**Community Crisis: Public Health's Role in the Methamphetamine Epidemic
"Partnering to Confront the Issue"**

Date of webcast: September 26, 2006

Link:
<http://www.mchcom.com/archivedWebcastDetailNewInterface.asp?aeid=400>

*[Drug Endangered Children]{.underline}*

**Question: If someone is interested in developing a statewide Drug
Endangered Children (DEC) initiative in a particular state, whom would
they contact?**

 

Response: The best first steps to develop a statewide DEC initiative
would be to schedule a brainstorming meeting and invite stakeholders
from the disciplines of law enforcement, Emergency Medical Services
(EMS), Child Protective Services, Prosecution, Mental Health Providers,
and School Systems. I recommend beginning with introductions and a 2-3
minute summary of how the meth epidemic impacts the work of each group.
State leadership is vital to policy and community participation. Often a
grassroots effort is helpful for an effective response for children. It
is helpful, prior to meeting, if you collect sample protocols from other
states to serve as a guide for local response. The National Alliance for
Drug Endangered Children is another resource; the website is:
[www.nationaldec.org](http://www.nationaldec.org/). *(H. Hopper)*

**Question: Do the DEC programs provide treatment for the parents or
does it lead to incarceration?**

Response: DEC Programs do not provide adult treatment although they can
be a key part of family reunification after the courts have determined
the outcome. Incarceration will not happen in every situation, nor will
access to drug treatment. However, coerced treatment, through Drug
Court, can be very effective. Few adults seek treatment without external
motivation to do so. DEC teams can oversee and encourage services for
children so they have a better understanding of what addiction means and
what changes are happening in their family. *(H. Hopper)*

**Question: Has the DEC evaluated what are the most effective
interventions in a community, i.e. increasing awareness via Public
Service Announcements, expanding treatment options, beefing up law
enforcement?**

Response: No assessments have been completed to date. *(H. Hopper)*

**Question: What specific screening questions do police, child
protection investigators and health professionals use to identify the
presence of meth when responding to reports of violence, child
abuse/neglect and medical emergencies?**

Response: DEC has screening protocols located at
[http://www.nationaldec.org/medical%20protocol/DECNationalProtocol.pdf](http://www.nationaldec.org/medical protocol/DECNationalProtocol.pdf)
. *(H. Hopper)*

*[Related Child Welfare Issues]{.underline}*

**Question: What should a judge consider when a child's caretaker is
brought up on meth-related charges?**

 

Response: If a person is in a judge\'s courtroom on a drug related
charge, this is an excellent opportunity to identify children who may
have been removed from the home at the time of arrest. Removal may not
be necessary in every situation but it is important to identify the
child and see that his/her needs are met and any medical, dental,
psychological, or developmental assessments that may be needed can be
provided or arranged. *(H. Hopper)*

A useful website may be the National Center on Substance Abuse and Child
Welfare located at <http://www.ncsacw.samhsa.gov/>.

**Question: Are there statistics showing an increase in child abuse,
physical abuse, sexual abuse and neglect, in relation to
parent/caregiver meth use?**

Response: During the past decade and previously, most such data has been
collected by state, county or other local agencies.  An example is data
collected and released by the Iowa Department of Human Services, in
March 2005.  Among those findings:

-   Iowa Statewide:  5,887 children since 2001 were involved in child
    abuse cases involving drug use (mostly meth) where abuse charges
    were based upon children testing positive or their physical presence
    in meth labs.

-   Add to this number, numerous cases of child neglect where parents'
    neglectful behavior stemmed from meth use.

-   Meth played a role in roughly one-half (720 of 1,469) the serious
    child abuse cases in a 16-county region.

Much of the credit for carrying state meth concerns to the national
level must be given to the National Association of Counties (NACO) whose
nationwide surveys in 2005 and 2006
(<http://www.naco.org/Template.cfm?Section=Meth_Action_Clearinghouse>)
focused on meth and crime, impact on children, effect of meth use on
hospital emergency departments, and on the challenges of treating meth
abuse.

