Smoking Methamphetamine Research Articles

Safety and efficacy of varenicline to reduce positive subjective effects produced by methamphetamine in methamphetamine-dependent volunteers.

Methamphetamine use is increasing in the US. Although there are no Food and Drug Administration (FDA)-approved medications for methamphetamine dependence, preclinical and clinical studies suggest that methamphetamine users may benefit from treatments that enhance cholinergic neurotransmission. Consequently, we determined the safety and the efficacy of varenicline treatment, a partial agonist at α4β2 and a full agonist at α7 nicotinic acetylcholine receptors, to reduce positive subjective effects produced by smoked methamphetamine. Additionally, the effects of treatment with varenicline on the cardiovascular and reinforcing effects of methamphetamine were determined. We conducted a double-blind, placebo-controlled, within-subjects trial of varenicline vs. placebo in methamphetamine-dependent volunteers who were not seeking treatment. Participants were randomly assigned to receive one dose of varenicline (0, 1, or 2mg) po BID, titrated up to the target dose over days 1-7, during each of three separate inpatient phases. Safety measures included the frequency, duration, severity, and relatedness of adverse events reported. Positive subjective effects included 'Any drug effect', 'High', 'Good effects', 'Stimulated', and 'Drug liking', which were rated by participants before and for 1h after smoking methamphetamine (0, 10, and 30mg). There were no serious adverse events and no differences in adverse events reported during the three phases. Varenicline (2mg) significantly reduced ratings of 'Any drug effect' and 'Stimulated', as well as attenuated ratings of 'High', 'Drug liking', and 'Good effects', produced by methamphetamine (30mg). The ability of varenicline to attenuate the positive subjective effects of methamphetamine in the laboratory suggests that varenicline should continue to be explored as a treatment for methamphetamine dependence.

Interstitial Pulmonary Fibrosis and Progressive Massive Fibrosis Related to Smoking Methamphetamine With Talc as Filler

We present a case of interstitial pulmonary fibrosis accompanied by radiographic evidence of progressive massive fibrosis in a patient who had a 15-20 year history of almost daily recreational inhalation of methamphetamine. Mineralogical analysis confirmed the presence of talc on biopsy of the area of progressive massive fibrosis. The coexistence of interstitial pulmonary fibrosis and progressive massive fibrosis suggests that prolonged recreational inhalation of methamphetamine that has been "cut" with talc can result in sufficient amount of talc being inhaled to result in interstitial pulmonary fibrosis and progressive massive fibrosis in the absence of other causes.

“Meth Circles” and “Pipe Pirates”: Crystal Methamphetamine Smoking and Identity Management Among a Social Network of Young Adults

This article analyzes crystal methamphetamine smoking among a social network of young Australian adults. Ethnographic data were collected from 2005 to 2007 among 60 individuals, and semistructured in-depth interviews were conducted with a sub-set of 25 individuals. Fieldnotes and interview transcripts were entered into NVivo7 and thematically analyzed. We argue that although drug use may be considered “normal” among some social networks, the management of stigma associated with drug use is more complex and contested than portrayed in the literature. Policy implications are discussed. The study was supported by funds from Australia's National Health and Medical Research Council.

A Comparison of the Subjective and Cardiovascular Effects Produced by Exposure to Intravenous versus Smoked Methamphetamine in the Laboratory

Previous research has demonstrated that intravenous (IV) and smoked cocaine administration produced similar increases in heart rate (HR) and blood pressure (BP), whereas comparable doses of smoked cocaine resulted in higher subjective ratings of stimulated and high. To our knowledge, there have not been any studies conducted directly comparing the subjective and cardiovascular responses produced by IV methamphetamine (METH) versus smoked METH. Thirteen non‐treatment seeking METH‐dependent individuals, participated in separate protocols in which they were administered IV METH and smoked METH. In the first study, participants were administered METH (0 and 30 mg, IV) and subjective effects, as well as cardiovascular effects, were assessed prior to and 5, 15, 30, 45, and 60 min after METH administration. In the second study, smoked METH (0 and 30 mg) was administered and subjective and cardiovascular effects were obtained on the same time course as above. While not reaching statistical significance, METH administered via the IV route resulted in higher BP and HR across the time course assessed. Interestingly, subjective reports of desire METH and likely to use METH was higher when the route of administration was smoked. These findings demonstrate that the administration of IV versus smoked METH have differential cardiovascular and subjective effects in METH‐dependent participants.

