A Four-Pillars Approach to Methamphetamine Policies for Effective Drug

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A Four-Pillars
Approach to
Methamphetamine
Policies for Effective Drug
Prevention, Treatment,
Policing and Harm Reduction
Bill Piper
Director of National Affairs
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A Four-Pillars Approach to Methamphetamine:
Policies for Effective Drug Prevention,
Treatment, Policing and Harm Reduction
Bill Piper
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Copyright © March 2008
The Drug Policy Alliance
All rights reserved
Printed in the United States of America
This report is also available in PDF format
on the Drug Policy Alliance website:
www.drugpolicy.org/meth
“Being addicted is being addicted.
Meth wasn’t my problem.
Addiction is my problem.
But [with treatment],
I’ve been sober for three years.”
Cynthia, Escondido, CA
No dedicated funds were or will be received
from any individual, foundation or corporation
in the writing or publishing of this booklet.
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Table of Contents
Executive Summary
2
Four-Pillars Policy Checklist
4
Introduction
• A Brief History of Methamphetamine in Society
• Moving Beyond a ‘Drug War’ Approach
• Facts about Methamphetamine Use
• Perpetuating Old Myths Only Makes Matters Worse
6
Prerequisites for Sucesseful Drug Policy
• Supply-side Strategies: Wasteful and Misguided
• Treatment, Not Incarceration, Can Keep Families Together
9
Prevention: A New Strategy for Methamphetamine
• Elements of More Effective Prevention
• Providing Real Drug Education
• Moving Beyond Zero Tolerance
• Rejecting Scare Tactics
11
Treatment is the Answer
14
• Focus on: Increasing Access to Treatment for All Americans
• Treatment Works: California’s Proposition 36
• Women and Methamphetamine Policy
• Focus on: Supporting Women in Recovery
• Gay Men and Methamphetamine
• Special Mental Health Issues
• Replacement Therapy
Enforcement: A Proper Role for Policing
21
Harm Reduction: Education and Outreach Save Lives
Focus on: Optimal Syringe Law Reform
22
Conclusion
24
Endnotes
25
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Executive Summary
It has been more than 40 years since the first illegal
methamphetamine laboratory was discovered in the
United States. The national strategy for dealing with abuse
of this powerful stimulant is the same now as it was then:
incarcerate as many methamphetamine law violators as
possible and hope for the best. This punitive strategy has
devastated families and public health while failing to make
the country safer. There are clear steps, however, that can
be taken to reduce methamphetamine abuse and protect
public safety, and places like California, New Mexico,
Utah, and Vancouver, Canada are leading the way.
This report lays out the fundamentals of an effective
national strategy for reducing the problems associated
with both methamphetamine misuse and misguided
U.S. methamphetamine policies. It presents policymakers
with a diverse range of evidence-based policy proposals
that seek to save lives, reduce wasteful government
spending, and empower communities. The “four pillars”
of an effective national methamphetamine strategy are
prevention, treatment, policing and harm reduction.
Prevention
Encouraging people to make healthy choices and providing
alternatives to drug use is crucial to reducing substance abuse
problems. Scare tactics and zero tolerance policies, however,
often impede prevention efforts. Policymakers can prevent
youth methamphetamine abuse by increasing funding for
after-school programs and supporting the development of
a better drug education paradigm that fosters trust and
emphasizes factual information over failed scare tactics.
Adult methamphetamine abuse can be reduced by increasing
employment and educational opportunities, strengthening
families, and promoting economic growth. Cutting funding
to ineffective programs, such as Drug Abuse Resistance
Education (D.A.R.E.), the National Youth Anti-Drug Media
Campaign, and random student drug testing, would produce
tremendous savings.
Treatment
The quickest, cheapest and most effective way to undermine
drug markets and reduce drug abuse is to make quality
substance abuse treatment more widely available through
public spending, tax credits and other measures. Policymakers
should expand access to treatment and mental health services,
divert methamphetamine offenders to treatment instead of
jail, and promote family unity. More funding should be provided for longer, more intensive methamphetamine treatment,
especially in rural areas, with a focus on reducing the significant
barriers to treatment that exist for women and gay men.
There should also be a greater investment in pharmacotherapy
research, including replacement therapy. Policymakers should
take every step possible to advance the development of a
substitution treatment for methamphetamine abuse, akin to
methadone and buprenorphine for opioid addiction.
Policing
Strategic policing is critical to protecting public safety. Law
enforcement agencies should concentrate on what only they
can do, disrupting and dismantling crime syndicates, apprehending violent criminals and keeping neighborhoods safe.
This requires prioritization in the war on drugs, which means
focusing on violent offenders instead of nonviolent drug law
violators and on the most problematic drugs instead of the
least problematic drugs. Congress should set clear statutory
goals for the disruption of major methamphetamine operations, and federal agencies should be required to report on
their progress toward these goals, including resources wasted
on arresting and prosecuting low-level nonviolent offenders.
2
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Harm Reduction
Utah
Investing in harm reduction programs will minimize the
public health threats associated with methamphetamine abuse
and reduce healthcare expenditures. Methamphetamine use is
closely associated with high-risk sexual behavior, which can
contribute to the spread of HIV/AIDS and other sexually
transmitted diseases. The sharing of syringes among people
who use methamphetamine intravenously is also a factor in
the spread of HIV/AIDS, as well as hepatitis C and other
infectious diseases. Policymakers should ensure that free
condoms and sterile syringes are widely available and increase
funding for safe-injection and safe-sex education programs.
The federal government should repeal the ban on using federal
HIV/AIDS prevention money on syringe exchange programs.
Utah recently enacted an innovative program that provides
substance abuse screening and assessment to anyone convicted
of a felony offense (drug- and non-drug-related). The results
of these screenings and assessments are provided to the court
before sentencing, allowing judges to divert certain offenders
to treatment instead of jail. This program, the Drug Offender
Reform Act (DORA), is based on a pilot program that has
diverted more than 200 offenders in Salt Lake County to
treatment instead of jail, many of whom have methamphetaminerelated problems. The state is also in the process of expanding
access to treatment for pregnant and parenting women struggling with methamphetamine. The Utah Methamphetamine
Joint Task Force recently rejected calls to develop scare-based
TV ads in favor of developing a more realistic and uplifting
prevention campaign.
While the U.S. government has failed to develop an effective
methamphetamine strategy, other governments have
implemented successful policies at the state and city level:
California
Although not methamphetamine-specific, California’s
Substance Abuse and Crime Prevention Act of 2000
(Proposition 36) has proven to be the nation’s most systematic
public health response to methamphetamine to date. This
landmark measure, approved by 61 percent of voters, diverts
approximately 35,000 persons from jail to drug treatment
every year – over half of whom identify methamphetamine
as their primary illegal drug. No other statewide program
in the nation has offered treatment to or graduated more
methamphetamine users than Proposition 36. In the process,
California taxpayers have saved more than $1.5 billion over
the program’s first seven years.
New Mexico
New Mexico is the only state to have developed a statewide
methamphetamine strategy that combines prevention,
treatment, policing and harm reduction. This strategy could
become a model for bringing together key stakeholders,
fostering interagency collaboration, and implementing a
coordinated methamphetamine strategy. In addition, Drug
Policy Alliance New Mexico is working with state agencies
and the private sector to implement a youth methamphetamine education program funded by federal grant money. This
campaign will serve as a pragmatic alternative to the failed
scare tactics of, most notably, D.A.R.E., the National Youth
Anti-Drug Media Campaign, and random student drug testing.
Vancouver
Vancouver, Canada, leads the world in innovative solutions
to the problems posed by methamphetamine production and
abuse. Not only does the city have a well-developed, integrated
four-pillars approach to methamphetamine misuse, it is
developing a replacement therapy program to treat methamphetamine users with legal alternative stimulants such as
methylphenidate (Ritalin) and dextroamphetamine. This
program, based on research trials from around the world,
could serve as a model for how to apply successful replacement strategies found effective in treating heroin and nicotine
addiction to methamphetamine and other stimulants.
Past experience with the cyclical nature of drug abuse
outbreaks, as well as an analysis of U.S. and international
drug policies, make it clear that local, state and federal governments and the Native American nations should embrace a
strong public health response to methamphetamine abuse
centered on prevention and treatment. Law enforcement
agencies have a very important role to play in this response.
Locking up tens of thousands of our fellow citizens, however,
is a sign of a failed policy, not a successful one. The problems
associated with methamphetamine are manageable, but only
if policymakers take a balanced approach.
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Four-Pillars Policy Checklist
For a More Effective
Methamphetamine Policy
Page 6
Prevention Checklist
Eliminate wasteful and counterproductive government
prevention programs that rely on scare tactics, such
as D.A.R.E., the National Youth Anti-Drug Media
Campaign and random student drug testing.
Increase funding for after-school programs and
substance abuse treatment.
Develop better prevention campaigns based on
peer-reviewed research.
Support reality-based drug education programs
in schools.
Eliminate failed zero-tolerance programs in
schools and focus scarce resources on professional
counseling, intervention and therapy.
Increase employment and educational opportunities,
strengthen families and promote economic growth.
Treatment Checklist
Make substance abuse treatment more
widely available:
Divert people convicted of simple methamphetamine
possession to drug treatment.
Ensure treatment programs are meeting the needs of
populations who have faced unique obstacles to
effective treatment in the past, such as women,
people of color, at-risk youth, lesbian, gay, bisexual
and transgendered individuals, and rural populations.
Increase funding for replacement therapy research.
Make treatment available to all who need it as often
as they need it.
Allow individuals to deduct the costs associated with
substance abuse treatment from their taxes.
Eliminate zoning and other regulatory obstacles to
opening new treatment centers.
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Keep families together:
Increase funding for family treatment programs.
Increase funding for treatment programs designed
for pregnant and parenting women.
Establish programs that will pay for child care in
areas where no treatment programs exist that
provide child care services.
Enact treatment immunity policies that shield parents
who seek drug treatment from having their children
taken away.
Evaluate state and federal prisons on their ability to
transport incarcerated parents to custody hearings.
Find ways to increase the ease and quality of family
members’ visits to prison; make family caseworkers
available in prison.
Expand re-entry services to help parents returning
from prison more quickly get their children back
into their lives, including expanding housing,
employment, education and substance abuse
treatment services.
Eliminate barriers that prevent people from getting
their lives back together, such as laws that prohibit
drug offenders from accessing school loans and
public assistance.
Eliminate programs that stigmatize former offenders,
such as public databases of drug offenders.
Improve mental health services:
Remove barriers separating substance abuse
treatment from mental health services.
Fund research examining root causes of
methamphetamine abuse and better practices
for treating individuals with dual diagnoses.
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Policing Checklist
Provide law enforcement officers with better training
on arresting individuals when children are present to
reduce the emotional damage to children and help
parents understand their rights.
Focus local and state drug law enforcement on
arresting and prosecuting offenders who commit
crimes against people or property by shifting focus
away from nonviolent offenders.
Re-prioritize federal anti-methamphetamine law
enforcement resources toward drug cartels, and
leave low- and medium-level offenders to states.
Set clear statutory goals for the disruption of major
methamphetamine operations and require agencies
to report on them.
Harm Reduction Checklist
Make free condoms more available and increase
funding to safe-sex education for high-risk groups.
Make sterile syringes more available and increase
funding for safer-injection prevention programs.
Deregulate the sale of syringes through pharmacies.
Decriminalize the possession of syringes.
Establish and fund syringe exchange programs.
Eliminate regulatory and zoning barriers to private
syringe exchange programs.
Repeal the federal ban on using HIV/AIDS prevention
money on syringe exchange.
Increase public funding to help clean up clandestine
methamphetamine lab sites.
Train first responders on how to reduce the harms
associated with exposure to methamphetamine
operations.