From the Executive Summary of NACO's July 2005 survey on meth and
children:

"Meth is a major cause of child abuse and neglect:

-   Forty percent of all the child welfare officials in the survey
    report increased out-of-home placements of children because of meth
    in the past year.

-   During the past five years:

    1.  71% of the responding counties in California reported an
        increase in out-of-home placements because of meth; and

    2.  70% of Colorado counties reported an increase

-   In the past year:

    1.  More than 69% of counties in Minnesota reported a growth in
        out-of-home placements of children

    2.  54% of the responding counties in North Dakota reported a growth
        in out-of-home placements of children

Meth hurts children and families over the long-term. County officials
were asked if the particular nature of the meth user parent has
increased the difficulty of family reunification and 59% said yes." *(D.
Durkin)*

 

**Question: Is a rash on a child a common occurrence with meth
exposure?**

 

Response: Rashes and other skin irritations are common in children with
meth exposure. *(H. Hopper)*

**Question: What should a local health department be doing in response
to the meth epidemic in general and with respect to children, in
particular?**

Response: For Public Health Departments, key groups to involve are Home
Visitor Programs, WIC, and Early Childhood Interventionists. Many of
these individuals are involved in home visitation, provide information
to child care providers, make referrals for developmental assessments,
and have many educational opportunities with families. Programs such as
"Meth: Too Close to Home" at ky.train.org includes a photo guide for
home visitors.

Also, local public health agencies can be active in the following
efforts:

-   Development of local medical protocols for children removed from
    meth manufacturing environments.

-   Education of local agency staff (i.e. EMS) who may respond to meth
    lab seizures or whose staff may unknowingly visit homes where meth
    is made or used.  The dangers of the meth environment are not
    restricted to chemical contamination but also require staff to be
    well trained in response to violent behavior and other physical and
    biological hazards.

-   Education of the public and of other public and private agencies who
    serve the public about meth use/abuse.

-   Involvement in the Drug Endangered Children's (DEC) movement whose
    goal it is to encourage us to examine the lives of children who are
    endangered by substance abuse (not just meth) and to be part of a
    collaborative, comprehensive response to their needs. 

-   Because maternal and child health workers are often closely involved
    with families in crisis, it is particularly important that these
    staff work well with other agencies who provide services to families
    and that they coordinate their efforts to prevent harm; to intervene
    before a critical event; and to provide the resources that may
    preserve life, health, safety and family stability.

The role of public health is especially critical in rural areas where
public health workers typically wear many hats, take leadership roles,
and are critical to the well-being of their communities in many ways.
*(H. Hopper and D. Durkin)*

 

**Question: Are there any data on toxicity to infants of meth
transmitted through breast milk?**

Response: Dr. Carol L. Chervenak in Albany, Oregon has written a
document that may provide some useful information. For more information
please contact her at: Carol L. Chervenak, MD, Medical Director, ABC
House, P.O. Box 68, Albany, OR 97321 or <abchousedoc@comcast.net>. Click
here to view the document:
<http://128.248.232.90/archives/mchb/dcafh/september262006/CommonDrugsofAbuseinBreastFeeding.pdf>

**Question: Is there research being done with pregnant women who use
meth and the effects use has on the baby such as: crying for 24 hrs. at
a time?  Is there research being done with meth use and Shaken Baby
Syndrome?**

Response: The Infant Development, Environment, and Lifestyle Study:
Effects of Prenatal Methamphetamine Exposure, Poly drug Exposure, and
Poverty on Intrauterine Growth (IDEAL) is the first major study of
infants and pregnant women who use meth during their pregnancies.  Among
early findings was the fact that in the cities studied (Los Angeles,
California; Des Moines, Iowa; Tulsa, Oklahoma; and Honolulu, Hawaii)
five percent of all women used meth during their pregnancies.  Other
IDEAL results can be found at
<http://pediatrics.aappublications.org/cgi/content/full/118/3/1149>.

