the United States. To date, however, few scholarly works have explored the prevalence and correlates of methamphetamine use in the United States. To address this limitation, a secondary analysis was undertaken with data collected through the Arrestee Drug Abuse Monitoring (ADAM) Program. An examination of methamphetamine-positive rates among ADAM arrestees interviewed between 1991 and 2001 identified that its use is concentrated within the Western part of the United States. Supplementary analyses of Sacramento arrestees indicated that 71% were diagnosed as needing some form of alcohol or other drug treatment. Compared to those arrestees who were detected methamphetamine-negative, methamphetamine-positive arrestees in Sacramento were three times as likely to be white and to have been diagnosed in need of drug treatment. Implications for drug control policy are discussed.     

The disparate impact of alcohol,methamphetamine, and other drugs on family reunification

Parental substance abuse is one of the most prominent reasons that children enter foster care. The relative role of substance type in delaying reunification has remained elusive. This study sought to understand the impact of parental use of alcohol, methamphetamine, other drugs, and poly-substances on reunification rates for children in foster care. The authors used administrative foster care data from a Midwestern state between years 2007 and 2012 to evaluate the unique contribution of each substance use domain. Results suggest that parental methamphetamine use has the most significant impact on the likelihood of reunification, followed by other drugs, and poly-substances. These findings further indicate that children removed due to any parental drug use stay in foster care for an average of 49–156 days longer than their peers. Implications for research and practice are addressed.     

Physical victimization of rural methamphetamine and cocaine users

Substance use and physical violence often coincide, but little has been published on the correlates associated with receipt of partner versus nonpartner physical violence for rural users of methamphetamine and/or cocaine. In this study, participants' substance use, depression and past-year physical victimization were assessed. In separate logistic regression models, received partner violence in females was associated with age; alcohol, cocaine, and methamphetamine abuse/dependence; and number of drugs used in the past 6 months. In males, received nonpartner violence was associated with age, cocaine abuse/dependence, and being Caucasian. Findings suggest a relationship between stimulant use and received violence among rural substance users and a need for victimization screenings in settings where such individuals seek health care.     

Psychosocial Correlates of Methamphetamine Use

Methamphetamine (MA) abuse is a devastating problem that has been sweeping the United States from west to east and has reached epidemic proportion in many areas. Literature on the drug itself, its history, and its effects are reviewed. The current project aimed to examine the psychosocial correlates of MA use using Hudson's Multi-Problem Screening Inventory (MPSI). The MPSI was given to a control group consisting of undergraduate social work students (n = 17) and a group of past-year MA users (n = 15). Differences between users and non-users were examined across the 27 domains of the MPSI, and subscales for which MA users exceeded the clinical cutting score were noted. In addition, the correlation between severity of craving for MA and MPSI scores was examined. MA users differed significantly from non-users on the depression, partner, child and neighbor problems, aggression, fearfulness, ideas of reference, phobias, guilt, disturbed thinking, memory loss, and drug abuse subscales. MA users exceeded clinical cutting scores on all of these scales except child problems; fearfulness; ideas of reference; self-esteem; sexual discord; personal stress; friend, school and coworker problems; and confused thinking. Severity of craving was correlated with MPSI score on all MPSI scales except self-esteem; sexual discord; mother, father, friend, coworker, school and family problems; suicide; non-physical abuse; and alcohol abuse. Interesting findings regarding the control group are also discussed.     

Treating drug-abusing offenders. Initial findings from a five-county study on the impact of California's Proposition 36 on the treatment system and patient outcomes

Five counties (Kern, Riverside, Sacramento, San Diego, San Francisco) that demonstrate both variations and similarities in their implementation of Proposition 36 (e.g., treatment approaches, urine testing) and patient mix have been selected to participate in a study assessing how California's Proposition 36 is affecting the drug treatment system and patient outcomes. Except for San Francisco, treatment admissions increased during the first year of Proposition 36 implementation over the prior year (27% in Kern, 21% in Riverside, 17% in Sacramento, and 16% in San Diego), mostly in outpatient drug-free programs. Compared to non-Proposition 36 patients, Proposition 36 patients were more likely to be men, first-time admissions, treated in outpatient drug-free programs, employed full-time, and users of methamphetamine or marijuana. They were less likely to be treated in residential programs or methadone maintenance programs and fewer reported heroin use or injection drug use. Guided by the multilevel open systems framework, the study examines key issues of Proposition 36 that influence treatment systems and outcomes and empirically identifies "best practice" approaches in treating drug-abusing offenders.     

Assessing environmental prevention strategies for reducing the prevalence and associated harms of methamphetamine use

Developed primarily in clandestine laboratories, methamphetamine is a highly addictive synthetic drug whose physical effects include hyperactivity, euphoria, tremors, and a sense of increased energy. While the accuracy of recent accounts suggesting a methamphetamine epidemic in the United States is unclear, these reports have nevertheless translated into significant funding allowances by the federal government. This increased funding suggests that the opportunity is ripe for the development of a scientific, environmentally-based model for methamphetamine prevention.