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

Introduction

The prevalence of methamphetamine (ME) use among American Indians and Native Alaskans (AI/NAs) is strikingly high in comparison to other ethnic groups in the U.S. (Iritani, Dion Hallfors & Bauer, 2007). However, few datasets are available that allow for estimates to characterize the problem or describe the variation of the ME problem among tribes. Only recently has anecdotal information emerged about the spread of ME use and manufacture into tribal communities in newspapers, radio stories, wire services, agency reports, and on websites. Due to the lack of stable data and other unique problems of rural populations, multi-agency approaches that include counties, states, federal law enforcement agencies, and other institutions to combat ME use, distribution, and production, have been difficult to organize. In order to develop optimal responses to this crisis, it is necessary to better understand the extent of the problem and the various factors that lead to ME abuse. Research and data collection collaborations between federal and tribal professionals working in the areas of law enforcement, social services, drug court system, domestic violence, services for children, mental health, prosecution, juvenile justice, housing, and addictions are needed to curb this devastating problem (Bubar, Winokur & Bartlemay, 2007).

History of Methamphetamine

ME has been part of the U.S. drug culture for more than 40 years. Methamphetamine hydrochloride is commonly known as “speed,” “meth” and “chalk.” Highly pure forms of ME that are smoked form are referred to as “ice,” “crystal,” “crank,” “crico,” “cri-cri” and “glass.” In fact, there are there are 435 street names for ME (National Congress of American Indians [NCAI], 2006). ME is a white, odorless, bitter-tasting crystalline powder that can be dissolved in water, alcohol and other beverages (e.g. coffee). It was developed from its parent drug, amphetamine and used in nasal decongestants and bronchial inhalers. ME is classified as a Schedule II stimulant by the U.S. Drug Enforcement Agency (DEA), which means it has a high potential for abuse with severe psychic or physical dependence liability and is available only through a prescription. It is indicated for the treatment of narcolepsy and ADHD, but these medical uses are limited and the doses are much lower than those typically abused (NIDA, 2006b).

ME is produced from common decongestants containing ephedrine or pseudoephedrine, in combination with ordinary products such as iodine crystals, battery acid, red phosphorous, and anhydrous ammonia (a widely used liquid fertilizer). The drug, especially the ME “cooked” in local labs, may be a powder ranging color form white or yellow to peanut butter brown or red. The crystal ME made by Mexican drug cartels resembles glass chards or larger crystals and are highly potent and pure (Dreisbach, Hickler & Koester, 2006).

Origins of Methamphetamine

Amphetamine was first synthesized at Universität Berlin by Romanian chemist Lazar Edeleanu in 1877 and originally named phenylisopropylamine (Erowid, 2006). The first wide use of amphetamine occurred in the 1940s, when it was used by Japanese, American, and German military personnel to combat fatigue and increase performance, as well as by Japanese factory workers, during World War II. In 1940, ME was marketed as “methedrine” by Burroughs Wellcome. By 1942, dextro-amphetamine and ME were reported to be widely available. After the war, surplus military stocks appeared on the Japanese market, culminating in an epidemic of abuse. Despite the passage of a 1951 stimulant control act, 1953 marked the height of the Japanese amphetamine epidemic, in which an estimated 2 million people in a population of 88.5 million were users and were experiencing psychotic symptoms (Frontline, 2006; Meredith, Jaffe, Ang-Lee & Saxon, 2005). The U.S. military dispensed amphetamine in 1950 to 1953 to troops in Korea. By 1959, reports emerge of the contents of amphetamine-containing inhalers being injected (Erowid, 2006; Frontline, 2006).