We do have additional information regarding effects at birth and in
later years to children who were exposed in utero, including the work of
Dr. Rizwan Shah of Des Moines, Iowa.  Some reports of Dr. Shah's finds
can be found at
<http://72.14.203.104/search?q=cache:XsJa6EdzIs4J:www.ncsacw.samhsa.gov/files/MethCaliberTeleconference.ppt+Dr.+RIzwan+Shah+meth&hl=en&gl=us&ct=clnk&cd=3>

and <http://aia.berkeley.edu/media/pdf/shah_children_meth.pdf>.  Her
power point presentations and other materials are readily available
online.

 

Also note the following documents from the National Alliance for Drug
Endangered Children and Dr. Kathryn Wells which can be found at
<http://www.colodec.org/decpapers/decpapers.htm#childabuseneglect>. *(D.
Durkin)*

**Question: Our community has been trying to come up with a protocol for
responding to meth labs and homes where meth has been used, in relation
to the safety of EMS, law enforcement officers and child protection
workers who respond to meth use in homes. Is there an example of a good
protocol available...a protocol that addresses everyone\'s role: Who
will transport children to the hospital for decontamination? Who will
provide clean clothing? When to decontaminate?**

Response: There are two documents and one website that may be helpful.

The first document is "Chemical Residual Removal for Children Associated
with Clandestine Methamphetamine Laboratories (April 2006)" can be found
at:
[http://www.nationaldec.org/medical%20protocol/Children%20Decon%20Proposal%20FINAL.pdf](http://www.nationaldec.org/medical protocol/Children Decon Proposal FINAL.pdf). 
This document addresses decontamination procedures and the research
basis for the recommendations.

The second document is color-coded to describe the role of each agency
involved in a meth lab seizure.  "Medical Protocols for Children Found
at Methamphetamine Labs" can be found at:
[http://www.colodec.org/decpapers/Documents/DEC%20Medical%20Protocol.pdf](http://www.colodec.org/decpapers/Documents/DEC Medical Protocol.pdf)

The website is the National Resource Center for Child Protective
Services (NRCCPS) at [http://www.nrccps.org](http://www.nrccps.org/).
*(D. Durkin)*

*[Physiological concerns]{.underline}*

**Question: What causes the marks all over the faces/bodies of meth
users? I would like some more information on physical signs of meth use.
Thanks.**

Response: Marks on the face and body of users are caused by a
combination of factors. 1) Meth addicts tend to be dehydrated and to
therefore have very dry skin, 2) Use of meth creates a psychotic
response that is known as *formication* or a sensation of bugs crawling
under the skin, 3) The body becomes toxic from chemicals that are in the
meth and this causes a breakdown of skin tissue and irritation as the
body sweats and attempts to excrete these toxins. The combination of
these three factors results in the condition known as "crank bugs" or
"meth bugs". *(H. Hopper)*

**Question: What is oral neglect? How early is one able to detect severe
oral health problems?**

Response: The following information is from the American Dental
Association and can be found at:
<http://www.ada.org/prof/resources/topics/methmouth.asp>.  The material
*indicates* that counseling and advice are recommended. 

# Oral effects

*The oral effects of methamphetamine use can be devastating. Reports
have described rampant decay that resembles early childhood decay and is
being referred to as "meth mouth". A distinctive decaying pattern can
often be seen on the cheek side (buccal) smooth surface of the teeth and
the inter-proximal surfaces of the anterior teeth.*

The rampant decaying associated with methamphetamine use is probably
caused by a combination of drug-induced psychological and physiological
changes resulting in xerostomia (dry mouth), extended periods of poor
oral hygiene, frequent consumption of high calorie, carbonated beverages
and tooth grinding and clenching. Some reports have also speculated that
the acidic nature of meth is a contributing factor.

