Feature:
The
Methamphetamine
Epidemic
--
Less
Than
Meets
the
Eye
8/5/05
News consumers on the US East Coast can be forgiven for nervously glancing over their shoulders in search of that 20-foot wave of crystal meth rolling toward them out of the Midwest, leaving in its wake a shattered landscape of trailer parks turned into toxic dumps, runny-nosed neglected toddlers clutching worn teddy-bears, and good parents turned into crazed, toothless tweakers who take time off from cooking more meth only to commit heinous crimes, steal more supplies, or have sex with their children. After all, this is, with only a little exaggeration, the message trumpeted by an ever louder cacophony of news reports about the "methamphetamine epidemic" sweeping the nation.
Fortunately, there is less here than meets the eye. A review of the standard indicators of drug use, such as the Monitoring the Future (MTF) surveys of students, the National Household Survey (now known as the National Survey on Drug Use and Health), and the Drug Abuse Warning Network (DAWN) of hospital emergency room reports, does not show any rapid increase in methamphetamine use in recent years. In the MTF surveys, 15.4% of 12th graders in 1991 reported ever using amphetamines. By 1998, that figure had inched up to 16.4%, but by last year the figure had declined back to 15.0%, indicating that amphetamine use over the past decade has remained essentially flat. When MTF looked only at methamphetamine, which it separated out from other amphetamines only in 1999, it found that the percentage of seniors who reported ever using the drug actually declined from 8.2% in 1999 to 6.2% in 2004. Similarly, the National Household Survey actually shows a tiny decline in reported non-medical stimulant use in 2002 and 2003, the most recent years for which data is available. According to the survey, 5.3% of people over 12 reported ever using amphetamines in 2002, while that figure was 5.2% the following year. That same survey found that the number of people who had ever used meth was 1.24 million in 2002 and 1.23 million the following year. A longer-term review of reported life-time stimulant use from the survey is even more surprising. Going back to 1965, it shows hundreds of thousands of people reporting life-time use each year, peaking in 1974 at 646,000 and then dropping gradually over the next 20 years before bottoming out at 219,000 in 1991. [The drug-taking counterculture of the 1960s caught on quickly. Bob Dylan's slightly exotic speed user with "her fog, her amphetamine, and her pearls" was replaced by the end of the decade by Canned Heat's Amphetamine Annie: "Her mouth worked like a grinding mill, her lips were chapped and sore, she saw things in the windows, she heard things at the door." Ironically, Canned Head main man and lead vocalist Bob "Bear" Hite died of a barbiturate overdose shortly thereafter.] Since the early 1990s, the number of reported life-time users has climbed back to just slightly more than in 1974, peaking at 707,000 in 1999 and declining slightly to 697,000 in 2003. [Again, the new mood was reflected in song, with the Bay area band Primus singing of "Those Damned Blue-Collar Tweakers," whom they noted "are the backbone of this town." The tune is also notable for a swipe at then President Bush the Elder that applies again today: "And Curious George's drug patrol is still out there hunting snipe."] A more direct measure of meth-related harm, the DAWN emergency room mentions, likewise paints a picture of flat -- not rapidly escalating -- methamphetamine use. According to the DAWN numbers, there were 17,537 methamphetamine mentions in 1994. Last year, that number was 17,696. "There is no evidence of an increase in meth use. In fact, it's been flat for a decade or more or even declining slightly," said Craig Reinarman, co-editor of the groundbreaking "Crack in America," which debunked many of the myths surrounding that drug, and currently professor of sociology at the University of California at Santa Cruz. "To be fair, 2003 is the last year for which there is good data available, and this flood of meth stories appears to have really taken off in the last six months or so, so it is possible we are missing something. But most of these recent stories appear to be based on little more than anecdotes from law enforcement or social workers. It may be true that there is a small number of meth users who are getting in serious problems, but it looks like the press is falsely extrapolating to create a trend that is not supported by the aggregate numbers," he told DRCNet. "This is the beginning of a classic scare where you have horrible anecdotes substituted for epidemiological evidence and the media going with those easy stories," Reinarman explained. "Story-based coverage can be very misleading. They pick the most dramatic story with