The methamphetamine epidemic:
    Even real problems get hyped

Reciting the mantra “moral panic” doesn’t make real problems disappear.

Press skepticism about official claims regarding drug abuse is always in short supply. Insofar as Jack Shafer of Slate merely wants to encourage such skepticism, I’m on his side.

But just as even paranoids have real enemies, genuine problems are sometimes the subjects of hype. Shafer seems to believe that cultural and media criticism is a substitute for exploring the real world, and that’s a bad mistake. Reciting the mantra “moral panic” doesn’t make real social problems disappear.

Some people, and in particular some officials, engaged in hyperbole with respect to crack. That doesn’t mean that crack didn’t create a horrible problem, and it certainly doesn’t mean that methamphetamine won’t create a horrible problem. There was an argument in the late 1970s and early 1980s about how dangerous cocaine was; back then the pessimists thought it might be nearly as dangerous as methamphetamine, but the optimists doubted it.

The pessimists were right that time, but they could have been wrong. However, there aren’t any sensible optimists with respect to the current meth wave, except for those who remain convinced that a drug as awful as meth will always generate quick social learning and therefore peak out at a relatively low level, leaving only one cohort of casualties.

Instead of analyzing Shafer’s writings line-by-line, let me simply state the facts as they are known to people who pay attention to this set of problems for a living.

1. No drug is instantaneously addictive. But some drugs — alcohol, for example — tend to have a slow buildup of abusing and then dependent behavior, while others tend to be faster. The stimulants tend to be on the fast side, with periods from first use to dependency typically measured in months rather than years.

2. No drug is addictive for everyone; no drug except nicotine in the form of cigarettes causes dependency in a majority of its users, and true addiction — chronically relapsing dependency — occurs only in a minority of those who become dependent. So if you interpret “methamphetamine is addictive” to mean “everyone or almos everyone who uses methamphetamine becomes an addict,” than it’s not true that methamphetamine is addictive. Of course, by that standard it’s not true that heroin is addictive either.

3. How dangerous a drug is doesn’t depend just on its addictive potential, but also on its toxicity and on the social circumstances surrounding its use.

*Heroin isn’t very toxic; its physical health risks mostly stem from adulteration, infection due to poor needle hygeine, self-neglect including poor nutrition and exposure to the elements, and dangerous ways of getting money to buy it.

*Cocaine is more toxic, both to the nose or throat if it’s snorted or smoked and to the brain.

*Methamphetamine taken by snorting, smoking, or injection is horribly toxic; a period of heavy methamphetamine abuse is likely to leave permanent cognitive deficits, the way a very long period of very heavy drinking sometimes does.

4. Another important dimension of harm is behavioral toxicity, especially aggressinon.

*Heroin (and the other opiates and opioids, such as oxycodone) produce mostly sedation; a heroin user acts aggressively only when he can’t get heroin.

*Cocaine is a stimulant, and notoriously a source of paranoid thoughts, but cocaine alone hasn’t been shown to lead to aggressive behavior, either, except in the rare case of those who use so much of it as to induce a stimulant psychosis.

*However, cocaine plus alcohol is a deadly mixture; the cocaethylene molecule that forms in the bloodstream of those who use the two together can be shown to unleash aggression under laboratory conditions. And heavy cocaine use not accompanied by alcohol use is rare; coke users need a way to calm down, and although some of them use the benzodiazepines or heroin alcohol is much more available.

*Methamphetamine is similar to cocaine, except that it’s cheap enough that stimulant psychosis is well within the price range of a substantial number of its users. It wasn’t drug warriors who first discovered that speed freaks aren’t good neighbors; that discovery was made by hippies in the Haight in the summer of 1967, leading to the famous “Speed Kills” posters.

5. Any expensive drug used by poor people will cause more havoc than the same drug used by richer people, because poor people who become dependent wind up doing more damage to themselves and others in the course of getting money to buy the drug.

6. The same drug used in different ways can have very different harm profiles. In general, anything taken by mouth is less of a problem than the same thing taken by snorting, which in turn is less risky than smoking or injection.

