Top Banner
Methamphetamine: Methamphetamine: Review of The Problem Review of The Problem Igor Koutsenok, MD Igor Koutsenok, MD Assistant Professor of Psychiatry Assistant Professor of Psychiatry University of California San Diego University of California San Diego Associate Director, Associate Director, Center for Criminality & Addiction Research, Training & Application Center for Criminality & Addiction Research, Training & Application www.ccarta.ucsd.edu www.ccarta.ucsd.edu
77

Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Dec 18, 2015

Download

Documents

Elmer Wells

methamphetamine slide

white slide

methamphetamine labs

kamikaze slide

europe slide

yaba slide

decongestant slide

speed methamphetamine

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine: Methamphetamine:

Review of The ProblemReview of The Problem

Igor Koutsenok, MDIgor Koutsenok, MDAssistant Professor of PsychiatryAssistant Professor of PsychiatryUniversity of California San DiegoUniversity of California San Diego

Associate Director,Associate Director,Center for Criminality & Addiction Research, Training & ApplicationCenter for Criminality & Addiction Research, Training & Application

www.ccarta.ucsd.eduwww.ccarta.ucsd.edu

Page 2: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

• Powerfully addictive stimulant thatdramatically affects the central

nervous system

• Made easily in labs with OTC ingredients

What Is Methamphetamine?What Is Methamphetamine?

Page 3: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

The active ingredient in making The active ingredient in making methamphetamine is ephedrine or methamphetamine is ephedrine or pseudoephedrine, commonly found in over pseudoephedrine, commonly found in over the counter cold remedies.the counter cold remedies.

Page 4: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

CH2CH

CH3

NH CH3

Methamphetamine

Page 5: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Ephedrine and MethamphetamineEphedrine and Methamphetamine

Page 6: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Forms of MethamphetamineForms of Methamphetamine

Methamphetamine PowderMethamphetamine PowderIDU Description: Beige/yellowy/off-whiteIDU Description: Beige/yellowy/off-whitepowderpowder

Base / Paste MethamphetamineBase / Paste MethamphetamineIDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel,moist, waxygel,moist, waxy

Crystalline MethamphetamineCrystalline MethamphetamineIDU Description: White/clearIDU Description: White/clearcrystals/rocks; ‘crushed glass’ / ‘rock salt’crystals/rocks; ‘crushed glass’ / ‘rock salt’

Page 7: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

SpeedSpeed

Methamphetamine powder ranging in color from white, Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown. yellow, orange, pink, or brown.

Color variations are due to differences in chemicals Color variations are due to differences in chemicals used to produce it and the expertise of the cooker. used to produce it and the expertise of the cooker.

Other names: shabu, crystal, crystal meth, crank, tina, Other names: shabu, crystal, crystal meth, crank, tina, yabayaba

Page 8: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

IceIce

High purity High purity methamphetamine methamphetamine crystals or coarse crystals or coarse powder ranging from powder ranging from translucent to whitetranslucent to white

Page 9: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine Lab SeizuresMethamphetamine Lab SeizuresA small percentage of labs are labeled “Super Labs” and A small percentage of labs are labeled “Super Labs” and are capable of producing over 10 lbs per batch. are capable of producing over 10 lbs per batch.

Super Labs are operated by Mexican National Drug Super Labs are operated by Mexican National Drug Trafficking Organizations (MNDTO’s), and supply the Trafficking Organizations (MNDTO’s), and supply the majority of meth to the market.majority of meth to the market.

Page 10: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Chemical IngredientsChemical Ingredients

Trichloroethane (Gun Scrubber)Trichloroethane (Gun Scrubber)EtherEther (Engine Starter)(Engine Starter)

TolueneToluene (Brake Cleaner)(Brake Cleaner)

MethanolMethanol (Gasoline Additive)(Gasoline Additive)

GasolineGasoline

KeroseneKerosene

Page 11: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 12: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetaminesMethamphetaminesA Brief HistoryA Brief History

18871887

19191919

19321932

Amphetamine developedAmphetamine developed

Methamphetamine developedMethamphetamine developed

Amphetamine & Amphetamine & methamphetamine used as methamphetamine used as decongestantdecongestant