Illicit amphetamine production reportedly began between 1959 and 1963. During this period, the California Attorney General requested that injectable ampules of amphetamine be removed from the marketplace. Various pharmaceutical companies withdrew several formulations of ME from the domestic market. As a result, underground ME labs emerged in the California Bay Area. Illicit producers of ME, known as “cooks”, who were making the drug for West Coast motorcycle gangs are thought to have discovered that ephedrine from cold medicines could be used to produce ME, which is twice as potent as amphetamine (Frontline 2006). Motorcycle gangs (e.g. Hells Angels) took control of the new product, and ME abuse throughout the West Coast. Other reports contend that biker groups originally used the “P2P method” of ME synthesis, using phenyl-2-propanone (P2P), aluminum, methylamine, and mercuric acid. Because passage of the Federal Chemical Diversion and Trafficking Act of 1988 led to the development of strict federal controls on P2P, bikers manufacturers replaced the P2P method with the ephedrine/pseudoephedrine reduction method, which use a phosphorous-based precursor such as red phosphorous or hypophosphorous acid. These and other law enforcement efforts targeting motorcycle gangs, coupled with the development of simpler methods for ME synthesis, had the effect of shifting control of the U.S. illicit ME market to Mexican-based traffickers in the early 1990s (Meredith, Jaffe, Ang-Lee & Saxon, 2005; Brouwer, Case, Ramos, Magis-Rodriguez, Bucardo, et al., 2006).

As it turns out, the ephedrine-pseudoephedrine reduction method is cheaper, simpler, and more efficient than the P2P method, and yields a purer, more potent and more addictive D-isomer of ME. This newer method of synthesis allowed “superlabs” to develop, with the capacity to produce ten or more pounds of ME in one production cycle. Superlabs have spread extensively throughout Mexico and the American Southwest. Precursor compounds are diverted from legitimate use and smuggled across the borders of the U.S., Mexico, and Canada for use in clandestine ME production in both the Southwest and Northwest. For example, elemental lithium can be isolated from camera batteries and used as a catalyst in the ammonia/alkali method of reduction of ephedrine into ME. Anhydrous ammonia, a common fertilizer, is often siphoned from storage tanks or tanks are stolen from dealers and farms (Denehy, 2006). Also known as the “Nazi method,” ephedrine-pseudoephedrine reduction method has become popular in some western regions of the U.S., resulting in the production of crystal ME or “crank.” The name “crank” is said to derive from bikers’ using motorcycle crank cases to transport the substance (Meredith, Jaffe, Ang-Lee & Saxon, 2005; Brouwer, Case, Ramos, Magis-Rodriguez, Bucardo, et al., 2006). Mexico-based groups are believed to control 70-90 percent of ME production and distribution in the U.S. Increased availability of these drugs at reduced prices has led to a parallel rise in local drug consumption (Brouwer, Case, Ramos, Magis-Rodriguez, Bucardo, et al., 2006).

The Spread of Methamphetamine Manufacture and Use to Indian Country

Despite the limited amount of data available and the dependence on anecdotal reports, it is clear that ME use intensified in the rural, Midwest, and Southwest U.S. in the 1990s and gradually invaded AI/NA communities. Rural states have been hard hit by the epidemic because of the easy access to raw materials used to manufacture this illicit drug; the ease in setting up laboratories in isolated areas; and the quick dispersal of ME odors , which allows it to be produced without it being noticed (Denehy, 2006). Geographic isolation, rural poverty, and closed social networks in rural communities may contribute to the appeal of ME and the challenges of eradicating it. Mexican cartels understood these dynamics and moved into a number of AI reservations to commence ME production, promotion of use, and sales (Associated Press, April 29, 2007). Remote settings and limited law enforcement resources decrease the likelihood of getting arrested during a drug sale or during ME production. Travel between communities and counties to buy, sell, or use drugs and or access services, makes users difficult to identify, track, and treat. Low paying, tedious jobs make ME use and selling ME for large profits enticing. Inadequate mental health and drug counseling services and the vast distances required to access them can be substantial barriers to treatment. (Dreisbach, Hickler & Koester, 2006). Sales for local lab productions have been supplemented by a substantial increase in highly pure and potent crystal ME imported from Mexico and distributed throughout the country in both urban and rural areas (Dreisbach, Hickler & Koester, 2006).