A Case of Priapism Associated With Rapid Increase in Risperidone Dose

To the Editor: In Greek mythology, a son of Aphrodite and fertility god named Priapos was best noted for his permanently large and erect penis,1 which gave rise to the medical term priapism. Priapism is defined as a genital organ tumescence or rigidity, with or without pain, that persists without any sexual purpose.2 Psychotropic medications can cause this rare side effect by blocking the α1 receptor; among the atypical antipsychotics, risperidone has one of the highest affinities for the α1-adrenergic receptor.3 We report a case of a 21-year-old man who developed priapism after risperidone was restarted and the dose rapidly increased. Early recognition of priapism is emphasized. Case report. Mr A, a 21-year-old Asian-American single man with a 12th-grade education, was admitted to the psychiatric inpatient unit for increasing psychosis and schizophreniform disorder. Initially, the patient reported outpatient compliance on his sole medication of risperidone 2 mg twice daily. On admission day 1, the patient was prescribed risperidone 2 mg orally twice daily. On day 3 of his hospitalization, the risperidone dosage was increased to 3 mg orally twice daily. On the morning of day 4, the patient complained of a persistent and painful erection lasting for 2 hours. Through patient re-interview, it was discovered that the patient was noncompliant with risperidone treatment for approximately 3 days prior to admission. Prior to this event, the patient had no history of priapism, penile trauma, or sexual dysfunction. He had no family history of sickle cell trait or disease. His medical history was significant for cigarette smoking, recreational alcohol and marijuana use, and one instance of smoking methamphetamine months prior to admission; his urine drug screen was negative on admission. He was not taking any other medications. His physical examination was without abnormalities except for penile erection. Laboratory workup results revealed no significant abnormalities. Mr A was given 10 mg of terbutaline orally, and within 1 hour there was complete detumescence and no further treatment was necessary. Risperidone was discontinued, and he was started on asenapine 5 mg twice daily. On follow-up 3 weeks later, no further priapism nor sequelae of sexual dysfunction were reported. Risperidone is an atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It is generally used due to its characteristically fewer extrapyramidal side effects as compared with typical antipsychotics. Initial dosing is generally 2 mg/d with increases of 1 to 2 mg/d every 24 hours.4 Risperidone 4–8 mg/d is the recommended dose range for schizophrenia.4 Risperidone has a high affinity for the dopamine D2, 5-HT2A/2C, α1/α2-adrenergic, and histamine H1 receptors.5 Time to steady state for risperidone ranges from 1 to 7 days with a mean elimination half-life of approximately 19 hours.5 Despite speculation, the most commonly accepted theory for drug-induced priapism is the characteristic α1-adrenergic antagonism leading to decreased sympathetic tone and little to no blood flow in the corpora cavernosa of the penis. Although the mechanism of action of terbutaline is unclear, it is a β2-adrenergic agonist thought to relax the smooth muscles of the corpora cavernosa.6 Approximately 30% of all priapism cases are drug-induced, some of which are from psychotropic medications.7 Without urgent intervention, priapism can lead to fibrosis of tissue leading to permanent impotence. Due to its emergent nature, early patient education is crucial to provide immediate treatment on presentation of symptoms. The uniqueness of this case involves an association of priapism with rapidly restarting risperidone at a medium dose. Physicians should be aware, especially early in the course of therapy, of this rare but potentially serious side effect of risperidone.

Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play?

BackgroundCrystal methamphetamine smoking is associated with many negative health consequences, including the potential for transmission of hepatitis. We examined whether or not a kit for crystal methamphetamine smoking might have some potential to reduce the negative health effects of crystal methamphetamine smoking.MethodsFive focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada. Target groups included homeless/street-involved youth, sex workers, men who have sex with men, and youth in the party scene. Participants (n = 32) were asked questions about motivations for crystal methamphetamine use, the process of smoking, health problems experienced, sharing behaviour, risky sexual practices, and the ideal contents of a harm reduction kit.ResultsPipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed.ConclusionsChanging pipe sharing behaviours may be difficult because many participants considered sharing to be integral to the social experience of smoking crystal methamphetamine. Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.

