Methamphetamine, also known as speed, crystal, crank and ice, is a potent psycho-stimulant that can be smoked, injected, snorted or taken as a pill. For decades, California was home to the majority of the country's methamphetamine production facilities, so called "meth labs." Despite the fact that most meth labs have moved to Mexico, California and the West Coast still exhibit higher rates of methamphetamine usage than the rest of the country.

In a recent analysis of approximately 80,000 people admitted for publicly funded treatment in Los Angeles County from 2001 to 2005, methamphetamine was the most commonly reported primary drug of use. Significantly, the number of primary methamphetamine-using treatment admissions for participants ages 18 to 79 increased from 19 percent in 2001 to 36.4 percent in 2005.

While usage rates are rising throughout Los Angeles County, the drug is not affecting all sectors of our population equally. From 2001-05, females admitted for treatment were more likely to list meth as their primary drug of use than males. Surveys have indicated that this higher rate of use by women may be due to the drug's association with weight loss as well as its association with alleviating depression, a condition more common among women.

Meth use is also not evenly split across racial or ethnic lines. The treatment admission percentages of Asians, Latinos, Native Americans and whites entering county-funded treatment for primary meth use was high, increasing from 29.3 percent in 2001 to 49 percent in 2005. However, during this time period, only 3.3 percent of African-American treatment admissions were for primary meth use. There is also a discrepancy between age groups and their respective drug use patterns, with data indicating that younger people are reporting methamphetamine as their primary drug of use more often than older treatment program participants.

Methamphetamine use can lead to increased energy levels and physical activity, and a depressed appetite. Furthermore, it is associated with serious health conditions, including memory loss, aggression, violence, psychotic behavior, and potential heart and neurological damage. Known to increase sex drive and reduce sexual inhibitions, methamphetamine use also contributes to increased transmission rates of infectious diseases, especially hepatitis and HIV.

What Physicians Need to Know
Physicians in primary care settings can play an important role in assisting patients. Recognizing meth use is the first step.

Some typical signs and symptoms include:

1. Heightened alertness and mental acuity;

2. Elevation of mood and physical energy;

3. Reduced inhibitions and increased sexuality;

4. Depression;

5. Anxiety;

6. Paranoia;

7. Irritability;

8. Hallucinations;

9. Confusion;

10. Suicidal ideation;

11. Violent behavior;

12. "Meth mouth" (Gum disease and tooth decay accompany continued meth use, resulting from restricted blood flow and reduced nourishment to the gums and teeth.);

13. Dry eyes that may have led to scratching and damage to the eye and surrounding areas;

14. Perception that tingling under the skin is caused by "bugs," resulting in addicts digging under their skin in an attempt to remove these bugs; and

15. Rapid weight loss for no apparent medical condition or being extremely underweight.

The use of structured drug/alcohol use screening instruments, such as ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), can be of great value in recognizing patients who may be in the early stages of methamphetamine use. The ASSIST screening instrument is accompanied by a very brief (5-10 minutes), but extremely effective physician counseling intervention. World Health Organization research found this procedure can result in substantial reductions in drug use by nondependent, problem drug users. The ASSIST tool can be downloaded at www.who.int/substance_abuse/activities/assist/en/index.html.

Since drug-dependent individuals require intensive treatment, knowledge of local treatment programs is important. Information on resources throughout Los Angeles County can be obtained at 800/624-DRUG or at www.lapublichealth.org.

By taking a moment to learn about the signs and symptoms of methamphetamine use and the appropriate measures to take, physicians can have a significant impact on getting drug users on the road to recovery.

Drs. Richard Rawson, Chad Snow and Desiree Crevecoer are members of the UCLA Integrated Substance Abuse Programs. The UCLA Integrated Substance Abuse Programs are working closely with the Los Angeles County Department of Public Health to develop and implement a comprehensive local plan to prevent, control and treat methamphetamine use and addiction.