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Introduction
A Brief History of
Methamphetamine in Society
The history of the use of methamphetamine is intertwined
with the history of its chemical cousin amphetamine. Their
chemical structures are similar but the effect of methamphetamine on the central nervous system is more pronounced. Like
amphetamine, methamphetamine increases activity, decreases
appetite and causes a general sense of well-being. The initial
effects can last up to eight hours, after which there is typically
a period of high agitation. Consequences of long-term
methamphetamine abuse can include psychosis, malnutrition,
severe depression and loss of control.1
Amphetamine was first synthesized in Germany in 1887.2
Methamphetamine was discovered in Japan in 1919.3 By
1943, both drugs were widely available to treat a range of
disorders, including narcolepsy, depression, obesity, alcoholism
and the behavioral syndrome called minimal brain dysfunction
(MBD), known today as attention deficit hyperactivity
disorder (ADHD).4
Following World War II, during which amphetamine was
widely used to keep combat duty soldiers alert, both
amphetamine (Adderall, Benzedrine, Dexidrine) and methamphetamine (Methedrine, Desoxyn) became more available
to the public. Amphetamine was used for weight control,
for athletic performance and endurance, for treating mild
depression, and to help truckers complete their long hauls
without falling asleep. Methamphetamine was widely
marketed to women for weight loss and to treat depression.5
The first instances of clandestine manufacturing of amphetamine and methamphetamine began in 1963, when the
California Attorney General and U.S. Justice Department
convinced companies to remove injectable forms of
prescription methamphetamine (Benzedrine inhalers and
liquid methamphetamine in ampoules) from the market.6
In 1971, Congress passed the Comprehensive Drug Abuse
Prevention and Control Act, which among other things
classified amphetamine and methamphetamine as Schedule II
drugs, the most restricted category for legal drugs. As a result,
it became much more difficult to legally obtain either drug
to stay awake, increase productivity, boost stamina, feel
better or anything else deemed recreational and not medical.
In response to an ever-increasing demand for black market
stimulants, their illegal production, especially that of methamphetamine, increased dramatically.7
Pharmaceutical methamphetamine is still available legally
under the brand name Desoxyn, but only infrequently
prescribed to treat severe obesity, narcolepsy and ADHD.
Pharmaceutical amphetamine is available by prescription
under a number of brand names (most notably Adderall) and
is commonly prescribed to treat narcolepsy, ADHD, fatigue
and (to a much lesser extent) depression.8 Although ostensibly
not available to enhance productivity or wakefulness,
amphetamine is commonly used that way.9 This has created a
divide between those with health insurance who are able to
obtain stimulants through legal means and those who seek
out black-market stimulants and face arrest.
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Facts about Methamphetamine Use
The number of Americans who report binge drinking in
the last month – an indicator heavily associated with crime,
violence and family dissolution – is more than 90 times the
number who report using methamphetamine in the same
period. The following official estimates, though not exact,
provide a sense of the relative popularity of various drugs
and a realistic snapshot of current methamphetamine use
rates in the U.S.*
Moving Beyond a ‘Drug War’ Approach
While in some ways methamphetamine abuse seems to present
new and unique challenges, there are important lessons to
be learned from failed efforts to address the abuse of other
drugs, such as cocaine and heroin. The bulk of federal efforts
to control illegal drugs is comprised of costly – and largely
unsuccessful – programs to reduce the availability of drugs by
attempting to halt their production abroad, interdict them at
the border, and incarcerate as many (mostly nonviolent) drug
law violators as possible.10 And yet, despite spending hundreds
of billions of dollars and incarcerating millions of Americans,
experts acknowledge that illicit drugs remain cheap, potent
and widely available in every community.
Meanwhile, the harms associated with drug abuse – addiction,
overdose and the spread of HIV/AIDS and hepatitis –
continue to mount, while entire communities are devastated
by astronomical incarceration rates. To this record of failure,
add the extensive collateral damage of drug prohibition and
the drug war: broken families, racial inequities, billions of
wasted tax dollars, and the erosion of hard-fought civil
liberties. Punitive drug war policies are no more likely to
succeed in addressing methamphetamine abuse.
While federal, state and local officials have grappled with
the issue for more than 40 years, methamphetamine abuse
continues to present serious and complex threats to health
and public safety. In rural areas, for example, the wide
availability of methamphetamine has exacerbated significant
shortages of resources for drug treatment and infectious
disease prevention, creating new public health challenges.11
As a consequence, the problems typically associated with
methamphetamine – crime, environmental contamination,
risky sexual behavior and the spread of HIV/AIDS – have
jumped to the forefront of national concern.
• 10.3 million Americans have tried methamphetamine at
least once – far fewer than those who have tried inhalants
(23 million), hallucinogens (34 million), cocaine (34 million),
or marijuana (97 million).
• Of those 10.3 million, only 1.3 million used methamphetamine in the last year; and only 512,000 used it within the
last 30 days.
• The estimated number of semi-regular methamphetamine
users in the U.S. (those who use once a month or more)
equals less than one quarter of one percent of the population
(0.2 percent).
• There is no indication that meth use is increasing. The
proportion of Americans who use methamphetamine on
a monthly basis has hovered in the range of 0.2 percent
to 0.3 percent since 1999.
* Substance Abuse and Mental Health Services Administration. (2006).
Results from the 2005 National Survey on Drug Use and Health: National
Findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication
No. SMA 06-4194). Rockville, MD.03.
Crafting an intelligent national methamphetamine response
offers the opportunity to make a clean break with the
mistakes of the past and embrace a new policy framework
based on reason, compassion and equal justice under the law.
Numerous cost-effective policy options, many developed at
the state and municipal levels, are already working to reduce
rates of addiction, protect public safety and save countless
lives. An effective national methamphetamine strategy will
depend on strong leadership, a determination to abandon old
falsehoods about methamphetamine, and the courage to work
with treatment professionals, community leaders and parents
to implement evidence-based policies. It is time for a new
bottom line for U.S. drug policy, one that focuses on reducing
both sets of problems: those associated with drug misuse and
those stemming from the destructive war on drugs.
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Introduction
continued from page 7
Perpetuating Old Myths
Only Makes Matters Worse
Discussions about methamphetamine and related policy in the
U.S are often reminiscent of discussions about crack-cocaine
and related policy in the 1980s. Many of the assertions made
about crack then – “it’s instantly addictive,” “once you try
it you’re hooked for life” – are sometimes made about
methamphetamine today. Copious amounts of scientific
evidence, however, and numerous studies, including a recent
analysis by the U.S. Sentencing Commission, show that many
of the assertions that elected officials and the media made
about crack in the 1980s were not supported by sound data
and were exaggerated or outright false.12 Unfortunately,
the punitive crack policies created during this hysteria (most
notably the 100-to-1 crack/powder cocaine sentencing
disparity) are still in place.
Like crack cocaine, methamphetamine poses some serious
public health and law enforcement challenges, but hysteria
and media hype will once again serve only to impede our
efforts to address the problem. A culture that perpetuates
myths about methamphetamine, its use and misuse presents
a formidable obstacle to progress by biasing the national
discussion and lowering expectations.13
Judging by today’s newspaper headlines, the clandestine
manufacture, trade and misuse of methamphetamine appears
intractable. Reports abound of a national “methidemic.” But
methamphetamine is among the most infrequently used illegal
drugs, with its use declining among youth, stabilizing among
adults, and demonstrating small decreases in first-time users.14
Only two tenths of one percent of Americans regularly use
methamphetamine. Four times as many Americans use cocaine
on a regular basis and 30 times as many use marijuana.15 The
federal government’s own statistics show a clear stabilization
of methamphetamine use since 1998, and even declines in
recent years.16
The prevalence of methamphetamine use is higher in selected
areas, however. Nationwide, just five percent of adult male
arrestees tested positive for methamphetamine, compared with
30 percent who test positive for cocaine and 44 percent who
test positive for marijuana. But in some cities (Los Angeles,
San Diego and San Jose, California, and Portland, Oregon)
arrestees tested positive for methamphetamine at a rate of
25-37 percent. The Sentencing Project found that in those
cities the overall rate of drug use did not rise between 1998
and 2003, suggesting that an increased use of methamphetamine replaced the use of other drugs, particularly cocaine.17
Any discussion of a truly effective strategy to confront
the misuse of methamphetamine requires an honest and
straightforward discussion of facts:
“I was introduced to
methamphetamines while
serving in the Navy. I used
the drug for over 20 years.
The authorities tried to
scare me straight with jail
time, but it never worked.
Without [treatment] the
only thing that would
have gotten me off of
drugs would have been
an overdose.”
Bill, Los Angeles, CA
8
• Methamphetamine is not instantly addictive for most people
who use it; and most people who use methamphetamine are
never hooked for life;18
• Far from untreatable, treatment for methamphetamine
addiction is similar to that for cocaine and other stimulants
and just as likely to succeed;19
• The effects of prenatal exposure to methamphetamine are still
not fully known, but there is no peer-reviewed research that
demonstrates that prenatal exposure to methamphetamine
harms infants;
• Methamphetamine abuse is neither on the rise nor out of
control on a national scale, though there are, of course,
regional differences.20
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Prerequisites for
Successful Drug Policy
Supply-side Strategies:
Wasteful and Misguided
Drug control strategies that seek to interrupt the supply at
its source have failed over and over again for cocaine, heroin,
marijuana and virtually every drug to which they have been
applied – including alcohol during alcohol Prohibition.21
Fundamental economic principles demonstrate why: as long
as a strong demand for a drug exists, a supply will be made
available at some price to meet it.22 Worse than simply being
ineffective, supply-side strategies drive immutable market
forces to expand cultivation and trafficking, generate
unintended consequences and, in many instances, ultimately
worsen the problem.
Methamphetamine is no exception, and an effective national
methamphetamine strategy must therefore depart from past
approaches to drug control. Previous attempts to curtail
access to methamphetamine have mostly failed; in some
cases, they even backfired. Legislation designed to restrict
the availability of legally produced amphetamine and
methamphetamine, introduced in the 1950s and 60s, had
the unintended, though perhaps predictable consequence of
driving the manufacture of methamphetamine to clandestine
labs.23 The subsequent proliferation of illegal methamphetamine labs – which employ highly volatile and toxic chemicals
in an unregulated setting – created unique environmental
dangers, special job-related hazards for law enforcement,
and new, complex threats to public health and community
well being.
their associated environmental dangers. But while much
of the media surrounding methamphetamine focuses on
“home cooks” and the need to restrict public access to
pseudoephedrine, approximately 80 percent of the methamphetamine consumed in the United States is actually made
beyond our borders.24 Most methamphetamine is smuggled
into the U.S. by organized groups of Mexican producers
who obtain pseudoephedrine in bulk and mass produce
methamphetamine in “super labs.”
The shrinking number of domestic clandestine labs could
be attributed to Mexican drug cartels working with major
domestic traffickers to manufacture and import higher
potency methamphetamine. As Florida Attorney General
Bill McCollum noted in 2007, “The volume [of methamphetamine] is increasing, it appears to us, and meth in its crystal
form is still very readily available, maybe even more available
in our state today than through the homegrown labs.”25
Should authorities successfully crack down on Mexican drug
cartels, other distribution channels are likely to emerge to
meet the demand. For example, a recent Drug Enforcement
Administration (DEA) report cites the importation of methamphetamine tablets from Southeast Asia through the mail.26
Worse than simply being
ineffective, supply-side
strategies drive immutable
As state and federal enforcement agencies in the 1970s,
80s and 90s implemented precursor restrictions designed
to curb access to the chemicals needed to manufacture
methamphetamine, traffickers exploited loopholes, switched
to new ingredients, bought ingredients in smaller amounts
and set up many more – though smaller – illegal labs.
More recent precursor controls, such as requiring Americans
to produce identification and sign a government-mandated
register before purchasing cold and allergy medicines containing pseudoephedrine, may have played a significant role in
reducing the number of domestic methamphetamine labs and
market forces to expand
cultivation and trafficking,
generate unintended
consequences and, in
many instances, ultimately
worsen the problem.
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Prerequisites for
Successful Drug Policy
continued from page 9
Treatment, Not Incarceration,
Can Keep Families Together
In all their deliberations on our national strategy for methamphetamine, and other drugs, policymakers should avoid
enacting policies that do more harm than good. A policy of
simply incarcerating low-level drug users, for example, may
create more problems than it solves. Former drug law violators
face countless challenges after completing a jail or prison
sentence (the majority of which are for simple possession),
including ineligibility to receive public assistance benefits like
federal housing, food stamps and student loans, as well as
tremendous difficulty finding employment. Punitive drug
policies that rely on incarceration also result in tearing apart
families, children being placed into foster care, and the steady
erosion of entire communities. Moreover, incarceration is
incredibly expensive, certainly far more so than drug treatment
with few long-term societal benefits.
Alternative approaches abound, with California, New Mexico,
and several other states leading the way.27 California’s hugely
successful drug demand reduction program, the Substance
Abuse and Crime Prevention Act (Proposition 36), allows
first- and second-time nonviolent, simple drug possession
offenders the opportunity to receive community-based
substance abuse treatment instead of incarceration. Approved
by 61 percent of California voters in 2000, Proposition 36
has helped tens of thousands of people improve their lives
Proposition 36 graduates, 2005
Long Beach, CA
10
while increasing public safety and saving taxpayers more than
one billion dollars through reduced criminal justice expenses.
