08/1/17

Repeating Past Mistakes

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At 4:45 a.m. on September 1, 1939, 1.5 million German troops invaded Poland. Two days later Britain and France declared war on Germany and World War II had begun. This “blitzkrieg” strategy became a blueprint of how Hitler intended to wage war. Generally unknown, one of the key tools in the success of the German Wehrmacht was their use of a methamphetamine called Pervitin. The troops were literally on cloud nine about Pervitin, as were their commanders.

Reports from the front lines on the drug included the following glowing testimonies:

Everyone fresh and cheerful, excellent discipline. Slight euphoria and increased thirst for action. Mental encouragement, very stimulated. No accidents. Long-lasting effect.The feeling of hunger subsides. One particularly beneficial aspect is the appearance of a vigorous urge to work. The effect is so clear that it cannot be based on imagination.

Not surprisingly, addiction became a problem. In April and May of 1940 alone, the Nazis shipped 35 million units of Pervitin and similar medications to its troops. Troops at the front sent letters home begging for more Pervitin. “Everybody, from generals and their staffs to infantry captains and their troops, became dependent on methamphetamine.” A lieutenant colonel leading a Panzer division wrote the following in a report:

Pervitin was delivered officially before the start of the operation and distributed to the officers all the way down to the company commander for their own use and to be passed on to the troops below them with the clear instruction that it was to be used to keep them awake in the imminent operation. There was a clear order that the Panzer troop had to use Pervitin.

“Speed” or amphetamine is in ADHD medications like Adderall (amphetamine/dextroamphetamine), Vyvanse (lisdexamfetamine). Methylphenidate (Concerta, Ritalin, Daytrana) is their close chemical relative. By the way, don’t be fooled by the creative spelling done by Shire for Vyvanse: “lisdexamfetamine” instead of “lisdexamphetamine.” Writing for The Guardian, Alexander Zaitchik noted  how the phonetic sleight-of-hand of Shire with Vyvanse and its aggressive marketing contributed to its success in getting the FDA to approve Vyvanse to treat “Binge Eating disorder.”

The company’s neo-phoneticism is intended to put more distance between its new golden goose and the deep clinical literature on speed addiction, not to mention last century’s disastrous social experiment with widespread daily speed use, encouraged by doctors, to temper appetites and control anxiety.

What follows is a history of amphetamines gleaned primarily from two sources: a paper on Amphetamines from the Center for Substance Abuse Research (CESAR) of the University of Maryland and a 2008 article by Nicolas Rasmussen for the American Journal of Public Health, “America’s First Amphetamine Epidemic 1929-1971.”

Amphetamine was first synthesized by a German chemist in 1887, but its stimulant effects weren’t noticed until the early 1930s, when it was rediscovered by accident. The chemist was trying to make ephedrine, a decongestant and appetite suppressant. Branded as Benzedrine, amphetamine was marketed as an inhaler for nasal congestion by the pharmaceutical company, Smith, Kline & French starting in 1933. It didn’t take some people long to figure out how to use Benzedrine for its euphoric effect. They cracked the container open and swallowed the Benzedrine-coated paper strip or steeped it in coffee.

Its use grew rapidly as medical professionals recommended amphetamine for alcohol hangover, depression, narcolepsy, weight-loss, hyperactivity in children and morning sickness in pregnant women. “The use of amphetamine grew rapidly because it was inexpensive, readily available, had long lasting effects, and because medical professionals purported that amphetamine did not pose an addiction risk.” During World War II, amphetamines or methamphetamine (a derivative of amphetamine) were used by both Allied and Axis troops to increase their alertness and endurance, as well as to improve their mood.

By 1945, over 500,000 civilians were using amphetamine psychiatrically or for weight loss. Between 1945 and 1960 commercial competition drove amphetamine use higher. After a patent expired in 1949, the FDA estimated the production of amphetamine and methamphetamine rose almost 400% by 1952. By 1962, production of amphetamines was approaching 43 standard 10-mg doses per person. This compares to concerns with the 65 doses per year in the present decade that social critics of our cultures point to as evidence of the overuse of psychotropic medications.

The adverse effects of amphetamine were becoming more evident by 1960. Amphetamine psychosis had been known since the 1930s, but was initially attributed to the drug unmasking latent schizophrenia. This claim is eerily similar to current interpretations of antidepressant activation unmasking latent bipolar disorder, rather than being seen as an adverse side effect of antidepressant medication. There were also concerns that amphetamines were addictive. But this didn’t stop individuals like President John F. Kennedy from using regular injections of vitamins, hormones and 15 mg of methamphetamine to help maintain his image of youthful vigor.

