From Texas to North Carolina: A Forty Year Perspective on Methamphetamine Use
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From Texas to North Carolina: A Forty Year Perspective on Methamphetamine Use William Zule, Dr.P.H. First National Conference on Methamphetamine HIV and Hepatitis 2005: Science and Response

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3040 Cornwallis Road ■ P.O. Box 12194 ■ Research Triangle Park, North Carolina, USA 27709

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3040 cornwallis road p o box 12194 research triangle park north carolina usa 27709

From Texas to North Carolina: A Forty Year Perspective on Methamphetamine Use

William Zule, Dr.P.H.

First National Conference on Methamphetamine HIV and Hepatitis 2005: Science and Response

Parts of this study were funded by Grants DA017373, DA13763, DA05741, DA07471from the National Institute on Drug Abuse

3040 Cornwallis Road ■ P.O. Box 12194 ■ Research Triangle Park, North Carolina, USA 27709


3040 cornwallis road p o box 12194 research triangle park north carolina usa 27709

The interpretations presented here reflect the views of the author. They do not reflect the position of any funding agency or of RTI.


Presentation goals

Presentation Goals

  • Describe the evolution of methamphetamine use in Central Texas from the 1960s through the present.

  • Describe methamphetamine use in North Carolina.

  • Compare endemic methamphetamine use with use in an emerging epidemic


Methamphetamine use in central texas evolution of an epidemic 1960s 1990s

Methamphetamine Use in Central Texas:Evolution of an Epidemic1960s-1990s


Primary data sources

Primary Data Sources

  • Informal longitudinal cohort (1968-present)

  • Formal ethnographic study using semi-structured interviews and participant observation (1990-1991)


Central texas

Central Texas

TRAVIS

AUSTIN

BEXAR

SAN

ANTONIO


Timeline

Timeline

  • 1950s: Oral use was common; intravenous use was present but rare

  • Early to mid 1960s: methamphetamine moved into the counter-culture in Austin

  • Late 1960s: rapid increase in the number of users

  • Early 1970s: used peaked and began decreasing

  • Mid 1970s-late 1990s: use stabilized and remained endemic through the 1990s.

  • 2000: Increase since 2000


Actions and reactions

Actions and Reactions

  • 1965: FDA restricted sales of pharmaceutical methamphetamine

  • 1968-1971:Desoxyn: script doctors and drugstore burglaries

  • 1970-1973: Crack down on script doctors and increase in drugstore security

  • 1972-1975:Rise of local labs

  • 1980s: Restrictions on P2P and other precursors

  • 1990s:Ephedrine/pseudoephedrine methods


1960s media hype

1960s Media Hype

Speed Kills!

“The average life expectancy of a speed freak is five years.”

(Yeah, sure.)


Where are they now

Where are they now?

  • Most moved on to other things within 5 to 10 years.

    • The more successful rarely disclose their past

    • Some of these still use occasionally

  • Some are still “in the life”--using, selling, and manufacturing

  • Some switched to heroin after 20 or 30 years

  • Heavy alcohol use is common

  • Some are in prison

  • Some are beginning to die from HCV and alcohol use


3040 cornwallis road p o box 12194 research triangle park north carolina usa 27709

Methamphetamine Use in North Carolina:

An Early Epidemic 1990s-Present


Methamphetamine in north carolina

Methamphetamine In North Carolina

  • Methamphetamine was popular in late 1960s early 1970s but was less common in the 1980s and early 1990s.

  • Current wave of methamphetamine use is still relatively new—since 1999.

  • Manufacturing and use started in the mountains of western North Carolina and spread east through rural areas across the state

  • Use is on the rise among MSM in urban areas (Raleigh, Charlotte)

  • Number of meth lab seizures increased from 9 in 1999 to 322 in 2000

    NOTE: Some counties report roadside finds of trash and hazardous waste as lab seizures


Clandestine meth lab reports

Clandestine Meth Lab Reports

2001

2004


Pictures from local papers

Pictures from Local Papers

A hand-written note warns against entry into a mobile home in Johnston county housing a meth lab. (4-1-05)

Law enforcement dismantles a meth lab in Sampson County. (3-25-05)


3040 cornwallis road p o box 12194 research triangle park north carolina usa 27709

COMPARISONS


Manufacturing distribution

1960s-1990s (Central TX)

P2P method

Racemic mixture of D & L isomer methamphetamine

Few loosely organized manufacturers produced 5 to 100 pounds per year each in batches of 1 to 10 pounds.

