Social - Methamphetamine use in Dayton, Ohio: preliminary findings from the Ohio substance abu

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Title:
Methamphetamine use in Dayton, Ohio: preliminary findings from the Ohio substance abuse monitoring network ([dagger]).
Author(s):
Raminta Daniulaityte, Robert G. Carlson and Deric R. Kenne.
Source:
Journal of Psychoactive Drugs 39.3 (Sept 2007): p.211(11). (8955 words) From Academic OneFile.
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Magazine/Journal
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Full Text :COPYRIGHT 2007 Haight-Ashbury Publications

Abstract--Since the 1990s, methamphetamine manufacturing and use have been spreading into midwestern and southern United States. However, most research on methamphetamine use has been conducted in the western United States. This exploratory study is based on qualitative interviews with 26 people recruited in Dayton, Ohio, for the Ohio Substance Abuse Monitoring Network, a statewide epidemiological surveillance system. Participants ranged in age from 21 to 57 years. The majority were White and male. The participants reported increases in methamphetamine availability and identified powder-type locally manufactured methamphetamine as the most commonly seen form of the drug. The participants reported extensive drug use histories, and were introduced to methamphetamine in the context of their involvement with pharmaceutical stimulants, crack, powder cocaine, and/or club drug scene. A large proportion of the participants continued to use crack or powder cocaine in addition to methamphetamine. Many primary methamphetamine users felt they were able to moderate methamphetamine use and fulfill their daily responsibilities related to work and family life. Ranking results and consensus analysis revealed that participants shared high agreement about drug-related risks, and perceived methamphetamine as a serious drug, although not as risky as heroin, crack or OxyContin[R]. Implications for treatment and prevention are discussed.

Keywords--cultural consensus model, methamphetamine, Midwest, OSAM Network, qualitative methods

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Since the 1990s, methamphetamine manufacturing and abuse have been spreading from the West Coast into the southeastern and midwestern United States and among some populations on the East Coast, including gay men in the New York City area (Sexton et al. 2006 a, 2005; Stoops, Tindall, Mateyoke-Scrivner, & Leukefeld 2005; Community Epidemiology Work Group 2006, 2004, 2000; Weisheit & Fuller 2004; Barnes, Boeger, & Huffman 1998). In the context of recent increases in methamphetamine manufacturing and abuse, mass media, law enforcement, and policy makers tend to characterize methamphetamine as "the most dangerous" emergent drug trend in the United States (Boulard 2005; Jefferson 2005; Smith 2005; Falkowski 2004). Scientific research has also identified a number of negative health and social consequences associated with methamphetamine abuse (Lineberry & Bostwick 2006; Meredith, Jaffe, Ang-Lee, & Saxon 2005). For example, research has shown that chronic methamphetamine use can permanently alter the brain (Thompson et al. 2004) and cognitive functioning (Simon et al. 2000). Methamphetamine abuse has been associated with poor health (Greenwell & Brecht 2003), cardiovascular and dental problems (Klasser & Epstein 2005; Turnipseed et al. 2003), increased risk for psychiatric symptoms (Zweben et al. 2004), high exposure to interpersonal violence (Cohen et al. 2003; Richards et al. 1999), and increased risk of engaging in unsafe sexual behaviors (Semple, Patterson & Grant 2004; Molitor et al. 1998; Frosch et al. 1996). Methamphetamine manufacturing and abuse have also been associated with serious environmental hazards and increased risk for child abuse and neglect (Sexton et al. 2006 b; Denehy 2006; Lineberry & Bostwick 2006; Meredith et al. 2005; Skeers 1992).

Methamphetamine use is a highly localized phenomenon, and significant variation in patterns and associated consequences of methamphetamine use exists across and within geographic areas and cultural groups in the United States (Sommers & Baskin 2006; Pach & Gorman 2002; Laidler & Morgan 1997; Morgan & Beck 1997; Helschober & Miller 1991; Miller 1991). More research is needed to explore local patterns and trends of methamphetamine use. With a few notable exceptions (Booth et al. 2006; Sexton et al. 2006 a, 2005; Stoops et al. 2005; Weisheit & Fuller 2004), most research on methamphetamine abuse has been conducted among populations in the western United States.

Ohio, being the easternmost of the midwestern states, has experienced a slower increase in methamphetamine production and abuse than some other states in the region, such as Iowa, Nebraska or Missouri (Lineberry & Bostwick 2006). Although primary methamphetamine/amphetamine treatment admissions in Ohio have not changed since the early 1990s (1% of all substance abuse treatment admissions in 2005, compared to about 0.8% in 1992; SAMHSA 2005), several other indicators suggest that methamphetamine abuse is increasing in the state. Since 2002-2003, the Ohio Substance Abuse Monitoring (OSAM) Network, a statewide epidemiological surveillance system that uses qualitative methods to obtain information about emerging substance abuse trends (Daniulaityte et al. 2004; Siegal et al. 2000), has reported increases in methamphetamine abuse in most areas of the state (OSAM Network 2005 a, c, 2004, 2003). According to the Ohio Bureau of Criminal Investigation and Identification, methamphetamine lab busts across the state increased from 34 in 2000 to 345 in 2004 (Ohio Task Force Commanders Association 2006).