Large quantities of amphetamines were dispensed in the 1960s directly by diet doctors and weight loss clinics. Calculations of amphetamine use and misuse in 1970 estimated that at least 9.7 million Americans had used the drugs in the past year. And of those 9.7 million users, 3.8 million do so for nonmedical reasons and 2.1 million of those abused the drugs. Rasmussen said this first amphetamine epidemic was iatrogenic, “created by the pharmaceutical industry and (mostly) well-meaning prescribers.”  The current problem with the misuse of amphetamines has reached the peak of the original epidemic, namely about 3.8 million past-year nonmedical amphetamine users, with an estimated 320,000 of whom are addicted.

Parallel to this trend has been the surge in the legal supply of amphetamine-type ADHD medications such as Ritalin, Adderall and Vyvanse. American doctors, unlike those in other countries, have found it hard to resist prescribing these drugs. According to DEA production data, since 1995 medical consumption of these drugs has quintupled. In 2005, it exceeded the amphetamine consumption of 2.5 billion 10-mg amphetamine base units for medical use in 1969—compared to 2.6 billion base units in 2005. The following graph, taken from Rasmussen’s article, illustrates this increase. The data is based upon DEA production quotas and expressed as common dosage units of 10-mg amphetamine and 30-mg methylphenidate.

Rasmussen downplayed a causal connection between childhood stimulant treatment for ADHD and later nonmedical amphetamine consumption, but others don’t (See more on this below). However, he did think the wide distribution of ADHD stimulants, noted in the above graph, created a hazard. He cited data from a study that indicated 600,000 reported using stimulants other than methamphetamine nonmedically in the past month. So, “legally manufactured attention deficit medications like Adderall and Ritalin appear to be supplying frequent, and not just casual, misusers.”

An analysis of stimulant abuse in recent national household drug surveys found that half of the 3.2 million reporting past-year nonmedical use of stimulants in the U.S. only used psychiatric stimulants. And 750,000 of those reported they had never used anything but attention deficit pharmaceuticals in their entire lives. “On this evidence alone, one can fairly describe the high production and prescription rates of these medications as a public health menace of great significance.”

Another problem is the widespread acceptance of prescription amphetamines as a legal and relatively harmless drug that can be given to small children. Rasmussen said it is difficult to make a convincing case that the same drug is harmful if used nonmedically. Therefore he concluded any attempt to deal harshly with methamphetamine users today in the name epidemic control, without touching medical stimulant production and prescription was practically impossible and hypocritical.

There is some evidence of a connection between childhood stimulant treatment and later abuse or use of stimulants. See “ADHD: An Imbalance of Fire Over Water or a Case of the Fidgets?” on this website for a discussion of the association of addiction and ADHD medications as well as other adverse effects.

Nadine Lambert did a longitudinal study of ADHD children and normal controls. Her participants were followed through their childhood and adolescence and then evaluated three times as young adults. “ADHD was also significantly associated with amphetamine dependence.” However, being diagnosed with ADHD did not increase the odds of lifetime use of stimulants. She found that treatment with stimulants increased the odds of lifetime use of amphetamine and cocaine/amphetamines.

Commenting on Lambert’s findings in Brain Disabling Treatments in Psychiatry, Peter Breggin said:

It is not ADHD but the treatment for ADHD that puts children at risk for future drug abuse. This conclusion is entirely consistent with the fact that animals and humans cross addict to Ritalin, amphetamine and cocaine and that exposure to Ritalin in young animals causes permanent changes in the brain.

Hitler and his generals wanted victory at any cost and Pervitin (methamaphetamine), was part of that solution. German pilots called it “pilot’s chocolate”; soldiers on the front called it “Panzerschokolade” or “tank chocolate.” But towards the end of WW II, Vice Admiral Hellmuth asked German pharmacologists to develop a miracle drug. They had a wonder drug with Pervitin, but now they needed a miracle drug. So Gehard Orxzechowski synthesized D-IX. It was supposed to keep soldiers ready for battle even when they were asked, “to continue beyond what was considered normal.” It contained 5 mm of cocaine, 3mm of Pervintin and 5mm of morphine. It seems it was a good thing the war ended before they could distribute it widely to their troops.

