The National Methamphetamine Drug Conference

The National Methamphetamine
Drug Conference

Workgroup 1
Prevention: Public Information Initiatives
At Home And Work
PRESENTATION SUMMARIES:
"Toxicity of Methamphetamine Use,"
Gabriel George S Nahas, M.D., Ph.D., Physiologist and Pharmacologist, New York University Medical Center, New York City, New York
The basic message of the toxicity of methamphetamine to brain, behavior and reproductive function must be spelled out for parents to consider and motivate their preventive efforts oriented towards abstention from the drug. The experimental evidence of neuronal destruction is scientifically established (since 1987), and "methamphetamine toxicity" should be the primary topic of any preventive initiative.
Methamphetamine, cocaine and other psycho stimulants affect the brain's so-called "limbic system," which also controls the body's reproduction and nutrition functions. Dr. Nahas reported on many medical articles describing complications such as convulsion, stroke, brain hemorrhage, heart attack and sudden death that occur with psycho stimulantsdrug use. He underscored that damage resulting from amphetamine and methamphetamine abuse is much worse than any other drug, profoundly altering the information processing in the brain by interactions with cellular mechanisms.
Dr. Nahas stressed that the methamphetamine abuser may suffer persistent damage to the brain, an important fact that informational campaigns should bring to the attention of the public. He also discussed the deleterious effect of psycho stimulants use on the human reproductive function and outlined Yale University studies reporting that cocaine abuse impairs fetal development. This drug alters the migration of cells to the brain early in the development stage, causing permanent structural changes.
Consequently, many physicians believe that the toxicity of methamphetamine should be at the center of any prevention program in order to clearly spell out the necessity of abstention from its use. Methamphetamine ("speed, ice") is a man-made, major stimulant-hallucinogenic compound (which associates the properties of cocaine with that of LSD) and induces an enslaving dependence. It kills by causing heart failure (myocardial infarction), brain damage, and stroke (a form of brain infarction), and it induces extreme, acute psychiatric and psychological symptoms that may lead to suicide or murder. Chronic use, generated by dependence to the drug, exacerbates all of these symptoms. A detailed description of the neurotoxicity of amphetamines and surrogates is in Ellenhorns' "Medical Toxicology" (1997), ANeurotoxicity and Neuropathology Associated with Cocaine Abuse," NIDA's Monograph #163 (1996), and Goodman and Gilman's textbook of pharmacology (1996).
Besides the toxic effects of the drug, a prevention policy against methamphetamine use should consider the success of two countries, Japan and Sweden. These countries managed to roll back major epidemics of amphetamine abuse by adopting a policy based on: (1) A national consensus supported by a media campaign recognizing the personal and societal damage wrought by amphetamine and the necessity of curtailing its use, and (2) strict implementation of the United Nations conventions on narcotics, which ban use, possession and traffic of addictive substances under penalty of the law. Zero tolerance to the drug was the goal of this national policy, and it was achieved.
Japan was the first country to face an epidemic of amphetamine addiction during the 1950s when amphetamine-induced criminal behavior resulted in thousands of arrests. As a result of an exemplary anti-drug campaign, there were only several hundred arrests a few years later. The Japanese were able to interdict fabrication and traffic of amphetamine by strict law enforcement measures combined with sound prevention policy. Sweden had an epidemic of amphetamine in the 1960s when the drug was freely provided by physicians. This epidemic was curtailed by a similar policy based on interdiction of traffic and systematic early referrals of addicts to rehabilitation centers. However, the production and the source of supply could not be entirely controlled in Sweden as in Japan because of the proximity of Holland, which continues to smuggle the drug into Sweden and has become a major market for drugs.
Is there consensus within the scientific community that methamphetamine abuse causes permanent brain damage?

Yes, the body of knowledge illustrating this point dates back 13 years and is abundantly reported in the medical literature and in several monographs.

If methamphetamine use can result in permanent brain damage, how is it that physicians can prescribe the drug to patients?

The key is in the dosage. Methamphetamine abusers use much higher dosages of the drug than a physician would routinely prescribe when treating a patient. Furthermore, the long-term effects of psycho stimulants (as approved medication) on the brain have not been clearly established and are the subject of a persistent controversy.
"Pharmaceutical Industry Programs,"
Eve Bachrach, J.D., Deputy General Counsel, Nonprescription Drug Manufacturers Association (NDMA), Washington, D.C.
Jim Kielley, Business Director, Warner-Lambert, New York, New York
Legitimate drug manufacturers are facing real problems with illegal use of over-the-counter (OTC) products. Many common OTC medications for coughs, colds and allergies contain the precursor chemicals necessary for methamphetamine production. Although most of the methamphetamine production today comes from the Mexican drug cartels, U.S. drug companies must find ways to prevent the diversion of legal drugs into the hands of "bathtub meth labs" currently springing up around the United States. The speaker emphasized that "it is a multi-level problem that requires multi-level approaches."
Several NDMA approaches include the following:

The support of diversion control laws at the federal and state level, including compliance with the Methamphetamine Control Act of 1996.