Besides general drug trend surveillance, the OSAM Network conducts targeted response studies designed to provide a more focused investigation of emerging substance abuse issues across the state. In 2005, a Targeted Response Initiative was conducted to obtain a better understanding of methamphetamine use trends across the state (OSAM Network 2005 a). This article focuses on data obtained from 26 recent methamphetamine users recruited in Dayton, Ohio. Building on qualitative interviews and drug ranking results that were analyzed using cultural consensus analysis (Romney, Weller & Batchelder 1986), the article aims to describe the perceived local trends of methamphetamine availability, patterns of methamphetamine initiation and use, and participant views and experiences related to negative consequences of methamphetamine abuse.

METHODS

In the Dayton area, 26 individuals who reported at least one episode of methamphetamine use within the past 12 months were interviewed. Recruitment was facilitated by outreach workers, treatment providers, and other study participants using convenience and chain-referral techniques (Bernard 2006). Audiotaped interviews were conducted at the project site office or in the treatment/incarceration facilities. Informed consent forms were administered to each participant. The study was approved by the Wright State University Institutional Review Board. Each interview lasted about 60 minutes, and each participant was compensated $20 for his/her time.

The interview protocol consisted of three parts: (1) structured questions on demographic information; (2) open-ended questions on methamphetamine and other drug use; (3) ranking of 16 commonly abused substances according to their risks or negative consequences. Open-ended questions focused on issues related to the history and patterns of methamphetamine and other drug use, availability, treatment experiences, and perceived risks of methamphetamine use. The aim of the ranking task was to elicit "insider" beliefs about methamphetamine risks in comparison to other drugs of abuse. Ranking is an ethnographic data gathering technique used to study the organization of knowledge, cultural sharing and intracultural variation (Bernard 2006; de Munck & Sobo 1998). In the ranking task, participants were given 16 cards with the names of commonly abused substances and were asked to rank them according to their risks or negative consequences by placing the drug with the most serious consequences first and the drug with the least serious/negative consequences at the end. Participants were asked to comment on their ranking decisions. The ranking task was completed by 18 interviewees.

Interviews were audiotape-recorded and transcribed verbatim. Qualitative data analysis was performed using NVivo, a qualitative data management software (Richards 1999). Ranking results were analyzed using a cultural consensus model, which is both a theory that defines culture as shared information or knowledge, and a statistical method that assesses the level of cultural sharing in some cultural domain and provides a "culturally best" estimate of the correct answer to each question asked of the informants (Romney, Weller & Batchelder 1986). Consensus analysis was performed using ANTHROPAC (Borgatti 1996).

RESULTS

Participant Characteristics

The majority of the participants were male (17). Six individuals were African American, and 20 were White. Age ranged between 21 and 57, with over half of participants being in their 30s and 40s (Table 1). The majority of the participants (14) had either a high school diploma or a GED. Nine reported some post-secondary education. Fifteen participants were active drug users. Eleven were in recovery. Ten participants reported last methamphetamine use within the previous week, five reported last use one to four weeks ago, and eleven more than a month ago. The majority of the participants held construction or service-type jobs.

Trends in Methamphetamine Availability and Use

The majority of the participants reported that methamphetamine availability in the Dayton area had been increasing over the past few years, mostly in relation to increases in local production. For example, "Joy" described these increases, "A few years ago we used to say well, when it's in, it's in, you might wanna get it now. But nowadays I think it's a lot more readily available. More labs, more people learning to make it.... Availability's easy."

Participants reported seeing two types of methamphetamine in the area. "Crystal meth" was described as white or yellowish (sometimes brownish) powder (also sold in a rock form). It was produced locally using the anhydrous ammonia method, and sold for $80 to $100 per gram. The term "crank" was used by older users when speaking about methamphetamine used in the 1970s and 1980s. Some believed that old-time "crank" is what people call crystal meth these days. Another type of methamphetamine was referred to as "glass," and looked like shiny shards of glass. Some believed it was brought or shipped into the area from outside the state, although others knew about locally manufactured glass. Glass was less available than crystal meth, and sold for higher prices, typically $120 per gram. Some participants felt that glass was of higher quality than crystal, but others had varying experiences with it.

Three men reported they manufactured methamphetamine both for their personal use and dealing. Two women were dating or were close friends with "dealers/cookers." According to these participants, methamphetamine manufacturing typically occurred in the surrounding rural or semirural locations. To protect their families' safety and/or to avoid law enforcement attention, they typically avoided cooking methamphetamine in their own homes. Other participants had a few connections to obtain methamphetamine. They typically called their dealer and then arranged a meeting at a gas station or another public place to purchase the drug. In some cases, dealers delivered methamphetamine to private homes.

The general perception shared by most participants was that methamphetamine use has been increasing among very diverse user groups, but remained more common among White individuals. As noted in the previous section, the majority of our participants were White. Six African-American participants became involved with methamphetamine as a result of their connections with White user networks. All of these African Americans continued using crack cocaine, and none reported methamphetamine as their primary drug of abuse.