We have a lesson to learn from the German Wehrmacht’s failure to make a better, smarter, stronger soldier through chemicals. The American war on drugs needs to recognize its greatest casualties are now coming from within—as with ADHD medications. And I think we need to reflect on the words of George Santayana in The Life of Reason: “Those who cannot remember the past are condemned to repeat it.”

10/12/15

“Shake and Bake” Meth Labs

© Mikko Lemola | 123rf.com

© Mikko Lemola | 123rf.com

The DEA posted maps of the total number of meth lab incidents from 2004 through 2014. There were 23,829 total incidents in 2004; 6,858 in 2007; 13,432 in 2012; and 9,306 in 2014. Missouri, Tennessee and Iowa were the state with the highest amounts of reported meth lab accidents in 2004; Indiana, Missouri, and Tennessee for 2014. Many states throughout the US had dramatic decreases in reported accidents. That’s the good news. The bad news is that a CDC study indicates injuries from methamphetamine-related incidents are on the rise in some parts of the country.

The CDC report noted there was an increase of reported incidents from 2001 through 2004; followed by decreases through 2007; with increases again through 2012. In 7% of the meth-related incidents, 162 people were injured, including 26 children (16%).  Among the injured, 136 (84%) were treated at a hospital, including 19 of the injured children. There were also two reported deaths: one probable meth cook and one law enforcement official.

The percentage of incidents with injured persons increased from less than 5% during 2001-2004 and 2005-2007 to 10% during 2008-2012. Most of the injuries were to members of the general public (97) and law enforcement officials (42). The most frequently reported injuries overall were: respiratory irritation, burns and eye irritation. Burn injuries were almost exclusively experienced by the general public, with 42 of the 44 reported injuries.

The researchers speculated that the initial declines in injuries were related to state and federal restrictions on the retail sales of common meth precursor drugs, ephedrine and pseudoephedrine. This was reversed in 2008 when meth cooks adapted by buying permitted quantities from multiple locations, often with false identification. Additionally, a new method for making meth became popular, one called “shake-and-bake.” This involves shaking smaller amounts of the precursor chemicals in a 2 liter plastic bottle. Unfortunately, the bottles frequently burst, causing burns and environmental contamination. “Burn injuries increased during this time, particularly to members of the public, who might have been meth cooks or household residents.”

Children who are present during the production of meth face many hazards. The Horton et al. study cited below reported that half the events with injured children occurred between midnight and 6 am, when most children are asleep. The authors speculated that sleeping children have an even higher risk of acute injury during an emergency event. “This is particularly true if the parents/care givers are in another part of the house and/or are under the influence of meth.” Several states have enacted laws to protect children from meth-related injuries.

A 2003 study by Horton et al. examined data from Hazardous Substances Emergency Events Surveillance (HSEES Events) identified eight children injured in meth events. “Five of the meth events with children occurred in private residences: three of which occurred in houses, one in an apartment building, and one in a duplex.” One of the children injured was 8 years-old. They concluded:

The HSEES data appear to indicate that the numbers of meth labs and associated emergency events will continue to increase, putting more children and other unsuspecting individuals at risk for hazardous substance(s) exposure. More action is needed to remove children from these dangerous environments and to educate innocent bystanders, as well as the substance abusers themselves, about the risks involved with meth and its illicit production.

A 2009 study by Thrasher et al., using case reports from the Washington State Poison Control Center found that a large proportion of meth lab exposures occurred in private households. Of the 198 exposed persons, 10.6% were meth cooks, 15.7% were law enforcement personnel, 35.4% were residents and 38.3% were classified as other. Twenty-eight of the reported exposures (19.2%) were children. “A subject’s own residence was the predominant site of exposure for cooks (71%), other adults (41%), and children (66%).”

Although the CDC study indicated recent increases in an increase in meth-related injuries, there is distinct likelihood the true incidence is significantly under reported. One limitation of the CDC study was that only five states were included. Now this was because those five states (Louisiana, Oregon, Utah, New York, and Wisconsin) were the only ones with complete information available for the time period 2001-2012. Another limitation was that meth incidents in homes were not included in the original data from the National Toxic Substance Incidents Program (NTSIP) unless there was a public health action, such as an evacuation.

