The geography of drug use. To paraphrase an old tune by Gerry Rafferty, we got meth to the left of us, cocaine to the right, and here we are, stuck in the middle with pot. The National Drug Threat Survey of 2007, a product of the National Drug Intelligence Center (NDIC) at the Department of Justice, illustrates the stark nature of regional variation when it comes to illegal drugs of choice in the United States. The map at the right represents the responses of state and local law enforcement agencies to the question: "What drug poses the greatest threat to your area?" Blue indicates cocaine, red indicates methamphetamine, and green stands for marijuana. (Click map for larger image.) According to the Oregonian in Portland, reporting on similar numbers from the U.S. Substance Abuse and Mental Health Services Administration: "The politics of methamphetamine have been shaped by geography. Lawmakers from the East, Midwest and South focused on cocaine--the most heavily abused drug by far in their home states. By contrast, more than 90 percent of people treated for meth abuse live west of the Mississippi River." The NDIC's stated mission is "to provide strategic drug-related intelligence, document and computer exploitation support, and training assistance to the drug control, public health, law enforcement, and intelligence communities of the United States...." NDIC obtains its data through direct surveys of federal, state and local law enforcement and intelligence agencies, as well as information from court documents, news sources, and public health agencies. The NDIC has produced a National Drug Threat Survey annually since 2000, and began deriving state-level estimates in 2003. Federal, state and local government agencies use the statistical estimates as guidelines for promulgating drug legislation and enforcement strategies. Graphics Credit: National Drug Intelligence Center

  Meth: It’s All About Extremes.

Although scientific research on Meth is in its infancy, treatment guidelines issued this year by the U.S. Center for Substance Abuse Treatment say “some of the most frightening research findings about Meth suggest that its prolonged use not only modifies behaviors but literally changes the brain in fundamental and long-lasting ways.”

A clinical neuroscientist who specializes in nuclear brain imaging in Northern California, Dr. Daniel Amen, ranks Meth’s addictive character second only to heroin’s. But he says it’s far more dangerous to users - and the people around them - because of the paranoia and psychosis that inevitably follow.

“Our scans basically show that these people are dealing with a defective brain,” Amen said.

As a trauma surgeon at Mercy Hospital in San Diego, where Meth first gained a foothold in the United States, Dr. Michael Sise believes that Meth “carries a prognosis that is worse than many cancers.”

In Bellingham, Dr. Greg Hipskind observes that because Meth decreases the blood flow to the brain, “it dumbs you down.”

In layman’s language, Meth rewires the brain, and while recovery may be possible, the brain won’t be the same. Cocaine, by contrast, doesn’t stay long in the brain because it almost completely metabolizes in the body.

Any physician with more than a passing acquaintance with Meth, and certainly West Coast physicians who specialize in addiction medicine, describe the drug in the most graphic of terms. Their assessments have been shaped by firsthand experience trying to return Meth addicts to some semblance of normalcy.

This drug is very adept - but eventually way too adept - at what it does.

Meth messages the brain’s pleasure center to release more dopamine and endorphins, two natural chemicals that make people feel good.
 
An extra helping of these chemicals makes people feel more confident, lose weight, work quicker at a myriad of tasks and enjoy sex more.

Eager to slim down? That’s what the earlier version of Meth was prescribed for in the ’50s and ’60s. Today’s more potent form can emaciate people. One Tacoma addict, a woman of average height, dropped to 80 pounds while she was pregnant. High-intensity users can shed 50 to 100 pounds. Lust for mind-numbing sex? Meth will produce it - at first. That is why it is so popular at “raves” in nightclubs or in the gay bathhouses in Seattle.

But what’s initially so enticing about Meth becomes intolerable.

The rate of addiction is breathtaking: Over six months of use, 94 percent of those who smoke Meth become addicted, as do 72 percent who snort it. That compares with 14 percent who inject heroin and 8 percent who smoke marijuana.
 
Eventually, the drug inhibits sexual functioning in both sexes. The consequences cited in the guidelines from the Center for Substance Abuse Treatment include men developing breasts, losing interest in sex and experiencing impotence, and women developing menstrual problems, infertility and difficulty achieving orgasm.

One of Meth’s most alluring qualities is extra energy. At the extreme, Meth facilitates behavior that is persistent, repetitive and compulsive. The federal treatment guidelines describe these activities as stereotypical of Meth use: “vacuuming the same part of the floor over and over, popping knuckles, picking at scabs, or taking apart and reassembling mechanical devices.”

Daily, Dr. Alex Stalcup, an addiction physician in Concord, Calif., treats people who have gone without sleep for as long as 10 days. The record-holder was a woman up 21 days. “Politely put, she was crazier than a barn owl,” he says.
 
Obviously, that patient had not been able to restrict her Meth use to recreational. She was on a Meth binge.

During the roller-coaster ride, the Meth user continues to chase - but can never recapture - the intensity of the initial euphoric sensation. Over three to 15 days, he will help himself to more and more Meth. He typically favors smoking or injecting it over snorting or drinking it dissolved in liquid (usually alcohol), because the payoff is so much faster and stronger.
 
Aggression and paranoia set in during the tweaking stage, which can persist 24 hours. (Afterwards, the body must collapse, so the user sleeps for one to three days.)

The only thing more dangerous than a tweaker is a tweaker in the company of others, notably those who are weaker. The Pierce County Sheriff’s Department has documented the intersection of Meth labs and domestic violence in the area surrounding McChord Air Force Base. Tweakers, with extreme sleep deprivation, need no provocation to lash out. They exist in their own world during this phase of the binge.
 
In his San Diego emergency room, Sise repairs the handiwork of tweakers far too often. He’s stitched together the heart of a woman stabbed by the Meth dealer who stole her money, removed a blood clot from the gangrenous leg of a young binger. He told a woman her daughter died of a gunshot wound suffered during an argument with her Meth-using boyfriend.

People steeped in the culture of Meth, be they police officers or treatment providers, say when they hear of an abnormally violent act, their first thought is Meth. Two years ago an Arizona man repeatedly stabbed his 14-year-old son, then decapitated him and threw his head out the window of a van. The man, now serving a 30-year sentence, had been convinced the devil was inside the van.

Meth abusers die at higher rates from suicide, traffic accidents and murder, and commonly succumb to overdoses or malnutrition.

Ron Jackson, director of Seattle’s Evergreen Treatment Center for heroin addiction, paints the difference:
 
“People on heroin are basically going to leave you alone unless they’re desperate for money. Somebody loaded on Meth is going to be much more dangerous.”

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Young adults who abuse meth at greater risk of suffering a heart attack. Heart attacks caused by increasing heart rate and blood pressure and by inflammation and artery spasms due to meth abuse. Blood to the heart muscle is

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