The education of drug company retailers, wholesalers and distributors to be suspicious of unusually large amounts of OTC drugs sold to individual parties.

The encouragement of individual drug companies to repackage their products in smaller sizes (blister packs) to meet the "safe-harbor" packaging provision of the Methamphetamine Control Act.

The education of youth to prevent them from experimenting with drugs. For example, the NDMA is underwriting a major methamphetamine campaign currently in the research phase and coordinated by the Partnership for a Drug-Free America.
Kielley outlined Warner-Lambert's efforts to act in partnership with the NDMA. He said Warner-Lambert will meet the packaging requirements of the Methamphetamine Control Act of 1996 by October, 1997. He also said his company is developing a "Break the Silence" program to help Warner-Lambert employees talk to their children about drugs.
"PDFA Initiatives,"
Leslie Bloom, Western Regional Director Partnership for a Drug-Free America, Phoenix, Arizona
Bloom discussed the PDFA's use of media advertising to reduce the demand for illegal drugs. A recent PDFA study analyzed advertising messages that ran twice as often in 11 targeted cities or markets. They recorded increases in anti-drug attitudes and corresponding declines in drug use. The results were dramatic. The value of the total media contribution from April, 1987, to July, 1998, was $2.7 billion.
She also spoke about the importance of PDFA partnerships. Working with statewide anti-drug organizations at no cost, PDFA provides the guidance, technical assistance and materials necessary to shape a multimedia campaign tailored to the needs and activities within the state. Often, PDFA applies the same approach to large cities. The PDFA media messages also help the target audience build self-esteem. "There is a perception among youth that everyone is doing drugs, and if you don't use, you're not cool," Bloom said. PDFA targets its efforts against this thinking.
Several renowned institutions have validated the PDFA approach. The department of pediatrics at the Johns Hopkins University School of Medicine, the Leonard N. Stern School of Business at New York University and the Institute for Social Research at the University of Michigan endorse this media informational approach.
"WORKPLACE DRUG INFORMATION PROGRAMS,"
DAVID HATCHER, PRESIDENT, HATCHER CONSULTANTS, INC., TOPEKA, KANSAS
Research about drug use in the workplace shows: (1) employers have drug users on their payrolls; (2) drug use is harmful to work productivity; and (3) employers want to do something about the problem. The following statistics reveal the extent of employee drug use:

Eleven percent of the work force uses illegal drugs.

Nine percent use alcohol on the job.

Seventy percent of all illegal drug users are employed at some time.
Drug use in the workplace reduces productivity in such areas as increased safety violations, absenteeism, and poor performance. Consequently, employers want to correct this behavior and desire to establish workplace drug programs. Yet, the major impediment for the lack of workplace drug abuse programs relates to the financial incentive. Several companies do not want to make a drug policy program or improve an existing one, due to a tight hiring market or the chief financial officer (CFO) thinking such programs are not cost-effective. More businesses need instruction on the costs of employee drug abuse; changes must occur with tax and insurance incentives to improve the odds of operating a successful drug prevention program within industry.
Discussion—Questions and Comments

Do we recommend a national information campaign focused specifically on methamphetamine abuse?

What should the elements and target audiences of the campaign be?

What are the roles of NGOs and different levels of government in the campaign?

How can we measure the effectiveness of the campaign?

The campaign should focus on substance abuse and the nature of addiction.

Those of us who work in prevention know that an information campaign is only one "slice" of prevention. The first component of prevention is a relationship with a caring adult, preferably the parents.

Messages must get inside the home with a focus on the family.

Parents must break drug use initiation by focusing on the gateway drugs.

The campaign should be controlled at the state level, such as through block grants.

A national campaign would greatly enhance the efforts already in place. We need to reach parents through the workplace by making information available to employers.

Analysis of the target population affected by meth use must be built into the program.

Other prevention tools—not just video media—must be integrated into the policy.

Existing communities and alliances know what works best.

Methamphetamine use appears to follow the meat-packing industry. Employees are using it initially to survive on the job or to work two or three jobs.

No one understands the violence associated with methamphetamine use.

Schools, churches, and employers need different messages.

We need support from the medical field to address the methamphetamine issue. Where are the doctors?

A national program should target new or emerging areas. Methamphetamine is not yet a problem in New England, but there is a resurgence of heroin use there.

With the evolution of managed care, insurance companies are more willing to fund prevention opportunities. They view it as a reinvestment into the community.

Previous Contents Next