A Comparison of Registered and Unregistered Female Sex Workers in Tijuana, Mexico

Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers (FSWs) are registered with the municipal health department, which requires regular screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). We examined correlates of registration to determine if it confers measurable health benefits. From 2004 to 2006, we interviewed FSWs in Tijuana > or = 18 years of age who reported recent unprotected sex with at least one client and were not knowingly HIV-positive, and tested them for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with registration. Of 410 FSWs, 44% were registered, 69% had been tested for HIV, 6% were HIV-positive, and 44% tested positive for any STI. Compared with unregistered FSWs, registered FSWs were more likely to have had HIV testing (86% vs. 56%, p < 0.001) and less likely to test positive for any STI (33% vs. 53%, p < 0.001) or HIV (3% vs. 8%, p = 0.039). Factors independently associated with registration included ever having an HIV test (adjusted odds ratio [AOR] = 4.19) and earning > $30 per transaction without a condom (AOR = 2.41), whereas working on the street (AOR = 0.34), injecting cocaine (AOR = 0.06), snorting or smoking methamphetamine (AOR = 0.27), and being born in the Mexican state of Baja California (AOR = 0.35) were inversely associated with registration. Registered FSWs were more likely than unregistered FSWs to have had HIV testing and to engage in less drug use, but did not have significantly lower HIV or STI prevalence after adjusting for confounders. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.

High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico

Soft tissue infections are common among injection drug users (IDUs), but information on correlates and treatment in this highly marginalized population is lacking. Six hundred twenty-three community-recruited IDUs in Tijuana, Mexico, completed a detailed interview on abscess history and treatment. Univariate and multiple logistic regressions were used to identify factors independently associated with having an abscess in the prior 6 months. Overall, 46% had ever had an abscess and 20% had had an abscess in the past 6 months. Only 12% had sought medical care for their most recent abscess; 60% treated the abscess themselves. The most common self-treatment method was to apply heated (24%) or unheated (23%) Aloe vera leaf. Other methods included draining the wound with a syringe (19%) or knife (11%). Factors independently associated with recent abscess were having income from sex work (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) 2.08-10.00), smoking methamphetamine (aOR 1.65, 95% CI 1.05-2.62), seeking someone to help with injection (aOR 2.06, 95% CI 1.18-3.61), and reporting that police affected where they used drugs (aOR 2.14, 95% CI 1.15-3.96). Abscesses are common among IDUs in this setting, but appropriate treatment is rare. Interventions to reduce barriers to medical care in this population are needed. Research on the effectiveness of Aloe vera application in this setting is also needed, as are interventions to provide IDU sex workers, methamphetamine smokers, and those who assist with injection with the information and equipment necessary to reduce abscess risk.

The Relationship Between Methamphetamine Use and Increased Dental Disease

Methamphetamine (MA) use has been linked anecdotally to rampant dental disease. The authors sought to determine the relative prevalence of dental comorbidities in MA users, verify whether MA users have more quantifiable dental disease and report having more dental problems than nonusers and establish the influence of mode of MA administration on oral health outcomes. Participating physicians provided comprehensive medical and oral assessments for adults dependent on MA (n=301). Trained interviewers collected patients' self-reports regarding oral health and substance-use behaviors. The authors used propensity score matching to create a matched comparison group of nonusers from participants in the the Third National Health and Nutrition Examination Survey (NHANES III). Dental or oral disease was one of the most prevalent (41.3 percent) medical cormorbidities in MA users who otherwise were generally healthy. On average, MA users had significantly more missing teeth than did matched NHANES III control participants (4.58 versus 1.96, P<.001) and were more likely to report having oral health problems (P<.001). Significant subsets of MA users expressed concerns with their dental appearance (28.6 percent), problems with broken or loose teeth (23.3 percent) and tooth grinding (bruxism) or erosion (22.3 percent). The intravenous use of MA was significantly more likely to be associated with missing teeth than was smoking MA (odds ratio=2.47; 95 percent confidence interval=1.3-4.8). Overt dental disease is one of the key distinguishing comorbidities in MA users. MA users have demonstrably higher rates of dental disease and report long-term unmet oral health needs. Contrary to common perception, users who smoke or inhale MA have lower rates of dental disease than do those who inject the drug. Many MA users are concerned with the cosmetic aspects of their dental disease, and these concerns could be used as behavioral triggers for targeted interventions. Dental disease may provide a temporally stable MA-specific medical marker with discriminant utility in identifying MA users. Dentists can play a crucial role in the early detection of MA use and participate in the collaborative care of MA users.

