BflflHmllli

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991

Figure 1

Number of Clandestine Methamphetamine Laboratories Seized in the United States, 1981— 1991

source: U.S. Department of Justice (1992).

TABLE 1

Drugs and Their Precursors

TABLE 1

Drugs and Their Precursors

Controlled Substance

Precursor

Methamphetamine

Phenyl-2-propanone

Amphetamine

Phenylacetic acid

Methamphetamine

Ephedrine

Phencyclidine (PCP)

Piperidine

Methaqualone

Anthranilic acid

Lysergide (LSD)

Ergotamine tartrate

turing and distribution process. Although motorcycle gangs continued to control a share of the market, in 1995 well-established Mexico-based polydrug trafficking organizations began manufacturing and distributing methamphetamine. Importing precursor chemicals and reagents into or through Mexico, these organizations established "superlabs" in Mexico and in southern California that were capable of producing ten pounds or more of high-purity methamphetamine in one to two days. These superlabs are in marked contrast to the more numerous and widely distributed "mom-and-pop" labs producing several ounces that may be set up in a motel room, a car trunk, or on a kitchen counter. By 1999, it was estimated that superlabs were producing approximately 85 percent of the methamphetamine in the U.S. mainland. Portions of the Crime Control Act of 1990 and the Chemical Diversion Control Act of 1993, as well as the Comprehensive Methamphetamine Control Act of 1996, were all enacted to counter the changes in the synthetic process, the changes in the trafficking patterns, the emergence of superlabs, and the proliferation of mom-and-pop labs for the clandestine manufacture of methamphetamine.

Changes in Indicators of Abuse. The Drug Abuse Warning Network (DAWN), a nationally based surveillance system that monitors emergency medical consequences and deaths related to drug use, reflected a stable trend across the United States from the mid-1970s until the mid-1980s. Over seven hundred hospitals in twenty-one metropolitan areas and a panel of hospitals outside of these areas report to DAWN. During the mid-1980s sharp increases in nonfatal emergency-room episodes began to appear, largely in metropolitan areas on the West Coast. Increases in drug-use indicators were also reported for methampheta-

mine through the Community Epidemiology Work Group (CEWG), a network of state and local drug-abuse experts representing twenty cities and metropolitan areas across the United States.

Total methamphetamine and amphetamine mentions in DAWN rose from earlier levels during 1988 and 1989, decreased during 1990 and 1991, then rose sharply during the early 1990s to reach an erratic higher plateau for the rest of the decade (see figure 2). Among DAWN emergency-room cases, the most common route of administration of methamphetamine was intravenous. Methamphetamine accounted for approximately 3.0 percent of the total DAWN drug mentions in 1994 and just under 2.5 percent in 1998, compared with 16.0 percent and 17.5 percent for cocaine during 1984 and 1998, respectively.

The Treatment Episode Data Set (TEDS) collects information nationwide on admissions to drug and alcohol treatment facilities that report to state administrative data systems. Data on Primary, secondary, and tertiary substances of abuse, their route of administration, frequency of use, and age at first use are among the data collected. In 1997, TEDS captured data on an estimated 67 percent of all U.S. drug and alcohol treatment admissions.

Figure 2

Trends in Methamphetamine-Related Emergencies, 1986—1991

source: The Drug Abuse Warning Network (DAWN). note: "Estimates for 1986-1987 are provisional. The estimates are based on a nonrandom sample of hospital emergency rooms in the coterminous U.S. bEstimates for 1988-1991 are based on a representative sample of nonfederal short-stay hospitals with 24-hour emergency rooms in the coterminous U.S.

1986a 1987 1988b 1989 1990 1991

Figure 2

Trends in Methamphetamine-Related Emergencies, 1986—1991

source: The Drug Abuse Warning Network (DAWN). note: "Estimates for 1986-1987 are provisional. The estimates are based on a nonrandom sample of hospital emergency rooms in the coterminous U.S. bEstimates for 1988-1991 are based on a representative sample of nonfederal short-stay hospitals with 24-hour emergency rooms in the coterminous U.S.