Pathways to Methamphetamine

Participants could be grouped into two distinct generations of users (Table 1). The "new user" group included 15 individuals who were introduced to smoking or snorting methamphetamine in the 1990s and 2000s. Two of them were living outside of Ohio at the time of their first use. The "older user" group included 11 individuals who were introduced to snorting or injecting methamphetamine in the 1970s or 1980s. Six of them were introduced to methamphetamine when they were living in other states. The majority (10) of the older users reported that because of decreased availability of methamphetamine, unpleasant side effects or other life circumstances, their initial phase of methamphetamine use had faded away. Many turned to other substances, including crack, heroin, and/or pharmaceutical opioids. However, in the mid-to-late 1990s or early 2000, they "rediscovered" methamphetamine in Ohio. Many learned to smoke it, which often was perceived as a better way of administration than snorting or injection.

For both new and old generation users, first methamphetamine use typically occurred in recreational situations. Individuals were offered methamphetamine by their boyfriends/ girlfriends, close friends, or somebody they had met at a party. In a few situations, methamphetamine was first offered by dealers. For example, "Michael" commented: "They heard that we were selling a lot of cocaine. So they bring it [meth] over one day. We sit down and they introduce me to it. They're like here, smoke some of this.... If you wanna sell some, here's my phone number."



Half of the participants were introduced to methamphetamine in their teenage years, seven reported first methamphetamine use in their 20s, and six were over thirty when they used methamphetamine for the first time. The majority of participants had fairly extensive prior experiences with other illegal substances. Besides alcohol and marijuana which were used in many situations where methamphetamine use first occurred, participants specified four drugs that played important "mediating" roles in initiation scenarios--powdered cocaine, crack cocaine, Ecstasy, and pharmaceutical stimulants.

Eight "old generation" methamphetamine users reported pharmaceutical stimulant abuse before their first use of illicit methamphetamine, including Ritalin[R] (methylphenidate), Desoxyn[R] (methamphetamine) and Dexedrine[R] (dextroamphetamine). Two of them reported active pharmaceutical stimulant use at the time they were introduced to methamphetamine. "Roy" described his first use, "I was at a drug house, and she come in. And we started talking, and I asked her did she do Ritalin. She said, 'Ritalin?' I said, 'Yea.' She said, "No, I do meth.' She said, 'Try some a this.' And it's history."

For many individuals, first exposure to methamphetamine occurred in the context of their powdered cocaine use. Twenty-one participants reported a history of powdered cocaine use before they were introduced to methamphetamine. In many initiation scenarios, the methamphetamine high was compared to powdered cocaine. Some participants were offered methamphetamine when they were looking for powdered cocaine. For example, "Kim" explained: "I wanted to come off that weed. And that time I was like on coke. So I'm like, well, need something [coke] ... And then we went over somebody's house, and then they just, ya know, just started putting out little lines [of meth] talkin' about, 'It's better than coke, you won't geek, it lasts a long time.'" "Geeking" refers to socially demeaning activities that a person engages in to obtain more powdered cocaine or crack (Carlson & Siegal 1991).

Ten individuals reported crack-cocaine use prior to trying methamphetamine for the first time. Six of them were introduced to methamphetamine in the setting where they also used crack cocaine. "Dave" described his first exposure to methamphetamine: "I was like damn it, I need to go find a rock. He's [friend] like, 'I got some meth.' And I was like, 'What the hell is that?' 'Oh, here, try it. It's the same thing except it's cheaper.' I tried it, hey, alright, good, let's get some more." Some users felt that methamphetamine was a better alternative to crack because the high lasted longer, they spent less money, and they were able to lead more productive and normal lives. For example, "Pete" commented, "The meth kept me away from the crack, and I liked the high better, I didn't geek, ya know, like you was geeking [on crack]. I couldn't go to work on smoking crack. I could do the crystal, and I could go to work."

Prior Ecstasy use was reported by eight individuals, and three of them indicated that their first methamphetamine use occurred as a part of the rave or club drug scene. "Kathy" described how she was introduced to methamphetamine at a rave party about five years prior to the interview:

We hung out for about an hour, danced a little bit, they got to
know me. They figured out it was my birthday. They took me
in the bathroom and we did meth. That was the first time I did
meth. I didn't really like it at first. 'Cause it hits you really
hard. It's not like Ecstasy. It's a little harsh.

Perceived Reasons of Continued Use

In some situations, sustained methamphetamine use was recreational in nature--participants used it to party or hang out with friends, or simply because they enjoyed its pleasurable effects. For example, "John" commented, "I like the way it made me feel. Plain and simple.... When you take the first hit, it almost makes you smile. You almost can't help but smile. It just gives you such a feeling of pleasure...." A few individuals described methamphetamine as a "sex inducer," and indicated that besides other things, they used it to intensify sexual encounters.