Page 13: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetaminesMethamphetaminesA Brief HistoryA Brief History

WW II Extensive use by:WW II Extensive use by:

- Fighter pilots- Fighter pilots

- German Panzer troops- German Panzer troops

- Japanese workers - Japanese workers

- Kamikaze - Kamikaze

Page 14: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetaminesMethamphetaminesA Post-War EpidemicA Post-War Epidemic

FACTORSFACTORS

Large quantitiesLarge quantities

Social disorganizationSocial disorganization

““Work pills”Work pills”

500,000 addicts500,000 addicts

JAPAN

Page 15: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetaminesMethamphetaminesEpidemic in SwedenEpidemic in Sweden

FACTORS FACTORS

Large supplyLarge supply

3% are users3% are users

Preludin use Preludin use widespreadwidespread

Mostly oral useMostly oral use

SWEDEN

Page 16: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetaminesMethamphetaminesFactors Related to EpidemicFactors Related to Epidemic

Over supplyOver supplyOpportunity to experienceOpportunity to experienceWidespread knowledgeWidespread knowledgeA reliable marketA reliable marketNo need for injections (in most No need for injections (in most cases)cases)Many “speed labs”Many “speed labs”

Page 17: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Worldwide Trends of Worldwide Trends of Methamphetamine UseMethamphetamine Use

WHO 2005 data estimates 42 million meth WHO 2005 data estimates 42 million meth users worldwide; 15M- heroin; 12M- cocaineusers worldwide; 15M- heroin; 12M- cocaine

Areas of very heavy use: Thailand, Areas of very heavy use: Thailand, Philippines, Indonesia, SE Asia, Eastern Philippines, Indonesia, SE Asia, Eastern Europe, Russia, ChinaEurope, Russia, China

Areas of increasing use; Northern Mexico, Areas of increasing use; Northern Mexico, USA, Canada, South Africa, EuropeUSA, Canada, South Africa, Europe

Page 18: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

The Eastward Spread of The Eastward Spread of Methamphetamine EpidemicMethamphetamine Epidemic

Page 19: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 20: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 21: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Total Number of Primary Total Number of Primary Methamphetamine Admissions:1998-2002Methamphetamine Admissions:1998-2002

0

2,000

4,0006,000

8,000

10,000

12,000

14,00016,000

18,000

20,000

1998 1999 2000 2001 2002

Nu

mb

er o

f A

dm

issi

on

s

SAMHSA, Treatment Episode Data Set: 1992-2002.

50% Increase

from 1998-2002

Page 22: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine: A Growing Problem Methamphetamine: A Growing Problem in Rural Americain Rural America

In 1998, rural areas In 1998, rural areas nationwide reported nationwide reported 949 methamphetamine 949 methamphetamine labs. labs.

In 2003, 9,385 were In 2003, 9,385 were reported. reported.

Source: El Paso Intelligence Center (EPIC), Source: El Paso Intelligence Center (EPIC), U.S. DEAU.S. DEA, 2005, 2005

Page 23: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 24: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 25: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 26: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine/Amphetamine TreatmentMethamphetamine/Amphetamine TreatmentAdmissions, by Route of Administration: Admissions, by Route of Administration:

1992-20021992-2002

Page 27: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

A Major Reason People Take Methamphetamines

is they Like

What It Does to Their Brains

A Major Reason People Take Methamphetamines

is they Like

What It Does to Their Brains

Page 28: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 29: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Dopamine Pathways

Functions•reward (motivation)•pleasure,euphoria•motor function (fine tuning)•compulsion•perseveration

Serotonin Pathways

Functions•mood•memory processing•sleep•cognition

nucleusaccumbens

hippocampus

striatum

frontalcortex

substantianigra/VTA

raphe

Page 30: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine: Neurochemical Methamphetamine: Neurochemical MechanismsMechanisms

Methamphetamine enters the brain through Methamphetamine enters the brain through dopamine transporters dopamine transporters

Enters dopamine vesicles Enters dopamine vesicles

Vesicles deplete themselves of dopamineVesicles deplete themselves of dopamine

Free-floating DA produces “free radicals” Free-floating DA produces “free radicals” (neurotoxins). (neurotoxins).