                       

*[What the dental health professional should look for:]{.underline}*

-   *Unaccounted for and accelerated tooth decay in teenagers and young
    adults.*

-   *Distinctive pattern of decay on the cheek side (buccal) smooth
    surface of the teeth and the inter-proximal surfaces of the anterior
    teeth.*

-   *Malnourished appearance in heavy users, because methamphetamine
    acts as an appetite suppressant.\"*

*[What dental health professionals can do when they suspect meth
use:]{.underline}*

-   *Complete a comprehensive oral examination that includes taking a
    thorough dental and medical history.*

-   *Express concern regarding the dental findings.*

-   *If the patient is receptive to a medical consultation, have the
    phone number of a local physician, clinic or substance abuse
    rehabilitation facility available and be familiar with their
    protocol, so that the patient can be told what to expect.*

-   *Apply and suggest preventive measures such as topical fluorides.*

-   *Encourage consumption of water rather than sugar-containing
    beverages.*

-   *Be very cautious when administering local anesthetics, sedatives or
    general anesthesia, nitrous oxide, or prescribing narcotics.*

-   *Take opportunities to educate your patients about the risks
    associated with methamphetamine or any illicit drug use.*

Also note that other sources report that smoking meth is believed to
cause more damage and more rapid oral deterioration than is caused from
using other routes of administration, i.e., injection, inhalation and
ingestion.

It is difficult to distinguish the early stages of "meth mouth" from
regular dental decay.  In most cases, severe damage will be found in
chronic users.  Corrections staff report that once the damage to oral
structures reaches a moderate to severe stage, deterioration escalates
quickly. *(D. Durkin)*

 

**Question: Are any of the meth coalitions using their dental community
in the use and reporting of meth abuse? **

Response: We hope that they are. The National Alliance for Drug
Endangered Children has given awareness presentations to many dental
hygiene societies. For more information visit the website:
[www.nationaldec.org](http://www.nationaldec.org/). *(H. Hopper)*

**Question: What is the percentage of people who try meth who progress
to dependence?**

Response: We are not aware of a particular percentage; however, you may
find some useful information in the following journal article:

*Cocaine and methamphetamine: differential addiction rates (Gonzalez
Castro F, Barrington EH, Walton MA, Rawson RA, Department of Psychology,
Arizona State University, Tempe, Arizona 85287-1104, USA., Psychol
Addict Behav 2000 Dec; 14(4):390-6)*

*ABSTRACT*

*Clients admitted to treatment centers for stimulant addiction were
categorized as either regular users of cocaine or of methamphetamine
based on an algorithm involving 5 specific criteria. A sub sample
consisting of 90 regular users of cocaine and nonusers of
methamphetamine, and 39 regular users of methamphetamine and nonusers of
cocaine, was selected for comparison. Analyses showed that, when
compared with cocaine users, the methamphetamine users exhibited a
shorter period of time from 1st use to regular use (period of initial
use) and from 1st use to treatment entry (period of pretreatment use).
Relative to cocaine use, the use of methamphetamine appears to induce a
faster rate of progression toward regular use and subsequent need for
treatment.*

Those findings were based upon abuse of an earlier version (isomer) of
the drug methamphetamine.  According to national survey data, numbers of
past-month meth users remained stable from 2002 to 2004.  However, while
27.5 percent of past month users in 2002 satisfied the criteria for
dependence and abuse, 59.3 percent of past month users in 2004 were
considered dependent.  This demonstrates the increasingly addictive
nature of the more potent meth now available on our streets. *(D.
Durkin)*

*[Substance Abuse Addiction and Treatment]{.underline}*

**Question: How is meth intoxication treated? How is addiction
handled?**

Response: Please reference the following website for more information:
<http://csat.samhsa.gov/>

**Question: I like the focus on meth and the attention it brings to
chemical use, but I get concerned that we are getting so focused on meth
and we lose track of alcohol use and alcohol is the most abused drug.
This reminds me of the Speed Kills campaign of years past. I think we
need to focus on all drugs, not just meth or whatever the \"drug de jour
is of the year.\"**

Response: Without the *Speed Kills* campaign and the policies that
emerged from that campaign, we may well have had a far more serious meth
problem 30 years ago.  Speed did kill, and this stronger, more powerful
isomer of the drug methamphetamine has far more potential to destroy
lives.  Meth requires this level of effort because it destroys lives so
rapidly; because its users move so quickly from first use to full
addiction, to criminal acts and harm to others.