In other cases, methamphetamine was used to increase functioning in day-to-day life. Several participants referred to methamphetamine as a "work drug" because it provided energy and motivation to work and complete everyday activities. "Pete" commented, "I was laying carpet and stuff and the guy, he'd chop us all a line out.... We'd go in, and it would kick our butt, ya know, working and making good money down there laying carpet." Several individuals viewed their continued involvement with methamphetamine as a way to increase their income either by selling the drug or working extended hours at their legal occupations. "Jim" described his experiences, "It got me through a lot of hard work. I made a lot of money not just from selling but ya know, from my regular job.... We had a lotta overtime, and there was no way I could have done that [without meth]."

A few participants felt they used methamphetamine as a way to self-medicate emotional distress. "Jeff" who was deeply depressed because of his parents' death and a recent separation from his wife, explained his methamphetamine use: "It takes my pain away. Well it don't take my pain away. It makes, let's see ... I guess it don't make me think about the situations that's causin' me my pain. That's why I'm using it."

Ease of access and social influences were also cited as important reasons for continued methamphetamine use. "Amy" commented, "It was around, everybody was doing it. Everybody! I don't know, ya know, like I've never been peer pressured easily, but like when it was around, everybody else was getting high, I wanna feel like that too."

Patterns of Methamphetamine Use

Administration. Smoking and intranasal inhalation were reported as the most common modes of administration (Table 1). Participants described a number of different methods to smoke methamphetamine. Melting methamphetamine on an aluminum foil and then "chasing" and sucking up the fumes through a pen barrel or a straw was described as one of the most popular methods. Some indicated that they used glass pipes or light bulbs to smoke methamphetamine. A few participants mentioned that on some occasions they also mixed methamphetamine in coffee, kept it on gums, or ingested methamphetamine put in capsules or wrapped in a tissue paper ("parachuting"). Injection was reported by four "old generation" users who started intravenous methamphetamine use when they were teenagers or young adults.

Those who preferred smoking or injection used other modes of administration depending on specific situations. They "snorted" or sometimes ate methamphetamine when they needed to be awake for a longer period of time or when they did not have the privacy needed to smoke or inject methamphetamine.

Types of methamphetamine users. Participants varied greatly in the intensity of methamphetamine and other drug use. Although their use changed over time, on the basis of most recent experiences with methamphetamine, participants could be grouped into four distinct types of users (Table 1).

* Occasional users: Occasional methamphetamine use was described by seven individuals. One of them was a primary powdered cocaine user, and the other six used crack cocaine on a regular basis. These participants, typically, had poor access to methamphetamine, and used it only when somebody offered it to them. In some situations, they were turned away from methamphetamine by some of its side effects, such as bad teeth or its overly powerful and long-lasting high. For example, "Dave," who used crack on a regular basis, indicated that he had initially enjoyed methamphetamine, but then it took a "back seat" because he was disgusted by some of its effects: "I saw that through the guy, the guy made it in his apartment. When he first started makin' it, you know, he mighta had a cavity here or there. But then like three weeks later he's missin' teeth and I mean they're all disgusting.... So, I sorta like skimmed away from that, because ... I gotta have my teeth."

* Consistent users: A more consistent pattern of methamphetamine use was described by other six crack users. They tended to alternate between methamphetamine and crack depending on a number of different factors--accessibility, social setting of use, mood, or available monetary resources. These individuals used one of the two stimulants on a regular, nearly daily basis, sometimes making short breaks, but then getting back to intense use again. Typically, their use interfered with their ability to maintain regular employment and/or independent housing. For example, "John" described his use in the following way, "I was a really heavy smoker of crack and meth. I would even be a binger, ya know, I might disappear for days at a time after I got my paycheck. I wouldn't take it home to the kids."

* Moderate primary methamphetamine users: A regular but moderate pattern of methamphetamine use was described by nine individuals who used methamphetamine as a primary drug, typically one to several times per week. They tried to control their use to a certain degree, in order to keep their jobs, take care of their bills, and maintain "decent" appearances. For example, "Dan" snorted a very small amount of methamphetamine on a nearly daily basis, but avoided using it in the afternoon so he could sleep at night. He went to work every day and took care of his son. "Molly" also indicated that after a period of intense use she learned to use methamphetamine in a more controlled and moderate manner which she felt did not disrupt her life in any significant way. She commented, "I got to the point to where I didn't overdo it like I did before ... All ya had to do is a line and you were fine all day. So I didn't really think I had a problem with it."

* Heavy primary methamphetamine users: The other four primary methamphetamine users described a pattern of intense, daily methamphetamine use where they would stay up for several days in a row and take short breaks only when they felt absolutely exhausted and worn out. They typically referred to this pattern of use as "tweaking." Different from moderate users, "tweakers" did not limit their use in any way. Their daily activities were structured around methamphetamine use, and they were not able to maintain any functional boundaries of normal life. "Tweakers" typically had easy access to methamphetamine because of personal ties to dealers or those who cooked the drug themselves. For example, "Michael" described his use:

We'd stay up for days and days getting high, ya know, not
eating, started losing a lot of weight. He taught me how to
make it, and I was making my own, so I had like an endless
supply of this real expensive drug.... I was using more
than I was selling. I would stay up three, four days easy.
Sometimes seven days for like three, four months in a row
living like this, ya know, not wanting to do nothing, stay
locked in the room.