It has also proved to be the nation’s most comprehensive
public health response to methamphetamine abuse to date.28
Since its inception, 150,000 people have entered drug treatment
through Proposition 36, half of whom used methamphetamine
as their primary drug. Many of those entering treatment
have long histories (10 or more years) of drug abuse and
Proposition 36 provided them with their first opportunity at
medically supervised treatment. Proposition 36 data also
demonstrate that methamphetamine abuse is a treatable
medical condition, with third-year completion rates for
methamphetamine (35 percent) comparable to those for
cocaine (32 percent) and heroin (29 percent).29
New Mexico, which has long been at the forefront of effective
public policy on drug-related problems,30 has crafted a
statewide methamphetamine strategy based on the four
pillars approach that links prevention, treatment, policing and
harm reduction. It is a winning model for how policymakers
can bring key stakeholders together, foster interagency collaboration and implement a truly effective methamphetamine
strategy. New Mexico’s approach includes leveraging research
grants to help fund treatment with both traditional and
alternative modalities, increasing access to syringe exchange
and infectious disease testing, reducing criminal activity by
increasing funding for drug treatment, and ensuring that
standardized reporting and evaluation tools are used by all
prevention agencies to enhance evaluation efforts.31
In formulating a national methamphetamine strategy, policymakers have an historic opportunity to correct what has been
missing from our national approach to drug policy for the
last 40 years: a commitment to substance abuse treatment for
all who need or seek it. Indeed, better access to treatment
options for more Americans may well have prevented the
problems associated with methamphetamine abuse currently
plaguing many American communities. In lieu of funding for
new prisons, a rational methamphetamine strategy would
fund treatment services critical to reducing methamphetaminerelated problems at their source. The death, disease and
disability related to drug abuse can be prevented through
closer partnerships between public health and public safety
with the larger investment of resources going toward
prevention and treatment rather than incarceration.
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Prevention: A New Strategy
for Methamphetamine
Among the world’s most effective drug policies is the fourpillars approach pioneered in Switzerland and Germany in
the 1990s. A four-pillars drug strategy is a coordinated,
comprehensive approach that balances public order and
public health in order to create safer, healthier communities.
In Geneva, Zurich, Frankfurt, Sydney and other cities,
most notably Vancouver, British Columbia, the four-pillars
approach has resulted in a dramatic reduction in the number
of users consuming drugs on the street, a significant drop in
overdose deaths, and a reduction in the infection rates for
HIV/AIDS and hepatitis.32
A new national strategy on methamphetamine must be as
comprehensive and address the four-pillars of any effective
drug policy: prevention, treatment, policing and harm reduction.
Elements of More Effective Prevention
The single most effective way for policymakers to prevent
drug abuse among youth is to increase funding for after-school
programs. Research shows that most dangerous adolescent
behavior (including drug use) occurs during the unsupervised
hours between the end of the school day and parents’ return
home in the evening.33 Increasing funding for after-school
programs is especially critical to preventing youth methamphetamine abuse in rural areas, where methamphetamine is
heavily concentrated and often where fewer activities are
available. Research shows that students who participate in
extracurricular activities are:
• less likely to develop substance abuse problems;
• less likely to engage in other dangerous behavior such as
violent crime; and
• more likely to stay in school, earn higher grades and set and
achieve more ambitious educational goals.34
Unfortunately, the federal government continues to waste
hundreds of millions of dollars every year on three failed
prevention programs: D.A.R.E., the National Youth AntiDrug Media Campaign and student drug testing. Ineffective
at best and counterproductive at worst, lawmakers should
discontinue all three programs,35 and shift existing funding
to after-school programs and substance abuse treatment.
Ineffective drug prevention messages are a big part of why
prevention efforts are losing ground:
• Despite D.A.R.E.’s special status as the most widespread
school-based prevention program in the country, 20 years of
studies, including a 2003 U.S. General Accounting Office
evaluation, have consistently concluded that D.A.R.E. has no
significant impact on student drug use.36 Moreover, some
studies conclude that the program may actually be backfiring,
with students becoming even more likely to use drugs the
longer they are in the program.37
• Both U.S. and European studies show that scare tactics,
the over-use of authority figures, speaking condescendingly
to young people, and conveying messages or ideas that
are misleading, extremist or do not conform with young
people’s own perceptions and experiences – also known as
“manipulative advertising” – are ineffective and may have a
counterproductive effect on the target audience.38 Yet, an
enormous amount of federal prevention dollars targeting
America’s youth are devoted to just such media advertisements, though with little progress to show for it. The
federal government’s premier youth prevention program,
the National Youth Anti-Drug Media Campaign, seeks to
reduce youth drug use through television, radio and print ads.
Unfortunately, after spending more than $1.5 billion over the
last nine years, eight separate government evaluations have
concluded that the ads have had no measurable impact on
drug use among youth.39 Two of these studies found the ads
might make some teenagers more likely to start using drugs.40
Additionally, a recent study by researchers at Texas State
University at San Marcos found that 18- to 19-year-old
college students who viewed the program’s anti-marijuana
TV ads developed even more positive attitudes toward
marijuana than those who did not.41
• Student drug testing is the latest costly, scientifically unproven
prevention program to gain the federal government’s favor.
According to experts in the fields of medicine, adolescent
development, education and substance abuse treatment,
random, suspicionless drug testing undermines the trust
between teenagers and adults and deters students who have
substance abuse problems from participating in extracurricular
activities – the very intervention shown to prevent drug
use.42,43 The only national, federally funded, peer-reviewed
study to date compared 94,000 students in almost 900
American schools with and without a drug testing program,
and found virtually no difference in illegal drug use.44
The looming public health and safety threats posed by
methamphetamine abuse should spur governments at all
levels to implement better prevention programs, especially
as they pertain to youth (where most prevention resources
are already focused). Three key areas for reform stand out.
11
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Prevention: A New Strategy
for Methamphetamine
continued from page 11
Providing Real Drug Education
Moving Beyond Zero Tolerance
Policymakers should support the development of an education
paradigm for older adolescents, who have matured beyond
the scare tactics intended to inoculate adolescents against
drug use without critical thinking. For older adolescents, an
emphasis on factual information and interactive discussions
among peers and credible adults is essential. Research shows
that when teens hear what they perceive as lies or half-truths
from an authority figure they are much less likely to believe
that source in the future.45 Federal programs that attempt to
convince adolescents that marijuana is as dangerous for them
as cocaine or methamphetamine, for example, are discrediting
themselves and their messages with high school and collegeage persons.
Most American high schools fail to offer either effective drug
education or appropriate interventions that would assist
students struggling with abuse of alcohol or other drugs.
Instead, school-based prevention efforts overly rely upon
the threat of the “big four” consequences – exclusion from
extracurricular activities, transfer to another school, suspension
and expulsion – which proponents believe serve as deterrents.
Extensive research has shown, however, that these punishments
are not likely to change students’ behavior, can potentially
compound the harms associated with drug abuse by isolating
students, and that the only factors likely to have a positive
impact on adolescent health-risk behavior are school and
family “connectedness.”47,48 “Zero-tolerance” drug policies
that punish students who have problems with drugs instead
of helping them should be eliminated by schools and replaced
with a restorative process, in which offenders identify harms
they caused and make amends (for more information, see
www.safety1st.org). A far better prevention strategy than
suspending students with methamphetamine-related problems
or otherwise excluding them from an education would be
helping them get access to treatment.
Young people need and deserve verifiable information about
drugs, drug chemistry, drug effects, and the relative risks of
different drugs, both legal and illegal. Honest information
de-mythologizes drug use and the romance of transgression
against authority. A good example of an innovative, realitybased drug education and support program for high
schools is the UpFront program operating in Oakland, CA
(see www.upfrontprograms.org and www.safety1st.org).
Although not limited to methamphetamine, UpFront stands
in sharp contrast to D.A.R.E. and other failed, scare-based
school prevention programs in its ability to create the kind
of trusting relationships that will keep teens safe.46
The Four-Pillars Drug Strategy
is a coordinated,
Rejecting Scare Tactics
The Office of National Drug Control Policy (ONDCP) has
focused only a small part of the National Youth Anti-Drug
Media Campaign on methamphetamine prevention (most
of the campaign has been focused on marijuana). Some
policymakers have urged ONDCP to run more methamphetamine-related TV ads. But as long as the agency remains
wedded to the same outmoded scare-based campaign that
has been failing for years, any new methamphetamine ads
would likely be just as ineffective, and possibly could do
more harm than good.
comprehensive approach
that balances public order
and public health
in order to create safer,
healthier communities.
12
Consistent with the federal government’s usual approach
to drug education, a private venture in Montana has been
running scare-based anti-methamphetamine TV ads since
2005.49 The preliminary results are discouraging.50 While
policymakers around the country are understandably anxious
to implement media campaigns in their own states, they
should be cautious. Most importantly they should invest
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“Our job is to create environments
where young people talk
about what they do … and
why they think doing it might
or might not be a good idea.
It’s not a simple thing and
there’s no simple answer.”
Chuck Ries, Director,
UpFront Program
in research and evaluation and ensure that they are implementing science-based campaigns. If they are interested in
innovative approaches that reject scare tactics, they should
look at New Mexico and Utah.
In 2006, the Drug Policy Alliance New Mexico (DPANM)
was awarded a grant through the U.S. Department of Justice
to create a statewide methamphetamine prevention and
education project directed at high-school-age youth. Working
with a statewide advisory committee comprised of representatives from state health agencies, local prevention programs
and community-based coalitions, DPANM is focusing on
promoting science-based information and youth engagement,
rather than simplistic “Just Say No” messages. The grant
funded a two-day statewide conference entitled Building
Positive Communities: A Public Health Approach to Teen
Methamphetamine Prevention in October 2007, which was
attended by more than 300 teachers, counselors, prevention
specialists, parents and youth. The conference featured
nationally recognized keynote speakers and interactive breakout sessions that provided current data on methamphetamine
use, prevention, treatment, and reality-based approaches to
drug education and student assistance programs. The grant is
also being used to fund a social marketing campaign created
by and for youth, including a prevention video and discussion
guide that is currently in production. The final phase of the
grant will fund training and technical assistance to communities statewide to build prevention capacity and enhance
effective substance abuse prevention and education programs
for our youth.
In Utah, the Utah Methamphetamine Joint Task Force rejected
a proposed Montana-like scare-based media campaign in favor
of a more realistic and nuanced one. Instead of commercials
featuring “ghoulish faces that demonize meth users,” the Utah
media campaign will emphasize that recovery is possible and
that people have it in them to improve their lives.51
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Treatment is the Answer
At least 20 recent studies show the efficacy of methamphetamine treatment, despite the persistence of myths to the
contrary.52 A 2003 survey of various treatment approaches
published in the Journal of Substance Abuse Treatment
concluded, “Clients who report methamphetamine abuse
respond favorably to existing treatment.”53 A Washington
State study found “there were no statistically significant
differences across a series of outcomes between clients using
methamphetamine and those using other substances.”54
Treatment success rates and relapse rates for methamphetamine
are similar to those for other drugs, with no documented
differences among male and female users.55
In 2005, an open letter to the media signed by 92 prominent
physicians, treatment specialists and researchers warned,
“Claims that methamphetamine users are virtually untreatable
with small recovery rates lack foundation in medical research,”
and noted that such erroneous claims were causing great
harm. The open letter continues, “Analysis of dropout,
retention in treatment and re-incarceration rates and other
measures of outcome, in several recent studies indicate that
methamphetamine users respond in an equivalent manner as
individuals admitted for other drug abuse problems.”56
Moreover, dozens of scientific studies to date have shown
that increased funding for treatment is absolutely the most
cost-effective way to undermine drug markets and reduce
drug abuse. The evidence of the effectiveness of treatment is
overwhelming:
• A RAND Corporation study for the U.S. Army and the
Drug Czar’s office found treatment to be 10 times more
effective at reducing drug abuse than drug interdiction,
15 times more effective than domestic law enforcement, and
23 times more effective than trying to eradicate drugs at their
source. It concluded that for every dollar invested in drug
treatment taxpayers save an estimated $7.46 in social costs.
