FINAL REPORT METHAMPHETAMINES IN ALBERTA: A Focus on Children, Youth, and Families Authored by: Laura Parks, BKin Monica Jack, BComm, BSc Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 1 of 31 Acknowledgements The authors of this report and the Alberta Centre for Child, Family and Community Research would like to thank the members of the Alberta Methamphetamine Inter-ministerial Working Group for functioning as the Advisory Committee during the development of this report. Their input and feedback during this process was invaluable. The Advisory Committee included representation from: Alberta College of Pharmacists Community Members Edmonton Police Service Government of Alberta • Aboriginal Affairs and Northern Development • Alberta Alcohol and Drug Abuse Commission • Agriculture, Food and Rural Development • Children’s Services • Education • Environment • Health and Wellness • Human Resources and Employment • Justice and Attorney General • Municipal Affairs • Solicitor General and Public Security Health Canada (Healthy Environments and Consumer Safety) Justice Canada Royal Canadian Mounted Police We would also like to express our appreciation to those people who we interviewed to gather additional information for this report. Thank you for your time and insight into the issues around methamphetamine in Alberta. In particular, we would like to thank The Honourable Lynn Cook-Stanhope, Pam Downey, Mary-Anne Jablonski, MLA, Lisa Luciano, David Ray, Darcy Strang, Bill Tatton, Uwe Terner, Harold Trupish, Nina Vaughan, and those youth who so willingly shared their stories with us. We would also like to thank Alberta Children’s Services and the Alberta Alcohol and Drug Abuse Commission for funding the development of this report. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 2 of 31 Table of Contents Acknowledgements 2 Table of Contents 3 Introduction 4 Methamphetamine in the World and in Alberta 5 The Development of This Report 5 The Scope of the Methamphetamine Problem 6 History Who Uses Methamphetamine? Effects of Methamphetamine The Production of Methamphetamine 6 6 7 8 Methamphetamine Addiction ~ Not Just the Addict’s Problem Effects of Fetal Exposure The Effect of Addiction on the Family Effects of Production on the Family and Community Understanding Youth Culture Education Social Marketing Designing a Message Treatment Youth Treatment in Alberta Research into Youth Treatment Moving Forward Policy Implications Future Research In the End 9 10 10 11 Peer Influence Stress Other Factors Related to High Risk Behaviors Prevention 9 11 12 12 12 13 15 16 17 17 18 19 19 21 23 Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 3 of 31 Introduction Parents and community members alike worry about the impact of both legal and illegal drugs on their children and communities. Alcohol, cigarettes, marijuana, cocaine, ecstasy, methamphetamine—these are some of the many drugs that are impacting our society. They are addictive substances that cause damage not only to the health of individuals who abuse these substances but to the health of our society. People who abuse substances may face disease as a result of their addiction. They may injure someone, intentionally or unintentionally, as a result of their substance abuse. And they may lose their family, friends, and community as a consequence of their addiction. Addiction has been defined in numerous ways. However, the underlying concept relates to selfadministration of a substance or product which the user knows is not in his or her best interest. To combat addictions, then, the goal is to build healthy communities that work to reduce the likelihood of addiction from a biochemical, environmental, and behavioral perspective. Such community development will require strategies for prevention, treatment, and enforcement around substance abuse. Policy makers, service providers, researchers, and others are trying to work towards solutions in these areas to improve the health of our communities and decrease the negative influences of drugs. For more information about methamphetamine, other drugs or AADAC services, please contact your local AADAC office, call 1-866-332-2322 or visit www.aadac.com. Methamphetamine is a drug that has resurfaced in North America, but this time as a more potent type and more easily produced. As of late, the impact of methamphetamine on Alberta has become a concern. This report was written to describe the issues around methamphetamine from a unique Alberta perspective and focuses particularly on the impact this drug has on children, youth, families, and communities. Opportunities for policy and research around the issue of methamphetamine are suggested in the hopes that we can learn more about building healthy communities and put this knowledge into practice and policy. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 4 of 31 Methamphetamine in the World and in Alberta World-wide methamphetamine has become a pronounced problem in recent years, particularly among youth. Originally methamphetamine (also known as speed, meth, crystal, crystal meth, crank, or ice) gained popularity in Asia and the South Pacific, later working its way over to Hawaii and the West Coast of North America. Recently its use has spread eastward across Canada and the United States.1 Amphetamine-type stimulants, the family of drugs to which methamphetamine belongs, are the most popular illicit drug worldwide after cannabis; an estimated 0.6% of the global population used amphetamine-type stimulants in 2003, or about 16% of drug users worldwide.2 In North America where methamphetamine is the most common amphetamine-type stimulant, 1.1% or almost 3 million people used amphetamine-type stimulants.2 Although the following statistics and observations are limited (e.g. some include drugs other than methamphetamine), they suggest that Alberta has also been affected by the wave of methamphetamine use. • • • • • • In 2002, approximately 1 in every 13 high school students in Alberta reported using club drugs, like crystal meth or ecstasy, in the past year.3 Of youth receiving services from the Alberta Alcohol and Drug Abuse Commission (AADAC) in 20032004, 25% had used amphetamines/stimulants (e.g. methamphetamine, ecstasy) in the past year and 9% were concerned about this use.4 Doctors have noticed an increase in the number of patients coming in for emergency medical treatment relating to the use of methamphetamine although there are no readily available statistics documenting this.5 Royal Canadian Mounted Police notice the methamphetamine being In 2002, approximately 1 in sold on the streets is of higher purity than in the past and there is an every 13 high school increase in the sheer amount of the drug available.6 students in Alberta had The number of Schedule III drug seizures (including CNS stimulants used club drugs, like like ecstasy, amphetamines, and methamphetamine) in Alberta 7 crystal meth or ecstasy, in increased from 21 in 1998 to 252 in 2003. (Since that time, 7,8 the past year. methamphetamine has been reclassified as a Schedule I drug. ) The number of cases of methamphetamine trafficking has increased from 13 in 1998 to 198 in 2002, likely reflecting both an increase in use of the drug and an increased awareness and vigilance of law enforcers.7 The Development of This Report This report was prepared by the Alberta Centre for Child, Family and Community Research in response to the increasing concern about methamphetamine use among Alberta youth. The Alberta provincial government’s Inter-ministerial Methamphetamine Working Group was enlisted to act as an expert advisory panel. A search of academic literature was conducted using the following article databases: MEDLINE, PsycINFO, CINAHL, PubMed, ABI Inform, and Google Scholar. Because the literature on drug addictions spans many different sectors of research and society, these databases were selected to cover a variety of relevant disciplines. A limited search of Internet web sites provided insight into general information available to the public as well. Much of the research found in the academic literature was completed outside of Alberta and Canada, so caution should be taken in generalizing findings from such research studies to Alberta. To further understand the nature of the methamphetamine problem in Alberta, interviews were conducted with Alberta professionals in various sectors that handle issues involving methamphetamine. These professionals included police and fire fighters, a Provincial Court Judge, medical professionals, treatment and rehabilitation professionals, researchers, Alberta Children’s Services and a Member of the Legislative Assembly of Alberta. In total, approximately 300 journal articles, reports, web resources and personal communications were obtained, and those which were most relevant to the objectives of this report were Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 5 of 31 included. This report is not intended to be a comprehensive or systematic review of the research literature but highlights important issues around methamphetamine as pertains to children, youth, and families. The purpose of this report was to describe how the use, abuse, and manufacture of methamphetamine may be affecting Alberta children, youth, and families. It covers the scope of the problem, including who uses the drug, its effects, and how it is produced. Next, the impact of methamphetamine on infants, families and the community are discussed. In keeping with a focus on youth, the youth culture is explored as well as prevention and treatment efforts. Finally, recommendations for policy and future research are provided. The Scope of the Methamphetamine Problem History Methamphetamine, a stimulant of the central nervous system, was first synthesized in 1893 in Japan. It is a derivative of amphetamine, which was created in Germany in 1887.1,7 Among its first uses, methamphetamine was prescribed to treat certain medical conditions, such as asthma, obesity, and depression, and was also used by armies during the Second World War to enhance the endurance of soldiers.1 In the 1960s, the first illicit labs began to appear in California, producing methamphetamine or “speed” as it was commonly known at that time.1 The dangerous properties of the drug were not fully understood until the 1970s; subsequently, new restrictions were placed on the legal production and distribution of the drug.1 With legal uses restricted, illegal production and use of methamphetamine increased.1 In Canada, methamphetamine was classified as a Schedule III drug until this year, but recent legislation in Canada has re-classified methamphetamine as a Schedule I drug. This means maximum penalties for offences involving methamphetamine are now the same as those for offences involving cocaine or heroin.8 If someone is caught producing, selling, importing or possessing any of these drugs, they can face up to a life sentence in prison. The first type of methamphetamine that was popular during the 1960s was dl-methamphetamine and could only