The synapse is flooded with dopamine, The synapse is flooded with dopamine, producing a profound sense of pleasure producing a profound sense of pleasure

Page 31: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

00

5050

100100

150150

200200

00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Ou

tpu

t%

of

Bas

al D

A O

utp

ut

EmptyEmpty

BoxBox FeedingFeeding

Source: Di Chiara et al.Source: Di Chiara et al.

FOODFOOD

100100

150150

200200

DA

Co

nce

ntr

ati

on

(%

Bas

elin

e)D

A C

on

cen

tra

tio

n (

% B

asel

ine)

MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

55

1010

Co

pu

latio

n F

req

ue

nc

yC

op

ula

tion

Fre

qu

en

cy

SampleNumberSampleNumber

11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717

Female 1 PresentFemale 1 Present Female 2 PresentFemale 2 Present

Source: Fiorino and PhillipsSource: Fiorino and Phillips

SEXSEX

Natural Rewards Elevate Dopamine LevelsNatural Rewards Elevate Dopamine LevelsNatural Rewards Elevate Dopamine LevelsNatural Rewards Elevate Dopamine Levels

Page 32: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

00100100200200300300400400500500600600700700800800900900

1000100011001100

00 11 22 33 44 5 hr5 hr

Time After AmphetamineTime After Amphetamine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

DADADOPACDOPACHVAHVA

AccumbensAccumbens AMPHETAMINEAMPHETAMINE

00

100100

200200

300300

400400

00 11 22 33 44 5 hr5 hrTime After CocaineTime After Cocaine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

DADADOPACDOPACHVAHVA

AccumbensAccumbensCOCAINECOCAINE

00

100100

150150

200200

250250

00 11 22 33 44 5hr5hrTime After MorphineTime After Morphine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

AccumbensAccumbens

0.50.51.01.02.52.51010

Dose (mg/kg)Dose (mg/kg)

MORPHINEMORPHINE

00

100100

150150

200200

250250

00 11 22 3 hr3 hr

Time After NicotineTime After Nicotine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Source: Di Chiara and Imperato, 2004Source: Di Chiara and Imperato, 2004

Effects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine Levels

Page 33: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Dopamine Reward Pathway Activation

without drugs

Page 34: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

The brains of people addicted to methamphetamine

are

different than those of non-

addicts

Methamphetamine Addiction

Page 35: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 36: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Axon

Neurotransmitter

Synapse

Dendrite

Receptors

Reuptake

МАО

Signal

storage

G-protein

Page 37: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 38: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 39: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 40: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.
Page 41: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Prolonged Drug Prolonged Drug Use Changes the Use Changes the

Brain In Brain In Fundamental and Fundamental and

Long-Lasting WaysLong-Lasting Ways

Page 42: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Comparison Subject METH userComparison Subject METH user

Dopamine Transporter Loss After Heavy Methamphetamine Use

Page 43: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Partial Recovery of Brain DopaminePartial Recovery of Brain DopamineTransporters in Methamphetamine Abuser Transporters in Methamphetamine Abuser

After Protracted AbstinenceAfter Protracted Abstinence

Normal control Meth abuser Meth abuser

(1 month detox) (24 month in recovery

Volkow, ND, Journal of Neurscience, 21, 2001

Page 44: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetamineMethamphetamine

Cognitive Cognitive

and and

Memory EffectsMemory Effects

Page 45: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Executive Systems FunctioningExecutive Systems Functioning

Deficits on executive tasks associated with:Deficits on executive tasks associated with:

– Poor judgment.Poor judgment.– Lack of insight.Lack of insight.– Poor strategy formation.Poor strategy formation.– Impulsivity.Impulsivity.– Reduced capacity to determine consequences Reduced capacity to determine consequences

of actions.of actions.