the eye-catching headlines, but those sorts of stories distort the real picture. You don't want to mistake worst case scenarios for the norm, but that is what happens, and it's true of every drug scare. Instead of solid epidemiological evidence that can be tiresome and boring, you get these dramatic anecdotes." "We in the field like to say that a Newsweek cover story is the surest sign the epidemic has ended," laughed Dr. David Duncan, chairman of the National Association for Public Health Policy's Council on Illicit Drugs and head of Duncan & Associates, a Kentucky-based epidemiological and statistical consulting firm. "We define an epidemic as an incidence significantly greater than the expected background level," he explained. "Five cases of bubonic plague in Chicago is an epidemic; 500 cases in Calcutta is not." As for methamphetamine, said Duncan, "By that standard, we have experienced a methamphetamine epidemic for the past 20 years, where we've seen more meth use since the 1970s. But we are clearly on the downswing of the epidemic. Usage has been declining since 1999 and arrests have been going down since 2000. Despite all the publicity, they are actually arresting fewer people than they did five years ago," he told DRCNet. "Technically, it is an epidemic, but it is one that appears to be fading." But even if meth use isn't on the rise, it's still a highly addictive drug whose users are not amenable to treatment, right? Wrong. "The research shows it's pretty much the same as any other drug," said Duncan. "If you look at usage information, you see that of all the people who ever used the drug, one in 10 used in the past year. Of those, one in 10 used in the past week. And among those past week users, the majority only used it once." It's the same story with treatment, he said. "All the data show the same success rate with meth as any other drug dependence -- except for tobacco, which is by far the most addictive drug. It doesn't matter if you're talking about meth or heroin or alcohol -- in each case most of the people who become addicted wind up getting off the drug." "The data always lags behind reality," agreed Doug McVay, an analyst for Common Sense for Drug Policy. "By the late 1990s, feds and researchers were studying and publishing about rural meth use and talking about the escalation of the problem in the 1990s. Now, it seems to have leveled off. Instead of an increase in meth use, what we are seeing is an increase in the attention paid to it." There are several possible reasons for this. While the numbers show that meth use is actually fairly flat in recent years, the wide dissemination of information about how to home-cook the drug, which began with books like "Secrets of Clandestine Meth Manufacture," by "Uncle Fester," and has now exploded via the Internet, has indisputably led to an increase in home meth labs. There appears to be some conflation of the rise in home meth labs with an actual increase in meth use. "It is not meth use that we need to be so concerned about, but home manufacturing," said Duncan. "It is a serious environmental and public health problem, but it is one that is caused entirely by the war on drugs. If meth users could go to a pharmacy and get pure meth, not only would they be better off, but so would everyone else. This meth lab stuff helps feed the frenzy. It doesn't matter if it's just some guy with a Bunsen burner on his kitchen counter, you still get all these headlines about meth labs." As for laws aimed at home labs, such as the ones either passed or under consideration in 40 states that restrict the sales of cold remedies containing pseudoephedrine, they are having unintended consequences, said McVay. "If you look at Oklahoma, which led the way with those Sudafed laws, what you are seeing is, yes, a 90% drop in lab busts, but the number of ice seizures has increased five-fold. Ice is the smokeable meth being imported by the Mexican gangs. In terms of overall meth use, these laws really do nothing except protect the market share of the Mexicans." In addition to concerns over home meth labs -- which, according to the National Drug Intelligence Center account for only 20% of all meth consumed in the country -- the Bush administration's move to cut finding for anti-drug law enforcement task forces through proposed cuts in the Justice Assistance Grants program and the High Intensity Drug Trafficking Areas program has motivated law enforcement and elected officials to scream long and loud about how badly they need that money. For many of them, methamphetamine is exhibit one. And the rhetoric has been remarkable. "Meth is the biggest threat to the United States, maybe even including al-Qaeda," warned Rep. Tom Osborne (R-NE) during a hearing last month where representatives ripped the Office of National Drug Control Policy over the proposed