be injected or snorted. Starting in the 1980s, the popularity of methamphetamine grew again, but this time the methamphetamine was a more potent type (d-methamphetamine hydrochloride). This new type of methamphetamine can be produced using easier cooking methods and more readily available precursor chemicals (i.e. ingredients) than in the past. It also comes in many different forms, including pills, crystals, powder, or liquid. Although it can be taken in a variety of ways, smoking is one of the most common ways. It is this type of methamphetamine (d-methamphetamine) that is popular today, and it is about ten times the strength of the type of methamphetamine that was popular in the 1960s (dlmethamphetamine). Who Uses Methamphetamine? In the past, there were typical groups that used methamphetamine, and these groups still use the drug today. People who typically used methamphetamine were those who felt they needed extra energy to stay up longer, like students, people in occupations with pressure to work longer hours, and parents balancing work outside the home with child care and housework.1,9,10 In addition, methamphetamine, or “tina,” was, and still is, a popular drug in the homosexual club scene because it gives rise to reduced social inhibitions and increased sexual arousal.11,12 However, young people from all walks of life are also using methamphetamine. Street-involved youth as well as junior and senior high school students may try the drug, usually under the influence of their peers.13 As The Alberta Youth Experience Survey (TAYES) conducted by AADAC in 2002 found, 2.7% of youth in grades 7 to 9 and 7.6% of youth in grades 10 to 12 had Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 6 of 31 used club drugs (crystal meth or ecstasy) in the past year.3 However, this survey was administered to Alberta youth who were in school and does not reflect the higher prevalence of methamphetamine use among street-involved youth.13,14 As an example, three of the four people approached for in-depth interviews at a popular youth hangout in Calgary had used or been addicted to methamphetamine.13 In the past ten years or so, the rave culture has also become popular among youth, although some believe the growth of this culture is now leveling off.15,16 Raves are all-night parties with techno music and marathon dancing where drugs, like methamphetamine and ecstasy, are widely available and inexpensive.15,16 Drug use is generally accepted at raves although some youth may choose not to use drugs.15,16 Data from a limited sample of Alberta youth who attend raves suggests that although most may believe methamphetamine and cocaine are harmful and dirty drugs, perhaps close to half may try both drugs at least once and about one-third may use methamphetamine on a weekly basis.16 Of Alberta youth who attend raves, most may believe methamphetamine is a harmful and dirty drug, but close to half may try the drug at least once and about one-third may use methamphetamine on a weekly basis. Methamphetamine is sometimes referred to as “poor man’s cocaine” due to its relatively low cost compared to cocaine and heroin.13,17 Although drugs of all kinds are prevalent on the streets (and perhaps even in group homes according to a former resident), methamphetamine is popular with streetinvolved youth because it is inexpensive, easily available and has a long-lasting high.13,18-20 Although certain types of people may be more likely to use methamphetamine, it is important to recognize that people may use the drug for a variety of reasons. Some of these reasons may include the following: • To escape from boredom, sadness, or reality13 • To fit in and feel socially connected13 • To gain courage and confidence to experience things they might not have otherwise had the nerve to do11 • To gain energy to meet the demands of life, work, or school10 • To lose weight10 If methamphetamine use progresses to addiction, the drug often becomes a barrier in life as things the addict once valued slip away (e.g. friends, family, health, job, housing, or children), holding the user on the outskirts of a society the drug was supposed to help them fit into.11,13,18,21 Effects of Methamphetamine Methamphetamine is an addictive drug that can be injected, smoked, inhaled, or ingested orally and can provide the user with up to 12 hours of increased energy, euphoria, and lowered inhibitions.1,21 When smoked or injected, methamphetamine produces an intense “rush”, or sense of intense pleasure, lasting a few minutes.1,21 This is then followed by the period of euphoria. Because the drug reaches the brain so quickly after smoking or injection and produces a rush, methamphetamine is especially addictive when smoked or injected.1,21 Methamphetamine increases the heart rate and breathing rate and can also cause shakiness, loss of appetite, agitation, paranoia, violent behavior, and psychosis-like symptoms (e.g. hallucinations).1,5,12,21,22 Because methamphetamine causes an increase in heart rate and blood pressure, users may come into the emergency room complaining of chest pains or a heart attack. Seizures and dangerously high body temperatures are other effects of high methamphetamine doses and can be deadly.5,21 People who use methamphetamine may also have itchy skin which could lead to sores and infection. Furthermore, methamphetamine is a highly acidic drug which causes teeth to decay at an extremely accelerated rate, especially when combined with high soft drink and sugar consumption and neglect of self-care or