In contrast, taxpayers lose 85 cents for every dollar spent
on source-country control, 68 cents for every dollar spent on
interdiction, and 48 cents for every dollar spent on domestic
law enforcement.57
14
• California’s CALDATA study found that every dollar
invested in alcohol and drug treatment saved taxpayers
more than seven dollars, due to reductions in crime and
healthcare costs.58
• Oregon estimates its return on every dollar invested in
treatment to be $5.62, primarily in the areas of corrections,
health and welfare spending.59
• A Substance Abuse and Mental Health Services
Administration (SAMHSA) study found that treatment
reduces drug selling by 78 percent, shoplifting by almost
82 percent and assaults by 78 percent. Treatment decreases
arrests for any crime by 64 percent. After only one year,
use of welfare declined by 10.7 percent, while employment
increased by 18.7 percent. Medical visits related to substance
abuse decreased by more than half following treatment,
while in-patient mental health visits decreased by more than
25 percent.60
Implementing prohibitionist policies without providing and
funding treatment options poses its own special problems.
A three-state, $6.1 million study conducted in counties in
Arkansas, Kentucky and Ohio raises concerns that laws
intended to drive down the manufacture and use of methamphetamine in rural areas may actually be causing unwanted
side effects by driving up the use of cocaine. The two-year
study, funded by the National Institute on Drug Abuse and
published in a 2008 issue of the journal Addiction, noted a
statistically significant increase in cocaine use of nine percent
associated with the implementation of laws designed to
reduce methamphetamine use although, due to the study’s
observational design, the authors caution against making
definitive conclusions.
This and studies like it underscore the importance of making
a broad spectrum of treatment services available to the public.
Simply instituting restrictions on precursor ingredients, such
as over-the-counter cold medicines, will not decrease overall
substance abuse. Treatment on demand – not incarceration –
is the surest way to ensure that well-intended policy measures
do not merely exchange one set of societal problems for
another.
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Increasing Access to
Treatment for All Americans
Policymakers at all levels of government
should ensure that substance abuse
treatment is available to all who need it,
whenever they need it, and as often as
they need it. Unfortunately, as many as ten
million Americans each year do not receive
the substance abuse treatment for alcohol
and other drugs that they need.*
Of the ways to expand access to
treatment, four stand out:
1) Increase federal, state and local funding to provide
treatment for more people. Treatment should include
mental health services, as well as sexual abuse, domestic
abuse and child abuse services to deal with the root
causes of addictive behavior. Treatment options should
strive for inclusion and offer both abstinence-based and
non-abstinence-based treatment. Policymakers should
also ensure that treatment programs are meeting the
needs of populations that have faced unique hurdles to
accessing substance abuse treatment in the past, such as
women, people of color, youth, lesbian, gay, bisexual and
transgendered individuals, and rural populations.
2) Provide people in need of treatment with vouchers
redeemable for treatment services through the program
of their choice. The Bush administration has already
established a model program, Access to Recovery, which
provides block grants to states for distributing treatment
vouchers to those who need it. Congress should fully fund
this program, and states should take advantage of it and
supplement it with their own funds where needed. The
City of Milwaukee has operated its own treatment voucher
program for a decade and could serve as a model.
3) Increase the number of people who can access substance
abuse treatment through their health insurance. This
would require expanding access to health insurance
in general, encouraging more companies to include
substance abuse and mental health treatment in the
insurance policies they offer their employees, and
requiring insurance companies to reimburse their
customers for treatment expenses at the same level as
other medical expenses (known as “parity”).
4) Provide tax credits to people who pay for substance
abuse treatment for themselves or others.
* U.S. Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, “Changing the Conversation: Improving
Substance Abuse Treatment: The National Treatment Plan Initiative;
Panel Reports, Public Hearings, and Participant Acknowledgements”
(Washington, D.C.: SAMHSA, November 2000), p. 6.
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Treatment is the Answer
continued from page 15
Treatment Works:
California’s Proposition 36
California is leading the way in providing comprehensive
treatment to reduce methamphetamine abuse and its associated
problems. The Substance Abuse and Crime Prevention Act of
2000 – also known as Proposition 36 – sponsored by a Drug
Policy Alliance affiliate and approved by California voters,
requires the state to provide drug treatment, rather than jail
time, for nonviolent drug possession offenders. While not
specific to methamphetamine offenders, more than 19,000
methamphetamine users enter treatment annually under this
program, and no other program in the nation has offered
treatment to or graduated more methamphetamine users.
A recent evaluation by the University of California Los
Angeles (UCLA) found that California taxpayers saved nearly
$2.50 for every dollar invested in the program. Of people
who successfully completed their drug treatment, California
taxpayers saved nearly $4 for each dollar spent. In all,
Proposition 36 is estimated to have saved state and local
government more than $1.3 billion over its first six years.61
Other states to implement treatment-instead-of-incarceration
programs in recent years include Maryland, Texas and Utah,
although none as comprehensive as California’s Proposition 36.
While Proposition 36 is unquestionably a model for how to
effectively address the methamphetamine problem, it does not
go far enough. People with substance abuse problems should
not have to get arrested to receive effective drug treatment. It
is both cheaper for taxpayers and better for public safety to
provide quality treatment to those who need it before they
encounter the criminal justice system. An estimated 300,000
Americans who sought treatment in 2005 for the abuse of
alcohol or other drugs did not receive it. The most commonly
cited reason for failure to obtain treatment was cost.62
16
Women and Methamphetamine Policy
It is especially important that policymakers devote more
resources to tailored treatment services for women, especially
pregnant and parenting women. In contrast to other
illicit drugs, rates of admission to treatment for methamphetamine are roughly equal for women (47 percent) and men
(53 percent).63,64 Women also face unique obstacles to
recovery, ranging from being the primary caretaker of their
children to having been physically, emotionally or sexually
abused. Yet, a 2004 U.S. government study found that only
32 percent of treatment facilities in the U.S. have unique
programs for women, while only 14 percent have special
programs for pregnant or postpartum women.65
While no national data are currently available on child
welfare cases specifically attributed to methamphetamine,
some state and county agencies have reported increases in the
number of children separated from their families because of
parental use of methamphetamine.66 Unfortunately, less than
eight percent of all U.S. treatment programs provide childcare,
and only five percent provide residential beds for children.67
Yet almost two thirds of all individuals seeking treatment for
methamphetamine are believed to have minor children.68
Women with children cannot enroll in in-house treatment
programs unless accommodations exist for their dependent
children. Mothers needing outpatient treatment services
may have difficulty being on time or making every meeting –
problems arise with their children and they need to balance
work and family with treatment.
In a 2005 survey of 13 states, 40 percent of child welfare
officials reported an increase in out-of-home placements in
the last year due to methamphetamine use.69 While it may be
warranted to remove children from a parent who is violent,
dysfunctional or clearly unable to fulfill their parental responsibilities, the removal of a child, placement in foster care and
adoption all have significant drawbacks as well. Too often
children are removed based solely upon a parent’s drug use.
Policymakers should strive to preserve family unity to the
extent possible.
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Women who use methamphetamine and bear children have
increasingly become the targets of state prosecutors seeking
to prosecute them for “fetal” abuse and delivery of drugs
through the umbilical cord.70 Advocates for women and
children universally agree that women should engage in
behaviors that promote the birth of healthy children.
However, they also recognize the complex factors inherent to
substance abuse must be met with constructive responses.71
According to the American Medical Association, “Pregnant
women will be likely to avoid seeking prenatal or other
medical care for fear that their physician’s knowledge of
substance abuse … could result in a jail sentence rather than
proper treatment.”72 The effects of prenatal exposure to
methamphetamine are still unknown. “In utero physiologic
dependence on opiates (not addiction), known as Neonatal
Narcotic Abstinence Syndrome, is readily diagnosable and
treatable, but no such symptoms have been found to occur
following prenatal cocaine or methamphetamine exposure.”73
Drug use during pregnancy is a health issue that requires
appropriate care from qualified health professionals, not
destructive interventions by law enforcement. Every major
medical and public health organization in the country
opposes the arrest and jailing of pregnant women for the use
of alcohol, methamphetamine or other drugs.74 Policymakers
should stress treatment over incarceration when it comes to
women who use methamphetamine or other drugs during
pregnancy.
Page 19
Supporting Women in Recovery:
• Nearly 15 percent of women who use methamphetamine are
single parents, more than four times the percentage of men.i
• More than 40 percent of women who use methamphetamine
are unemployed compared to about 10 percent of men.ii
• Women who seek treatment for methamphetamine on average use methamphetamine with greater frequency than men.iii
• Women in treatment for methamphetamine have higher
instances of psychological trauma, physical trauma, and both
long and short-term sexual abuse. Women are more than four
times as likely to have been sexually abused in the 30 days
immediately prior to entering treatment.iv
• Approximately 37 percent of women who use methamphetamine in California say that they use the drug to lose weight,
compared to nine percent of men; an equal number of men
and women use it to relieve depression.v
• Young girls represent almost 70 percent of treatment
admissions for methamphetamine among 12- to
14-year-olds, and more than half of treatment admissions
for 15- to 17-year-olds.VI
i The CSAT Methamphetamine Treatment Project: A Comparison of
Characteristics of Men and Women Participants at Baseline, slide 6.
ii Ibid (slide 7).
iii Ibid (slide 9).
iv Yih-Ing Hser, Elizabeth Evans, Yu-Chuang Huang, “Treatment outcomes
among women and men methamphetamine abusers in California,”
Journal of Substance Abuse Treatment 28, no. 1, page 84.
v Ibid (table 3, page 82).
vi Ibid (page 2).
Proposition 36 Rally, 2008
Sacramento, CA
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Treatment is the Answer
continued from page 17
Gay Men and Methamphetamine
Gay men also face a shortage of prevention and treatment
programs tailored to their needs. A November 2006 report
by the Gay and Lesbian Medical Association (GLMA),
“Breaking the Grip: Treating Crystal Methamphetamine
Addiction Among Gay and Bisexual Men,” draws upon several
studies to estimate that 10-20 percent of gay men in major
cities have used methamphetamine in the past six months.75
The report notes that, “Psychosocial pressures – including
homophobia, discrimination, fear, loss and stigma resulting
from HIV/AIDS, and a public discourse which denigrates the
‘lifestyle choices’ of [lesbian, gay, bisexual and transgendered]
persons, same-sex marriage, and equal rights – often result in
internalized homophobia, feelings of low self worth and
depression, and these conditions increase susceptibility to
drug addiction in some individuals. Gay men frequently use
methamphetamine to cope with anxiety, depression, loneliness
and fears about being physically unattractive due to aging.”76
Yet, effective treatment programs for gay men are
severely lacking:
Even in major urban areas with large gay populations and
established general healthcare programs serving them,
there is still a significant lack of culturally appropriate
substance abuse programs for gay men. Substance abuse
treatment professionals in other cities and rural areas, have
little understanding of the clinical needs of gay men or
knowledge of resources to provide treatment. When dealing
with methamphetamine dependence among gay men, it is
important that healthcare providers are able to discuss
frankly with their patients and clients the situations and
motivations surrounding their methamphetamine use. In
many, if not most instances, these situations and motivations will include past and/or present sexual activity. Focus
group members provided numerous anecdotes about
patients who reported previous experiences in addiction
treatment programs where staff [was] unwilling to discuss
such issues, and core triggers in their addictions were never
addressed during the treatment. This suboptimal treatment
results in poor clinical outcomes, alienates patients who
feel that their needs are not being met, and wastes financial resources of government and private insurance funds
that pay for treatment that demonstrates poor efficacy.77
The GLMA recommends increasing the cultural competency
of substance abuse clinicians, conducting more research on
the social and sexual context of methamphetamine use, and
developing more effective treatment programs (including
pharmacological approaches).78
Special Mental Health Issues
Additional funding for research that examines the root causes
of methamphetamine abuse, including whether methamphetamine offenders are self-medicating for depression, Attention
Deficit Disorder or other disorders would help lay a foundation
for new treatment modalities. A key component of such
studies should be what role the lack of access to healthcare
generally, and prescription drugs specifically, plays in perpetuating methamphetamine abuse.
In general, policymakers should facilitate better collaboration
between mental health programs and substance abuse
programs. Although 80-90 percent of mental disorders
are treatable using medication and other therapies, only
50 percent of adults who need help receive it.79 In many
cases, mental health agencies will not treat someone who is
abusing drugs, while substance abuse agencies cannot treat
the person until their mental health issues are resolved.
This bureaucratic Catch-22 situation prevents many drug
offenders from getting the help they need. Lack of health
insurance or inadequate coverage may drive some people
to treat medical conditions with black market drugs.
After receiving treatment
through a prison diversion
program, Mary Pruitt went
back to school in the field
of recovery, received her
certification and has been
working in a women’s
recovery house in
Sacramento since 2003.
