Transcript Methamphetamine - 4TC Collaboration Meeting

Methamphetamine
Thomas E. Freese, Ph.D.
Director, Pacific Southwest Addiction Technology Transfer Center
Director of Training, UCLA Integrated Substance Abuse Programs
4TC Collaboration Meeting
Albuquerque, NM
October 17-19, 2006
How can we help each other?
•
•
Training issues related to
methamphetamine
How can the 4TCs collaborate?
Training Issues
•
We don’t have a problem…
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 1992
(per 100,000 aged 12 and over)
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 1997
(per 100,000 aged 12 and over)
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 2002
(per 100,000 aged 12 and over)
< 12
12 - 35
35 -58
58-99
100-149
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
150-199
200 or more
Treatment is a lagging indicator
What do lab data show us?
Clandestine Lab Incidents: 2000
944
2
28
351
34
127
123
0
26
7
8
283
283
127
142
2,198
384
641
399
50
889
0
363 29
0
3
104
243
1
1
4
126
<100
54
84
100-499
429
15
Source: national Clandestine Laboratory Database
(http://www.dea.gov/concern/map_lab_seizures.html)
1
14
249
26
5
0
21
36
209
0
2
12
1
500-999
15
>1000
Clandestine Lab Incidents: 2001
1,480
2
65
587
85
131
154
0
45
18
17
578
259
319
240
1,883
312
852
806
103
2,180
521 89
17
175
1
0
5
32
404
10
224
<100
59
166
100-499
619
16
Source: national Clandestine Laboratory Database
(http://www.dea.gov/concern/map_lab_seizures.html)
1
2
495
14
3
1
122
208
162
1
8
30
2
500-999
35
>1000
Clandestine Lab Incidents: 2002
1,443
0
89
525
207
119
250
0
79
34
30
861
105
552
450
1,743
253
769
883
121
2,767
723 97
52
373
2
0
10
47
431
36
462
<100
127
264
100-499
547
133
Source: national Clandestine Laboratory Database
(http://www.dea.gov/concern/map_lab_seizures.html)
3
1
608
33
10
1
225
357
121
0
26
61
1
500-999
157
>1000
Clandestine Lab Incidents: 2003
1,011
0
73
419
252
91
309
0
101
40
253
751
352
1,287
140
62
1,272
131
85
641
1,068
195
2,885
979 124
75
485
0
1
2
30
168
776
65
319
<100
250
341
100-499
677
94
Source: national Clandestine Laboratory Database
(http://www.dea.gov/concern/map_lab_seizures.html)
1
2
953
40
3
1
18
267
26
1
500-999
240
>1000
Clandestine Lab Incidents: 2004
947
3
65
472
234
42
168
2
78
31
205
79
72
228
764
122
584
659
120
66
1,335
106
1 286
1
0
1,058 7
165
4
75
2,788
571
318
1,327
800
170
261
267
285
452
123
20
Source: national Clandestine Laboratory Database
(http://www.dea.gov/concern/map_lab_seizures.html)
1
48
0
295
21
1
0
0
3
<100
100-499
500-999
276
>1000
Training Issues
•
•
We don’t have a problem…
Rumors speak louder than truth
Methamphetamine Rumors
•
•
•
•
It causes holes in the brain
Use it once and you are addicted
Only truckers and gay men use
It is not associated with sex in
heterosexuals
Rumor based policy?
A pervasive rumor has surfaced in many geographic
areas with elevated MA problems:


MA users are virtually untreatable with negligible
recovery rates.
Rates from 5% to less than 1% have been quoted in
newspaper articles and reported in conferences.
**The resulting conclusion is that spending money on
treating MA users is futile and wasteful, BUT…
no data exists that supports these statistics**
Training Issues
•
•
•
We don’t have a problem…
Rumors speak louder than truth
Which meth problem are we talking
about?
There are at least 3 meth
“epidemics”
•
•
•
Urban
Rural
Performance enhancement