Page 46: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Reasons for Meth UseReasons for Meth Use

Reasons for using meth were wide-ranging:Reasons for using meth were wide-ranging:– To get high (56%)To get high (56%)– To get more energy (37%)To get more energy (37%)– To cope with mood (34%)To cope with mood (34%)– To lose weight/feel more attractive (29%)To lose weight/feel more attractive (29%)– To party (28%)To party (28%)– To escape (27%)To escape (27%)– To enhance sexual pleasure (18%)To enhance sexual pleasure (18%)

Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87

Page 47: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Meth and WomenMeth and Women

Typical gender ratio of heroin users in Typical gender ratio of heroin users in treatment : treatment : 3 men to 1 woman3 men to 1 woman

Typical gender ratio of cocaine users in Typical gender ratio of cocaine users in treatment : treatment : 2 men to 1 woman2 men to 1 woman

Typical gender ratio of methamphetamine Typical gender ratio of methamphetamine users in treatment : users in treatment : 1 man to 1 woman *1 man to 1 woman *

**among large clinical research populationsamong large clinical research populations

Page 48: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

0%

10%

20%

30%

40%

50%

60%

70%

80%

to g

et h

igh

to e

scap

e

peer

pre

ssur

e

to re

lax

to s

tay

awak

e

to g

et m

ore

ener

gy

to e

xper

imen

t

* to

relie

ve d

epre

ssion

to re

place

ano

ther

dru

g

* to

work

mor

e ho

urs

to c

once

ntra

te b

ette

r

* to

lose

weig

ht

* p< .001

female male

Self-Reported Reasons for Starting Methamphetamine Use

Page 49: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine and SexMethamphetamine and Sex

Page 50: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

My sexual My sexual drivedrive is increased by the is increased by the use of …use of …

18.1 20.5

43.9

70.6

55.3

11.1

85.3

55.6

0

10

20

30

40

50

60

70

80

90

100

% R

esp

ond

ing

"Y

es"

opiates alcohol cocaine meth

Primary Drug of Abuse

malefemale

(Rawson et al., 2002)

Page 51: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

My sexual My sexual pleasurepleasure is enhanced by is enhanced by the use of …the use of …

16.0 18.224.4

38.244.7

11.1

73.5 66.7

0

10

20

30

40

50

60

70

80

90

100

% R

espo

ndin

g "Y

es"

opiates alcohol cocaine meth

Primary Drug of Abuse

malefemale

(Rawson et al., 2002)

Page 52: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

My sexual My sexual performanceperformance is improved is improved by the use of …by the use of …

19.115.9

24.432.4

18.411.1

58.8 61.1

0102030405060708090

100

% R

espo

ndin

g "Y

es"

opiates alcohol cocaine meth

Primary Drug of Abuse

malefemale

(Rawson et al., 2002)

Page 53: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MethamphetamineMethamphetamine

IncarcerationIncarceration

Page 54: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

0 5 10 15 20 25 30

Methamph.

Cocaine

Other

Heroin

Alcohol

Marijuana

Primary Substance Reported Primary Substance Reported by California Inmatesby California Inmates

(N=22,903)(N=22,903)

6

11.5

15

17.4

21.5

28.8

Cartier J, Farabee D, Prendergast M. Cartier J, Farabee D, Prendergast M. Journal of Interpersonal Violence.Journal of Interpersonal Violence. 2006;21:435-445. 2006;21:435-445.

Page 55: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Those who used MA (81.6%) were significantly Those who used MA (81.6%) were significantly more likely than those who did not use MA more likely than those who did not use MA (53.9%) to have been returned to custody for (53.9%) to have been returned to custody for any reason or to report committing any violent any reason or to report committing any violent acts in the 30 days prior to follow-up (23.6% vs. acts in the 30 days prior to follow-up (23.6% vs. 6.8%)6.8%)MA use is significantly predictive of violent crime MA use is significantly predictive of violent crime and general recidivismand general recidivismOffenders who use MA may differ significantly Offenders who use MA may differ significantly from their peers who do not use MA and may from their peers who do not use MA and may require more intensive treatment interventions require more intensive treatment interventions and parole supervision than other types of drug and parole supervision than other types of drug involved offendersinvolved offenders

Cartier J, Farabee D, Prendergast M. Cartier J, Farabee D, Prendergast M. Journal of Interpersonal Violence.Journal of Interpersonal Violence. 2006;21:435-445.2006;21:435-445.