18
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Replacement Therapy
Like alcohol and other drugs it is important for policymakers
to invest in research for viable replacement therapy options
for methamphetamine abuse. Under replacement therapy,
doctors prescribe one or more pharmaceutical drugs to
people with substance abuse problems to eliminate or reduce
their use of problematic drugs and improve their mental and
physical well-being. The exact therapy differs from drug to
drug and patient to patient. In some cases the therapy is
direct, such as prescribing medications that block or limit the
effects of the drug the patient is abusing (e.g., Naltrexone for
opiates.) In other cases the therapy is indirect, such as prescribing medication to treat problems that might be driving
their drug use (treating depression with Prozac or Attention
Deficit Disorder with Ritalin). Sometimes doctors prescribe
patients an alternative to the drug they are abusing that is
longer lasting but less euphoric (such as methadone and
buprenorphine for heroin users). And sometimes doctors
prescribe an alternative form of the drug a patient is abusing
that is safer and less problematic (the “patch” for cigarette
smokers and pharmaceutical-grade heroin for heroin users).
Research into pharmacotherapies for the treatment of stimulants has fallen into two areas: antagonists that block the
abused drugs’ effects thus precluding or reducing use; and
agonists that partially replace effects of the abused drug,
thereby stabilizing the patient. Because stimulants affect multiple neurotransmitter systems both antagonists and agonists
must interfere with the action of a number of systems to be
effective, making the development of an effective medication
challenging. So far no medication has been approved as
uniquely effective for treatment of methamphetamine abuse
or dependence in the United States.80
Antagonist strategies have traditionally not shown much
success in treating stimulant abuse.81 The use of agonists,
however, to treat stimulant abuse (including methamphetamine) has shown promise. Currently, there are two stimulant
drugs that are praised globally in research for replacement
therapy for stimulant abuse: dextroamphetamine82 and
modafinil.83 A 2004 comprehensive review of the available
research on stimulant replacement therapies concluded that
oral dextroamphetamine may help stabilize illicit amphetamine users’ dependency and provide some reduction in the
use of other drugs, injection behavior and criminal activity.84
Page 21
In 1998, Australian and New Zealand researchers found
positive results in the use of dextroamphetamine to treat
intravenous amphetamine users. Seventy percent of the
patients who were prescribed dextroamphetamine in pill
form decreased their intravenous use of illegal street amphetamine.85 In contrast, 67 percent of intravenous heroin users
who were prescribed methadone decreased their heroin use.86
Similarly, researchers in the United Kingdom are extremely
confident in the use of dextroamphetamine to treat stimulant
abuse. In a 2001 study, researchers found that prescribing
dextroamphetamine decreased their clients’ consumption
of street methamphetamine and amphetamine and reduced
the frequency of intravenous drug use.87 Other studies have
reached similar conclusions.88
The United Kingdom’s Department of Health recommends
the limited prescription of dextroamphetamine to patients
who use street amphetamine in order to reduce craving,
minimalize withdrawal, and stabilize them as part of drug
treatment.89 It is not uncommon for British doctors to
prescribe dextroamphetamine to amphetamine abusers on
an ongoing basis to reduce criminality and legal problems,
discourage injection drug use and improve the health of their
patients.90
Unfortunately, many studies on the use of dextroamphetamine
to treat stimulant abuse have been limited by their small
sample sizes and lack of controlled randomization. More
studies are needed, especially in the United States.
A federally-funded report prepared for the National Institute
of Justice, a division of the U.S. Justice Department, concluded:
Poor results with [antagonist] drugs have encouraged a
further look at the use of replacement or agonist therapies
in the treatment of amphetamine/methamphetamine abuse,
much like the approach used with methadone in the treatment of opioid abuse. As with methadone, the approach
relies in part on a harm reduction model in that it replaces
the illicit drug, methamphetamine, with a legal, controlled
dose of a stimulant or replacement drug provided, however,
in a therapeutic setting together with supportive services
can be supplied. The replacement of, for example, dextroamphetamine for methamphetamine would ideally
reduce problems related to crime, injection practices, family
and economic issues, and health problems related to
escalating illegal use. Grabowski and colleagues (2003)
have reviewed the available and somewhat limited
research on using replacement (agonist) therapies in the
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Treatment is the Answer
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treatment of methamphetamine or amphetamine abuse.
These studies are often small and involve self selected
samples and self reporting of behavior changes. However,
many indicate that using oral dextroamphetamine to
stabilize illicit amphetamine users’ dependency can provide
some reduction in the use of other drugs, injection behavior
and criminal activity.91
Modafinil (marketed under the name “Provigil”) is a mild
non-amphetamine stimulant originally approved as a medication for narcolepsy. It is increasingly used to ward off fatigue
and increase concentration and alertness in both the military
and the private sector. Numerous studies have confirmed that
its use does not cause elation or euphoria like amphetamine
and methamphetamine, making it an unlikely drug to be
abused.92 In fact, the DEA has classified it as a Schedule IV
drug because it has a “low potential for abuse.” Early studies
suggest that it is helpful in the management of psychostimulant
withdrawal symptoms such as hypersomnia, poor concentration and low mood. Case reports point to positive responses
in both cocaine- and amphetamine-dependent patients with
no apparent over-stimulation or abuse.93
Although the use of modafinil in treating methamphetamine
abuse is still in the early stages of research, Nora Volkow,
M.D., the director of the National Institute on Drug Abuse
notes that, “Because modafinil has shown early efficacy in
cocaine treatment and may have positive effects on executive
function and impulsivity, it is being tested as a potential
treatment in methamphetamine addiction.”94
The city of Vancouver, Canada, is working to implement the
first stimulant replacement program in North America. Under
the plan, called Chronic Addiction Substitution Treatment
(CAST), up to 700 chronic cocaine and methamphetamine
users would be provided with replacement medication, such
as Ritalin or dextroamphetamine. The program, which would
need an exemption from Canada’s drug laws from the federal
government, is part of an ambitious city program to cut
homelessness, panhandling and drug dealing in half by 2010.95
The United States lags behind Canada and Europe in allowing
doctors to prescribe medication to treat substance abuse
problems. U.S. policymakers should increase funding for the
study of both agonists and antagonists to treat methamphetamine abuse. Doctors should be able to use dextroamphetmaine, modafinil and other medications to treat stimulant
addiction as part of counseling and drug treatment, if it is
deemed medically warranted, in the same way that methadone
and buprenorphine are used to treat opiate addiction. People
struggling with substance abuse problems should have a
diverse array of treatment options.
“I started using alcohol and drugs when I was 12.
I had been in and out of state and federal prison
throughout my life for nonviolent drug offenses
and was never before offered treatment. In prison
there were more drugs in a smaller area. I was
worn out and struggling with crank when I entered
Proposition 36. I switched to a more intensive
residential treatment program and felt like I was
finally offered the tools I needed to make a change.”
Scott, Sacramento, CA
20
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Enforcement:
A Proper Role for Policing
Law enforcement agencies have been required to play an
unrealistic role in our nation’s drug policies for far too long,
and have been unfairly blamed for their failure to grapple
with social problems largely beyond their control. For
instance, because treatment, prevention and other public
health strategies have not received adequate funding, the
brunt of addressing methamphetamine and its associated
harms has fallen on the shoulders of state and local law
enforcement. Instead of being the last line of defense, law
enforcement has become the first – and in some cases only –
response to methamphetamine-related problems. This has
strained policing budgets and put law enforcement officers
in perpetual danger.
Ultimately, policymakers must begin to treat drug abuse as
a healthcare issue that has an important criminal justice
component. Implementing a comprehensive approach to
methamphetamine provides a good opportunity to do so.
An effective policing strategy for methamphetamine and
other illegal drugs would:
• Concentrate law enforcement resources on drug law offenders
who threaten public safety – people who commit violence,
steal to support their habit, or drive while impaired. People
who are not harming others should be left to private and
public health agencies to deal with. Since many drug law
violators cause no harm to others, law enforcement could
easily improve public safety with existing resources by
shifting the public health burden to appropriate public
health agencies.
• Refrain from doing anything that exacerbates the harms
associated with drug abuse, such as arresting people enrolled
in syringe exchange programs – especially those that local
authorities have legalized and encouraged96,97 – or arresting
drug users who call 911 when a companion is overdosing.
One study of nearly 400 current or former drug users in
Baltimore, Maryland, who reported having witnessed a drug
overdose, found that just 23 percent of the participants
reported calling an ambulance to report the overdose.98 To
the greatest extent possible, law enforcement should build
partnerships with the public, helping drug users find public
health services and seeking their help in protecting public
safety.99
• Re-prioritize scarce law enforcement resources. This means
refocusing enforcement on those who pose the greatest
threat to others and on the most dangerous drugs. Violent
methamphetamine sellers should take enforcement priority
over nonviolent marijuana sellers. Shutting down major
methamphetamine crime syndicates should take precedence
over incarcerating people simply for methamphetamine use.
A recent publication by the American Enterprise Institute
summarizes this last point succinctly:
[I]t is hard to find evidence that the sharp ratcheting-up
of [drug arrests] since the late 1980s has done much to
reduce availability or increase price. At the same time,
however, there has been some good news about enforcement, which is that carefully crafted policing strategies can
materially reduce drug-related crime and violence and the
blight of open drug markets.
Clearly, retail-level drug enforcement should focus on what
it can accomplish (reducing the negative side effects of
illicit markets) and not on what it can’t achieve (substantially
raising drug prices). Thus, instead of aiming to arrest drug
dealers and seize drugs – the mechanisms by which
enforcement seeks to raise prices – retail drug enforcement
should target individual dealers and organizations that
engage in flagrant dealing, violence, and the recruitment of
juveniles. Arrests and seizures should not be operational
goals, but rather tools employed, with restraint, in the
service of public safety.100
Local and state anti-methamphetamine law enforcement
resources should focus on apprehending violent methamphetamine sellers or users who commit crimes against people
or property, and disrupting criminal networks. Federal antimethamphetamine resources should focus on large cases that
cross international and state boundaries, with a priority on
disrupting Mexican drug cartels and major domestic crime
syndicates. Low- and medium-level offenses should be left
to state criminal justice systems. Congress should set clear
statutory goals for the disruption of major methamphetamine
operations, and federal agencies should be required to report
on their progress toward these goals, including resources
wasted on low-level drug offenses.
21
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Harm Reduction: Education
and Outreach Save Lives
Harm reduction (sometimes called risk minimization) is a
public health strategy designed to reduce the harms of activities that cannot be completely eliminated. It is often used as a
fall-back strategy when prevention efforts fail. For example,
one of the best known examples of a drug-related harm
reduction strategy is when parents instruct their teenagers to
call home if they are ever intoxicated or stranded and need a
ride home, no questions asked. Other examples include providing cigarette smokers with safer nicotine delivery devices
(such as nicotine patches) or making sterile syringes available
to injection drug users to reduce the spread of HIV/AIDS and
other infectious diseases. Harm reduction strategies in other
areas include safe sex education, seat belt laws and amnesty
laws that encourage desperate mothers to drop their babies
off at hospitals and churches rather than abandoning them.
While there are many harm reduction strategies that could
mitigate problems associated with methamphetamine abuse,
the most urgent need is to address related public health
threats. As noted above, methamphetamine use is of particular
concern among the gay male community. Among gay men
methamphetamine is closely associated with high-risk sexual
behavior, which can spread HIV/AIDS and other sexually
transmitted diseases. For instance, a 2003 study of gay and
bisexual men who used methamphetamine, found that more
than half had engaged in high risk sexual behaviors such as
unprotected sex, or having sex with someone who had HIV
or later developed HIV.101 While little research has been
devoted to studying the association between methamphetamine
use and sexual risk among heterosexuals, what research has
been conducted suggests prolonged use of the drug significantly increases high-risk sexual behavior.102 In addition to
culturally appropriate drug and safe-sex education, the
widespread availability of free condoms is essential to prevent
HIV infections and reduce government healthcare expenditures.
Sharing of syringes among people who use methamphetamine
intravenously is also a factor in the spread of HIV/AIDS, as
well as hepatitis C and other infectious diseases. Policymakers
at all levels should make sterile syringes widely available, and
increase funding for safe-injection education programs. The
federal government should repeal the ban on using federal
HIV/AIDS prevention money on syringe exchange programs.