That said, meth must be addressed in the broader context of all
substance abuse. Remedies will be found in addressing the reason why so
many of us feel the need or the compulsion to be altered by the use of
legal and illegal substances.

The first incarnation of the Drug Endangered Children's movement was
focused on children removed from meth labs.  The National DEC Alliance
is being refreshed and refocused in an effort to address the needs of
children and families affected by all substance abuse. *(D. Durkin)*

*[Home Visitors]{.underline}*

**Question: Are there any national continuing education courses for home
visitors or public health workers?**

 

Response: Yes.  [http://ky.train.org](http://ky.train.org/) Meth: Too
Close to Home, 1 hour Nursing Credit is available. *(H. Hopper)*

**Question: Some of my staff are home visitors. What things might they
see or smell that would indicate danger for them? Besides things visible
in the home, what might they see in a person who is high on meth?**

Response: The Illinois Attorney General has some common sense advice
about how to recognize a meth lab.  That fact sheet can be found at:
<http://www.illinoisattorneygeneral.gov/methnet/recognizingmeth/outside.html>. 

 

Another document entitled "Working with Methamphetamine Abusers:
Personal Safety Recommendations and Procedures" and located at
<http://www.drugfreeinfo.org/PDFs/strengthensupervision.PDF>, deals with
physical indicators of abuse as well as worker safety.

That document, an update of one produced by the Illinois University
School of Social Work in 2001, lists the following "Indications of
Pending Violence toward Visitors:"

-   Presence of weapon in the vicinity

-   Signs of meth use

-   Rapidly shifting mood

-   Client is extremely irritable, argumentative

-   Escalation of client irritability, anger

-   Regular client does not seem to know who you are or attitude seems
    different

-   Evidence of paranoid thinking, delusions

-   Client verbalizes implicit or explicit threats against caseworker

> *(D. Durkin)*

*[Meth Labs]{.underline}*

**Question: What should the role of rental property or landowners be?**

 

Response: We encourage landowners to \"Walk Your Land\" to decrease the
risk of clandestine production of meth on property without the owner\'s
knowledge. An online publication located at:
[www.ca.uky.edu/land](http://www.ca.uky.edu/land). This awareness can
protect the safety of children who may spend time playing outdoors or
who live in rural areas. This publication and related lessons may also
be helpful for owners of rental property. *(H. Hopper)*

 

**Question: Have meth cleanup guidelines been developed?**

Response: At the Federal level, the Office of Research and Development
at the United States Environmental Protection Agency (EPA) has been
tasked with conducting research to support Federal meth lab remediation
guidelines.  According to an October, 2006, presentation by Dr. Kevin
Teichman, Acting Deputy of that office, their strategy is as follows:

-   *December 2006: EPA will complete their research plan.*

-   *January 2008:  EPA will publish best-practice guidelines for meth
    lab remediation.*

-   *January 2011: EPA will release draft Federal health-based
    guidelines for remediation*

At the State level, cleanup standards can be found on the publications
page for the National Alliance for Model State Drug Laws
(<http://www.natlalliance.org/publications.asp>) at
[http://www.natlalliance.org/pdfs/Environmental%20Cleanup%20Standards%20as%20of%2007.25.pdf](http://www.natlalliance.org/pdfs/Environmental Cleanup Standards as of 07.25.pdf).

The first cleanup guidance was written by the state of Washington in
1996.  Most of the subsequent documents are adaptations of that
document.  None of the remediation standards (i.e., amount of
methamphetamine per foot squared) are health-based.  There are many
unknowns, including at what level and where meth residues pose a health
threat; toxicity for each exposure route; and the bioavailability of
various chemicals.  There has not been adequate research to demonstrate
the "no effect" level of methamphetamine in an environment.