Total Meth Incidents 2004 Total Meth Incidents 2014
Oregon 632 1
Utah 107 1
Wisconsin 109 14
Louisiana 176 11
New York 136 197
Missouri 2,913 1,034
Tennessee 2,341 958
Iowa; Ohio (2014) 1,666 919
Illinois; Michigan (2014) 1,576 750
Indiana 1,377 1,471

One illustration of this under reporting can be seen by examining the incidents reported in the DEA maps for those five states included in the CDC study to the incidents in the five states with the highest reported incidents in 2004 and 2014. The five states included in the CDC study were: Oregon, Utah, Wisconsin, Louisiana, and New York. The five states with the highest reported incidents in 2004 were: Missouri, Tennessee, Iowa, Illinois, and Indiana. The five states with the highest reported incidents in 2014 were: Missouri, Tennessee, Indiana, Michigan, and Ohio. The total meth incidents for the five states in the CDC study, for 2004 AND 2014 were less than the incidents for just one of the top five states—for both 2004 and 2012. Another readily noticeable fact is that the highest incident states for both 2004 and 2014 cluster in the Midwest, with the border states of Tennessee and Kentucky thrown in for good measure.

We can say there was an increase for the five states included in the CDC study, but can’t assume that increase holds throughout the US. It is likely the real total is much higher, especially in the selected states from the DEA map noted here.

The Department of Justice has produced a handy pamphlet of “Fast Facts” about meth labs. It described signs to look for if you suspect the presence of a meth lab. These signs include: unusual odors; excessive trash, especially chemical containers, coffee filters, red stained pieces of cloth, and duct tape rolls. Other indications are secretive, unfriendly occupants; frequent visitors, esp. at unusual hours; curtained or blackened windows; extensive security measures or attempts to ensure privacy, such as “no trespassing” or “beware of dog” signs.

Meth labs come in all sizes. Super labs produce 10 pounds or more of meth at a time; smaller “box” labs produce as little as an ounce and can fit in a box or backpack. They can be located almost anywhere: private homes, hotels and motels, automobiles, boats and luggage. They can also be found in commercial and industrial districts; or nestled away in a secluded rural area.

The chemical used to produce methamphetamine are extremely dangerous. Some are very volatile and could ignite if not handled properly, as apparently was the case in the motel video mentioned below. Even if there is not fire or explosion, meth production is dangerous. Exposure to the chemical can pose a series of health risks, including respiratory problems, severe chemical burns, pulmonary edema, and more. Look at a table in the pamphlet listing various chemicals used in meth labs and the hazards associated with them.

Health Research Funding posting some facts about meth lab explosions and also had two embedded videos of meth lab explosions. One video shows a mobile home in a rural setting going up in smoke. The other captured an explosion in a motel room on a security camera. Seven burn units have shut down over the last six years because of the unreimbursed costs of treating burn victims in meth lab explosions. One pound of meth results in six pounds of toxic waste. Eighty percent of the meth labs found and dismantled by authorities used the “shake and bake” method.

The simplified “shake and bake” method and smaller size of these labs means that rolling meth labs in cars, trailers or mobile homes can be easily moved to a secluded location where the manufacturing fumes can’t be detected and the toxic waste discarded. In 2002, Interstate 24 in southwest Kentucky was temporarily shut down when a car containing anhydrous ammonia exploded. It was a rolling meth lab. “Trucking down the highway allows them to disperse the rotten egg smell the labs produce and keep the waste out of their own homes.” Of the 2,000 chemicals that could be used to make meth, at least half are explosive.

Illustrating how meth labs can be found anywhere, here is an article about an explosion that occurred at a federal facility in Gaithersburg, MD. The explosion happened on the main campus of the National Institute of Standards and Technology (NIST) on June 19th, 2015. Federal law enforcement officials found pseudoephedrine, drain opener and a recipe for making methamphetamine in the lab. Representative Lamar Smith wrote in a letter to the Commerce Secretary said: “I am troubled by the allegations that such dangerous and illicit activity went undetected at a federal research facility.”

01/26/15

Meth is Coming to YOUR House

Congratulations, Walter White. Methamphetamine production (meth, speed, crank crystal meth, “ice” and others) has gone international … big time.  There has been a seizure of 2.8 tons of drugs, worth more than $1.5 billion dollars in Australia. There were 1,917 kilograms of MDMA and 849 kilograms of methamphetamine. This made it the largest seizure of meth in Australia and the second largest seizure of MDMA. The previous record for meth seizures was 580 kilograms.