The ME crisis has reeked havoc on the already vulnerable health of AI/NA communities. Short and long term health risks from ME abuse include depression and anxiety from withdrawal, hyperthermia, convulsions, physiological and psychological brain injury, dental problems (“meth mouth’) and skin abrasions ( due to scratching at imaginary “meth bugs”), children’s poisoning from exposure to the drug and precursor chemicals in small labs (causing a myriad emotional cognitive and physical problems), various birth defects due to prenatal exposure, increased risk of HIV and hepatitis infection due to the increased libido associated with ME intoxication, and progression of HIV infection if present (NIDA, 2006b; Denehy, 2006; Bubar, Winokur & Bartlemay, 2007).

Early Efforts to Address the Methamphetamine Problem in Indian Country

The earliest mention of ME use by AI/NAs on Lexis Nexis Academic was in testimony provided by Ron Martin, Executive Director of the San Diego American Indian Health Center, to the Senate Committee on Indian Affairs on May 21, 1998 on unmet Indian healthcare needs. He described severe under-funding and the resulting difficulties of serving urban AI/NAs. At about the same time, the ME Interagency Task Force, headed by U.S. Attorney General Janet Reno, formed in response to a provision in the Comprehensive Methamphetamine Control Act of 1996. The Task Force met for the first time in Washington, DC, on May 4, 1998. They convened various times throughout 1998 and 1999 in Washington, DC, Omaha, NE, and San Diego, CA. However the first direct mention of the ME crisis in rural America was not addressed by this Task Force until their final town hall meeting on November 30, 1999. There were no representatives from any AI/NA specific agency include in this Task Force (Methamphetamine Interagency Task Force, Final Report, March 2000).

In July 2003, the U.S. Commission on Civil Rights released a report titled “A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country,” which described the substandard state of policing, justice systems, corrections, and health and human services provisions when compared to the rest of the U.S. (Bubar, Winokur & Bartlemay, 2007). Between 2003 and 2006, a number of tribal councils, government agencies, media outlets, and healthcare provider began to investigate and document the growing ME crisis among AI/NAs. In 2005, The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that ME use has grown to 1.7 percent in the Native population in comparison to 0.7 among American Caucasians (OAS, 2007). According to the publication Trends in Indian Health, produced by the Indian Health Service (IHS) in 2000-2001, AI/NA populations experienced a 164 percent increase in the number of drug-related deaths, corresponding to the increase of ME in Indian communities (Bubar, Winokur & Bartlemay, 2007). Requests to IHS providers for ME rehabilitation increased from 137 in 1997 to 4,946 in 2004. However, the average healthcare provided by the IHS or through contracted services met only ten percent of the need (Bubar, Winokur & Bartlemay, 2007).

The movement to address the ME epidemic in AI/NA gained momentum in 2006. On April 5^th , the Senate Committee on Indian Affairs held an oversight hearing on the problem of ME in Indian Country, where a number of tribal leaders and members of the National Congress of American Indians testify to the devastation wrought by ME abuse. On April 12^th, Mark Evans, Tactical Intelligence Supervisor at the New Mexico Investigative Support Center, released a reported commissioned by the Bureau of Indian Affairs titled “National Methamphetamine Initiative Survey: The Status of the Methamphetamine Threat and Impact on Indian Lands” (Evans, 2006). On October 4^th, SAMHSA awarded $49.3 million in FY 2006 grant funding for 14 new and one supplemental discretionary grants to tribal organization for prevention, treatment, and recovery support services. The funds were designated to “support relevant programs to promote mental health and prevent suicide, mental illness and substance abuse—especially methamphetamine use.” (SAMHSA Advisory, October 4, 2006). About six weeks later, President George W. Bush proclaimed November 30^th as National Methamphetamine Awareness Day and a coalition of the Department of Interior, the Partnership for a Drug-Free America, the Department of Health and Human Services, the Office of National Drug Control Policy, and the National Congress of American Indians contributed $300,000 for a public awareness campaign. The press released stated that “before the forging of this coalition, there was no national anti-ME media campaign tailored to Indian Country.” (McMullin, Wolfe & Deaktor, 2006).