Confronting crystal meth

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The first time the government took Cookie into foster care, he was a baby, just six months old. By the time Cookie had reached his eighth birthday, he had been bounced between 15 different foster homes and his home with his mother. She was an alcoholic, deemed unfit to care for her child. She died when he was 11. Cookie started running away from foster care at nine years old. He's been living on his own since he was 13. Now at 24 years old, Cookie says he thinks he's 12 but feels like he's 86.

You can earn a PhD in eight or nine years, including an undergraduate degree. Cookie has spent the past 11 years living on the streets of Victoria and Vancouver, and he's been getting schooled about drugs for the past 14. So it would be fair to say Cookie knows a lot about the latest "it" drug, crystal meth, and what it's doing to people on Vancouver's streets. He started smoking cigarettes and pot when he was 10 years old; he did LSD at 11. He's been using meth for the past five or six years.

Cookie asked to be identified only by his street name. He hasn't touched meth for a week.

About meth, Cookie said: "It'll swallow somebody's soul."

But methamphetamine is consuming more than just souls these days. Campaigning politicians fill the airwaves, pledging millions of taxpayer dollars for anti-meth campaigns. Police departments are pouring money and manpower into busting meth labs. And the story of meth is chewing through forests worth of paper in publications across North America.

What is this monster we're said to be facing? And what can be done to keep people from its maws? An ounce of prevention, the cliché tells us, is worth a pound of cure. Research published in the Journal of Drug Education in 1995 estimated a $15 savings for every dollar spent on drug-abuse prevention.

Battle lines are being drawn under the banner of stopping meth abuse. It's become a major plank in several parties' platforms for the municipal elections on November 19. Some say it's an epidemic that must be eradicated with education and enforcement. Others urge a broader perspective-they say meth's popularity is a symptom of greater ills. The crux of the issue centres on the drug's very nature and the reasons why people use or abuse it.

Methamphetamine, as its name implies, is a member of the amphetamine class of stimulants. The "meth" refers to an additional methyl group (one carbon atom and three hydrogen atoms) attached to the amphetamine molecule. The methyl group makes the drug more fat-soluble and thus facilitates entry to the brain.

First synthesized in 1919 by a Japanese researcher, meth is known by various names. On the street it's called speed, jib, crank, ice, or crystal. Doctors prescribe the drug to kids with attention deficit disorder under the brand name Desoxyn. Over the decades, it has also been widely used to help soldiers fight or to help people control their weight. Like its chemical cousins cocaine, amphetamine, and Ritalin, chronic use of meth at high doses can lead to a schizophrenia-like psychosis.

Gord Robson's voice is thick with urgency as he describes the threat posed by crystal meth today. The Maple Ridge businessman and mayoral candidate leads the Rotary Club-funded Crystal Meth Task Force in his town.

"It's an epidemic that's sweeping through our society," he said. "My God, 10 percent of kids in high school are taking the drug. That's scary."

Robson said meth is uniquely addictive-that just one hit can lead a person down the road to addiction and ruin. He warns that B.C. could become like places in the U.S. where, he claimed, a third of some towns' populations are addicts.

In Vancouver, municipal candidates are scrapping over the battle on meth. One civic party, the NPA, pledged anti-meth education for students in Grade 4 and up, as well as a controlled- substances act. "It's a big problem. It could explode in the city," NPA mayoral candidate Sam Sullivan told the Georgia Straight. He said meth is a drug in a class of its own.

Sullivan's opponent, Vision Vancouver's Jim Green, said the NPA is overhyping meth and that alcohol causes far greater problems. Green wants to see the city address the broader issues that can lead people to addiction. He said people need alternatives if they are to stay away from drugs. "We need to allow our youth to blossom and flower."

Senior levels of government have joined the fray. This fall, the federal government announced stiffer penalties for meth production and funding for prevention programs. The B.C. government announced in September a $7-million package aimed at fighting the drug.

"[Crystal meth] is probably the most dangerous drug out there," B.C. Solicitor General John Les told the Straight. "This is not about harm reduction. It's about harm elimination."

