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Meth Is Back and We're Not Ready

Drugs: Amphetamine-related deaths soar as U.S. drug policies stay focused on earlier battles with heroin and cocaine.

May 01, 1996|MARK A.R. KLEIMAN and SALLY SATEL | Mark A.R. Kleiman is an associate professor of public policy at Harvard's Kennedy School of Government and cochair of the Harvard Working Group on Drugs and Addictions. Sally Satel is a psychiatrist on the faculty of the University of Pennsyslvania Medical School and also works with the District of Columbia Drug Court

Methamphetamine ("speed," "crank," "meth" or in its smokable form, "ice") is back. Not that it was ever really gone, but a surge in production in Mexico and consequent falling prices have sent a new wave of methamphetamine use washing across the entire western U.S.--as far east as Des Moines--with the predictable results: addiction, injury, stimulant psychosis leading to bizarre and sometimes horrifying behavior and death. Nationally, amphetamine-related deaths more than tripled between 1992 and 1994.

What are we going to do about it?

We could work with Mexico to squeeze down on methamphetamine production there. That would require the establishment and enforcement of the same sort of system for the control of precursor chemicals (in this case ephedrine and pseudoephedrine) that has worked reasonably well in the U.S. But the problems of Mexican drug law enforcement limit how much we can reasonably expect from that quarter.

We could try to make smuggling harder, but interdiction is never more than partially effective and methamphetamine is even less bulky than cocaine.

We could increase the penalties for dealing. There may be something to be gained here, though the cocaine experience isn't encouraging.

We can add to the current enforcement effort, if necessary by moving resources away from drugs that are spreading less quickly. That's almost certainly a good idea; an extra agent makes a much bigger impact on a small, growing market such as meth than on a large, mature market such as crack.

We can get the word out to people who think of meth as somehow safer than crack. Early in an epidemic is a good time for prevention messages, both because many people are being exposed to a drug for the first time and because most of them don't know much and will actually benefit from information.

In the case of methamphetamine, there's no need for the exaggeration that has created a credibility problem for other drug-prevention campaigns. The truth is quite scary enough: Speed is more likely to make you psychotic than cocaine. You can stay paranoid and violent for hours and days; sometimes the delusions and voices in your head persist indefinitely.

We can get ready to deal with a flood of speed freaks coming in for drug treatment or psychiatric care, or showing up as perpetrators of heinous crimes. The main challenge here is to get drug treatment folks, mental health workers and criminal justice agencies to recognize that any one person may fit all three categories.

Just because someone comes in for drug treatment, we shouldn't neglect to treat the psychiatric diagnosis of stimulant psychosis. Similarly, the person diagnosed by a psychiatrist as delusional and paranoiac also needs to be treated for the underlying substance abuse disorder. Most important, perhaps, the person who gets arrested for threatening a neighbor needs treatment and psychiatric help in additon to criminal justice processing; he's likely to be a continuing menace unless he stops using.

This isn't going to be any fun. Methamphetamine use and dealing are much less concentrated than crack dealing. The flip side of the concentration of crack use in urban poverty populations, primarily African American or Latino, has been the relative safety of most of the rest of the population. Methamphetamine, by contrast, is traditionally a drug of the white working class. The population potentially at risk is therefore substantially larger.

Nor is methamphetamine the only rising drug problem: Heroin also threatens a major outbreak and there are smaller but still worrisome problems with methcathinone ("cat") and the recently banned flunitrazepam (better known by the brand name Rohypnol). The tendency of our drug policies to keep fighting the previous battle--heroin in the late 1970s and early 1980s, cocaine now--ought to be replaced with a lively sense that the policies need to change as fast as the problems.

An election year is, of course, the worst possible time to deal with a problem of this sort. The politics of the drug issue puts a premium on the symbolism of toughness rather than on getting results, and many elected officials and their tame think tanks seem to prefer embarrassing their opponents to making real progress. We can only hope that the new director of the Office of National Drug Control Policy, Gen. Barry R. McCaffrey, will be able to dampen the partisan bickering and finger-pointing that has made it so hard to get any real work done.

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