personal hygiene among those addicted to the drug.23 As use continues, people may take the drug for several days to maintain the high (i.e. binge). Particularly on weekends, emergency rooms may encounter people on methamphetamine binges as one Calgary doctor observed.5 These cases tend to be characterized by dehydration and exhaustion from all night dance parties and malnutrition from not eating while on the drug.5 As users come down from the high, Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 7 of 31 they may experience “tweaking” or out-of-control rages before they “crash”. When crashing, users usually feel extremely exhausted and may also experience depression and irritability.11,24,25 One reason methamphetamine users tend to use many different drugs is to control the crash after the high.18,20,26 Chronic methamphetamine users tend to develop a tolerance to the drug, which forces them to seek larger and more frequent doses to bring on the high that was experienced at first use.21 Prolonged use of the drug also causes changes in the brain, resulting in slower reaction times and a loss of short term memory.27,28 Symptoms caused by long-term methamphetamine use can be like those found in Parkinson’s disease and schizophrenia.18,29 In particular, methamphetamine abuse causes damage to dopamine terminals in the brain, a finding similar for people with Parkinson’s disease. (Dopamine is a chemical messenger in the brain involved in motor control.) To determine if there is a link between methamphetamine abuse and later development of Parkinson’s disease, researchers are first trying to see if damage to dopamine terminals caused by methamphetamine is long-lasting, or if partial recovery is possible with lengthy periods of abstinence.27,29 At this point, the evidence is mixed as to whether the damage is irreversible.27,29 In Japan, researchers are beginning to explore whether methamphetamine induces the onset of schizophrenia among those who are vulnerable to developing the condition.30 The Production of Methamphetamine Unlike cocaine and heroin, which are made in high-output production operations in foreign countries and imported illegally to dealers in Canada, methamphetamine can be produced, or “cooked,” by a quick, relatively simple process using readily available and legal ingredients (e.g. cold medications).7 The drug is produced in labs which often consist of a network of rubber tubing that connects glass heating containers and plastic storage tubs; such labs can be found anywhere from remote barns and pick-up trucks in rural areas to bathtubs, hotel rooms and garages in the city.6,19,20,31,32 Most labs run by individuals or small groups are small scale and generally make enough methamphetamine to support the cook’s habit with some left over to sell. Super labs, on the other hand, are capable of producing 10 lbs (or 4500g)1 or more of methamphetamine within a 24-hour production cycle and are more often run by organized crime groups.20,33 At the time of this report, there were 2 suspected large scale labs outside the Edmonton area.20 The financial lure for organized crime groups is clear. As a former user observed, for a relatively small investment of around $1000 for ingredients and supplies, a single cook can make about $10,000 a batch.13 Producing methamphetamine is a dangerous process because the chemicals used to make the drug and the waste produced are corrosive, explosive, flammable, and toxic if inhaled, ingested, or absorbed through the skin.6,19,20,34,35 Attesting to these dangers is the fact that methamphetamine labs are often discovered when they explode.19,20,32 Detection by other means is becoming more difficult as portable labs become more common, particularly in cities.19,20,32 In an effort to reduce the number of clandestine labs, both the provincial and federal governments are discussing the control of precursor chemicals used to produce methamphetamine, namely ephedrine and pseudoephedrine. Federal Bill C-349 proposes an amendment of the Controlled Drugs and Substances Act that would give Royal Canadian Mounted Police the right to prosecute people found to be in possession of the precursor chemicals used in the 1 A single hit of methamphetamine is 0.1g and often referred to as a ‘point’. Thus, 10 lbs of methamphetamine would equal about 45,000 hits. As a user’s body adapts to low doses of methamphetamine, a tolerance to the drug is built up and the user will need larger amounts of the drug to get the same rush they initially experienced. Consequently, those addicted to methamphetamine will often take many hits at one time, up to or even exceeding 1g. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 8 of 31 production of methamphetamine.36 In Alberta, Bill 204, the Precursor Limiting Act, proposes to reclassify all products that contain ephedrine or pseudoephedrine as the main therapeutic agent (e.g. cold medications) as Schedule II drugs, which would mean they could be sold only from behind a pharmacy counter.37 Some stores in Canada (e.g. Shopper’s Drug Mart) and United States (e.g. Walgreens) have already moved these products behind the counter, partly due to increased theft.6,38 Limiting the sale of these products is hoped to impact home-based labs in the province, but large-scale super labs likely have alternate routes to access the large amount of ephedrine and pseudoephedrine they require. Findings on the effectiveness of controlling precursor chemicals in the United States are unclear.39 Methamphetamine Addiction ~ Not