Many warnings are dire, but the available statistics present a more optimistic picture. Survey data from B.C. and the U.S. show the number of teens who have tried amphetamines has declined since the late 1990s.

Vancouver's McCreary Centre 2003 Adolescent Health Survey showed a slight decrease in amphetamine use for B.C. teens. Five percent of teens surveyed in 1998 said they had tried amphetamines at some point in their lives, compared to four percent in 2003. In Vancouver, the number was even lower. Only two percent of Vancouver teens surveyed in 2003 said they had tried amphetamines at least once.

And the 10 percent figure for teenage meth use quoted by Robson? That number looks less grim upon closer inspection. That figure was drawn from a Surrey school-board survey and has since been regularly quoted in the media. The survey asked Surrey students whether they had used meth during the previous year. Nine percent answered yes. However, it would be a leap to conclude that all of those kids in Surrey are regular users, and American research indicates that meth isn't as instantaneously addictive as many have suggested.

The U.S. government's National Survey on Drug Use and Health found that about five percent of those who had sampled meth at any time in their lives could be described as addicts. For that, the researchers defined an addict as anyone who had used the drug within the previous month, a commonly used, albeit broad, definition.

Using the same criterion, the U.S. survey showed that 60 percent of people who had tried alcohol in their lives could be called addicts. Twenty-seven percent said they had gone on a binge in the past month-that they had had more than five drinks at one sitting. Applying the same standard to other drugs, the addiction rates for cigarettes (37 percent), marijuana (15 percent), painkillers (10 percent), and crack cocaine (eight percent) were all higher than that for meth. Heroin, at three percent, ranks lower.

Applying that American five-percent meth-addiction rate to the McCreary survey data (two-percent having tried amphetamines) would suggest that 99.9 percent of Vancouver teens are not addicted to meth. Indeed, a report released this June by the Canadian Community Epidemiology Network on Drug Use (CCENDU) showed that although 13.2 percent of Vancouverites had tried LSD, heroin, or speed in their lifetime, only 1.3 percent had used any of those drugs in the past year.

The lesson from this is that for most people, using meth can be, and is, an occasional or one-time affair. Whether you're looking at meth or any other drug, there is a spectrum of greys between abstinence and the blackness of addiction.

Sadly, for a minority of people, addiction is a real and nightmarish problem. From a prevention standpoint, the logical question is why?

Ongoing research suggests that some personality types are more susceptible to addiction than others. People who are more antisocial or who are risk-taking sensation-seekers are thought to be more likely to try and later abuse illicit drugs. Researchers are even finding genetic clues indicating that some people can handle alcohol and drugs better than others.

But evidence is emerging that social factors can play an overwhelming role in determining a person's risk of addiction, possibly even rendering such biomedical arguments moot. In other words, it's not the differences between drugs or people's temperaments toward drugs that matter most but how people choose to deal with the different environments they face.

One clue that supports this is how drug use is clustered among certain groups of people. According to the McCreary data, the vast majority of Vancouver teens-some 98 percent-say they have never tried methamphetamines. But for those living on the city's streets, that figure is almost reversed. According to the CCENDU study, 71 percent of street-involved youth say they have tried amphetamines. Fifty-seven percent say they've used it more than 10 times.

So what is it about life on the city's streets that makes meth so much more alluring? Robert Weppler works for the Vancouver Coastal Health Authority as a coordinator of a peer-support program for addicted street youth. The number-one drug of choice on the street, he said, is pot. But although weed may be enjoyable, it makes users hungry and lethargic. Street kids use meth when they need the opposite effect.

"It almost seems designed for street life," Weppler said of meth. Meth helps street kids survive.

Just as dieters use amphetamines to ward off hunger, street youths take meth. And just as some students use meth or other stimulants to aid their all-nighters, homeless kids use them to stay awake and protect themselves from theft or worse.

"Every time I fell asleep," Cookie said, "I woke up with less stuff than I had. I just got tired of sleeping and tried to stay awake as long as I could."