Page 56: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

A history of physical or sexual violence A history of physical or sexual violence (controlling for gender) is significantly (controlling for gender) is significantly related to meth use and a number of related to meth use and a number of

negative treatment outcomes. negative treatment outcomes.

These results suggest the importance These results suggest the importance of understanding client background of understanding client background factors before they enter treatment.factors before they enter treatment.

CSAT Methamphetamine Treatment Project 2003CSAT Methamphetamine Treatment Project 2003

Page 57: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Drug Endangered Children in Drug Endangered Children in California: California:

Methamphetamine Use and Methamphetamine Use and ManufactureManufacture

Page 58: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Children are Children are notnot small adults! small adults!

Different dietDifferent diet

Growing & developing rapidlyGrowing & developing rapidly

Higher metabolic & respiratory rateHigher metabolic & respiratory rate

Developing nervous systemDeveloping nervous system

Unusual habits (hand-to-mouth behaviors; Unusual habits (hand-to-mouth behaviors; close to floor, contact with many surfaces, at close to floor, contact with many surfaces, at risk for all poisonings)risk for all poisonings)

Biologic & developmental vulnerabilityBiologic & developmental vulnerability

Page 59: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

• Children who live in and Children who live in and around the area of the meth around the area of the meth lab become exposed to the lab become exposed to the drug and its toxic precursors drug and its toxic precursors and byproducts.and byproducts.

• Nationally, over 20% of the Nationally, over 20% of the seized meth labs in 2002 had seized meth labs in 2002 had children present. children present.

• 80-90% of children found in 80-90% of children found in homes where there are meth homes where there are meth labs test positive for exposure labs test positive for exposure to meth. Some are as young to meth. Some are as young as 19 months old.as 19 months old.

Page 60: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

ChildrenChildren

In 2002, a total of 142 children were In 2002, a total of 142 children were present at lab seizures in Riverside and present at lab seizures in Riverside and San Bernardino Counties. San Bernardino Counties.

Most children reported as being present Most children reported as being present during a seizure were school age.during a seizure were school age.

Page 61: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Methamphetamine Methamphetamine TreatmentTreatment

Page 62: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Treatment Effectiveness? Treatment Effectiveness?

Common rumors re treatment of Common rumors re treatment of clients with MA problems: clients with MA problems: – MA users are untreatable MA users are untreatable – Negligible recovery rates (5% to less than 1% Negligible recovery rates (5% to less than 1%

have been quoted in newspaper articles)have been quoted in newspaper articles)– The resulting conclusion is that spending The resulting conclusion is that spending

money on treating MA users is futile and money on treating MA users is futile and wasteful, wasteful,

– No data exists that supports these statisticsNo data exists that supports these statistics

Page 63: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Limitations on Current TreatmentsLimitations on Current Treatments

Training of clinical personnel is essential to Training of clinical personnel is essential to successfully treat MA users.successfully treat MA users.

Training alone is insufficient if the funding Training alone is insufficient if the funding necessary to deliver effective treatment is not necessary to deliver effective treatment is not available.available.

Treatment funding that promote short duration or Treatment funding that promote short duration or non-intensive outpatient services are non-intensive outpatient services are inappropriate for providing adequate care for MA inappropriate for providing adequate care for MA users.users.

Page 64: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MA Treatment IssuesMA Treatment Issues

Acute MA OverdoseAcute MA OverdoseAcute MA PsychosisAcute MA PsychosisMA “Withdrawal”MA “Withdrawal”Initiating MA AbstinenceInitiating MA AbstinenceMA Relapse PreventionMA Relapse PreventionProtracted Cognitive Impairment andProtracted Cognitive Impairment andSymptoms of ParanoiaSymptoms of Paranoia

Page 65: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MA Acute WithdrawalMA Acute Withdrawal

DepressionDepressionParanoiaParanoiaFatigueFatigueCognitive ImpairmentCognitive ImpairmentAnxietyAnxietyAgitationAgitationAnergiaAnergiaConfusionConfusion

Duration: 2 Days - 2 WeeksDuration: 2 Days - 2 Weeks

Page 66: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Psychiatric SymptomsPsychiatric Symptoms

Hallucinations are reported by one-third of MA Hallucinations are reported by one-third of MA users.users.