Just the Addict’s Problem Although there is concern about youth being addicted to methamphetamine, this is not the only way that methamphetamine can impact children, youth, and families. Effects of Fetal Exposure A number of studies have been conducted on infants exposed to methamphetamine in utero (i.e. while in the womb), but results are inconclusive about the extent of damage to the infant.40-47 This is because many women who use methamphetamine also use alcohol, tobacco, marijuana and other drugs during their pregnancy, making it difficult to distinguish between the direct effects of methamphetamine and the effects of the other drugs on the fetus.40 In spite of these difficulties, some research suggests that women who use methamphetamine throughout the In utero exposure to methamphetamine entire pregnancy tend to have infants of lower birth may cause brain damage and persistent weight and smaller head circumference compared to behavioural problems to the child. women who only use the drug for the first two 40 trimesters. Such growth restrictions may be caused by methamphetamine restricting nutrients from being passed from the mother to the fetus and/or as a result of the mother’s poor eating habits when using the drug.40,46 In addition to growth restrictions, development of the fetal heart may be affected by methamphetamine exposure.47,48 Furthermore, case studies suggest a possible risk of premature delivery or spontaneous abortion due to increased maternal blood pressure from methamphetamine use.49 Other studies have looked at the childhood outcomes associated with in utero methamphetamine exposure. A recent small-scale study found that some brain structures were smaller in children exposed to methamphetamine in utero (but limited other drugs) compared to those who were not exposed.46 Children exposed to methamphetamine also had poorer performance than the non-exposed children in visual motor integration, sustained attention, long-term verbal memory, and long-term spatial memory.46 Researchers think there may be link between fetal methamphetamine exposure, smaller brain structures, and poorer learning among these children.46 A study in Sweden had followed up children who had been exposed to methamphetamine in utero and found that at four years of age their IQs were lower than the national average.42 At age 8, these children were found to have more aggressiveness and peer-related problems,45 and at age 14, a higher proportion of methamphetamine-exposed children were in lower than expected grades or receiving special lessons outside school, compared to the national average.50 However, this study included many children who had also been exposed to tobacco, alcohol, and other drugs and could not control for changes in care (e.g. parent custody to foster care) or unstable living environments.42,45,50 Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 9 of 31 The Effect of Addiction on the Family Children whose parents abuse methamphetamine experience the many detrimental social effects this drug has on families. Methamphetamine use can lead to a powerful addiction,21 and although some parents succeed in overcoming their addictions, many are overcome by their addiction which takes control of their life.43,51 Children of people addicted to methamphetamine are often the subjects of neglect.22,43,45,51-53 Domestic violence and criminal activity are also common in homes where methamphetamine is used or manufactured.45 Such living conditions could also contribute to social and emotional problems in these children, such as low self-esteem, aggression and withdrawal from society.54 Developmental delays in speech and language have also been noticed by professionals.53 If teachers and community members notice a child has poor hygiene, is showing up very early to school, or is coming unprepared without a lunch or proper clothing for the season, further investigation may be required and should consider the possibility of substance abuse in the home.22,51,53 To some extent, users may be aware of the negative impact their drug use has on their family although the most obvious consequences may not necessarily occur to them. Females addicted to methamphetamine in Seattle admitted that their drug use affected their ability to parent by making them irritable.55 However, they did not readily recognize that being “high” and drug seeking activities were also barriers to parenting well.55 According to a representative from Children’s Services, there seems to be a growing number of drugendangered children in Alberta.51 There is current legislation and policy in place to protect children who are found to be in danger due to chronic drug use by their guardians or caregivers.51 A court order is given for the children to be removed from the home until it is deemed safe for them to return.20,22 In the best case scenario, one parent may not be addicted to drugs, so Children’s Services will try to persuade that parent to remove themselves and their children from the addicted parent until he/she is rehabilitated. If both parents are found to be involved with drugs, Children’s Services will try to place children with an extended family member who has been deemed a capable guardian. If these two options are not possible, children will be placed in foster care until the parents are able to care for the children again or a more permanent care situation can be arranged.22,51 Although parents may promise to undergo treatment and stay off drugs to regain custody of their children, it may