7. The transition from powder cocaine to crack was a transition both from richer to poorer users and from snorting to smoking. In addition, crack distribution, because it involved smaller purchase units and therefore more frequent buys, led to the development of highly violent retail markets that hadn’t characterized powder cocaine. So the notion that crack geneated a harsher social response than cocaine because it was being used by poor people, and that the response to crack was therefore a mere exercise in class and racial bias, is a dangerous, and basically silly, half-truth. You can convince some professors and journalists of it, but don’t try peddling that line in, say, Anacostia or Harlem or South Los Angeles.

8. No baby is born addicted to anything. Some babies are born physically dependent on opiates: that is, they suffer withdrawal pains. That’s a nasty thing to do to a newborn but it’s not fatal and is treatable. Stimulants such as cocaine and methamphatamine don’t generate withdrawal pains, so that issue doesn’t arise with those drugs.

9. Babies can be damaged by maternal drug use; we know that to be true for alcohol (though only if the mother drinks a lot; the fuss likely to be made today if a pregnant woman has a glass of wine with dinner has no biological justification) and nicotine, and there’s plenty of animal research showing it’s tue of cocaine and methamphetamine if those drugs are taken early in pregnancy.

10. Early claims about a tidal wave of profoundly damaged “crack babies” were exaggerated. Women who keep smoking cocaine are typically poor. Few of them get good prenatal care. Many of them drink heavily enough to cause fetal damage. Many of them smoke tobacco. So in looking at natural populations, it’s hard to tease out statistically the dmage done by crack itself from the damage done by the rest of the crack lifestyle. (Since crack-smoking tends to promote heavy drinking as a way of getting unwired, it’s not even clear whether the damage done by alcohol should be factored out when measuring the damage done by crack. The same is true of prostitution, spells in jail, poor nourishment, and other correlates of crack use. Are they confounding factors to be partialled out statistically, or are they collateral sources of damage related to cocaine use itself?)

11. The current consensus is that crack-smoking by pregnant women is bad news, but not dramatically worse news than other bad prenatal health habits. On the other hand, crack-smoking by mothers of young children is a nightmare: a crack pipe is far more rewarding, on a moment-to-moment basis, than a dirty diaper. Crack-smoking mothers tend to be (I stress, tend to be) neglectful mothers. As Harold Pollack puts it, the crack-baby scare was a pediatric problem misdiagnosed as an obstetric problem. That didn’t justify the stupidly punitive measures put in place, in still in place, directed at crack-using pregnant women. (Regina Knight is now doing 12 years’ hard time for homicide for having used cocaine and had the misfortune to deliver a stillborn child, despite the lack of medical evidence that late-term cocaine use causes stillbirth.) But to dismiss the problem of poor outcomes in the children of crack-using mothers as “all lies,” as Shafer does, requires a heart of iron and an ear of tin.

11. The evidence on pre-natal methamphetamine use isn’t in, but it’s likely to prove somewhat more toxic to the fetus than cocaine, simply because meth is somewhat more toxic to everything than cocaine. And a child growing up around meth users, and in particular a child growing up in and around places where the stuff is cooked, is exposed to additional dangers. Again, that doesn’t mean we should persecute pregnant methamphetamine users. But we shouldn’t ignore the risks to their children, either.

12. Most victims of substance abuse and dependency recover within a few months or years, and recover without receiving any professional help; as noted above, addiction — the chronic, relapsing form of dependency — is relatively rare. (Addiction looks common to treatment providers because the people who come to treatment are precisely the ones who couldn’t quit on their own, and because those with the non-chronic form of the disease show up for treatment once while addicts show up over and over and over again.)