Six individuals who had past experiences of heavy methamphetamine use described current patterns of use that classified them as "occasional," "consistent," or "moderate" primary users (Table 1). In some situations, they had decreased their methamphetamine use to avoid negative health or social consequences. In other cases, their use decreased because they lost reliable connections to obtain methamphetamine, and/or they became involved with other drugs of abuse. For example, "Vince" described his experiences:

When I started using crack, I kind of slacked back on my meth
'cause it's harder to find. And when you get, get like a junkie
or whatever, you go for the easiest thing you can find. So I
got to where I'd use meth maybe a couple times a month or
something like that. . . . It got harder to find, and it seemed like
the more I got higher on crack, I started disassociating myself
with people. So I lost contact with a lot of, a lot of people. So
it really started getting hard to find [methamphetamine].

Use of other substances was common among both moderate and heavy methamphetamine users. For example, "Michael" commented, "We had a lot of drugs around. For some reason like, if you make meth, and you have a lot of meth, it's real easy for other drug sellers like, 'I'll trade you some Xanaxes for some meth, I'll give you some weed for some meth.' So you end up having a whole variety of drugs...." Many reported use of benzodiazepines, alcohol, marijuana, and in a few cases heroin to come down from a methamphetamine high.

Social setting of use. The majority of participants preferred to use methamphetamine in the company of their friends, relatives, or coworkers. In some situations, this preference was motivated by paranoia, fear of overdose, or a view that methamphetamine use was a "social thing." "Ann" commented, "I don't like bein' by myself 'cause I don't know what's gonna happen to me. When I smoke crack or meth I'm in a group." Many participants indicated that they would share methamphetamine with others in their social group. In some situations, they all had to contribute money to obtain methamphetamine. In other cases, the "host," typically a cooker or dealer, treated others without charging them.

Social settings of methamphetamine use and activities that people engaged in while using the drug were related to their reasons for and patterns of use. Individuals who used methamphetamine as a "work" or "energy" drug, tried to engage in some type of productive activities like going to work, working extra shifts, and doing housework, including cleaning, gardening, cooking, or taking care of children. Moderate users indicated that their daily activities did not change in a significant way when they started using methamphetamine. They reported that they just had a lot more motivation and energy to carry them through the day.

When participants used methamphetamine as a "leisure" drug, they described a number of recreational activities, including watching TV, going for a walk, playing video games, going to a club or bar, doing crossword puzzles, or having sex. A group of heavy users or "tweakers," described "tweaking" activities or things they would only do when really high on methamphetamine--play with children's toys, take things apart, tinker with clocks, electric appliances, bikes, and make candles, etc. For example, "Amy," explained: "When I'd get real high, there'd be like papers I haven't went through in a long time, going through them papers, ya know, things that I woulda never done sober. Just cleaning and playing with my nephews' toys, ya know, just tweaking like I had to be moving, I had to do something."

Perceived Risks of Methamphetamine Use

The participants varied in their opinions and knowledge about the negative effects of methamphetamine use. A few participants, like "Paul," felt that methamphetamine "has not been out long enough for ... people to be tested to see what it does." However, the majority of participants provided extensive and diverse lists of negative consequences associated with methamphetamine use.

The most prominent themes, cited by most participants, related to lifestyle and social consequences (identified by 23 participants) of methamphetamine abuse, including loss of material possessions, social status, and valued social relationships. For example, "Michael" commented:

It took me for a nice little ride. I lost everything I had,
everything! Ten years basically--flushed it down the toilet
... Ten years of my life, a relationship I built over ten
years. A family, I had my own family, ya know, [we] started
from high school sweet hearts ... Now it's all messed up.

The second most frequently cited group of themes related to health consequences that indicated deteriorating appearance, which was perceived as one of the most repulsive aspect of methamphetamine use. This thematic group included such issues as weight loss (11), bad teeth (4), poor hygiene (4), and skin problems (2). For example, "Amy" indicated, "My eyes were bugged out, I was losing weight real bad, didn't really care about taking a shower...." "DJ" also commented, "They be lookin' bad. I mean, they don't keep theyselves. They don't brush they teeth. They mouth be all rotten, hair be lookin' all matted."

Another frequently cited negative aspect of methamphetamine use related to unpleasant feelings experienced when coming down from a methamphetamine high, including depression (9), irritability (5), and various body aches (3). For example, "Molly" commented, "I would get so depressed on it. And the more I would do it, the more I would get depressed, the more I hated to live. It would just totally, just make me just, just hate life." "Joy" also indicated, "I could become jealous and snappy a whole lot easier on the second day [after using]."

Negative experiences associated with an extended episode of methamphetamine use, including hallucinations (9) and paranoia (5), were other important aspects of methamphetamine harm cited by the participants. For example, "Vince" described his experiences: "What I was seein' was shadows, but I thought it was people messing around my garage.... So I actually got my pistol out, got my two dogs out, and I was chasing shadows around the neighborhood."