Polydrug Use among IDUs in Tijuana, Mexico: Correlates of Methamphetamine Use and Route of Administration by Gender

Tijuana is situated on the Mexico–USA border adjacent to San Diego, CA, on a major drug trafficking route. Increased methamphetamine trafficking in recent years has created a local consumption market. We examined factors associated with methamphetamine use and routes of administration by gender among injection drug users (IDUs). From 2006–2007, IDUs ≥18 years old in Tijuana were recruited using respondent-driven sampling, interviewed, and tested for HIV, syphilis, and TB. Logistic regression was used to assess associations with methamphetamine use (past 6 months), stratified by gender. Among 1,056 participants, methamphetamine use was more commonly reported among females compared to males (80% vs. 68%, p < 0.01), particularly, methamphetamine smoking (57% vs. 34%; p < 0.01). Among females (N = 158), being aged >35 years (AOR, 0.2; 95% CI, 0.1–0.6) was associated with methamphetamine use. Among males (N = 898), being aged >35 years (AOR, 0.5; 95% CI, 0.3–0.6), homeless (AOR, 1.4 (0.9–2.2)), and ever reporting sex with another male (MSM; AOR, 1.9; 95% CI, 1.4–2.7) were associated with methamphetamine use. Among males, a history of MSM was associated with injection, while sex trade and >2 casual sex partners were associated with multiple routes of administration. HIV was higher among both males and females reporting injection as the only route of methamphetamine administration. Methamphetamine use is highly prevalent among IDUs in Tijuana, especially among females. Routes of administration differed by gender and subgroup which has important implications for tailoring harm reduction interventions and drug abuse treatment.

Characteristics and harms associated with injecting versus smoking methamphetamine among methamphetamine treatment entrants

To compare the characteristics and harms associated with injecting and smoking methamphetamine among methamphetamine treatment entrants. A structured face-to-face interview was used to assess demographics, drug use patterns and harms [physical and mental health, psychological distress, psychotic symptoms, crime and human immunodeficiency virus (HIV) risk behaviour] among 400 methamphetamine treatment entrants in Sydney and Brisbane, Australia. Participants who had injected but not smoked methamphetamine in the month before treatment (n = 195, injectors) were compared to participants who had either: (a) injected and smoked (n = 90, injectors who smoke), or (b) smoked but not injected (n = 73, smokers), during this time. In comparison with injectors, smokers were primarily non-injecting drug users, who were younger, more likely to be female and use ecstasy rather than heroin. After adjusting for these differences smokers were less dependent on methamphetamine than injectors, but they took the drug as often and had similarly high levels of psychological distress, poor physical and mental health, psychotic symptoms, sexual risk behaviour and criminal involvement. Injectors who smoked had a similar demographic and clinical profile to injectors, including comparable levels of needle sharing, but they used methamphetamine more often and had greater criminal involvement. Within this treatment sample, smoking methamphetamine occurred among both long-standing injecting drug users and a comparatively younger group of non-injecting drug users. It was associated with less severe methamphetamine dependence than injecting, but more intense use patterns and similar levels of other harms.

Crystal methamphetamine smoking among regular ecstasy users in Australia: increases in use and associations with harm

This study examined (a) changes in crystal methamphetamine use among regular ecstasy users (REU) in Australia and (b) associations of crystal use and smoking with demographics, drug use and harm. Cross-sectional surveys (2000-06) of REU in three Australian capital cities, and in 2006, 750 REU in all Australian capital cities. The interview included: demographics, drug use, risk behaviour, recent criminal activity and methamphetamine dependence using Severity of Dependence Scale. There was little change in overall methamphetamine use, but a marked increase in crystal methamphetamine smoking. Among recent methamphetamine users in 2006 (n = 606), crystal methamphetamine users (n = 364) reported more frequent methamphetamine use and higher levels of dependence. Compared with those who had used only other forms of methamphetamine, recent crystal methamphetamine users were more likely to 'binge' on drugs for > or = 48 hours, engage in crime and experience financial and legal problems related to drug use. Non-smoking crystal methamphetamine users (n = 78) more often reported recent injecting and heroin use. Recent smokers were more likely to have: greater polydrug use, recently overdosed on a 'party drug', and accessed medical services for their drug use. Many of these associations were accounted for by their injecting and heavier methamphetamine use, rather than smoking per se. Crystal methamphetamine smoking among REU has increased markedly and is associated with significant harm. This appears related to smokers' heavier levels of methamphetamine use. Effective harm reduction strategies should be tailored to these specific risks.