Rather, the "cleanup levels" in most of these guidance documents are an
attempt to reduce meth residue as close as possible to non-detect levels
and are based upon the presumption that even low levels may affect the
most vulnerable occupants of such environments, e.g., children, the ill
and elderly.

The basic instructions for cleanup include: 1) ventilation; 2) disposal
of carpeting and other absorbent materials; 3) soap and water, wash and
rinse; 4) encapsulation; 5) plumbing flushed; 6) heating and ventilation
system cleaned.

There are serious concerns about the current practice of pre- and
post-remediation sampling because of variability of results depending on
sampler, sampling methods, and material sampled among other things.

The Minnesota Department of Health and Minnesota Pollution Control
Agency guidance document can be found at:
<http://www.health.state.mn.us/divs/eh/meth/>.  Many other cleanup
guidance documents can be found online. *(D. Durkin)*

*[Legislation]{.underline}*

**Question: What has been the impact of placing
pseudoephedrine-containing products \"behind the counter\"?**

Response: The impact of precursor legislation has been significant. 
However, precursor legislation is not entirely responsible for the 70 to
80 percent decrease in meth lab seizures noted in many states and
nationwide.

For example, in Southern Minnesota the decline in labs began a full year
before Minnesota precursor laws came into effect.  Local authorities
attribute this decline in lab rates to several causes, including:

-   Successful awareness campaigns (e.g. Meth Watch) targeting retailers
    who sell meth-making ingredients, farmers who use anhydrous ammonia,
    first responders, and citizens who may notice ingredients in homes
    and the signs and odors of manufacture;

-   Increased supply of meth from Mexico at higher purity and potency;
    lower price;

-   Local policy;

-   Declining law enforcement resources, including loss of trained clean
    lab officers.

Many officers and others believe that the precursor legislation - though
very successful -- acts as what one officer called, "an idiot filter." 
That is, an inability to obtain precursors easily, paired with higher
sentences for meth cooks and the dangers of manufacturing have deterred
many cooks who found they had access to cheaper imported meth.

One or two years later, Minnesota and other states report one or more of
the following:

-   Prices are rising and potency decreasing again;

-   In places where limited purchases are not tracked electronically,
    whole families and/or groups of people are coming together to buy
    the limited amount of pseudoephedrine pills;

-   While labs are down in the broader community, lab reports on Indian
    lands (where there are many fewer peace officers per capita and per
    acre) are up;

-   Pseudoephedrine and ephedrine smuggling is being reported and
    shipments interdicted; and

-   Resourceful cooks who miss being able to produce high quality dope
    are finding a variety of ways around the limitations and being more
    resourceful and secretive about their cooking.

In short, precursor restriction, particularly with electronic monitoring
is a very helpful and important policy measure that has assisted in
slowing the problem.  Precursor restrictions alone are inadequate.  In
most communities, the unfortunate side-effect of precursor restriction
has been an increase in property crime and identity theft, as former
"cooks" have had to pay for their drugs. *(D. Durkin)*

*[Meth trends and Sub-populations]{.underline}*

**Question: Why do you think meth use hasn\'t been so prevalent in the
Northeast? Do you believe that it will become more of an issue in this
area?**

 Response: The spread of meth abuse from west to east started very
slowly but has increased in speed and intensity over the last five
years.  Many factors explain this unusual west-to-east pattern.  These
include:

-   The origin of "cooking" meth in the California desert and the
    association (stigmatization) of meth with biker gangs and other
    "outsiders."

-   Successful anti-meth campaigns (*Speed Kills*) of the 1970s which
    included education, plus major policy and legislation aimed at
    access to ephedrine and other precursors;

-   The fact that early cooking methods took longer (days then vs. hours
    now) and required larger facilities and rural locations.  Improved
    methods created the ability to make meth quickly and in towns and
    cities.

-   In urban areas, drug markets are controlled by purveyors of other
    drugs (e.g., cocaine, heroin, marijuana) who do not yield their
    territories easily. In the urban mid west, Mexican meth peddlers and
    outlaw gangs are catering to the urban market by supplying Mexican
    heroin and other drugs as well as meth.   