1990s-Present (Central TX/NC)

Ephedrine/pseudo-ephedrine reduction method

High % of d-isomer methamphetamine

Many small producers manufacturing batches of several grams to several ounces at a time.

Imported by international drug trafficking groups

Manufacturing & Distribution


Characteristics of users

1960s-1990s (Central Texas)

85% white; 60% male

Young adults in the 1960s-1970s

Mix of heterosexual blue collar workers, motorcycle riders, musicians, criminals, and rednecks

Some MSM

Use in rural areas was limited to outsiders

Experienced users mentored new users since mid-1970s

1990s-Present North Carolina

85% white; 60% male

Young adults

Mix of heterosexual blue collar workers and motorcycle riders in rural areas

MSM in the cities

Most rural users appear to be locals

Mostly new users, limited opportunities for mentoring

Characteristics of Users


Characteristics cont d

Central Texas

Majority injected

Heavy alcohol use common

Poly-drug use common

Marijuana

Cocaine

Benzodiazepines

North Carolina

Majority smoked

Alcohol use common

Poly-drug use common

Marijuana

Some cocaine

Benzodiazepines (?)

Characteristics cont’d


Patterns of use

Central Texas/Endemic Use

Occasional -- 1-2 doses over a few hours; 24-48 hours without sleep

Binge use – 3-14 day runs with minimal eating/sleeping followed by prolonged sleep (uncommon in endemic phase)

Weekend use – Friday-Saturday use followed by heavy alcohol benzodiazepine use on Sunday

Light daily use--A dose in the morning before work and sleeping each night

Maintenance use – high dose (400-1200 mg daily) use over periods of years (eating and sleeping regularly)

North Carolina/Emerging Epidemic

Occasional -- 1-2 doses over a few hours; 24-48 hours without sleep

Binge use – 3-7 day runs with minimal eating/sleeping followed by prolonged sleep

Weekend use – limited

Light daily use– not reported

Maintenance use – not reported

NOTE: Findings from North Carolina are preliminary.

Patterns of Use


Patterns of use1

Patterns of Use

Users in both regions reported using methamphetamine to:

  • engage in task oriented activities (e.g. housecleaning, fixing cars, working two jobs)

  • enhance recreational pursuits such as hunting and fishing in rural areas

  • enhance sex

  • Note: These activities may become repetitive and destructive


Summary everything old is new again

Summary: Everything Old is New Again

  • The current epidemic parallels the earlier epidemic in:

    • Race and gender of users

    • Initial heavy/binge use patterns

    • “Crisis” response from media and policymakers


Key differences

Key Differences

  • More potent d-isomer form of drug

  • Smoking as predominant mode of administration

  • Increased use among urban MSM and rural heterosexuals

  • Role of imported methamphetamine


The crystal ball aka the good news

The “Crystal” Ball (aka The Good News?)

  • What does history tell us about what might happen in NC (and other rural areas)?

    • Use will peak then begin to decline, becoming endemic to subpopulations

    • Patterns of use will change

      • Uncontrolled binge use will fade

      • “Controlled” use will become more common

    • Smoking will probably result in decreases in HCV transmission

    • New laws and enforcement will limit local manufacturing


Unanswered questions

Unanswered Questions

  • Will smoking lead to wider diffusion?

  • Will reductions in injection-related HIV risk be offset by increased sexual risk across wider segment of population?

  • What percentage of smokers will transition to injection?

  • What impact will imported methamphetamine have on:

    • Future domestic production?

    • Diffusion of methamphetamine to minority populations?


Acknowledgments

Acknowledgments

I would like to thank all of the people who have shared their thoughts with me, formally or informally, over the years.


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