Majority of MA users entered treatment in a state Majority of MA users entered treatment in a state of severe depression.of severe depression.

Many are suicidal at treatment admissionMany are suicidal at treatment admission

Intense paranoid ideation are very common in MA Intense paranoid ideation are very common in MA users. users.

Page 67: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

MedicationsMedications

Currently, there are no medications that canCurrently, there are no medications that canquickly and safely reverse life threateningquickly and safely reverse life threateningMA overdose.MA overdose.

There are no medications that can reliablyThere are no medications that can reliablyreduce paranoia and psychotic symptoms,reduce paranoia and psychotic symptoms,that contribute to episodes of dangerousthat contribute to episodes of dangerousand violent behavior associated with MAand violent behavior associated with MAuse.use.

Page 68: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Medication Research for Medication Research for Methamphetamine DependenceMethamphetamine Dependence

Negative ResultsNegative Results UnclearUnclearImipramineImipramine Gabapentin GabapentinDesipramineDesipramine Modafinil ModafinilTyrosineTyrosine Topirimate TopirimateOndansetronOndansetron Disulfiram DisulfiramFluoxetineFluoxetine Lobeline Lobeline

AripiprazoleAripiprazole

Promising EvidencePromising Evidence: Bupropion : Bupropion

Page 69: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Bupropion: An effective Bupropion: An effective pharmacotherapy?pharmacotherapy?

Newton et al. 2005. Newton et al. 2005. – Bupropion reduces craving and reinforcing Bupropion reduces craving and reinforcing

effects of methamphetamineseffects of methamphetamines

Elkashef (recently completed) Elkashef (recently completed) – Bupropion reduces methamphetamine use in Bupropion reduces methamphetamine use in

an outpatient trial, with particularly strong an outpatient trial, with particularly strong effect with less severe users.effect with less severe users.

Page 70: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Special treatment consideration should be Special treatment consideration should be made for the following groups made for the following groups ::

Individuals under the age of 21 Individuals under the age of 21 Female MA users (higher rates of depression; very Female MA users (higher rates of depression; very high rates of previous and present sexual and high rates of previous and present sexual and physical abuse; responsibilities for children).physical abuse; responsibilities for children).Injection MA users (very high rates of psychiatric Injection MA users (very high rates of psychiatric symptoms; severe withdrawal syndromes; high rates symptoms; severe withdrawal syndromes; high rates of hepatitis).of hepatitis).MA users who take MA daily or in very high doses.MA users who take MA daily or in very high doses.Homeless, chronically mentally ill and/or individuals Homeless, chronically mentally ill and/or individuals with high levels of psychiatric symptoms at with high levels of psychiatric symptoms at admission.admission.Gay men (at very high risk for HIV and hepatitis).Gay men (at very high risk for HIV and hepatitis).

Page 71: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Treatments for Stimulant-use Disorders Treatments for Stimulant-use Disorders with Empirical Supportwith Empirical Support

Motivational Enhancement StrategiesMotivational Enhancement Strategies

Cognitive-Behavioral Therapy (CBT)Cognitive-Behavioral Therapy (CBT)

Community Reinforcement ApproachCommunity Reinforcement Approach

Contingency ManagementContingency Management

12 Step Groups12 Step Groups

Page 72: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Treatment of MA-Use DisordersTreatment of MA-Use Disorders

No medications currently are available withNo medications currently are available withevidence of efficacyevidence of efficacy

Two approaches - Contingency Two approaches - Contingency Management and Cognitive Behavioral Management and Cognitive Behavioral Treatment have data to support efficacyTreatment have data to support efficacy

MA users appear to respond to otherMA users appear to respond to othertreatment interventions in rates comparable treatment interventions in rates comparable to other types of drug users.to other types of drug users.

MA users are responsive to treatmentMA users are responsive to treatment

Page 73: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Contingency ManagementContingency Management

A technique employing the systematic delivery of A technique employing the systematic delivery of positive reinforcement for desired behaviors. In positive reinforcement for desired behaviors. In the treatment of methamphetamine dependence, the treatment of methamphetamine dependence, vouchers or prizes can be “earned” for vouchers or prizes can be “earned” for submission of methamphetamine-free urine submission of methamphetamine-free urine samplessamples..

