March 27, 2007
Researchers See Trends In Synthetic Stimulant Misuse
University of Iowa researchers see trends in who is using synthetic, or manufactured, stimulants such as methamphetamine and misused prescription drugs, and the experts are focusing on one of the obstacles that prevent people from getting help to end their habit.
People who seek admission to substance abuse treatment facilities for misuse of synthetic stimulants are more likely to be younger than those who abuse non-stimulant drugs such as marijuana, say the researchers. In addition, women are increasingly likely to use stimulants rather than non-stimulants, and whites are much more likely than blacks and other ethnic groups to use stimulants.
In addition, the lack of routine screening for synthetic stimulant misuse hampers treatment efforts. Most of the estimated 26 million amphetamine users worldwide use methamphetamine, the federal Drug Enforcement Administration reported in May 2006. In the United States alone, slightly more than 5 percent of people age 12 and older have tried the drug, according to the 2003 National Survey on Drug Use and Health.
Amphetamine misuse is a significant problem nationwide, and understanding who misuses these drugs could help primary care providers ask questions to improve screening for substance use, said Tracy Gunter, M.D., assistant professor of psychiatry in the UI Roy J. and Lucille A. Carver College of Medicine.
"Methamphetamine and certain synthetic stimulants are purported to be 'super drugs,' in that the effects are more intense and long-lasting than those produced by cocaine. Stimulants can cause a severe addictive disorder that is very hard, but not impossible, to treat," Gunter said.
"The more we know about who is likely to try meth, the more we can do to screen for substance abuse, just as many primary caregivers currently screen for tobacco, alcohol or marijuana abuse."
"Many people entering their first treatment for meth came to treatment through the criminal justice system, not self-referral or a health-care setting," Gunter added, referring to one of the study results she and colleagues published in the September 2006 issue of the journal Substance Use and Misuse.
In that study, the team compared drug treatment center admissions that listed stimulants as the primary substance misused to admissions that did not list stimulants as a substance of misuse at all. The research was based on the Treatment Episode Data Set, a federal Substance Abuse Mental Health Services Administration database that is gathered every three years. The database included more than 1.7 million admissions in 2001 to facilities that received at least some federal funding.
The team also found that over half of stimulant users were in the 21-34 age group, whereas non-stimulant users tended to be age 34 and older.
Another disturbing trend, Gunter said, was that 46 percent of stimulant users were female, whereas only 29 percent of non-stimulant users were female. This fact, coupled with the likely ages of misuse from 21 to 34, raises questions about the impact of meth on women, as well as children.
"When women of a childbearing age are using a drug such as meth, you have to wonder about drug effects on the baby during pregnancy, as well as the level of parenting provided to children of addicted mothers," Gunter said.
The team also found that in the United States in 2001, whites accounted for 79 percent of treatment admissions for stimulants, compared to 3 percent for blacks and 18 percent for Native Americans, Asian and other groups.
Prescription stimulant drugs that are subject to misuse include Ritalin and Dexedrine. Yet, Gunter cautioned, people should not assume that prescribing these drugs to individuals who need them automatically leads to problems.
"In fact, in some studies, adults treated as children with prescription drugs to treat ADHD were less likely than those not treated to be involved in substance abuse of any kind in adulthood, not more," Gunter noted. "Oftentimes, the people who have substance abuse are not who you think they are."
Whoever may be using meth, providing screening to them is no easy task, Gunter said.
"Screening is not simple. Fifteen minutes at a doctor's office may not be enough time to make a connection, and people won't tell you about substance abuse if they don't trust you," she said. "The average diagnostic interview for substance use disorders takes two to three hours, and the interviewer needs to build rapport with the patient."
Despite the challenges of screening, Gunter said, psychosocial and behavioral treatments are effective, and research worldwide is raising the possibility of eventual pharmacologic treatments.
"We shouldn't lose sight that treatment programs now work. And we may be able to do something better down the road. The problems are severe but not insurmountable," Gunter said.
UI researchers will continue to analyze national and other data sets to understand the meth problem and find ways to address it.
The study was funded, in part, by the UI Department of Psychiatry and the Iowa Consortium for Substance Abuse Research and Evaluation. In addition to Gunter, the study team included Stephan Arndt, Ph.D., professor of psychiatry and biostatistics and director of the consortium, and Gloria Wenman, UI research assistant in forensic psychiatry.
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