22
Increasing the availability of sterile syringes through syringe
exchange programs, pharmacies and other outlets reduces
unsafe injection practices such as syringe sharing, curtails
transmission of HIV/AIDS and hepatitis, increases safe
disposal of used syringes, and helps intravenous drug users
obtain drug education and treatment. Every established
medical and scientific body that studied the issue concurs on
the efficacy of improved access to sterile syringes toward
reducing the spread of infectious diseases, including:
• National Academy of Sciences;
• American Medical Association;
• American Public Health Association; and
• Centers for Disease Control and Prevention.
Seven government reports conclude access to sterile syringes
does not increase drug use. No report yet exists that contradicts this basic finding.103
The consequences of failing to make sterile syringes more
widely available are dire. According to the U.S. Centers for
Disease Control and Prevention (CDC), of the 415,193 persons
reported to be living with AIDS in the U.S. at the end of
2004, at least 30 percent of cases were related to injection
drug use.104 About 12,000 Americans contract HIV/AIDS
directly or indirectly from the sharing of dirty syringes each
year.105 About 17,000 contract hepatitis C.106 An estimated
one in seven stimulant users (amphetamine and methamphetamine) report injection drug use in their lifetime.107 A recent
study found that rural methamphetamine users are more likely
to inject the drug than urban users.108 The strong presence of
methamphetamine in rural areas, combined with the significant
shortage of both drug treatment and HIV/AIDS prevention
resources in those areas, make the sharing of dirty needles a
serious threat to public health.109 The lifetime cost of treating
just one person with HIV can be as high as $600,000.110
Finally, policymakers should continue to adopt measures to
reduce the harms associated with the illegal production of
methamphetamine. Recent precursor controls may have
reduced some of the public health threats posed by domestic
methamphetamine labs (although as previously noted, with
some negative consequences); but more should be done. In
particular, the federal government should increase funding to
states for the safe clean-up of methamphetamine lab sites.
Local and state governments should provide better training
to law enforcement officers, first responders, child service
workers and anyone else who could become exposed to
dangerous methamphetamine precursors through the course
of their work.
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Optimal Syringe Law Reform
Depending on existing law in a particular
state, optimal syringe law reform may
require one or more of the following:
• Deregulate the sale of sterile syringes, so that pharmacies
can sell them to customers without a prescription.
Pharmacy sale is standard throughout most U.S. states,
Western Europe, much of Central and Eastern Europe, and
Oceania.i
• Eliminate criminal penalties for possession of syringes,
so that people who use drugs intravenously can carry
sterile syringes and properly dispose of used ones. (After
Connecticut changed its paraphernalia and prescription
laws in 1992 to allow for possession and sale of up to ten
syringes, needle sharing dropped 40 percent and needle
stick injuries to police decreased 66 percent.)ii
i
Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs
in the United States and Abroad (prepared for the Centers for Disease Control
and Prevention). Berkeley, CA: University of California, School of Public
Health, and San Francisco, CA: University of California, Institute for Health
Policy Studies; 1993:68. Ganz A, Byrne C, Jackson P. Role of community
pharmacies in prevention of AIDS among injecting drug misusers: findings
of a survey in England and Wales. British Medical Journal. 1989;299: 10761079. Bless R, et al. Urban Policies in Europe 1993. Amsterdam: Amsterdam
Bureau of Social Research and Statistics; 1993.
ii Vlahov D. Deregulation of the sale and possession of syringes for HIV prevention among injection drug users. Journal of Acquired Immune Deficiency
Syndromes and Human Retrovirology. 1995; 10:71; Editorial. Valleroy L,
Weinstein B, Jones TS, Groseclose SL, Rolfs RT, Kassler, WJ. Impact of
increased legal access to needles and syringes on community pharmacies:
needle and syringe sales – Connecticut, 1992-1993. Journal of Acquired
Immune Deficiency Syndromes and Human Retrovirology.1995; 10:73-81.
iii Hurley SF. Effectiveness of needle-exchange programmes for prevention of
HIV infection. Lancet 1997;349:1797. Survey included primarily U.S. cities
and found that cities with syringe exchange programs had an 11 percent
lower rate of increase in seroprevalence each year.
• Remove all legal barriers to syringe exchange programs and
increase public funding to such programs. A worldwide
survey found that HIV seroprevalence among intravenous
drug users decreased 5.8 percent per year in cities with
needle exchange programs, and increased 5.9 percent per
year in cities without syringe exchange programs.iii
23
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Conclusion
While methamphetamine abuse and the proliferation of
illegal methamphetamine labs have recently become subjects
of heightened national concern, state and federal policymakers
have been grappling with both problems for more than
40 years. During this time, policymakers have enacted one
ineffective policy after another. This is one reason why
the problems associated with methamphetamine – crime,
addiction, child neglect, the spread of HIV/AIDS – continue
to mount. An effective national strategy for addressing
methamphetamine abuse is possible but it will take real
leadership to pass and enact.
Policymakers must take the lead in stopping the perpetuation
of myths. Methamphetamine is not instantly addictive.
People who use it are not hooked for life. Methamphetamine
addiction is never untreatable. These and other myths permeate the national methamphetamine discussion and give rise to
both defeatism and hysteria. The problems associated with
methamphetamine abuse are serious, but they are manageable.
• Policymakers should also learn from the mistakes of the past:
Our country cannot incarcerate its way out of the methamphetamine problem. Punitive policies have been exhaustively
tried and they have failed, not just with methamphetamine,
but also with cocaine, heroin, marijuana and numerous
other drugs (including alcohol). Despite spending hundreds
of billions of dollars and incarcerating millions of Americans,
illegal drugs remain cheap, potent and widely available in
every community.
• Many drug policies do more harm than good. Breaking up
families perpetuates drug abuse, poverty and crime.
Prohibiting former drug offenders from receiving public
assistance, housing, school loans and other benefits makes
it even harder for them to put their lives back together.
Aggressively arresting and incarcerating people who use
drugs increases drug-related deaths because people are afraid
to call 911 when their friends are overdosing. Using scare
tactics and over-the-top messages in prevention campaigns
can cause people to rebel against prevention messages,
undermining prevention efforts.
24
• Severe consequences can result from ignoring public health
and human rights concerns. If policymakers had prioritized
making drug treatment available to all who needed it in the
1980s, instead of arresting millions of Americans for what
they put into their own bodies, they may very well have
prevented many of the methamphetamine-related problems
that plague our country now. Additionally, making sterile
syringes widely available would have saved tens of thousands
of American lives.
Implementing an effective national methamphetamine strategy
would provide policymakers with an opportunity to break
from the mistakes of the past. They could adopt a new drug
policy framework based on treatment instead of jail, strategic
policing and harm reduction. Ideally, and obviously, this new
framework should apply to all illegal drugs, not just methamphetamine. Its essential policies should include:
• providing treatment to all who need it, whenever they need it,
and as often as they need it;
• developing reality-based prevention programs that foster trust
and emphasize factual information;
• investing in pharmacotherapy, including replacement therapy,
and expanding treatment options;
• making sterile syringes more widely available to reduce the
spread of HIV/AIDS and other infectious disease;
• prioritizing family unity; and
• shifting enforcement resources away from incarcerating
low-level nonviolent drug law violators toward disrupting
and dismantling violent crime networks.
Methamphetamine poses many challenges to policymakers,
but there is no need for panic. There are clear steps elected
officials can take to reduce methamphetamine abuse, protect
public safety, eliminate government waste and save lives.
These steps – some small, some large – would improve the
lives of hundreds of thousands of Americans, and states like
California and New Mexico are already leading the way.
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Endnotes
1 National Institute on Drug Abuse. “Methamphetamine Abuse and
Addiction.” NIDA Research Report Sept. 2006: NIH Publication
No. 06-4210. National Institute on Drug Abuse. 2006. National
Institutes of Health, Bethesda, MD. <www.drugabuse.gov/
ResearchReports/methamph/methamph.html>.
2 “Owen, Frank. No Speed Limit: The Highs and Lows of Meth. New
York, NY: St. Martin’s Press, 2007.
3 Ibid.
4 Ibid; National Institute of Justice. “Methamphetamine Use: Lessons
Learned.” Cambridge, MA: Abt Associates Inc. Contract No. 99-C008.31, Jan. 2006.
5 Ibid; National Institute of Justice. “Methamphetamine Use: Lessons
Learned.” Cambridge, MA: Abt Associates Inc. Contract No. 99-C008.31, Jan. 2006.
6 National Institute of Justice. “Methamphetamine Use: Lessons
Learned.” Cambridge, MA: Abt Associates Inc. Contract No. 99-C008.31, Jan. 2006.
7 Ibid.
8 National Institute on Drug Abuse. “Methamphetamine Abuse and
Addiction.” NIDA Research Report Sept. 2006: NIH Publication
No. 06-4210. National Institute on Drug Abuse. Reprinted January
2002. Revised September 2006. National Institutes of Health,
Bethesda, MD. <www.drugabuse.gov/ResearchReports/methamph/
methamph.html>.
9 McCabe, Esteban, and John Knight, Christian Teter, Henry Wechsler.
“Non-medical Use of Prescription Stimulants among U.S. College
Students: Prevalence and Correlates from a National Survey.”
Addiction 100.1 (Jan. 2005): 96-106; and Teter, Christian, and
Esteban McCabe, James Carnford, Carol Boyd, Sallie Guthrie.
“Prevalence and Motives for Illicit Use of Prescription Stimulants in
an Undergraduate Student Sample.” Journal of American College
Health 53.6 (May-Jun. 2005).
10 Boyum, David, and Peter Reuter, An Analytic Assessment of U.S.
Drug Policy, Washington, D.C.: American Enterprise Institute Press,
2005; and Reuter, Peter. “The Limits of Supply-Side Drug Control,”
The Milken Institute Review (First Quarter 2001): 15-23.
11 Kraman, Pilar. “Drug Abuse in America – Rural Meth,” Trends
Alert. Lexington, KY: The Council of State Governments, Mar.
2004.
12 United States. Sentencing Commission. Report to Congress: Cocaine
and Federal Sentencing Project. Washington, D.C.: GPO, May 2007.
13 King, Ryan. The Next Big Thing? Methamphetamine in the United
States. Washington, D.C.: The Sentencing Project, Jun. 2006.
14 Ibid; and United States. Substance Abuse and Mental Health
Services Administration. Results from the 2005 National Survey on
Drug Use and Health: National Findings. NSDUH Series H-30,
DHHS Publication No. SMA 06-4194. Rockville, MD: Office of
Applied Studies, 2006.
15 King, Ryan. The Next Big Thing? Methamphetamine in the United
States. Washington, D.C.: The Sentencing Project, Jun. 2006.
16 United States. Substance Abuse and Mental Health Services
Administration. Results from the 2005 National Survey on Drug
Use and Health: National Findings. NSDUH Series H-30, DHHS
Publication No. SMA 06-4194. Rockville, MD: Office of Applied
Studies, 2006.
17 King, Ryan. The Next Big Thing? Methamphetamine in the United
States. Washington, D.C.: The Sentencing Project, Jun. 2006.
18 Surveys show that most people who use methamphetamine never
become regular users. See United States. Substance Abuse and
Mental Health Services Administration. Results from the 2005
National Survey on Drug Use and Health: National Findings.
NSDUH Series H-30, DHHS Publication No. SMA 06-4194.
Rockville, MD: Office of Applied Studies, 2006.
19 King, Ryan. The Next Big Thing? Methamphetamine in the United
States. Washington, D.C.: The Sentencing Project, Jun. 2006; and
Otero, Cathleen, and Sharon Boles, Nancy K. Young, Dennis Kim.
Methamphetamine Addiction, Treatment, and Outcomes:
Implications for Child Welfare Workers. Irvine, CA: National Center
on Substance Abuse and Child Welfare, April 2006: 12-13.
20 Ibid.
21 Boyum, David, and Peter Reuter. An Analytic Assessment of U.S.
Drug Policy. Washington, D.C.: American Enterprise Institute Press,
2005; Reuter, Peter. “The Limits of Supply-Side Drug Control.” The
Milken Institute Review Santa Monica, CA, First Quarter 2001: 1523; and Youngers, Coletta, and Eileen Rosin, Ed. “Drugs and
Democracy in Latin America: The Impact of U.S. Policy.”
Washington Office on Latin America Special Report Washington,
D.C., Nov. 2004: 1-5.
22 Reuter, Peter. “The Limits of Supply-Side Drug Control.” The Milken
Institute Review Santa Monica, CA, First Quarter 2001: 15-23.
23 Owen, Frank. No Speed Limit: The Highs and Lows of Meth. New
York, NY: St. Martin’s Press, 2007; National Institute of Justice.
“Methamphetamine Use: Lessons Learned.” Cambridge, MA: Abt
Associates Inc. Contract No. 99-C-008.31, Jan. 2006.
