The Methamphetamine Crisis in American Indian and Native Alaskan Communities: Toward a New Research Agenda

Gap Areas in Data Collection from AI/NA Populations

While studies of adolescents have provided critical information regarding drug use among AI/NA adolescents, the research to date leaves unanswered a number of important questions regarding the nature and extent of drug use among AI/NAs more generally. Rumbaugh Whitesell, Beals, Mitchell, Spicer, Novins, et al. (2007) and Szelemko, Wood & Thuman (2006) recently outlined the data needed to more effectively address disparities in drug use and drug use disorders in AI communities. These researchers highlight four important areas of unanswered questions. First, information on drug use across the life span in AI/NA communities is lacking: Are rates generally higher among younger age groups, as seen in other ethnic groups? Are disparities in drug use stable across age cohorts? Answers to these questions have important ramifications for intervention and treatment. Second, in most studies of drug use, AI/NAs have been treated as uniform groups, reflecting what cross-cultural researchers refer to as “ethnic gloss.” There are more than 500 federally recognized tribes and cultural homogeneity is unlikely. Are there significant variations in patterns of substance use and abuse? Are there variations in drug use among genders? This information is also needed to design or modify effective prevention and treatment efforts. Third, does AI/NA drug use among adolescents lead to higher rates of drug abuse or dependence. Because the most serious outcomes associated with drug use are associated with abuse or dependence, it is important to access the prevalence of drug use disorder. Finally, alcohol use in AI/NA communities has been extensively examined and documented. Data is needed that separates alcohol use from the use of other substances (Rumbaugh Whitesell, Beals, Mitchell, Spicer, Novins, et al., 2007; Szlemko, Wood & Thurman, 2006).

Infrastructures for Data Collection

The U.S. Department of Interior Bureau of Indian Affairs and the U.S. Department of Health and Human Services’ SAMHSA Office of Applied Studies, NIDA, and the IHS are the lead federal department offices needed to funded and monitor this effort. Other federal level agencies need for this effort include U.S. Department of Justice’s DEA, Bureau of Alcohol, Tobacco, Firearms and Explosives, Bureau of Immigration and Customs Enforcement, Center for Substance Abuse Treatment, Federal Bureau of Investigation, National American Indian Housing Council (NAIHC), National Center on Addiction and Substance Abuse (NCASA), National Clearinghouse for Drug and Alcohol Information, National Drug Intelligence Center, National Indian Health Board, National Native American Law Enforcement Association (NNALEA), The White House Office of National Drug Control Policy, and U. S. Commission on Civil Rights.

Federal agencies represented “in the field” that are designed for data collection include the Center for Disease Control and Prevention’s Office of Minority Health and Health Disparities AI/NA Epidemiology Centers. These 12 tribal epidemiology centers are mandated to provide surveillance for disease conditions, epidemiological analysis, interpretation, and dissemination of surveillance data, investigation of disease outbreaks, development and implementation of epidemiological studies, development and implementation of disease control and prevention programs, and coordination of activities with other public health authorities in the region.

A search of the Internet reveals that all states have substance abuse agencies that are attempting to address the ME crisis. These include task forces, health boards, coalitions, clearinghouses, working groups, initiatives, networks, prevention programs, legislation trackers, watch groups, prevention projects, alliances, and a host of other interested groups (for example, see www. methresources.gov).

The federal government departments listed above have funded or are currently funding a number of agencies that can be tapped for assistance in data collection to characterize the ME problem in AI/NA communities. These include the National Congress of American Indians, The One Sky National Resource Center for AI/NA Substance Abuse Services, the Tribal Policy Institute, the Pacific Institute for Research and Evaluation, the Native American Research Centers for Health, and the Nanizhoozhi Center. Also, there are a number of universities that are also researching the ME problem as well as other AI/NA health concerns. These include, to only name a few, the Tri-Ethnic Center for Prevention Research at the University of Colorado, the Johns Hopkins Center for American Indian Health, the Center on Alcoholism, Substance Abuse and Addictions at the University of New Mexico.

Law enforcement is a critical source of information and can be used as one measure of the success of interventions. Healing to Wellness Courts (HWC) evolved out of the Drug Court movement from the 1980s, which was a response to the judicial and treatment systems’ failure to effectively address substance abuse and its related activity. States call their efforts Drug Courts, whereas tribes prefer Healing to Wellness Courts (Lovell, 2007). Drug courts can be an important source of information on ME in Indian Country. Much legislation has been directed at regulating the sale and use of precursor chemical in order to curb the production and availability of ME. Cunningham and Liu (2005) have demonstrated that ME arrests stopped rising and dropped 31 to 45 percent in 1989, 1995 and 1996, when precursor chemicals used by large scale producers were regulated. Increasing the under-staffed law enforcement efforts in Indian Country and requiring structured data collection on ME arrests and lab seizures would also be a value source of information (Honahni, 2007; Woodis, 2007).