Meth doesn't make a user stoned or impaired like hallucinogens, alcohol, or pot. Some research indicates that meth can actually slightly improve a person's cognitive ability on simple tasks. Meth, or Desoxyn, is still prescribed to treat ADD. In other words, meth can help street kids get things done.

But the poison, as toxicologists like to say, is in the dose. Prescribed daily doses of methamphetamines-to children as young as six-range between 2.5 milligrams to 60 milligrams. Meth abusers typically take 100 to 1,000 milligrams a day, and they sometimes binge on as much as 5,000 milligrams, or five grams. Chronic use of amphetamines at such high doses can lead to a psychotic state indistinguishable from schizophrenia. That psychosis can sometimes be irreversible.

Sometimes, street kids use meth because there's nothing else to do. Meth's unique allure is that it's cheap, available, and long-lasting. As little as $5 can sometimes buy you a point (0.1 grams). Meth can produce an eight-hour high. The buzz from crack cocaine can last as little as a few minutes. That's why meth users rarely turn to crack as an alternative.

If you look at drug abuse as a disease, then you assume that drugs are the controlling factor. Therefore, the theory goes, people have little choice in how they use. But that doesn't seem to be the case. People usually have good reasons why they choose and use the drugs they do. People pop Prozac to ward off depression. People drink to lose their inhibitions. And as Weppler and Cookie described, street kids use meth to deal with life on the street.

"If you have a good relationship with drugs, you use them in ways that help you," said Donald MacPherson, the drug-policy coordinator for the City of Vancouver and author of the city's prevention report. But sometimes that relationship can sour.

MacPherson said a person who has a supportive network of friends, family, and community is less likely to abuse drugs. Such support can help make a person more resilient to stress and change. Abuse, poverty, homelessness, and alienation can all contribute to a person's risk of addiction. Yet these very factors are usually overlooked in anti-drug campaigns.

Transition periods in people's lives are when they are at most risk, according to MacPherson. Changing schools or jobs or homes are all events that can help trigger a slide into addiction. So can the end of a personal relationship.

It's not that such events are necessarily overwhelming, although sometimes that's the case. It's just that people behave differently in different contexts.

Many people try smoking in their teens, but few of those teenagers smoke a pack a day. It's after graduation and in the transition to their twenties when many casual-but-regular smokers turn into full-blown addicts. "Retirement is one time you just hit the booze," MacPherson said. Many seniors leave the workforce only to find themselves bored and then pick up problems with alcohol or gambling.

Cookie started using more meth after he broke up with his girlfriend. "I started getting into it more because there was nothing else to do," he said. Meth became a habit and then escalated into a problem.

Despite the many correlations between risk factors and abuse, it's still impossible to reliably predict which individuals will have a problem with drugs and why. Probably the best we can do is support initiatives that keep people connected to one another and minimize the harms caused by abuse and poverty.

When confronted with the issue of meth abuse, the public response has been to cry out for more education and enforcement. Governments, always sensitive to public pressure, have been eager to respond, directing resources particularly toward those two avenues.

The B.C government announced this September a $3-million public-awareness campaign to combat meth. One million will go to school-based programs; the rest will be spent in a mass-media effort. The federal government bumped up the maximum penalty for trafficking in meth to life in prison. Vancouver's NPA pledged childhood anti-meth education and stricter control of meth-making chemicals.

But of all the tools that can be applied toward drug-abuse prevention, education and enforcement may be the least effective. In the case of early drug education, it may even be counterproductive.

Several studies, including one conducted by University of Illinois researchers in 1998, found that kids who went through the popular elementary school-level Drug Abuse Resistance Education program (DARE) "had significantly higher levels of drug use" than kids who didn't. It seems that far from teaching kids about the dangers of drugs, the abstinence-based program may, in fact, have increased kids' interest in drugs.

And education-based prevention programs assume that people try illicit drugs only because they are unaware of the risks. But there is scant evidence available to back that premise.

"We should give people the information to make good choices," said Dan Reist, director of the communications and research branch of the University of Victoria's Centre for Addictions Research. "But if we think that giving people information will in and of itself change behaviour, we're dreaming."