cuts and over its failure to sufficiently prioritize the "meth menace." "We've got something right in our lap that is absolutely the worst kind of drug the nation has ever seen," said Umatilla (Oregon) County Commissioner Bill Hansell, president-elect of the National Association of Counties. "To not address it now would be a huge mistake." The association was the author of a much-hyped survey of sheriffs last month where 58% of sheriffs described meth as their worst drug problem. What has been as remarkable as some of the overheated rhetoric has been the fact that the federal government has been a relative voice of reason compared to cops and congressmen. It is, after all, the Bush administration that initially sought the budget cuts that have excited such outrage. In that same hearing where meth was compared -- unfavorably -- to Al Qaeda, deputy drug czar Scott Burns steadfastly refused to call meth use an epidemic, telling the hearing that police in the Northeast "would laugh at me if I told them there was a meth epidemic." In deference to his congressional overseers, he did, however, call meth "the most destructive, dangerous, terrible drug that's come along in a long time." There is one indicator that continues a steady climb, and that is the number of people receiving treatment for meth use. That number has increased more than five-fold in the past decade. "While the overall use figures are pretty much flat, we are seeing meth account for more than 20% of all drug treatment in some states, and I suspect that is what is fueling this," said Leah Young, a spokeswoman for the federal Substance Abuse and Mental Health Services Administration. In 1993, there were 21,000 meth treatment admissions; a decade later there were 116,000," she told DRCNet. "Meth is taking up treatment resources like it never did before, and the states are paying attention to it because it seems to have burst on them out of nowhere." But even the steady increase in the number of people in treatment for meth over the past decade does not necessarily mean more meth users are seeking treatment. Instead, alone with marijuana among all other drugs, a majority of meth users in treatment are there because a judge sent them there in a criminal proceeding. Nearly 51% of all meth users in treatment in 2003 were there as a result of criminal justice system referrals. While the thrust of this article has been to deflate overstated claims of a "meth epidemic," there is clearly problematic use out there. "We have seen some increased use and we've seen an increase in HIV transmitted by male injection drug users who are having sex with men, and this public health issue is our real concern," said Luciano Colonna, executive director of the Harm Reduction Project, which is sponsoring the First National Conference on Meth, HIV, and Hepatitis C later this month in Salt Lake City. "But we have also seen increased law enforcement attention, more crackdowns, more arrests." "We have to acknowledge there is enough of a kernel of truth in all these meth stories for people to be concerned," said Reinarman, "but instead of the big picture you get a rush to judgment." And a distorted picture of who is using the drug and how often. The laser-like focus on the stereotypical tweaker obscures both the reality of who is using meth (and how) and the larger social context of problematic use, said Reinarman. "I don't doubt that some people are ruining their lives with meth, but how representative is it and what else is going on in their lives that could account for extreme and dangerous drug use? This has been a largely rural phenomenon, and these areas have been economically hard-hit. We are looking at people who have lost real jobs that pay enough to get by because of deindustrialization, people who are part of a working class that is seeing its life chances evaporate before its eyes," Reinarman said. "The white, trailer trash guy with tattoos and a t-shirt, drinking beer, chain-smoking and shooting speed with dirty kids crawling around being neglected is the poster child," said Reinarman, "but there are a lot of different use patterns out there. "There is the middle class white woman who gets it from a psychiatrist's prescription, there are people who binge as a couple every few months, there are students who use it to study. So how representative is the stereotypical speed freak? I don't think anyone knows." Jason Zeidenberg, executive director of the Justice Policy Institute, has been watching the meth numbers, too, and he added some perspective. "Meth is a real problem for some people, but it is an over-hyped problem. All you have to do is look at the use rates and look at sentencing. When 100,000 people a year die from alcohol, I'm still saying that's the most dangerous drug in America."
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