Methamphetamine contamination on environmental surfaces caused by simulated smoking of methamphetamine

Previous publications have identified concerns regarding chemical exposures to children living in clandestine methamphetamine labs. Recently, however, concerns regarding exposures to children residing in homes where methamphetamine has been “smoked” have also been recognized. Many children associated with these residences reportedly test positive for methamphetamine. This study was conducted to determine methamphetamine contamination levels in a home where only “smoking” of methamphetamine was conducted. The study involved the simulated “smoking” of several amounts of methamphetamine in a hotel room. The levels measured after the “smokes” ranged from a mean of 0.23 μg/100 cm2 after a 0.1 mg “smoke” to a mean of 15.44 μg/100 cm2 after “smoking” a total of 2.4 mg of manufactured methamphetamine. The amount of contamination generally increased with the amount of methamphetamine “smoked”. Since a person was not inhaling, these levels would normally be reduced by 67–90% with contamination levels ranging from 0.02 to 0.07 μg/100 cm2 for a single “smoke” to between 1.54 and 5.10 μg/100 cm2 for multiple “smokes”. The methamphetamine contamination produced could result in a positive drug test for exposed children and may result in exposures above current standards.

Carotid artery dissection and middle cerebral artery stroke following methamphetamine use

Methamphetamine use may be associated with increased risk of stroke in young adults. We describe two cases of carotid artery dissection and ispilateral middle cerebral artery (MCA) stroke following methamphetamine use. ### Patient 1. A 36-year-old right-handed woman had sudden onset of speech difficulty and right-sided weakness while eating lunch. She presented to the emergency department within 30 minutes. Her medical history was significant for migraine and oral contraceptive and methamphetamine use. She was smoking methamphetamine with some left neck pain over the preceding two nights. Her initial examination was remarkable for global aphasia, left gaze preference, and right hemiplegia without Horner syndrome. The NIH Stroke Scale (NIHSS) score was 21. The initial head CT was unremarkable. IV tissue plasminogen activator (tPA) was started within 80 minutes of symptom onset. She improved significantly with only moderate expressive aphasia and mild right hemiparesis 8 hours after tPA therapy. A follow-up diffusion-weighted MRI of the brain showed a small infarct in the …

The relationship between crystalline methamphetamine use and methamphetamine dependence

Background The aim of the current study was to determine whether crystalline methamphetamine users are more dependent on methamphetamine than people who use other forms of the drug, and if so, whether this could be accounted for by their methamphetamine use history. Method A structured face-to-face interview was used to assess drug use patterns and demographics among a convenience sample of 309 regular methamphetamine users from Sydney, Australia. Dependence on methamphetamine in the past year was measured using the Severity of Dependence Scale. The use of crystalline methamphetamine in the past year was confirmed using a photographic identification sheet. Results Participants who had used crystalline methamphetamine in the past year were significantly more likely to be dependent on methamphetamine than participants who took only other forms of methamphetamine during this time (61% versus 39%). Methamphetamine dependence was also associated with injecting or smoking methamphetamine (67% and 58%, respectively versus 30% for intranasal or oral use), using methamphetamine more than weekly (68% versus 34%), having used the drug for more than 5 years (61% versus 36%), and having used ‘base’ methamphetamine in the past year (59% versus 39%). Crystalline methamphetamine use remained significantly associated with methamphetamine dependence after adjusting for these patterns of methamphetamine use. Conclusions Methamphetamine users who took crystalline methamphetamine in the past year were more likely to be dependent than methamphetamine users who had not taken the crystalline form of the drug during this time.

Potential Marker for Smoked Methamphetamine Hydrochloride Based on a Gas Chromatography-Mass Spectrometry Quantification Method for trans-Phenylpropene

Residue from smoked methamphetamine hydrochloride contains pyrolytic products that are detectable by gas chromatography-mass spectrometry (GC-MS). A validated GC-MS method was developed for the determination of trans-phenylpropene, a pyrolytic product of methamphetamine HCl, in residue of smoked drug as well as in human urine. trans-Phenylpropene and an isomeric internal standard, 2-phenylpropene, were extracted from urine using n-hexane. The method was validated for linearity over a range of 0.1-10 microg/mL with a limit of detection of 0.05 microg/mL, limit of quantification of 0.1 microg/mL, interday accuracy within 10.5%, intraday accuracy better than 3.7%, interday precision of 15.4%, intraday precision of 14.4%, and recovery of 89.1%. The method was applied to the detection of trans-phenylpropene found in the residue of methamphetamine HCl heated beyond its melting temperature on aluminum foil under simulated smoking conditions. The method is applicable to the detection of trans-phenylpropene in urine as a potential marker for smoked methamphetamine HCl abuse.