Linking Research to Prevention and Treatment

The following list of suggestions for a new research agendas were compiled from Mansergh, Purcell, Stall, McFarlane, Semaan, et al., (2005); Silmere and Stiffman (2006) Iritani, Dion Hallfors & Bauer (2007):

• Identify the tribes and regions affect by ME manufacture and abuse
• Increase surveillance and monitoring to follow ME use and associated high risk behavior, particularly in tribal subpopulations, child-bearing women, and diverse age groups
• Explore the natural history of ME use and its attraction in rural and urban areas with high AI/NA populations
• Explore the association of ME use with sexual risk behavior and incidence of HIV, Hepatitis B and C, and other sexually transmitted infections in subpopulations
• Develop and test prevention and risk reduction interventions to decrease risk behavior of non-addicted ME users
• Systematically explore the effectiveness of treatment components to reduce ME abuse
• Develop and test structural and policy-related interventions to reduce ME use
• Train health care providers in data collection in order to document ME prevalence, symptoms of use and abuse, and referrals to community services
• Systematically evaluate the effectiveness of community awareness building, risk reduction, and treatment programs to decrease ME users in order to create new programs based on proven effectiveness
• Increase collaboration among various public health agencies and coordinate research efforts
• Address use of other substances use separately from ME
• Prioritized the implementation of the Resource and Patient Management System (RPMS) throughout the IHS facilities and programs that provide health services to AI/NA populations through its 144 Service Units comprised of hospitals, health centers, school health centers, health stations, satellite clinics, and village clinics.

Stakeholders in the ME crisis in AI/NA communities need to address the large gaps in knowledge that currently exist, and federal, state, local, tribal and research agencies must collaborate to accomplish this goal. Once accurate reliable data and program evaluations are in place, tribal health officials and program specialists, with the support of federal agencies and funding, should use this information to implement more effective community programs. The ever-present challenge for tribal communities is to determine how best to allocate limited resources among prevention, treatment, and policy activities to achieve maximum epidemiological benefit (Mansergh, Purcell, Stall, McFarlane, Semaan, et al., 2005).

References

Associated Press (AP) (2007). How meth came to one American Indian reservation and took hold. International Herald Tribune, 1-4, Retrieved from the Internet http://www.iht.com/bin/print.php?id=5497400 on 9/25/2007.

Beauvais, F., Chavez, E., Oetting, E., Deffenbacher, J. & Cornell (1996). Drug use, violence, and victimization among White American, Mexican American, and American Indian dropouts, students with academic problems, and students in good academic standing. Journal of Counseling Psychology, 43, 292-299.

Brouwer, K. C., Case, P., Ramos, R., Magis-Rodríguez, C., Burcardo, J., Patterson, T. L. & Strathdee, S. A. (2006). Trends in production, trafficking, and consumption of methamphetamine and cocaine in Mexico. Substance Use & Misuse, 41, 707-777.

Bubar, R., Winokur, M. & Bartlmay, W. (2007). Perceptions of methamphetamine use in three western tribal communities: Implications for child abuse in Indian country. Tribal Law and Policy Institute, 1-52.

Cunningham, J. K. & Liu, L.-M. (2005). Impacts of federal precursor chemical regulations on methamphetamine arrests. Addiction, 100, 479-488.

Denehy, J. (2006). Editorial: The meth epidemic: Its effect on children and communities. The Journal of School Nursing, 22(2), 63-65.

Dreisbach, S. Hickler, B. & Koester, S. (2006). Rural methamphetamine use: Implications for AI/NA communities. The IHS Primary Care Provider, 31(12), 300-304.

Erowid (2006). 2006 A timeline of events in the history of amphetamines. Methamphetamine Vault, 2006, Retrieved from the Internet  www.erowid.org/chemicals/meth_timeline.php on 10/24/2007.

Evans, M. (2006). National methamphetamine survey: The status of the methamphetamine threat and impact on Indian lands. The New Mexico Investigative Center. Prepared for the Bureau of Indian Affairs, 1-16, Retrieved from the Internet http://www.ncai.org/ncai/Meth/BIA_MethSurvey.pdf on 10/25/2007.

Freese, T. E., Obert, J., Dickow, A., Cohen, J., & Lord, R. H. (2000). Methamphetamine abuse: Issues for special populations. Journal of Psychoactive Drugs, 32(2), 177-182.

Frontline (2006). The meth epidemic. , 2/14/2006, Retrieved from the Internet www.pbs.org/wgbh/pages/frontline/meth/ on 10/24/2007.

Honahani, D. W. (2006). Methamphetamine in Indian Country: A law enforcement perspective. The IHS Primary Care Provider, 31(12), 307.