From 1992 to 1997, both the absolute number of admissions reporting methamphetamine or amphetamine as the primary drug of abuse and the percentage of such admissions, relative to treatment admissions for all substances, more than tripled. The most common route was inhalation, but almost 30 percent of admissions reported injecting the drug.

The demographic profile of methamphetamine abusers in several studies that looked at different populations in the late 1980s and through the 1990s showed the majority of abusers to be predominantly Caucasian, low to middle income, high-school educated young adults generally ranging in age from 20 to 35, with slightly more males than females. However, by the end of the 1990s, there were indications of growing numbers of women and Hispanic abusers. Routes of administration tend to vary from locale to locale and from subgroup to subgroup, and include injecting intravenously, smoking (inhaling vaporized drug), and snorting. Methamphetamine abusers carry an increased risk of both Hepatitis B and HIV infections, predominantly through sharing of needles and increased unsafe sex practices.

Other U.S. Trends. At the same time that increases were being noted in methamphetamine use on the mainland of the United States, a new phenomenon was developing in Hawaii. Sharp rises in law-enforcement activity and in clients entering treatment because they smoked a new dosage form of methamphetamine were recorded between 1986 and 1989. The street names for this drug were ice, crystal, shabu (Japanese), and batu (Filipino for rock), and it looked like a large, usually clear crystal resembling broken fragments of glass or rock candy. Ice is of high purity (90 to 100 percent) and the d-isomer (the more psychoactive molecular form) of methamphetamine hydrochloride salt. In Hawaii it is almost always smoked in a glass pipe. The hydrochloride salt is sufficiently volatile to vaporize in a pipe so that it can be inhaled. This route of administration allows rapid absorption into the bloodstream, with onset of effects similar to those experienced with intravenous administration.

The use of ice was first detected by Hawaiian treatment programs during the summer of 1986, with more widespread use occurring into the 1990s. By 1997, The Treatment Episode Data Set reported that in Hawaiian drug and alcohol treat ment admissions, methamphetamine/amphet-amine was the most commonly reported single primary substance of abuse, accounting for almost one quarter of all admissions. This epidemic, which was described in an outbreak investigation and follow-up field study conducted by the NATIONAL Institute on Drug Abuse, involved a population varying widely in age and ethnic background and included both sexes. The ice-using treatment population was studied and reflected a younger population, with a higher representation of women and a larger proportion of Hawaiian/part Hawaiian than other drug users in treatment in the state. Ice was typically smoked in runs, or periods of continuous use, averaging three to eight days, with one or two days between runs, during which the user would "crash" into deep, prolonged sleep. Users reporting this pattern became rapidly addicted and experienced numerous adverse medical, social, and physiologic consequences. Precipitants of the epidemic included both a law enforcement campaign that effectively eradicated large portions of the Hawaiian marijuana or pakalolo crop, and well-orchestrated marketing campaigns by Asian ice distributors holding out ice as a replacement drug.

Until the late 1980s, the ice form of methamphe-tamine came only from Asia, specifically Hong Kong, Korea, Japan, Taiwan, Thailand, and the Philippines. Attempts to smuggle ice from Taiwan and Korea into Hawaii can be documented back to the mid-1980s by the Drug Enforcement Administration (DEA). The importation and distribution of ice in Hawaii has been linked to Asian and Hawaiian criminal organizations and gangs. By 1989, limited distribution of ice had occurred on the West Coast of the United States. In the following year, increased amounts of ice were found in California and subsequently in other limited locations. The increase in availability of ice was believed to stem from clandestine laboratories operating in California. During 1990, domestically manufactured ice began to be supplied to distributors in Hawaii and seven clandestine ice laboratories were seized nationwide, six of them in California. This domestic production was compensating for a disruption of the major Asian trafficking organizations smuggling ice from South Korea.

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