Heart damage and other cardiovascular issues resulting from methamphetamine use were cited by seven participants. For example, "Jim" explained, "I developed the high blood pressure and they told me that I had irregular heartbeat, and I know that it's from the speed I've used."

Six individuals discussed addiction as another negative aspect of methamphetamine use. They felt that methamphetamine is a powerful drug that takes control of a person's life and, as "DJ" put it, "makes you forget about your priorities." For example, "Amy" indicated: "The addiction, like you just have to have it and have it and have it, I know people who have went and stole things, sold 'em just to buy it."

Harmful chemicals used in methamphetamine production ("battery acid," "starting fluid," "pool chemicals") were discussed as another repulsive aspect of methamphetamine use. The issue was mentioned by five participants, although they were very vague about the possible health consequences associated with these chemicals. For example, "Paul" explained it in the following way: "I would imagine the stuff it's made with has to tear your insides up. Either your lungs or else maybe your stomach lining or somethin', I mean I don't think that ingesting Drano into your system is a good idea."

Five participants indicated that smoking methamphetamine may be harmful to the lungs, and two talked about sinus infections that may result from snorting methamphetamine. Other less frequently cited themes included legal problems (4), memory loss (3), effects on nervous system (2), and overdose (2). Although several individuals had injected methamphetamine, none of them mentioned injection-related risks as a dangerous aspect of methamphetamine use. Similarly, two individuals indicated that sexual promiscuity was a part of their methamphetamine lifestyle, but none of them thought about sexually transmitted diseases as important risks of methamphetamine abuse. Rather, the issue was conceptualized as a social consequence of methamphetamine abuse in terms of lost friendships and ruined marital relationships.

Comparing Methamphetamine Risks to Other Drugs of Abuse

Ranking results of 16 commonly abused substances provided additional insight into how participants viewed methamphetamine-related risks. Consensus analysis estimated that the ratio between the first and second eigenvalues was 5.6, average level of knowledge was 0.76 (SD 0.18), and about 78% of variance was explained by the first factor. A ratio of 3 is typically accepted as a standard cut-off indicating a single cultural model (Romney et al. 1986). In other words, consensus analysis results suggest that participants drew from a single cultural model when they compared drugs in terms of their perceived harmfulness/negative consequences. As seen from the Figure 1, methamphetamine was placed fairly high in the rank-order of drugs, but was perceived as being less harmful or dangerous than heroin, crack, or Oxycontin[R] (oxycodone controlled-release). It was ranked fairly similarly to PCP, but was placed above powdered cocaine, club drugs, Ritalin[R], Vicodin[R], Xanax[R], alcohol, marijuana and tobacco.

Ranking results and qualitative interviews suggest that since methamphetamine use is generally seen as a relatively new phenomenon in the Dayton area, examples of chronic, long-term methamphetamine use are much less common than examples of devastating social and health consequences related to crack or heroin abuse. For example, "Amy" was an intense methamphetamine user for two years before she was court ordered to attend treatment. She described numerous health and social consequences of methamphetamine use. Nevertheless, she felt methamphetamine was not as bad or as socially stigmatized as heroin or crack:

Meth, I never looked at it as it was that bad, I've always looked
at crack like "crack heads," like people sleeping in dumpsters
and things like that, heroin junkies. I've just never had an
urge to do crack or heroin, ever.... I've seen people die from
heroin, I've seen people die from crack. I've seen people sell
their houses and sell their cars for heroin and crack. I've never
seen anybody sell it for meth, ya know what I mean. Like they
might go out and steal something and then sell that to pay for
what they want, but I've never seen anybody give up their
house for meth.

DISCUSSION

Although this exploratory study is based on a small convenience sample that is limited to a single metropolitan area in Ohio, it does reveal significant variation in pathways and patterns of methamphetamine abuse. The participants represented two distinct generations of users, and were introduced to methamphetamine in the context of their involvement with different drug use settings, including the crack scene, Ecstasy and other club drug scene, and a less clearly defined but more inclusive scene of powdered cocaine users. Pharmaceutical stimulant abuse was not mentioned as a pathway to illicit methamphetamine use by individuals who were initiated to the drug in the more recent past. Despite these different pathways to methamphetamine use, the majority of our participants were fairly advanced in their drug use careers at the time of their first methamphetamine use. Many continued using various other substances in addition to methamphetamine. These findings are consistent with previous studies showing a high prevalence of other drug use among methamphetamine users and suggest a need for specialized treatment to address polysubstance abuse (Stoops et al. 2005; Brecht et al. 2004).

A large proportion of our participants were introduced to methamphetamine in the context of cocaine use. Many of them used both stimulants or resumed a more consistent pattern of cocaine use when their access to methamphetamine diminished. Research suggests that Ecstasy use and the rave scene have been losing their popularity among local users. For example, the Dayton Area Drug Survey shows that rates of lifetime Ecstasy use among area twelfth graders decreased from 10% in 2002 to 4% in 2004 (Center for Interventions, Treatment, and Addictions Research, WSU 2005). As a result, powder cocaine and crack may remain the major pathways to experimental or more regular use of methamphetamine. A perception that methamphetamine is a more functional and less stigmatized drug than crack cocaine may prevent some crack users from seeking treatment in a belief that by switching to methamphetamine, they could improve their lives and social functioning.