Iritani, B. J., Dion Hallfors, D. & Bauer, D. J. (2007). Crystal methamphetamine use among young adults in the USA. Addiction, 102, 1102-1113.

Lovell, A. (2007). Healing to wellness courts: Best practices for Indian Country. The IHS Primary Care Provider, 32(1), 7.

Mansergh, G., Purcell, D.W., Stall, R., McFarlane, M., Semaan, S., Valentine, J. & Valdiserr, R. (2006). CDC consultation on methamphetamine use and sexual behavior for HIV/STD infections: Summary and suggestions. Public Health Reports, 121, 127-132.

McMullin, A. Wolfe, S. & Deaktor, H. (2006). News Release: Coalition announces $300,000 for public awareness campaign. Office of the Secretary, U. S. Department of the Interior, 11/30/2006, Retrieved from the Internet http://www.doi.gov/news/06_News_Releases/061130.html on 9/25/2007.

Meredith, C. W., Jaffe, C., Ang-Lee, K. & Saxon, A. J. (2005). Implications of chronic methamphetamine use: A literature review. Harvard Review of Psychiatry, 13(3), 141-154.

Methamphetamine Interagency Task Force (2000). Final Report. , 2000, Retrieved from the Internet http://www.ojp.usdoj.gov/nij/publications/methintf/index.html on 9/25/2007.

National Congress of American Indians (NCAI) (2006). Fact Sheet: Street names for methamphetamine. Retrieved from the Internet www.ncai.org on 10/25/2007.

National Institute on Drug Abuse (NIDA) (2006a). NIDA InfoFacts: Methamphetamine. U. S. Department of Health and Human Services, National Institutes of Health, 11/2006, Retrieved from the Internet www.drugabuse.gov  on 9/25/2007.

National Institute on Drug Abuse (NIDA) (2006b). Research Report Series: Methamphetamine abuse and addiction, NIH Publication Number 06-4210. U. S. Department of Health and Human Services, National Institutes of Health, 9/2006, Retrieved from the Internet www.drugabuse.gov  on 9/25/2007.

Oetting, E. R., Deffenbacher, J. L., Taylor, M. J., Luther, N., Beauvais, F., Edwards, R. W. (2000). Methamphetamine use by high school students: Recent trends, gender, and ethnicity differences, and use of other drugs. Journal of Child & Adolescent Substance Abuse, 10(1), 33-50.

Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA) (2007). Substance use and substance use disorders among American Indians and Alaska Natives. The NSDUH Report, 1/19/2007, Retrieved from the Internet http://www.oas.samhsa.gov on 9/25/2007.

Rumbaugh Whitesell, N., Beals, J., Mitchell, C. M., Spicer, P., Novins, D. K., Manson, S. M. & the AI-SUPERPFP Team (2007). Disparities in drug use and disorder: Comparison of two American Indian reservation communities and a national sample. American Journal of Orthopsychiatry, 77(1), 131-141.

SAMHSA Advisory (2006). News Release: Tribal initiatives to promote mental health and prevent substance abuse and mental illness receive more than $49 million in FY 2006 SAMSHA grants. Substance Abuse and Mental Health Services Administration, 10/4/2006, Retrieved from the Internet http://www.samhsa.gov/news/newsreleases/061004_tribal.aspx on 9/25/2007.

Silmere, H. & Stiffman, A. R. (2006). Factors associated with successful functioning in American Indian youth. American Indian and Alaska Native Mental Health Research, 13(3), 23-47.

Spear, S., Crèvecoeur, D. A., Rawson, R. A. & Clark, R. (2007). The rise in methamphetamine use among American Indians in Los Angeles county. American Indian and Alaska Native Mental Health Research, 14(2), 1-15.

Spear, S., Longshore, D., McCaffrey, D. & Ellickson, P. (2005). Prevalence of substance use among White and American Indian young adolescents in a Northern Plains state. Journal of Psychoactive Drugs, 37(1), 1-6.

Swaim, R. C., Beauvais, F., Chavez, E. L. & Oetting, E. R. (1997). The effect of school dropout rates on estimates of adolescent substance use among three racial/ethnic groups. American Journal of Public Health, 87(1), 51-55.

Szlemko, W. J., Wood, J. W. & Thurman, P. (2006). Native Americans and alcohol: Past, present and future. The Journal of General Psychology, 133(4), 435-451.

Walker, D., Silk Walker, P. & Singer, M. (2007). Native communities respond to methamphetamine abuse: Organize, mobilize, and work together. Presentation to Confederated Tribes of Grande Ronde, September, 13, 2007. Retrieved from the Internet http://www.oneskycenter.org/education/presentations.cfm on October, 25, 2007.

Woodis, W. (2007). Strength through unity: The IHS/SAMHSA methamphetamine initiative. The IHS Primary Care Provider, 32(1), 3.