24 Tandy, Karen. “Statement by Administrator Karen P. Tandy on Two
Hundred and Seven Million in Drug Money Seized in Mexico City.”
2007. Drug Enforcement Administration. 20 Mar. 2007
<http://www.usdoj.gov/ dea/pubs/pressrel/pr032007.html>.
25 Associated Press. “Attorneys general say meth labs pushed offshore,
smuggled in.” Associated Press 12 April 2007.
26 Drug Enforcement Administration. “State Factsheets.” Washington,
D.C. 30 May 2008
<http://www.dea.gov/pubs/state_factsheets.html>.
27 Drug Policy Alliance. State of the States. Drug Policy Reforms:
1996-2002. New York, NY: Drug Policy Alliance, Sep. 2003.
28 University of California Los Angeles. Evaluation of the Substance
Abuse and Crime Prevention Act: Final Report. Los Angeles, CA:
UCLA Press, 13 April 2007; Drug Policy Alliance. Proposition 36:
Looking Back and Beyond. New York, NY: Drug Policy Alliance, Jun.
2003; and Drug Policy Alliance. Proposition 36: Improving Lives,
Delivering Results. New York, NY: Drug Policy Alliance, Mar. 2006.
29 Ibid.
30 Drug Policy Alliance. State of the States. Drug Policy Reforms:
1996-2002. New York, NY: Drug Policy Alliance, Sep. 2003.
31 New Mexico Methamphetamine Working Group. 2005 Statewide
Strategy Recommendations: A Comprehensive Plan for New Mexico
Communities. Santa Fe, NM: New Mexico Methamphetamine
Working Group, Sep. 2005 <http://www.drugpolicy.org/docUploads/
NM_Methamphetamine2005Recommendations_Final.pdf>.
32 “Four Pillars Drug Strategy.” City of Vancouver. 28 Sept 2007.
<www.city.vancouver.bc.ca/fourpillars>.
33 United States. Department of Education and Department of Justice.
‘Safe and Smart’: Making After-School Hours Work for Kids.
Washington, D.C.: GPO, 1998.
25
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Endnotes
continued from page 25
34 Willits, Glancy and Farrell, P. “Adolescent Activities and Adult
Success and Happiness: Twenty-four years later,” Sociology and
Social Research 70.3, 1986: 242.
35 While funding for D.A.R.E. and student drug testing has remained
relatively stable over the last few years, Congress has significantly
cut funding to the National Youth Anti-Drug Media Campaign,
cutting it from $100 million in FY2007 to $60 million in FY2008.
36 United States. General Accounting Office. “Youth Illicit Drug Use
Prevention: DARE Long-Term Evaluations and Federal Efforts to
Identify Effective Programs.” Memo GAO-03-172R to Hon. Richard
J. Durbin, U.S. Senate, Washington, D.C. 15 Jan. 2003: 2.
37 Rosenbaum, Dennis, and Gordon Hanson. “Assessing the Effects of
School-Based Drug Education: A Six-Year Multi-Level Analysis of
Project D.A.R.E.” Journal of Research in Crime and Delinquency
35.4, 1998: 381-412.
38 Hastings, Gerard, and Martine Stead, John Webb. “Fear Appeals in
Social Marketing: Strategies and Ethical Reasons for Concern,”
Psychology and Marketing 21.11, Nov. 2004: 961-986.
39 Hornik, Robert, et al. Evaluation of the National Youth Anti-Drug
Media Campaign. Rockville, MD: Westat,
Jul. 2000, Nov. 2000, Apr. 2001, Oct. 2001, May 2002, Jan. 2003,
22 Dec. 2003 and Jun. 2006.
40 United States. Government Accountability Office. “ONDCP Media
Campaign: Contractor’s National Evaluation Did Not Find That the
Youth Anti-Drug Media Campaign was Effective in Reducing Youth
Drug Use,” Report GAO-06-818, Washington, D.C., Aug. 2006: 42.
41 Czyzewska, Maria, and Harvey J. Ginsburg. “Explicit and implicit
effects of anti-marijuana and anti-tobacco TV advertisement,”
Addictive Behaviors 32.1, Jan. 2007: 114-127.
42 American Academy of Pediatrics, et al. Brief of Amici Curiae,
“Board of Education of Independent School District No. 92 of
Pottawatomie County, et al. v. Lindsay Earls, et al.” 536 U.S. 822
(2002) (No. 01-332), 30 May 2008
<http://drugtestingfails.org/pdf/amicus_brief.pdf>.
43 Taylor, Robert. “Compensating Behavior and the Drug Testing of
High School Athletes.” The Cato Journal 16.3, Winter 1997.
44 Yamaguchi, Ryoko, and Lloyd D. Johnston, Patrick M. O’Malley.
“Relationship Between Student Illicit Drug Use and School DrugTesting Policies,” Journal of School Health. 73. 4, 2003: 159-164
<http://www.monitoringthefuture.org/pubs/text/ryldjpom03.pdf>.
45 Beck, Jerome. “100 Years of ‘Just Say No’ Versus ‘Just Say Yes’:
Reevaluating Drug Education Goals for the Coming Century,”
Center for Educational Research and Development: Evaluation
Review 22.1 Feb. 1998: I5-45.
46 Through a series of dialogue-driven, interactive workshops,
combined with group and individual work, UpFront provides a
forum for discussion while conveying age-appropriate prevention
messages. Created primarily based on students’ feedback, this
multi-tiered program can be tailored to the specific needs of both
students and the school.
47 Taylor, Robert. “Compensating Behavior and the Drug Testing of
High School Athletes,” The Cato Journal 16. 3, Winter 1997.
48 Resnick PhD, Michael, and Peter S. Bearman PhD, et al. “Protecting
Adolescents from Harm: Findings from the National Longitudinal
Study on Adolescent Health.” Journal of the American Medical
Association 278.10, 10 Sep. 1997: 823-832.
49 Beginning in 2005, the Meth Project became Montana’s largest
advertiser <http://www.montanameth.org/View_ Ads/index.php>.
26
50 An initial evaluation of the Montana media campaign found that
the percentage of young people viewing methamphetamine use as
risky behavior actually declined during the campaign. A subsequent
evaluation found that teen methamphetamine use remained relatively
stable during the ad campaign, suggesting it had little to no impact
on methamphetamine use rates. More recently, the Montana Meth
Project has claimed that their media campaign has led to a decrease
in the number of first-time methamphetamine users in Montana.
This claim, however, is based on an independent survey that did not
measure the effectiveness of their ad campaign; thus it is impossible
to determine what impact if any the media campaign had on this
statewide trend. The survey also only looked at first-time meth use
and not regular use. Additionally, while the survey found that firsttime methamphetamine use rates were declining among Montana
high school students, it found that first-time methamphetamine use
rates were increasing among middle school students. In any event,
first-time methamphetamine use rates among both groups were
declining in the years preceding the launch of the advertising
campaign. See: Montana Meth Project. “Montana Meth: Use and
Attitudes Survey.” Apr. 2006, Montana Meth Project, 28 Sep. 2007
<http://www.montanameth.org/documents/ MMP_Survey_April_
2006.pdf>; Montana Office of Public Instruction. 2007 Montana
Youth Risk Behavior Survey Sep. 2007 <http://www.opi.mt.gov/
yrbs/>; and Fenske, Sarah. “For $5 million Arizona can grow its
population of meth users – just like Montana.” Phoenix New Times.
April 26, 2006.
51 Brenton, Ana. “TV spots offer meth addicts hope: New approach
differs from ‘ghoulish’ spots that demonized users, which were
rejected.” The Salt Lake Tribune. 15 May 2007.
52 King, Ryan S., “The Next Big Thing? Methamphetamine in the
United States,” The Sentencing Project: Washington, D.C., Jun. 2006.
53 Cretzmeyer, M., and M.V. Sarrazin, D.L. Huber, et al. “Treatment of
Methamphetamine Abuse: Research Findings and Clinical Directions.”
Journal of Substance Abuse Treatment, 24 (2003): 267-277.
54 Luchansky, B. “Treatment for Methamphetamine Dependency is as
Effective as Treatment for Any Other Drug.” Olympia, WA: Looking
Glass Analytics, 2003.
55 Otero, Cathleen, and Sharon Boles, Nancy K. Young, Dennis Kim,
“Methamphetamine Addiction, Treatment, and Outcomes:
Implications for Child Welfare Workers.” Irvine, CA: National
Center on Substance Abuse and Child Welfare, April 2006: 12-13.
56 David C. Lewis MD. “Meth Science Not Stigma: Open Letter to the
Media,” Brown University, 25 Jul. 2005 <http://www.jointogether
.org/resources/pdf/Meth_Letter.pdf>.
57 Rydell, and Evering. Controlling Cocaine. Washington, D.C.: Rand
Corporation, 1994.
58 California Department of Alcohol and Drug Programs. Evaluating
Recovery Services: The California Drug and Alcohol Treatment
Assessment. Chicago, IL: National Opinion Research Center, 2004.
59 National Center on Addiction and Substance Abuse at Columbia
University. “Shoveling Up: The Impact of Substance Abuse on State
Budgets.” New York, NY: CASA Jan. 2001.
60 Substance Abuse and Mental Health Services Administration.
National Treatment Improvement Evaluation Study. Washington,
D.C.: GPO, 1996.
61 University of California Los Angeles. Evaluation of the Substance
Abuse and Crime Prevention Act: Final Report. Los Angeles, CA:
UCLA Press, 13 April 2007.
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62 Substance Abuse and Mental Health Services Administration.
Results from the 2005 National Survey on Drug Use and Health:
National Findings. Rockville, MD: Office of Applied Studies,
NSDUH Series H-30, DHHS Publication No. SMA 06-4194, 2006.
63 Generations United. Meth and Child Welfare: Promising Solutions
for Children, Their Parents and Grandparents. Washington, D.C.:
Generations United, 2006: 10.
64 Brecht, Mary-Lynn, and Ann O’Brien, Christina von Mayrhauser, M.
Douglas Anglin. “Methamphetamine use behaviors and gender differences.” Addictive Behaviors 29, 2004: 90.
65 United States. Office of Applied Studies. National Survey of
Substance Abuse Treatment Services (N-SSATS). 2006, Substance
Abuse and Mental Health Services Administration, July 2008
<http://wwwdasis.samhsa.gov/04nssats/index.htm>.
66 Generations United. Meth and Child Welfare: Promising Solutions
for Children, Their Parents and Grandparents. Washington, D.C.:
Generations United, 2006: 9.
67 Ibid.
68 Ibid.
69 National Association of Counties. The Meth Epidemic in America:
Two Surveys of U.S. Counties; The Criminal Effect of Meth on
Communities; The Impact of Meth on Children. Washington, D.C.:
National Association of Counties, 5 Jul. 2005.
70 Center for Reproductive Rights. Punishing Women for their
Behavior During Pregnancy: An Approach the Undermines Women’s
Health and Children’s Interests. New York, NY: Center for
Reproductive Rights, Sep. 2000: 1.
71 Ibid: 8.
72 American Medical Association. “Board of Trustees Report: Legal
Interventions During Pregnancy.” Journal of the American Medical
Association 264, 1990: 2663-2667.
73 Lewis MD, David C., “Meth Science Not Stigma: Open Letter to the
Media,” Brown University, 25 Jul. 2005.
74 Center for Reproductive Rights. Punishing Women for their
Behavior During Pregnancy: An Approach the Undermines Women’s
Health and Children’s Interests. New York, NY: Center for
Reproductive Rights, Sep. 2000: 1-8.
75 Gay and Lesbian Medical Association. Breaking the Grip: Treating
Crystal Methamphetamine Addiction Among Gay and Bisexual
Men. San Francisco, CA: Gay and Lesbian Medical Association,
Nov. 2006: ii.
76 Ibid: 1.
77 Ibid: 24.
78 Ibid: 26.
79 United States. Centers for Disease Control and Prevention.
“Eliminate Disparities in Mental Health.” Centers for Disease
Control and Prevention. 30 May 2008, <http://www.cdc.gov/omh/
AMH/factsheets/mental.htm>.
80 De Lima, M.S., and B. Oliveira-Soares, A.A. Reisser, M. Farell.
“Pharmacological treatment of cocaine dependence: A systematic
review.” Addiction 97.8, 2002: 931-949.
81 Ibid.
82 Shearer, J., and J. Sherman, A. Wodak, I. van Beek. “Substitution
therapy for amphetamine users.” Drug Alcohol Review 21, 2002:
179-185.
