1. 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

2. How can we help each other? Training issues related to methamphetamine How can the 4TCs collaborate?

3. Training Issues We don’t have a problem…

4. Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992 (per 100,000 aged 12 and over) 35 - 58 12 - 35 < 12 No data > 58 SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

5. < 12 35 - 58 12 - 35 < 12 No data > 58 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

6. 58-99 < 12 12 - 35 35 -58 150-199 200 or more 100-149 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2002 (per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

7. Treatment is a lagging indicator What do lab data show us?

8. Clandestine Lab Incidents: 2000 2 127 26 283 889 243 399 429 641 36 7 123 34 12 142 50 384 209 28 283 2,198 351 1 104 14 249 4 15 54 84 126 15 8 29 21 363 3 944 1 2 127 0 0 0 0 0 1 1 5 26 <100 100-499 500-999 >1000 Source: national Clandestine Laboratory Database (http://www.dea.gov/concern/map_lab_seizures.html)

9. Clandestine Lab Incidents: 2001 8 319 45 578 2,180 404 806 619 852 208 18 154 85 30 240 103 312 162 65 259 1,883 587 5 175 32 495 10 35 59 166 224 16 17 89 122 521 17 1,480 2 2 131 0 1 1 1 2 0 1 3 14 <100 100-499 500-999 >1000 Source: national Clandestine Laboratory Database (http://www.dea.gov/concern/map_lab_seizures.html)

10. Clandestine Lab Incidents: 2002 26 552 79 861 2,767 431 883 547 769 357 34 250 207 61 450 121 253 121 89 105 1,743 525 10 373 47 608 36 157 127 264 462 133 30 97 225 723 52 1,443 1 0 119 0 0 1 3 1 0 2 10 33 <100 100-499 500-999 >1000 Source: national Clandestine Laboratory Database (http://www.dea.gov/concern/map_lab_seizures.html)

11. Clandestine Lab Incidents: 2003 18 751 101 1,272 2,885 776 1,068 677 641 253 40 309 252 26 352 195 140 85 73 131 1,287 419 30 485 168 953 65 240 250 341 319 94 62 124 267 979 75 1,011 1 0 91 0 1 1 0 2 2 1 3 40 <100 100-499 500-999 >1000 Source: national Clandestine Laboratory Database (http://www.dea.gov/concern/map_lab_seizures.html)

12. Clandestine Lab Incidents: 2004 48 1,058 78 1,335 2,788 800 659 452 584 205 31 168 234 21 228 120 122 72 65 79 764 472 75 571 318 1,327 170 276 261 285 267 123 106 286 295 10741074 165 947 1 3 42 2 1 0 0 1 3 0 20 66 <100 100-499 500-999 >1000 Source: national Clandestine Laboratory Database (http://www.dea.gov/concern/map_lab_seizures.html)

13. Training Issues We don’t have a problem… Rumors speak louder than truth

14. 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

15. 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**

16. Training Issues We don’t have a problem… Rumors speak louder than truth Which meth problem are we talking about?

17. 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

18. 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?

19. 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

20. 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.

21. 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

22. Treatments for Methamphetamine Cognitive Behavioral Therapies Contingency Management Motivational Interviewing MATRIX Model

23. Methamphetamine and the Brain: Implications for Treatment

24. Dopamine Transporters in Methamphetamine Abusers p < 0.0002 Normal Control Methamphetamine Abuser 78910111213 1.0 1.2 1.4 1.6 1.8 2.0 Time Gait(seconds) Dopamine Transporter (Bmax/Kd) Motor Activity 46810121416 1 1.2 1.4 1.6 1.8 2 Delayed Recall (words remembered) Dopamine Transporter Bmax/Kd Memory

25. PET Scan of Long-Term Meth Brain Damage

26. 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.

27. Methamphetamine and HIV in MSM: Time-to-Response Association? * Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep, *** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data

28. Q.10: I am more likely to have sex (e.g., intercourse, oral sex, masturbation, etc.) when using …

29. 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.

30. Predictors of Retention in Treatment for more than 90 days 1. Higher rates of retention for men 2. Legal supervision increases treatment retention 3. Those who began use at an older age were retained better than those who started when younger 4. Those who are older at admission were retained better 5. Injection users were retained more poorly 6. Those with chronic mental illness were retained more poorly 7. Daily users are retained more poorly than those who use less often than daily

31. 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?

32. Investigational Medication for High Blood Pressure Treatment Works!!!

33. New Behavioral Treatment for Methamphetamine Use Treatment Failed!!!

34. Relapse Rates Are Similar for Drug Dependence and Other Chronic Illnesses Relapse Rates Are Similar for Drug Dependence and Other Chronic Illnesses 0 0 10 20 30 40 50 60 70 80 90 100 Drug Dependence Drug Dependence Type I Diabetes Type I Diabetes Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000. Percent of Patients Who Relapse

35. Opportunities for Collaboration

36. 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).

37. 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).

38. What works in prevention? We need to work together to figure it out.

40. Montana Methamphetamine Initiative Media campaign Paint the State www.montanameth.org

41. Montana Meth Paint the State

42. An Example of a Successful Collaboration Trainings on the Border on Substance abuse and HIV for last three years. Various community trainings: HIV Task Force Mental Health Nurses Primary care physicians Meth Tip Sheet PAETC and PSATTC

44. Thomas E. Freese, Ph.D. tefreese@ix.netcom.com www.psattc.org