War on ‘ice’
heats up in Hawaii

Federal funds will help
local researchers study
a devastating addiction

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By Helen Altonn
haltonn@starbulletin.com

Hawaii, the "crystal meth capital of the country," is one of six sites selected for a national study of treatments for crystal methamphetamine (ice) addiction, says Dr. William Haning III, University of Hawaii psychiatry professor.

This is your brain This is your brain on ice The SPECT imaging system draws a three-dimensional picture of the brain based on the degree of circulation, thus indirectly measuring function. The top photo is of an undamaged brain of a normal adult without any drug addiction. The bottom photo is of the brain of an ice user with multiple defects, suggesting diminished activity and function.

Psychiatrists participating in the study hope to develop a treatment program and research structure that could support a clinic for ice addicts as a spinoff, Haning said.

Haning and Dr. Barry Carlton, also a UH psychiatry professor and chief of psychiatry at Queen's Medical Center, are principal investigators of the Pacific Addiction Center, a program of the John A. Burns Medical School and Queen's.

The National Institute of Drug Abuse is funding a series of studies that probably will amount to $350,000 in the first five years, Haning said.

Other sites in the study, coordinated by the University of California-Los Angeles, are Costa Mesa and San Diego, Calif.; Des Moines, Iowa; Kansas City, Kan.; and San Antonio. Rural areas are included because they are ice-manufacturing centers.

Haning said the study grew out of a 1999 ice addiction treatment think tank to which he was invited in Washington, D.C.

The major question was about what medications already on the shelf can be used to treat addicts, he said. Preliminary research suggested some will work, he said. "We just don't know how well they will work."

The Honolulu study began with a behavioral trial in August last year, using "talk therapy" to characterize ice withdrawal symptoms and establish a foundation for research with medications, Haning said.

Each site hopes to have 30 voluntary participants, each involved for about two months, Haning said. They are being drawn from Queen's emergency room, clinics or referrals from doctors and families, but recruitment is slow because of rigorous criteria, he said.

Expenses will be defrayed for participants, and they will receive free health screenings, treatments and referrals to specialists if medical problems are detected.

More than half of all psychiatric admissions to Queen's involve methamphetamine, Haning said, pointing out it is a growing health epidemic.

Usage in Hawaii has been estimated as high as 20 percent of the population but more realistically is 10 percent to 15 percent, he said. Those presently dependent on ice probably are in the 1 to 2 percent range, he said.

DEAN SENSUI / DSENSUI@STARBULLETIN.COM Dr. William Haning, left, and Dr. Barry Carlton used a computer-generated cross section of a brain to explain which portions are affected by crystal methamphetamine.

Ice is cheaper than marijuana now, said Carlton.

"For the cost of a movie, you can get high for a day and destroy your brain at the same time. That's actually the problem of kids."

Haning, medical school associate dean of graduate medical education and faculty affairs, said methamphetamine began in the United States as an oral tablet for therapeutic purposes and is still "a very good drug" for attention deficit hyperactivity syndrome.

But when the drug is used intravenously or by inhaling it "to enhance euphoric qualities," people are inclined to use it compulsively and progressively, he said.

He described how crystal meth spread from an intravenous epidemic in San Francisco to a nasal inhalation epidemic in San Diego. It became a "performance drug ... for bored, hard-working people to get through the day," he said.

In the first years, ice users may have a lower risk for accidents because they are more attentive, so they justify it as being "therapeutic," Haning said.

As they ramp up the dosage, however, they are at risk for developing psychiatric symptoms and medical problems, the psychiatrists said.

Illusions are the most common effect, followed by delusions and hallucinations, Haning said. What distinguishes crystal meth hallucinations is the subjects' feeling that something is touching them, like ants crawling on their skin, he said.

"You'll see some addicts with lots of gouges and scratches on the face and arms. They call it an 'ice rash.' But ultimately it's because they sense something is there and they're trying to carve it out of their arms or faces. It can be gruesome." Additionally, Carlton said they are "seeing 20-year-olds with 60-year-old hearts" and some addicts with ice-induced cardiac arrhythmia. Muscle also is destroyed, which can damage the kidneys, he said.

Ice also gets rid of chemicals that control mood and stability of the brain, and users coming off a high become overwhelmingly depressed, he said. Overstimulation causes paranoia and continued overstimulation "changes the brain to say, 'I need it, I need it, I need it,'" he said.

Criminal acts may occur with loss of restraint and inhibitions, Carlton said. Those doing crimes may argue that they were not intoxicated at the time, but the effects that reduce inhibitions last beyond intoxication, he said.

People who stop using crystal meth can return to normal, but if they even walk past or meet a person where they usually got their drugs, the brain tells them to "use, use, use" and the cycle starts over again, Carlton said.

The craving is also place-dependent, the psychiatrists pointed out. Haning said he had a student who spent months in recovery and got into Narcotics Anonymous. Taking the message to other addicts, he went to see a buddy with whom he used to smoke ice.

"An ice pipe was sitting on the coffee table. He goes with a copy of Narcotics Anonymous in hand, his head full of NA recovery, going up against someone willing to stop using, and before the hour was over, both were using ice because of the cue sitting there on the table," Haning said.

Participants will receive either a medication or a placebo (substitute) in a double-blind study, and the psychiatrists will meet with them three times a week for three hours a night. Sequential studies may go on five to 10 years, Haning said.