And Reist believes that students don't buy the "just say no-or die" message. He said most students inclined to try drugs know people who have used drugs safely.

"They're going to say, 'It's a con job,'?" Reist said. "And they're right. It is a con job."

John Blatherwick is Vancouver's chief medical health officer. He said any plan that relies on teenagers to make rational decisions is doomed from the start. "The part of the brain that determines good judgment doesn't develop until last," he said, adding that he thinks brains probably mature at about age 25.

Experimentation is a natural part of being a teenager, as is taking risks. Even the most credible teachers are powerless to change that. "You have to understand that's how the brain works," Blatherwick said. What's important, he added, is minimizing the risk that experimentation will lead to harm.

In theory, enforcement should be an effective prevention measure if it could diminish drug availability or drive up costs. But has enforcement been able to accomplish either? "I would say not," said the RCMP's drug-awareness coordinator, Scott Rintoul. He said meth is largely as cheap and plentiful as ever.

Rintoul is worried an American trend could cross the border: meth producers there have adapted to police busts on bigger labs and limits to sales of meth's "precursor" materials, or ingredients. Hundreds of smaller labs have sprouted up to take the bigger labs' place.

The result, Rintoul said, could be more dangerous drugs hitting the streets. Smaller labs tend to have poorly skilled drug makers. Decreased supplies of materials may lead to a switch to more harmful ones.

Cookie shares the same warning. "It'll just make the drugs dirtier," he said.

But if education and enforcement have limited effectiveness in preventing harm from drug abuse, what should be done instead? "Controlling price and access to drugs is far more effective than education," UVic's Reist said.

Price controls in the form of taxation have changed how much people smoke or drink. Regulating who can smoke and where and when has helped send smoking into decline, according to Reist. But illegal drugs sold on the black market are out of government hands.

Numerous groups, including the Health Officers Council of British Columbia, the Centre for Addictions Research of BC, the City of Vancouver, and the Fraser Institute, have all issued a call for a regulated, legal drug market for currently illicit substances. The hope is to find a middle ground between illegal black markets and laissez-faire sale of heavily marketed drugs like alcohol and tobacco.

The debate over drug prohibition will not likely be settled soon. But our knowledge about risk factors tells us that there is plenty that can be done right now.

Bruce Alexander, a Simon Fraser University professor emeritus of psychology, believes we need to take a broader look at the issue of addiction. "It's a much more holistic approach that we need," he said during an interview at his home. Alexander believes that addiction is the natural result in a society where the bonds of community are increasingly being severed.

MacPherson feels that much good can result from sound government social policies. "We need to grapple with the inequities in society," he said.

If factors like abuse, poverty, and homelessness can put people at risk of abuse, then tackling these issues should, obviously, become preventive strategies. And if strong family and social bonds help make people more resilient, then, equally obviously, governments should invest in measures that encourage them.

Yet many government programs that address these issues have been scaled back in recent years. The effects could be felt on the streets. "It got chaotic," Cookie said. "A lot of the services didn't know what to do."

SFU's Alexander said that as a psychologist, there's little use in taking away an addict's drugs if you don't address what first got him addicted. "I can't cure him, because what do I have to offer him?" he asked.

Things are looking up for Cookie. He's learned a lot over the past few years and he's putting his smarts to good use. He works as a peer counselor with Crystal Clear, a group where he supports his fellow meth users. He said the experience has changed his whole outlook. His work helps give users a sense of community that's usually absent. He helps them to keep safe.

Crystal Clear is what's called a "low-barrier" group. Members don't have to have kicked their habits in order to join. People who take a dose to fight withdrawal symptoms can still participate, so long as they're functional and committed to work. It means there's still a door open for them while they're working to change their habits.

"With Crystal Clear, I can help all the people I see having problems," Cookie said. "A lot of them will listen to me. They take to what I say."

His work is helping him find a better life as well as helping others.

"In order to get somebody off of drugs, if they really want to get off it, you just got to find something to consume their time better than drugs," he said.