Northwest Portland Area Indian Health Board: Indian Leadership for Indian Health


Key Indian Health Issues: Methamphetamine

During the October 2006 Quarterly Board Meeting Delegates voted to create the NPAIHB Methamphetamine Clearinghouse.  A successful attack on the meth problem in Northwest tribal communities requires collaboration and the extent of collaboration depends on the tribe’s particular meth problem and resources available, but could include: health, housing, law enforcement, drug endangered children, environmental protection, education, and drug courts.  Tribes can also benefit from collaborating with state, county, and federal agencies. We have tribes that have little to zero meth related activities, to tribes that have developed extensive and sophisticated collaborations within their area agencies to deal with their meth problems.  Stay tuned for a listing of what our NW tribal communities have accomplished to address meth issues.

What is Methamphetamine?

Methamphetamine is a highly addictive stimulant that affects the central nervous system. Although most of the methamphetamine used in this country comes from foreign or domestic superlabs, the drug is also easily made in small clandestine laboratories, with relatively inexpensive over–the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.
Methamphetamine is commonly known as speed, meth, and chalk. In its smoked form, it is often referred to as ice, crystal, crank, and glass. It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. The drug was developed early last century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Like amphetamine, methamphetamine causes increased activity and talkativeness, decreased appetite, and a general sense of well-being. However, methamphetamine differs from amphetamine in that at comparable doses, much higher levels of methamphetamine get into the brain, making it a more potent stimulant drug. It also has longer lasting and more harmful effects on the central nervous system.
Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription. It is indicated for the treatment of narcolepsy (a sleep disorder) and attention deficit hyperactivity disorder; but these medical uses are limited, and the doses are much lower than those typically abused.
Read the rest of the report:National Institute on Drug Abuse Methamphetamine Research Report

Why the popularity?

Meth is easy and cheap to produce, and unlike drugs such as marijuana and cocaine – much of which must be imported – meth is easily manufactured domestically with common household items such as batteries and cold medicine. There are retail and wholesale operators: Small-time meth cooks stash labs everywhere from mobile homes to car trunks, while Mexican organized crime has streamlined the high end of the industry in the past few years, supplying both finished product and the raw materials required for production, called “cooking” in the drug trade. What was once a regional West Coast problem can now be found in big cities and small towns alike.

American Indians and Alaska Natives suffer disproportionately from substance use disorders compared with other racial groups in the United States. The National Survey on Drug Use and Health (NSDUH) is one of the few surveys that collect data on this relatively small, but important population.
NSDUH asks persons aged 12 or older to report on their use of alcohol and illicit drugs, as well as symptoms of substance dependence or abuse during the past year. Illicit drugs refer to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. NSDUH defines illicit drug or alcohol dependence or abuse using criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Substance dependence or abuse includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.
State Profiles and Partners

Researchers zero in on brain effects, treatment approaches

The spread of methamphetamine production and abuse has sparked a flurry of research on the drug’s health effects and possible new ways for treating the addiction.
Until a few years ago, methamphetamine was considered a regional problem. Largely confined to the West Coast and Southwest, it was off the radar of federal drug offices in Washington, D.C. But as the drug swept into rural Midwestern communities in the mid-1990s, catching hospitals and treatment centers unprepared for its devastating effects, steps were taken to gain a better understanding of meth’s toll on the body. 
Meth addiction gained a reputation as being untreatable when the drug began to spread into small communities in the Midwest. These rural areas had not been very affected by cocaine or heroin so when they had to start dealing with meth users they had no idea what to do with them,” said Richard Rawson, executive director of the Matrix Institute, a non-profit addiction research organization in Los Angeles, and co-principal investigator at the Methamphetamine Treatment Project along with Anglin. “Patients were coming in psychotic, so you started hearing these horror stories that meth was untreatable. For those of us who’ve been dealing with heroin and crack users, it was more manageable.”
Though not impossible, meth addiction is a difficult disorder to treat, according to Anglin. “There’s not severe physical withdrawal with methamphetamine, but rather a feeling of anhedonia, an inability to experience pleasure, that can last for months and which leads to a lot of relapse at six months,” he said. The anhedonia appears to correspond with the period when the brain is recovering and producing abnormally low levels of dopamine.
“When you think of treatment of drugs like methamphetamine, you have to think of it like fixing a broken leg – treatment provides a structure to allow their brain chemistry to return to normal. Their brain is out of tune, it’s not working very well, and it takes a while to recover,” Rawson said.
Read more about Beating an Addiction to Meth