-   As the popularity of meth increased among the population of men who
    have sex with men, in rural populations, and finally in the cities
    of the west and Midwest, its reputation has grown, along with
    interest in meth among "entrepreneurs."

Meth has reached the east and will become a larger issue as users become
aware of its desirable properties.  Early predictions that meth would
quickly dissipate have been incorrect thus far. *(D. Durkin)*

 

**Question: What is the trend in the minority populations located in
urban areas? Is this another crack epidemic waiting to happen in Urban
areas?  What data is available for *minority populations* and meth?**

Response: Let me begin with the following excerpt from an article
titled, "The Next Crack Cocaine?  As Meth Use Grows, Officials Fear
Region Is Unprepared to Deal With It."   The article appeared in the
Washington Post in March 2006 and can be found at:
<http://www.washingtonpost.com/wp-dyn/content/article/2006/03/18/AR2006031801331_pf.html>.

*Experts said one of the biggest problems in bringing attention to the
meth problem in the area is the lack of reliable statistics on the
number of users. Richard Rawson, a professor at UCLA who has been
studying the drug for two decades, said "public health indicators that
should indicate the meth problem \-- such as emergency room visits and
patients in treatment \-- lag five to seven years behind the emergence
of the drug".*

*\"In some places, the public health people are saying, \'Well, we\'re
not seeing it; it\'s not that big a problem here,\' \"he said.\"But
that\'s not what the data means.\"*

*"The best predictors of an emerging meth epidemic", Rawson said, "are
the presence of meth use in the gay community and the discovery of even
small numbers of meth labs".*

Dr. Rawson tried to explain a phenomenon that has become familiar in
many states and communities where meth is now a significant problem. 
That is:  people serving the public, in emergency departments, jails,
and among front-line public health and human services workers have
typically recognized the problem before formal data and typical
statistical indicators have verified it.

That said, the National Survey on Drug Use and Health
(<http://www.oas.samhsa.gov/2k5/meth/meth.htm>) tells us that averages
for 2002, 2003, and 2004 indicate that:

-   The highest rates of past year methamphetamine use were found among
    Native Hawaiians or other Pacific Islanders (2.2 percent), American
    Indians or Alaska Natives (1.7 percent) and persons reporting two or
    more races (1.9 percent)

-   Past year methamphetamine use among whites (0.7 percent) and
    Hispanics (0.5 percent) was higher than among blacks (0.1 percent)
    or Asians (0.2 percent).

Meth, in rural America, has been predominantly a drug used by
Caucasians.  Notable exceptions, now proved statistically, have been
Hawaiian Natives (due to the overwhelming use of meth in Hawaii) and
Native Americans, due to use of the drug in Native American communities.

The spread of meth across this country was from west to east and has
typically occurred first in rural areas, later spreading to cities and
urban counties.  This is contrary to the spread of other drugs, which
have moved from both coasts towards the middle, more rural states.  This
has surprised and confounded data gatherers and others.

In rural, continental America, meth is predominantly used by Caucasians,
Native Americans and a few people of Hispanic origin.  When meth reaches
the city, we see a broader representation of ethnic groups and the
pan-ethnic use of meth by gay men.

The relatively small numbers of Asians, Blacks and Hispanics represented
by current data reflect a number of realities.  First, drug-using people
of color in large cities have existing drugs-of-choice and established
sources for those drugs that may be resistant to change.  Second, it may
be that people of color are less likely to receive treatment and other
services, so may not be reflected accurately in the statistics.  Third,
the statistics do not reflect current use.  And finally, as Dr. Rawson
and others have observed, the disability and disintegration that results
from meth use is so rapid that police officers and other health and
human services workers see trends and evidence of meth abuse long before
they are reflected in the statistics. *(D. Durkin)*

 

**Question: What is known about meth use and gay men?**

Response: Please see the following study: Shoptaw, S., Reback, C., Peck,
J., Yang, X., Rotheram-Fuller, E., Larkins, S., Veniegas, R., Freese,
T., Hucks-Ortiz, H. (2005). "Behavioral treatment approaches for
methamphetamine dependence and HIV-related sexual risk behaviors among
urban gay and bisexual men", in *Drug and Alcohol Dependence*, volume
78, pages 125-134. A comprehensive list of references on the subject is
included in the document.