13. Methamphetamine abuse, dependency, and addiction are just as treatable as most other forms of substance abuse disorder: that is to say, not very. Anyone who comes to treatment and stays in treatment is likely to reduce his or her consumption while the treatment episode lasts, and for some (often short) time thereafter; but most treatment episodes don’t last very long, because most people find undergoing treatment hard and unrewarding compared to using their favorite drug. (The big and important exception is opiate substitution therapy — methadone, buprenorphine, and LAAM — which has, for obvious reasons, a much better retention profile.) So it’s true that methamphetamine abuse and dependency are worth treating, but it’s also true that relapse rates are high and the lasting consequences of having been a heavy meth user are bad.

14. The current wave of methamphetamine use started in the Southwest in the mid-nineties (meth had long been endemic in San Diego) and has been spreading north and east ever since. It’s now virtually everywhere but the northeast. It tends to be the drug of rural working-class whites, though it also has a substantial Latino user base and a specialty market in the urban gay dance scene.

15. Methamphetamine is easily synthesised from pseudoephedrine (the active agent in Sudafed and other cold remedies) using as reagents a few other readily-available chemicals, though the production process is extremely smelly and leaves behind highly toxic waste products. The Internet-driven spead of knowledge of the pseudoephedrine synthesis was the driving force behind the current epidemic; a previous wave, associated with biker gangs in the 1970s, was based on a synthesis starting with phenyl-2-propanone (P2P) and fell back after the laws were changed to make P2P harder to get. As of five years ago, the market was dominated by very-small-scale “kitchen table” production, which in addition to making the drug widely available left a trail of Superfund sites in their wake.

16. It was proposed some years ago that pseudoephedrine be made a “behind-the-counter” rather than an “over-the-counter” drug (i.e., that each purchase require attention from a pharmacist, though not a prescription) in order to make it harder for kitchen chemists to get the stuff. The pharmacy chains and the drug companies, including Pfizer which owns the Sudafed brand name, resisted, and in doing so their hired lobbyists and publicity agents put out the word that the meth problem was mere “hype.” The libertarian “drug policy reformers” picked up that message, since it’s their basic view that no drug is as dangerous as the policy designed to control it. (Shafer’s piece basically recycles the “drug policy reform” talking points.)

So did the drug czar’s office, which preferred to keep the country focused on marijuana and other drugs used by middle-class kids (and associated with anti-war rallies rather than pick-up trucks with NASCAR decals): for the only time in recorded history, ONDCP criticized the anti-meth campaign as over-fearful. Now that the drumbeat of concern about meth has reached a sufficient volume, ONDCP has decided it really is a problem after all. (Pfizer has its substitute for Sudafed ready, which presumably means that its contribution to the “meth really isn’t so bad” movement will diminish.)

[Steve Suo of the Portland Oregonian wrote a brilliant series on the problem and its politics, which Shafer cites with appropriately effusive praise, without noticing that it demolishes his whole thesis that a non-problem is being hyped into a problem.]

17. Unfortunately putting Sudafed behind the counter now, while it would be useful in shutting down toxic domestic meth labs, probably wouldn’t matter much to overall meth supply; it’s estimated that 80% of the stuff now comes in from Mexico. Maybe if we’d done that ten years ago, the genie could have been kept in the bottle; but now that a mass methamphetamine retail distribution system and user base exist, it’s going to be next to impossible to shut off the supply of the bulk drug.

18. There’s probably some mileage to be obtained by spreading the “Speed Kills” meme in places where meth is just arriving, or where it hasn’t quite reached yet. If there’s any evidence that meth is jumping the racial barrier, that would be good time for heavy anti-meth messaging in the African-American community. The AIDS control commuity already has meth use among gays in its sights, but there’s more to be done on that front.

19. Other than that, we’re S.O.O.L as far as useful policy interventions go. Meth is simply not a good enforcement target because it has no obvious “choke point.” In particular, the hand-to-hand, acquaintance-to-acquaintance, low-frequency style of retail meth dealing makes it pretty close to invulnerable to enforcement, especially in rural areas where undercover work is hard.

I agree with Shafer that journalists should challenge their sources. I wish that he had challenged his, or talked to someone who regards drug abuse as a genuine problem to be managed rather than a battlefront in the culture wars.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com