Conversely, previous research has suggested that methamphetamine may have difficulty gaining a foothold in areas with strong cocaine markets (Sexton et al. 2005; Weisheit & Fuller 2004). The Dayton area has an established tradition of cocaine distribution and use (Carlson & Siegal 1991). Furthermore, over the past three to four years, the OSAM Network has reported substantial increases in cocaine availability in the Dayton area, with prices dropping from $80-$100 to $40-$60 per gram (OSAM Network 2005c, 2004, 2003). Contrasting many other areas of the country (Barnes et al. 1998; Pietschmann 1997), methamphetamine in Dayton and across Ohio continues to be a more expensive drug than cocaine, with an average price of locally manufactured methamphetamine reported to be as high as $80 to $100 per gram (OSAM Network 2005a). Although methamphetamine may seem appealing to some powdered cocaine and crack users, participant experiences and other OSAM Network data suggest that local patterns and trends of methamphetamine use are affected by a recent surge in availability of relatively inexpensive cocaine. Future research should also identify changes in methamphetamine markets and patterns of use resulting from the recently approved legislation in Ohio to control sales of pseudoephedrine, a primary ingredient in methamphetamine manufacturing. However, law enforcement and OSAM Network data suggest that besides local production, methamphetamine is also being shipped or brought into Ohio from other regions of the country (U.S. Drug Enforcement Administration 2006; OSAM Network 2005a).

There was some overlap between cocaine and methamphetamine use scenes, but there were also some important differences. First, among methamphetamine users, mode of administration did not have the same meaning and significance as it did among cocaine users where "smokers" (crack users) and "snorters" (powder cocaine users) were considered as two very different classes of users. Second, different from the urban crack scene, where most social connections are based on hostility and greediness (Carlson & Siegal 1991), there was somewhat more drug sharing among methamphetamine users. Such generosity, typically very rare among crack users, was more common among individuals who were involved in methamphetamine production and, as a result, did not have to pay for methamphetamine.

Participants provided diverse explanations for their continued use of methamphetamine, including recreation, social influences, ease of access, and self-medication of emotional distress--themes that are often cited among abusers of other psychoactive substances (German & Sterk 2002; MacDonald 2002; Khantzian 1985; Brown et al. 1971). However, in many situations, individuals also reported using methamphetamine to enhance productivity and daily functioning in their roles as family caregivers and providers. Other research has also found a common conception, especially among working-class users, of methamphetamine as a productivity enhancing drug (Sexton et al. 2006 a; Morgan & Beck 1997). Some, who used methamphetamine as a "work drug" and/or were involved in drug manufacturing and dealing related their use to the deteriorating economic situation in the area. These findings are consistent with other research that relates expansion of methamphetamine markets to weak local economies and the very high profitability of the drug (Weisheit & Fuller 2004; Morgan & Beck 1997; Pietschmann 1997)



Patterns of methamphetamine use described by our participants may provide a plausible explanation for low treatment admission rates in the area, despite law enforcement and drug abuser reports of increases in methamphetamine availability and use. First, a large proportion of our participants continued to use other stimulants in addition to methamphetamine. Among such individuals, a treatment entry may be considered as a primary cocaine admission, although methamphetamine abuse may be a factor as well. Second, many primary methamphetamine users avoided "hitting rock bottom" and, contrary to the popular image, were able to maintain "functional" lifestyles, including keeping their jobs, fulfilling their family obligations, and maintaining "decent" appearances. Several of those who ventured into heavy methamphetamine use were able to return to the more controlled pattern of use. These results correspond with some other studies showing that methamphetamine in some populations is viewed and used as a "functional" drug (Simon et al. 2002), and as a result, may have a long latency period (estimated average of nine years) between first use and treatment (Brecht et al. 2004).

In terms of negative effects of methamphetamine use, participants emphasized lifestyle and social consequences, and focused on the immediate and most visible health effects, including unpleasant feelings associated with prolonged episodes of use or coming down experiences and deteriorating appearance (weight loss, poor hygiene, tooth decay). Long-term health effects and addiction were cited as less salient issues. Although several participants injected methamphetamine, none of them viewed injection-related risks as a prominent issue in relation to methamphetamine use. Important issues relevant to social and public health research on methamphetamine such as violence and sexual risk behaviors were discussed in terms of disrupted social relationships rather than health risks or criminality.