Longer hours of work
Weight loss
Better sex
These overlap and intersect with each other
Training Issues
•
•
•
•
We don’t have a problem…
Rumors speak louder than truth
Which meth problem are we talking about?
Meth treatment is the same as
treatment for other drugs…isn’t it?
Statistics
During the 2002-2003 fiscal year:
•
•
35,947 individuals were admitted to
treatment in California under the Substance
Abuse and Crime Prevention Act funding.
Of this group, 53% reported MA as their
primary drug problem
Statistics
Analysis of:
• Drop out rates
• Retention in treatment rates
• Re-incarceration rates
• Other measures of outcome
All these measures indicate that MA users
respond in an equivalent manner as
individuals admitted for other drug abuse
problems.
Methamphetamine and
Treatment
•
•
•
•
Treatment outcomes with meth users
identical to results with cocaine users.
Outcomes using traditional methods are
poor.
Training resources seriously inadequate to
educate clinicians in areas affected by meth
Retention in treatment is the ballgame
Treatments for Methamphetamine
•
Cognitive Behavioral Therapies
•
Contingency Management
•
Motivational Interviewing
•
MATRIX Model
Methamphetamine
and the Brain:
Implications
for Treatment
Methamphetamine Abuser
p < 0.0002
Dopamine Transporter
Bmax/Kd
Normal Control
Dopamine Transporter
(Bmax/Kd)
Dopamine Transporters in
Methamphetamine Abusers
Motor Activity
2.0
1.8
1.6
1.4
1.2
1.0
7
8
9
10
11
12
13
Time Gait (seconds)
Memory
2
1.8
1.6
1.4
1.2
1
16
14
12
10
8
6
Delayed Recall
(words remembered)
4
PET Scan of Long-Term Meth Brain Damage
Training Issues
•
•
•
•
•
We don’t have a problem…
Rumors speak louder than truth
Which meth problem are we talking about?
Meth treatment is both the same as
treatment for other drugs…isn’t it?
HIV and Meth are intimately connected
across many populations.
Methamphetamine and HIV in MSM:
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
Drug-Free****
Residential****
* Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep,
*** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data
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
Results from the CADDs Data
System (2001)
*The statewide data collection system, CADDs has information on
the relative usefulness of treatment for MA users, by comparing
them to cocaine users.
Predictors of Retention in Treatment
for more than 90 days
1.
Higher rates of retention for men
2.
Legal supervision increases treatment retention
3.
4.
5.
6.
7.
Those who began use at an older age were
retained better than those who started when
younger
Those who are older at admission were retained
better
Injection users were retained more poorly
Those with chronic mental illness were retained
more poorly
Daily users are retained more poorly than those
who use less often than daily
Training Issues
•
•
•
•
•
•
We don’t have a problem…
Rumors speak louder than truth
Which meth problem are we talking about?
Meth treatment is both the same as
treatment for other drugs…isn’t it?
HIV and Meth are intimately connected
across many populations.
When are we going to find the sure for
addiction?
Blood Pressure
Investigational Medication
for High Blood Pressure
Before Tx
Tx
Tx Removed
Treatment Works!!!
Level of Use
New Behavioral Treatment
for Methamphetamine Use
Before Tx
Tx
Tx Removed
Treatment Failed!!!
100
90
80
40
30
20
50 to 70%
50
30 to 50%
60
50 to 70%
70
40 to 60%
Percent of Patients Who Relapse
Relapse Rates Are Similar for
Drug Dependence and
Other Chronic Illnesses
10
0
Drug
Type I Hypertension Asthma
Dependence Diabetes
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
Opportunities for Collaboration
Special Treatment Consideration Should be Made
for the Following Groups of Individuals:
•
•
Female MA users (higher rates of depression;
very high rates of previous and present sexual
and physical abuse; responsibilities for children).
Injection MA users (very high rates of psychiatric
symptoms; severe withdrawal syndromes; high
rates of hepatitis).
Special Treatment Consideration Should be Made
for the Following Groups of Individuals:
•
•
•
•
MA users who take MA daily or in very high
doses.
Homeless, chronically mentally ill and/or
individuals with high levels of psychiatric
symptoms at admission.
Individuals under the age of 21.
Gay men (at very high risk for HIV and
hepatitis).
What works in prevention?
•
We need to work together to figure it out.
Montana Methamphetamine
Initiative
Media campaign
Paint the State
www.montanameth.org
Montana Meth
Paint the State
An Example of a Successful
Collaboration
PAETC and PSATTC


Trainings on the Border on Substance
abuse and HIV for last three years.
Various community trainings:
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


HIV Task Force
Mental Health Nurses
Primary care physicians
Meth Tip Sheet
Thomas E. Freese, Ph.D.
[email protected]
www.psattc.org