Page 74: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Cognitive Behavioral Therapy and Cognitive Behavioral Therapy and Contingency ManagementContingency Management

CM is an effective treatment for reducing CM is an effective treatment for reducing stimulant use and is superior during treatment to stimulant use and is superior during treatment to a CBT approach alone. a CBT approach alone. CM is useful in engaging substance abusers, CM is useful in engaging substance abusers, retaining them in treatment, and helping them retaining them in treatment, and helping them achieve abstinence from stimulant use. achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels CBT also reduces drug use from baseline levels and produces comparable outcomes on all and produces comparable outcomes on all measures at follow-upmeasures at follow-up..

Rawson, RA et al. Addiction, Jan 2006, Rawson, RA et al. Addiction, Jan 2006,

Roll, JM et al, Archives of General Psychiatry, (In Press)Roll, JM et al, Archives of General Psychiatry, (In Press)

Page 75: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

SummarySummary

Methamphetamine is a significant publicMethamphetamine is a significant publichealth problem in the US and in the worldhealth problem in the US and in the world

It produces significant damage to the bodyIt produces significant damage to the bodyand the brainand the brain

Recovery from methamphetamineRecovery from methamphetaminedependence is possible and most braindependence is possible and most brainchanges are reversible.changes are reversible.

There are effective treatments forThere are effective treatments formethamphetamine dependence.methamphetamine dependence.

Page 76: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

If you have more questions…If you have more questions…

[email protected]@ucsd.edu

858/551 2946858/551 2946

Page 77: Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center.

Related Documents
EXPERIENCE FROM RESEARCH AND PRACTICE Treating … · Methamphetamine abuse Current Psychiatry 38 September 2014 tem through release of dopamine and norepinephrine, which increases

EXPERIENCE FROM RESEARCH AND PRACTICE Treating … ·...

Category: Documents
Methamphetamine Behavioral Treatments

Methamphetamine Behavioral Treatments

Category: Documents
MAINE METHAMPHETAMINE TOOLKIT METHAMPHETAMINE TOOLKIT This Toolkit is an early intervention and prevention strategy for Maine communities. While methamphetamine …

MAINE METHAMPHETAMINE TOOLKIT METHAMPHETAMINE TOOLKIT This.....

Category: Documents
Methamphetamine: A Devastation in Indian Country and Funding …unaha.org/images/2016-Methamphetamine-Presentation-WH... · 2017-04-17 · What is Methamphetamine Methamphetamine

Methamphetamine: A Devastation in Indian Country and Funding...

Category: Documents
Methamphetamine 101

Methamphetamine 101

Category: Documents
Methamphetamine contamination in residential properties ... · 1 Executive Summary Background – the methamphetamine situation in New Zealand • Methamphetamine is a powerful, highly

Methamphetamine contamination in residential properties...

Category: Documents
Oklahoma Methamphetamine Prevention Prevention.pdf · methamphetamine prevention programs, ... Oklahoma Methamphetamine Prevention Initiative Tel: ... meth lab decontamination

Oklahoma Methamphetamine Prevention Prevention.pdf ·...

Category: Documents
NEW MEXICO DEPARTMENT OF TRANSPORTATION METHAMPHETAMINE AWARENESS METHAMPHETAMINE AWARENESS.

NEW MEXICO DEPARTMENT OF TRANSPORTATION METHAMPHETAMINE...

Category: Documents
Idaho Methamphetamine Problem Methamphetamine Problem Idaho Methamphetamine Problem A Methamphetamine & Drug-Awareness Presentation by …

Idaho Methamphetamine Problem Methamphetamine Problem Idaho....

Category: Documents
Methamphetamine Large Scale

Methamphetamine Large Scale

Category: Documents
Igor Koutsenok, MD, MS Assistant Professor of Psychiatry, UCSD, Director, Center for Criminality & Addiction Research, Training & Application (CCARTA)

Igor Koutsenok, MD, MS Assistant Professor of Psychiatry,...

Category: Documents
Methamphetamine (TIK)

Methamphetamine (TIK)

Category: Documents