Ranking results revealed that the study participants viewed methamphetamine as being more harmful than marijuana, alcohol, powdered cocaine, and club drugs, but less dangerous than heroin, crack, or OxyContin[R]. These findings contrast with a popular portrayal of methamphetamine as being more addictive, potent, and harder to treat than most other drugs of abuse, including heroin and crack (Boulard 2005; Jefferson 2005; Barnes, Boeger & Huffman, 1998)

Qualitative explanations of the ranking results suggest that participants based their judgment on numerous examples of social and moral degradation associated with chronic crack and heroin abuse, and a recent surge in OxyContin[R] abuse that has been associated with transition to heroin injection (Daniulaityte, Carlson & Kenne, 2006; OSAM Network 2005c, 2004, 2003). Since in the Dayton area the methamphetamine market is less established and smaller (and/or more hidden) in scope than crack or heroin, most users have not experienced or had an opportunity to witness many cases of long-term, chronic methamphetamine abuse. These findings suggest a need for prevention messages that would be based on open and honest real-life examples of methamphetamine abuse. As "Jim," who has been regular methamphetamine user for more than eight years, suggested, "You have someone like me sit down and tell 'em the really bad times, really bad things that's happened [to me] ... and that I have seen and heard that happens through this."

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([dagger])The Ohio Substance Abuse Monitoring Network is funded by the Ohio Department of Alcohol and Drug Addiction Services (ODADAS). We are especially grateful to the team of the OSAM Network advisors at ODADAS: Sanford Starr, Robert Fine, Theresa Porter, Mack Sanders, Terri Willis, and Karin Carlson. We are thankful for the helpful comments provided by Tanya Hedges Duroy, Rocky Sexton, and Cristina Redko on earlier drafts of the article. We are also grateful to the participants who shared their time and experiences with us as well as Sherry Osborne, an outreach worker, who helped recruit the participants. The views expressed in this article do not necessarily reflect those of the funding source or any other government agency.

Raminta Daniulaityte, Ph.D. *; Robert G. Carlson, Ph.D. ** & Deric R. Kenne, M.S. ***

* Research Assistant Professor, Center for Interventions, Treatment and Addictions Research, Department of Community Health, The Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

** Professor and Director, Center for Interventions, Treatment and Addictions Research, Department of Community Health, The Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

*** Research Associate, Center for Interventions, Treatment and Addictions Research, Department of Community Health, The Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

Please address correspondence and reprint requests to Raminta Daniulaityte, Ph.D., Center for Interventions, Treatment and Addictions Research, Department of Community Health, The Boonshoft School of Medicine, Wright State University, Dayton, Ohio. 45435, Phone: 937-775-2066, Fax: 937-775-2214; email]

TABLE 1
Basic Profile of Study Participants

Pseudonym Age Gender Ethnicity

Occasional users
"Alison" * 21 Female White
"Dave" 28 Male White
"Kim" 23 Female White
"Rachel" * 46 Female White
"Tom" 32 Male African American
"Ted" 47 Male African American
"Tony" 39 Male African American

Consistent users
"Ann" 47 Female African American
"Bob" 40 Male White
"DJ" 44 Male African American
"John" 47 Male White
"Roy" 57 Male African American
"Vince" * 41 Male White

Moderate primary users
"Kathy" 27 Female White
"Dan" 43 Male White
"Jack" 24 Male White
"Jim"* 42 Male White
"Joy" 44 Female White
"Mike" 27 Male White
"Molly" * 26 Female White
"Paul" 53 Male White
"Pete" * 52 Male White

Heavy primary users
"Amy" 21 Female White
"Jeff" 44 Male White
"Michael" 26 Male White
"Tina" 42 Female White

Pseudonym First Methamphetamine Use:
Time, Place and Administration
Occasional users
"Alison" * 2002, Ohio, smoking
"Dave" 1998, Florida, smoking
"Kim" 2003, Ohio, snorting
"Rachel" * 1970s, Ohio, injection
"Tom" ?, Ohio, smoking
"Ted" 1980s, Ohio, snorting
"Tony" 2005, Ohio, smoking

Consistent users
"Ann" 2003, Ohio, smoking
"Bob" 1980s, Kentucky, snorting
"DJ" Early 1990s, Florida, smoking
"John" 1980s, Ohio, snorting
"Roy" 1960s, Phil., PA, injecting
"Vince" * 1980s, Texas, snorting

Moderate primary users
"Kathy" 2000, Ohio, snorting
"Dan" 1980s, Texas, snorting
"Jack" Mid-1990s, Ohio, snorting
"Jim"* 1980s, Ohio, snorting
"Joy" 2003, Ohio, snorting
"Mike" Late 1990s, Ohio, snorting
"Molly" * 2000, Ohio, snorting
"Paul" 2002, Ohio, smoking
"Pete" * 1980s, Ohio, snorting

Heavy primary users
"Amy" 2000, Ohio, snorting
"Jeff" 1970s, Kentucky, snorting
"Michael" 2002, Ohio, snorting
"Tina" 1980s, Oklahoma, snorting

* Participants who reported past experiences of heavy methamphetamine

use.


Source Citationaniulaityte, Raminta, Robert G. Carlson, and Deric R. Kenne. "Methamphetamine use in Dayton, Ohio: preliminary findings from the Ohio substance abuse monitoring network ([dagger])." Journal of Psychoactive Drugs 39.3 (Sept 2007): 211(11). Academic OneFile. Gale. Apollo Library. 27 Sept. 2008
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Gale Document Number:A172776808