The Methamphetamine Problem in Indian Country

History of the Problem:
Methamphetamine (meth) manufacturing, trafficking, sales, and abuse are having a significant impact on Indian individuals, children, families, and entire communities.  Indian Country’s meth problem stems from the drug’s origins in the central valley of California in the 1990s and its steady spread eastward across the United States.  Indian communities in state after state have been affected.  One of the earliest identified was the Northern Cheyenne Reservation in Montana.  Today, a number of tribes have reported serious meth problems among their citizenry, including the San Carlos Apache Tribe, White Mountain Apache Tribe and Navajo Nation in Arizona, the Cherokee Nation and Chickasaw Nation in Oklahoma, the Oglala Sioux Tribe in South Dakota, and the Eastern Shoshone and Northern Arapaho Tribes of the Wind River Reservation in Wyoming.
Tribal leaders have described in vivid detail the effect this dangerous and highly addictive drug is having in their communities.  One example of the devastating impact meth has had on a tribal community was provided by San Carlos Apache Chairwoman Kathleen Ketchiyan before the Senate Indian Affairs Committee earlier this year.  She testified that as recently as 2005 approximately 25 percent of reservation births resulted in babies born under the influence of meth.  Another tribal leader has stated that an “entire generation in my tribe is being lost to meth.”
Meth’s Effects:
Methamphetamine’s intense highs at low cost lead many to refer to it as the “poor man’s cocaine.”  It is easily manufactured with various household chemicals using recipes that are all too easy to obtain.  One of meth’s key ingredients is pseudoephedrine, which is commonly found in over–the–counter cold medicines.
Even small meth labs can be highly dangerous to children and families, as well as to emergency and law enforcement personnel, due to the large amount of highly toxic and combustible waste they generate.  The fumes produced from manufacturing meth affect everyone who is exposed and meth labs pose an extreme risk.  Since meth labs also must be treated as toxic waste sites, the costs and administrative burdens of containment and clean–up fall heavily on tribal, local, state, and federal resources.
In addition, users often engage in criminal conduct to support their meth habits, and many commit violent crimes while under its influence.  For example, the Navajo Nation has seen at least one meth–related triple homicide and one Navajo police chief recently reported that his department now sees a greater number of meth–related arrests than alcohol–related arrests. Again, combating the rise in the levels of meth–related crimes can have a large impact on a tribal government’s human and financial resources.

The Impact of Methamphetamine on Indian Communities:
Meth impacts all aspects of a tribal community – culture, people, property, land – not just a few individuals.  Even natural resources on Indian lands such as lakes, public areas, and open fields are at risk due to the dumping of toxic waste that is a by–product of the meth manufacturing process.  Due to the violence associated with meth production, trafficking, sales and use, BIA and tribal law enforcement and tribal courts personnel have been overtaken by meth-related arrests and cases.
Meth also has an impact on every social and economic aspect of Indian communities.  It has been closely linked to child abuse and neglect, domestic violence, suicide, reduced employability, degraded physical health, and reduced academic achievement.  As a result, meth is overwhelming Indian social, economic, education, and health programs. Even more troubling, Indian Country’s isolated reservation and rural communities are viewed by foreign drug cartels as numerous enterprise zones with limited law enforcement and resident populations in need of income-producing opportunities.  In order to alter the devastating course meth is taking across Indian communities, tribal leaders and community residents are reexamining their governing, social and economic policies and practices, and developing comprehensive, integrated community-wide strategies involving prevention, enforcement, treatment, and post-treatment recovery.

National Drug Threat Survey 2007 greatest drug threat as reported by state and local agencies.

National Drug Threat Survey 2007 greatest drug threat by region as reported by state and local agencies.
The Federal/Tribal Response:
The first step taken to address the meth problem in Indian Country was to acknowledge its existence.  In October 2005, the U.S. Attorney General’s Advisory Committee’s Native American Issues Subcommittee met in Coeur d’Alene, Idaho, to discuss the problem of meth in Indian Country.  This historic meeting was attended by over 20 United States Attorneys, the White House Office of National Drug Control Policy, the Bureau of Indian Affairs Office of Justice Services (formerly the Office of Law Enforcement Services), the Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), and over 30 tribes.  Consensus was reached that a meth epidemic existed, that it was affecting most tribes in the United States, and that the best way to tackle the problem from a law enforcement perspective was for federal, tribal and state/local law enforcement to work cooperatively together, by pooling resources and minimizing jurisdictional conflicts, in a common effort to combat meth in Indian Country.
In January 2006, the federal government followed the lead of many states so that federal law now requires that cold medications containing pseudo-ephedrine be under lock-and-key or behind pharmacy counters.  A direct result of making the main ingredient for meth production harder to obtain is that the small, toxic meth labs are becoming less common.
A new challenge for tribal, local, state and federal authorities is in combating the smuggling of illegal drugs from Mexico and Canada across tribal lands that border or are traversed by the U.S.-Mexico and U.S.-Canadian borders, such as the Tohono O’odham Nation in Arizona and the St. Regis Mohawk Reservation in New York State.  Approximately 80 percent of the current meth supply in the U.S. is due to illegal smuggling from Mexico.
While the numbers of dangerous meth labs in the U.S. are decreasing, problems with smuggling, violent crime, and social devastation of tribal communities continue to have a devastating impact throughout Indian Country.

Related Links:

Indian Health Service (IHS) provider newsletter (meth series) The january 2007 and december 2006 issues (series 1 and 2 of a four part series)
Montana meth project
IHS meth initiative
Office of National Drug Control Policy