83 Dackis, C., and C. O’Brien. “Glutamateric agents for cocaine
dependence.” Annals of New York Academy of Sciences, 1003,
2003: 328-345.
Page 29
84 Grabowski, John, and Shearer, Merrill, Negus. “Agonist-like
replacement pharmacotherapy for stimulant abuse and dependence,”
Addictive Behaviors, 29, 2004: 1439-1464.
85 Charnaud, B., and V. Griffiths. “Levels of intravenous drug misuse
among clients prescribed oral dexamphetamine substitution for
amphetamine dependence.” Addiction 96.9, 2001:1286-96.
86 Ibid.
87 Klee, Hillary, and Samantha Wright, Tom Carnwath, John Merrill.
“The Role of Substitute Therapy in the Treatment of Problem
Amphetamine Use.” Drug and Alcohol Review 20.4, 2001: 417-429.
88 Ibid; Shearer, James, and John Sherman, Alex Wodak, Ingrid Van
Beek. “Substitution Therapy for Amphetamine Users.” Drug and
Alcohol Review 21, 2002: 179-185; Myton, Tracey, and Tom
Carnwath, Llana Crome. “Health and Psychosocial Consequences
Associated with Long-Term Prescription of Dexamphetamine to
Amphetamine Misusers in Wolverhampton (UK) 1985-1998.”
Drugs: Education, Prevention, and Policy 11.2, April 2004; McBride,
A.J., G. Sullivan, A.E. Blewett, S. Morgan. “Amphetamine
Prescribing as a Harm Reduction Measure: A Preliminary Study.”
Addiction Research 5, 1997: 95-111; Fleming, P.M., and D. Roberts.
“Is the Prescription of Amphetamine Justified as a Harm Reduction
Measure?” Journal of the Royal Society for the Promotion of Health
114, 1994:127-131; Shearer, J., and A. Wodak, R.P. Mattick, I.V.
Beek, J. Lewis. “Pilot Randomized Controlled Study of
Dexamphetamine Substitution for Amphetamine Dependence.”
Addiction. 96, 2003: 1289-1296; Sherman, J.P. “Dexamphetamine
for ‘Speed’ Addiction.” The Medical Journal of Australia. 153, 1990:
306; Alexander, B.K., and J.Y. Tsou. “Prospects for Stimulant
Maintenance in Vancouver, Canada.” Addiction Research and
Theory 9, 2001: 97-132.
89 Northern Ireland. United Kingdom. Drug Misuse and Dependence –
Guidelines on Clinical Management. Department of Health, Scottish
Office. Department of Health, Welsh Office. Department of Health
and Social Services of Northern Ireland. 1999.
90 Ibid.; Moselh, H.F., and A. Georgiou, Kahn, E. Day. “A Survey of
Amphetamine Prescribing by Drug Services in the East and West
Midlands.” Psychiatric Bulletin 26, 2002: 61-62; Strang, J., and J.
Sheridan. “Prescribing Amphetamines to Drug Misusers: Data from
the 1995 National Survey of Community Pharmacies in England
and Wales.” Addiction 92, 1997: 833-838; Bruce, M. “Managing
Amphetamine Dependence.” Advances in Psychiatric Treatment 6,
2000: 33-40.
91 National Institute of Justice. Methamphetamine Use: Lessons
Learned. Bethesda, MD: Abt Associates Inc. Contract No. 99-C-008,
31 Jan. 2006.
92 Malcom, Robert, et al. “Clinical Applications of Modafinil in
Stimulant Abusers: Low Abuse Potential.” The American Journal on
Addictions 11,2002: 247-249.
93 Shearer, James; and Linda Gowing. “Phramacotherapies for problematic psychostimulant use: a review of current research.” Drug
and Alcohol Review 23, Jun. 2004: 203-211; Hart, et al. “Smoked
Cocaine Self-Administration is Decreased by Modafinil.”
Neuropsychopharmacology 2007:1-8; Camacho, A., and M.B. Stein.
“Modafinil for social phobia and amphetamine dependence.”
American Journal of Psychiatry 159, 2002: 1947-8; Dackis,
Malcolm. “Medications Development Research for Treatment of
Amphetamine and Methamphetamine Addiction – Report to
Congress.” Washington, D.C.: National Institute on Drug Abuse,
Aug. 2005.
27
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Endnotes
continued from page 27
94 Volkow, Nora. “Availability and Effectiveness of Programs to Treat
Methamphetamine Abuse.” Statement from the Director of the
National Institute on Drug Abuse, National Institutes of Health,
U.S. Department of Health and Human Services. Testimony before
the Subcommittee on Criminal Justice, Drug Policy, and Human
Resources, Committee on Government Reform, United States House
of Representatives. 28 Jun. 2006.
95 Join Together. “Vancouver Mayor Touts Drug Maintenance
Programs,” 23 Jan. 2007 Join Together, 30 May 2008
<http://www.jointogether.org/news/headlines/ inthenews/2007/
vancouver-mayor-touts-drug.html>.
96 Human Rights Watch. “Injecting Reason: Human Rights and HIV
Prevention for Injection Drug Users-California: A Case Study.”
New York, NY: Human Rights Watch, 15.2(G), Sep. 2003: 22.
97 Davis, Corey S., and Scott Burris, Julie Kraut-Becher, Kevin G.
Lynch, David Metzger. “Effects of an Intensive Street-Level Police
Intervention on Syringe Exchange Program Use in Philadelphia, Pa.”
American Journal of Public Health 95, 2 Feb. 2005: 233-236.
98 Tobin, Karin E., and Melissa A. Davey, Carl A. Latkin. “Calling
emergency medical services during drug overdose: an examination
of individual, social and setting correlates.” Addiction 100.3,
Mar. 2005: 397.
99 In 2006, Drug Policy Alliance New Mexico wrote
and backed a “911 Good Samaritan” bill, which Gov. Richardson
signed into law in April 2007, the first such law in the country. This
unique law will save thousands of lives by protecting people from
arrest when they call 911 in response to a drug overdose. The
chance of surviving an overdose, like that of surviving a heart
attack, depends greatly on how fast one receives medical assistance.
No one thinks twice about calling 911 when they witness a heart
attack, but people who witness an overdose often hesitate to call lest
they be arrested on drug law violations or other charges.
100 Boyum, David, and Peter Reuter. An Analytic Assessment of U.S.
Drug Policy. Washington, D.C.: American Enterprise Institute Press,
2005: 95.
101 Cretzmeyer, et al, “Treatment of methamphetamine abuse: research
findings and clinical directions.” Journal of Substance Abuse
Treatment 24, 2003: 267-277.
102 Semple, Shirley J., and Thomas L. Patterson, Igor Grant. “The context of sexual risk behavior among heterosexual methamphetamine
users.” Addictive Behaviors 29, 2004: 807-810.
28
103 The seven reports are: National Commission on AIDS. The Twin
Epidemics of Substance Abuse and HIV. Washington, D.C.: National
Commission on AIDS, 1991; United States. General Accounting
Office. Needle Exchange Programs: Research Suggests Promise as an
AIDS Prevention Strategy. Washington, D.C.: GPO, 1993; Lurie, P.,
and A.L. Reingold, et al. The Public Health Impact of Needle
Exchange Programs in the United States and Abroad. San Francisco,
CA: University of California Press, 1993; Satcher MD, David. Letter
to Jo Ivey Bouffard: The Clinton Administration’s Internal Reviews
of Research on Needle Exchange Programs. Atlanta, GA: Centers for
Disease Control and Prevention, 10 Dec. 1993; Normand, J., and D.
Vlahov, L. Moses (eds.). Preventing HIV Transmission: The Role of
Sterile Needles and Bleach. Washington, D.C.: National Academy
Press, National Research Council and National Institute of
Medicine, 1995: 224-226, 248-250; United States. Office of
Technology Assessment of the U.S. Congress. The Effectiveness of
AIDS Prevention Efforts. Springfield, VA: National Technology
Information Service, 1995; National Institutes of Health Consensus
Panel. Interventions to Prevent HIV Risk Behaviors. Kensington,
MD: National Institutes of Health Consensus Program Information
Center, Feb. 1997. Also see: Paone, D., and D.C. Des Jarlais, R.
Gangloff, J. Milliken, S.R. Friedman. “Syringe Exchange: HIV prevention, key findings, and future directions.” International Journal of
the Addictions 30, 1995: 1647-1683; Watters, J.K., and M.J. Estilo,
G.L. Clark, J. Lorvick. “Syringe and Needle Exchange as HIV/AIDS
Prevention for Injection Drug Users.” Journal of the American
Medical Association 271, 1994: 15-120.
104 United States. Centers for Disease Control and Prevention.
HIV/AIDS Surveillance Report 2004 Vol. 16, 2005: 20 (Table 10).
105 United States. Centers for Disease Control and Prevention.
Drug-Associated HIV Transmission Continues in the United States.
Washington, D.C.: Centers for Disease Control and Prevention,
May 2002.
106 United States. Centers for Disease Control and Prevention.
Viral Hepatitis and Injection Drug User. Washington, D.C.:
Centers for Disease Control and Prevention, Sep. 2002.
107 Li-Tzy ScD, Wu, and Daniel J. Pilowsky MD, Wendee M. Wechsberg
PhD, William E. Schlenger PhD. “Injection Drug Use Among
Stimulant Users in a National Sample.” American Journal of Drug
and Alcohol Abuse 30. 1, 2004: 61-83.
108 Ross, Timberly. “Study: Meth addicts in rural areas face more health
problems.” Associated Press. 25 Apr. 2007.
109 Ibid. A recent Nebraska-funded study found that rural addicts
began using meth at a younger age, were more likely to use the
drug intravenously and to be dependent on alcohol or cigarettes.
They also exhibited more signs of psychosis than urban addicts,
45 percent vs. 29 percent, according to the study.
110 Schackman, B. “The Lifetime Cost of Current Human
Immunodeficiency Virus Care in the United States.” Medical Care
44, Nov. 2006: 990-997.
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About the Drug Policy Alliance
The Drug Policy Alliance (DPA) is the nation’s leading
About the Author
organization promoting alternatives to the drug war
Bill Piper is director of national affairs for the
that are grounded in science, compassion, health and
Drug Policy Alliance, where he lobbies Congress in
human rights. It is headquartered in New York and
support of a “new bottom line” for U.S. drug policy;
has offices in California, New Jersey, New Mexico and
one that seeks to reduce the negative consequences
Washington, D.C.
associated with both drugs and the war on drugs.
He has more than 12 years of Washington, D.C.
DPA Network (our partner organization) was responsi-
political experience and writes and speaks often
ble for drafting and building broad public support for
on methamphetamine-related issues.
California’s Substance Abuse and Crime Prevention
Act of 2000 (Proposition 36), which has become the
Acknowledgements
nation’s most systematic public health response to
The author would like to especially thank Derek Hodel
methamphetamine abuse to date. In 2005, the
and Isaac Skelton for providing enormous help
Drug Policy Alliance’s New Mexico office assembled
writing, rewriting and editing this report. Ken Collins,
stakeholders from around the state to form the New
Grant Smith and Jasmine Tyler provided essential
Mexico Methamphetamine Working Group, co-chaired
research, along with Albert Cahn, Hilary Kimball,
by the governor’s drug czar and the director of DPA
Kristen Millnick, Julia Laskorunsky and Kelsey Nunez.
New Mexico. In 2007, DPA New Mexico received a
A large number of people provided crucial advice,
grant from the U.S. Justice Department to create
ideas and feedback, including Luciano Colonna, Carl
a statewide methamphetamine education and
Hart, Ethan Nadelmann, Roseanne Scotti and Reena
prevention program directed at New Mexico high
Szczepanski. This report was significantly influenced
school students. DPA’s Washington, D.C. office has
by the work of Glenn Backes and Mary Taft-McPhee.
helped shape numerous methamphetamine-related
federal laws.
DPA Office of National Affairs Contact
Bill Piper
Director, Office of National Affairs
[email protected]
202.683.2985 voice
Media Contact
Tony Newman
Director, Media Relations
[email protected]
212.613.8026 voice
626.335.5384 mobile
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Drug Policy Alliance
Office of National Affairs
925 15th Street, NW
2nd floor
Washington, D.C. 20005
202.683.2030 voice
202.216.0803 fax
[email protected]
Drug Policy Alliance Headquarters
70 West 36th Street
16th floor
New York, NY 10018
212.613.8020 voice
212.613.8021 fax
nyc @ drugpolicy.org
www.drugpolicy.org
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