*[HRSA Office of Rural Health Policy]{.underline}*

**Question: Will HRSA's priority of mental health and substance abuse
include funding for expansion grants to existing health centers?**

Response: We will not know activities related to HRSA's priority of
Mental Health until the Fiscal Year 2007 budget which is approved by
Congress. *(M. Brand)*

**Question: With emphasis on matching data with results for funding, is
HRSA flexible to allow room for qualitative data vs. quantitative?**

Response: HRSA's emphasis on data and results follow on the US
Department of Health and Human Services' (DHHS) strategy to data systems
for measuring progress toward achieving the public health and human
service goals and objectives.  Many of HRSA's grant programs provide
specific guidelines around what measures are collected with an emphasis
on quantitative measures.  However, the application narrative allows for
grantees to discuss more qualitative performance results. *(M. Brand)*

**Question: Suggestion for HRSA: Provide funding to HIV programs that
work with men who have sex with men (MSM) and provide funding for the
elimination of syphilis.**

Response: We will pass this information on to HRSA's HIV/AIDS Bureau.
*(M. Brand)*

*[Native Americans]{.underline}*

**Question: How would the Indian Health Service (IHS) of the US
Department of Health and Human Services best address this meth
epidemic?**

Response: First, the IHS should listen to Tribal Communities to hear
what their specific needs are as one size does not fit all. Second, IHS
must make reasonable efforts to include input form Tribal communities so
there is a focus on the specific needs of each. Third, IHS must provide
community development training for Tribal communities and lend support
to their effort of forming local solutions, coalitions, and prevention
efforts to address the methamphetamine concern. Finally, we must blend
our Western model approach (Matrix Model) with traditional medicine
(traditional healers and traditional culture) to the will of the Tribal
communities.

Research has a bad reputation among Tribal communities for many valid
reasons, and efforts to increase research in Tribal communities is a
very daunting task. Research and data collection, however, is key to
assisting IHS to identify best practices and direct our attention to
those best practices that address Methamphetamine or other health
concerns. *(G. Quinn, Indian Health Service)*

**Question: Is meth a problem for tribes in Montana?**

Response: Indian Health Service testimony in Spring, 2006, suggests that
meth is considered to be an issue by tribes across the country, but more
often in the West. Click here to learn more:
<http://128.248.232.90/archives/mchb/dcafh/september262006/methsurvey_bia_doj_tribalsurvey.pdf>

**Question: Are people on reservations making their own meth or is it
being imported from elsewhere?**

Response: Meth labs do exist on reservations. Please refer to this
website for more information:
<http://128.248.232.90/archives/mchb/dcafh/september262006/methsurvey_bia_doj_tribalsurvey.pdf>

**Question: What did the Northern Cheyenne do to break down the walls of
mass denial?**

Response: The September, 2006, web cast pointed out that tribal
leadership stood up and discussed the matter. They also encouraged their
community to spend time on more positive social activities such as the
rodeo. Go to MCHCOM.COM to view archived web cast. *(J. Thierry)*

**Question: Has anyone identified a \"model\" code for reservations?**

Response: Unfortunately, we were not able to find any codes for
reservations. *(J. Thierry)*

*[Additional Resources]{.underline}*

**Question: I am from Houston, Texas, where can I obtain written
information on meth and what to look for? What can I do to help here
where I live?**

Response: The webpage containing the meth web cast also has a link to
additional meth resources. Please click here for more information:
<http://128.248.232.90/archives/mchb/dcafh/september262006/METH_101_Resources.htm>

You'll also find helpful information at these two websites:
[www.methresources.gov](http://www.methresources.gov/)

and at [www.methpedia.org](http://www.methpedia.org/).