A Smoking Case in which Dimethylamphetamine as a Pyrolysis Product of Methamphetamine (MA) was Detected in the Urine of MA Abuser

There had been a smoking case in which dimethylamphetamine (DMA) and its metabolite DMA-N-oxide (DMAO) in addition to methamphetamine (MA) and amphetamine (AM), were detected in the abuser's urine. The analytical results of the confiscated leftover drug enabled us to consider that DMA detected in the abuser's urine would be the pyrolysis product formed by smoking MA. In this study, we carried out a smoking experiment based on this smoking case, and then gave the case full consideration. We heated MA hydrochloride in the range of 250°C to 350°C, in which demethylation and methylation reactions occurred mainly, with a smoke collection apparatus and a gas lighter, and trapped the generating vapor with an adsorption cartridge. AM and DMA were produced via the demethylation and methylation reactions of a methylamino group of MA. Allylbenzene, benzaldehyde, cis-β-methylstyrene, benzyl chloride and trans-β-methylstyrene were also formed as pyrolysis products. The sum of the formation ratio of DMA to the starting MA in the cartridge eluate and that in the residual materials inside the smoke collection apparatus was 4.98%. The adsorption of some pyrolyzates containing DMA on the cartridge means that these pyrolyzates can be taken into an abuser's body. The ratios of DMA to AM in the smoking experiments and the smoking case were 52.3% and 50.3%, respectively, and they were nearly equal. There will be no inconsistencies in considering that AM and DMA have been formed as pyrolysis products of MA in the smoking case, and DMA and its metabolite DMAO have been detected in the urine of this smoking abuser.

The Bioavailability of Intranasal and Smoked Methamphetamine

Clinical Pharmacology &amp; Therapeutics (2003) 73, P91–P91; doi:

Methamphetamine in Japan: the consequences of methamphetamine abuse as a function of route of administration

To determine differences in life backgrounds and clinical features between methamphetamine (MAP) smokers and injectors in Japan. Out-patient clinic at a psychiatric centre. Among 451 MAP abusers undergoing initial assessments, 116 subjects whom the first author had directly interviewed and treated were studied. In this study, life backgrounds, clinical features and psychiatric symptoms were compared between three subgroups: 42 (36.2%) in group S (smoking only); 57 (49.1%) in group I (injection only); and 17 (14.7%) in group SI (initially smoking, later injecting). Group I more often had parental absence (P < 0.001), a family history of alcoholism (P < 0.05), limited education (P < 0.001), or a criminal record (P < 0.001) than patients in the other two groups. Group S had the most cannabis use (P < 0.01), while group I had the most volatile solvents use (P < 0.01). Group S experienced their first psychotic episode sooner after first MAP use (P < 0.01), but showed fewer auditory hallucinations at initial assessment than patients in other groups (P < 0.001). Group SI was intermediate between groups S and I in life background, clinical features and psychotic symptoms, while they had lost control of their drug use most frequently (P < 0.02). In Japan, MAP smokers have different life backgrounds from injectors. Smoking MAP does not appear to be a safer route as regards losing control of MAP use and inducing psychosis than injection.

The suspected association between methamphetamine (‘ice’) smoking and frequent episodes of alcohol intoxication: data from the 1993 National Household Survey on Drug Abuse

This study estimates the strength of association between frequent episodes of alcohol intoxication and recent smoking of methamphetamine (‘ice’). Drawn from the 1993 National Household Survey on Drug Abuse, a total of 101 ice smokers were matched on neighborhood of residence to 816 non-smokers. Based upon conditional logistic regression analyses, persons with daily episodes of alcohol intoxication were an estimated five times more likely to have smoked ice, as compared with non-drinkers or drinkers with little or no history of alcohol intoxication. This estimate includes statistical adjustment for potential confounders (e.g. age, sex) and was statistically significant ( P=0.01). The association between frequent alcohol intoxication and ‘ice smoking’ offers an intriguing lead for a broad range of new research.