To put this in context, the entire amount of all drugs seized last year by Customs and Border Protection in Australia, was about 5 tons. The Commissioner of the Australian Federal Police, Andrew Colvin, said: “By any measure this is an enormous seizure of illicit narcotics that have been removed from distribution on our streets.” The investigation is ongoing and they expect to arrest more than the initial six Australians currently in custody. “This obviously has linkages overseas that will take us, I’m sure, into Europe and parts of Asia.” They expect to have a number of people and a number of organized crime groups involved.

The drugs were concealed with furniture and other belongings within a sea cargo container that came from Hamburg Germany. The Australian authorities are working closely with the German federal police and Interpol. The message the authorities wanted to send to the “Breaking Bad” individuals involved in this operation was: “Go somewhere else, go to another country. Don’t bring your evil poison here to Australia.”

The UNODC (the United Nations Office on Drugs and Crime) Global SMART Update, Vol. 12, said that in North America, meth production has been primarily within the U.S. and Mexico. The movement in the U.S. to control the precursors for cooking meth, such as pseudoephedrine and ephedrine, led the Mexican drug cartels to begin manufacturing it in large quantities. In February of 2012 Mexican soldiers overran an abandoned ranch south of Guadalajara and found 15 tons of methamphetamine. There was, of course, a laboratory and another seven tons of the precursor chemicals used to manufacture meth. “The cheap and potent meth they supply now provides some three quarters of the drug consumed in America.”

East and South East Asia has been another center for the manufacture and distribution of meth. In 2011 and 2012, eleven countries in the region reported methamphetamine laboratories, “with China (46 percent) and New Zealand (39 percent) accounting for the largest share.” Although Myanmar has reported finding only small-scale meth labs, it is one of the main destinations for trafficked preparations containing ephedrine and pseudoephedrine. This suggests that industrial-scale meth production is going on within that country.

In Africa, the illicit manufacture of meth had been confined to South Africa. But since 2010, laboratories have been reported in Egypt, Nigeria and Kenya. In 2011 and 2012, five large-scale labs were discovered and dismantled in Nigeria. In May of 2012, Nigerian drug enforcement agents raided a building on the outskirts of Lagos and discovered a factory capable of producing 25 kg of crystal meth every few hours. Four large-scale labs have been found in Nigeria. In 2013, Kenya reported that it had dismantled its first meth lab.

In 2008, meth or sheesheh/shishe (Farsi for “glass”) was introduced to Iran. By 2010, Iranian meth manufacturing operations expanded their reach into Japan, Malaysia and Thailand. In 2011 and 2012 Iran reported seizing bulk amounts of ephedrine. By 2012, Iran was the world’s fourth largest importer of pseudoephedrine (used to manufacture meth). Iran spends around 1 billion dollars per year on anti-drug operations. Since 1979, almost 4,000 Iranian law officers have been killed in the country’s fight against the drug trade. In part, this results from severe punishments given out. “Nearly 80% of prosecuted traffickers are given the death penalty.”

One of the primary reasons the use of meth has spread so quickly in Iran is the lack of information. Azarzksh Mokri, a psychiatrist who teaches at Tehran University of Medical Sciences, said: “We really had a hard time convincing people that this is addiction.” Drug use and addiction in Iran is now the second highest cause of death after traffic accidents.

The Global SMART Update Vol. 12 said that illicit methamphetamine manufacture in Europe seems to be concentrated in Central Europe (the Czech Republic, Germany and Slovakia) and the Baltic States, mostly in Lithuania. The Czech Republic typically has small-to medium scale operations that sell their product locally, as well as in Austria and Germany. Conversely, Lithuania has medium-to large-scale laboratories that supply the demand for meth in the Nordic countries and the United Kingdom.

There is a series of twenty segments, or brief reports on global meth operations in the 2014 Global Smart Report. Here is a sampling of three of them. London Police have found a suspected meth lab in a residential area of West London in February. Again in February, a joint operation by U.S. agencies and the Australian Federal Police prevented 60kg of “black ice” methamphetamine from being shipped to Australia. In May, Guatemalan authorities dismantled a lab estimated to manufacture nearly 3 tons of drugs per month.

“Imagine this:
Ice is coming to YOUR house.
Can you HEAR it knocking?
Are you ready?
What will YOU do?”
Cornelia Connie D. DeDona