be a condition of the court that parents are randomly screened for drug use to make sure they remain clean.22 If parents are committed to take immediate action to break their addiction and provide a better life for their children, Children’s Services may allow the child to remain with their parents, but again a court-ordered monitoring system would be in place.22,51 As a sign of how powerful this addiction can be, parents may give up their children when forced to choose between their addiction and their children.20 As with other drug addictions, methamphetamine addictions within families put costly demands on the social system required to care for drug-endangered children. Most importantly, it creates an unstable living environments for affected children—sometimes including changes in custody—and also hinders the optimal development of these children. Many times an addiction to methamphetamine will also lead to involvement in the production of methamphetamine, which adds to the negative impact on children in the home as described below.13 Effects of Production on the Family and Community As stated before, producing methamphetamine is a dangerous process because the chemicals used to make the drug and the waste produced are corrosive, explosive, flammable, and toxic if inhaled, ingested, or absorbed through the skin. 6,19,20,34,35 Thus, illegal methamphetamine labs pose a health risk to those who may come into contact with the lab and its chemicals.35,56 This may include the following people: • people involved in the cooking process • children living in a home where methamphetamine is produced • professionals who first respond to the scene of a discovered lab • people who are in the general area of the lab. Respiratory irritation, headaches, dizziness, nausea, eye irritation, and burns are effects found among people exposed to methamphetamine labs.35,53,56 Liver and kidney disease, cancer, anemia, risk of Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 10 of 31 infection, and severe lung disease have also been reported by those exposed to methamphetamine labs.53 There are no known published studies that have specifically looked at the effects of methamphetamine labs on the long-term health and development of children. However, it is clear that children in homes where methamphetamine is produced are in danger. Not only are they exposed to toxic chemicals, but there is the potential for these children to accidentally or intentionally take methamphetamine.53 Methamphetamine labs pose significant health and safety risks to all who are exposed, however, children It is clear that children in homes are particularly vulnerable. Proposed legislation is being where methamphetamine is developed in Alberta to ensure that children can be apprehended produced are in danger. from guardians or caregivers who have exposed children to clandestine drug labs or grow operations. This proposed legislation may be passed as early as Spring 2006. Methamphetamine labs pose a danger to the general public as well. For instance, there was a case in Alberta in 2002 where unsuspecting neighbours and housekeeping staff in an apartment building suffered from side effects from exposure to phosphine gas produced by a methamphetamine lab in an apartment unit.6,56-58 At high concentrations, phosphine gas can induce coma or even cause death, as with three men who died in a methamphetamine lab they had set up in a California hotel room.58 Thus, methamphetamine labs pose a risk to the safety and well-being of those who knowingly and unknowingly come into contact with the ingredients and by-products. Understanding Youth Culture Turning again to focus on youth methamphetamine use, it is important to first of all consider the youth culture. Adolescence is a time of hormonal and developmental changes, a changing social environment, and transitions from childhood to adulthood.59 As part of these changes, adolescents will try many new things for the first time, from driving a car and getting their first job to behaviors that are considered high risk. Risk-taking If a youth is involved with a peer behaviour is closely associated with the adolescent maturation 59 group who has easy access to and process. In fact, compared with other age groups, teenagers uses drugs, that youth is much participate in higher amounts of reckless, risk-taking and sensation-seeking behaviours.59 more likely to use drugs. Peer Influence During adolescence, peer influence and social interaction gain primary importance as youth seek the independence required for adulthood.59,60 Social influences are believed to be a primary reason young people start using drugs.61 Indeed, girls may start taking methamphetamine to control their weight, and teens will try drugs at parties to not feel left out.13,55,62,63 The rave culture, where drugs are widely used, is also popular among youth because everyone is accepted in this culture and social interactions seem easier for people.16 From junior high to high school, the amount of high-risk peer behaviours increases drastically,60 and if a youth is involved with a peer group who has easy access to drugs and uses drugs, that youth is much more likely to use drugs.3,16 Some youth end up on the streets as a result of their drug use, running away or being asked to leave their homes; underlying factors may include poverty, abuse, and family dysfunction.64 Sometimes young people, particularly those from high socioeconomic status may be drawn to the streets by the perceived excitement and challenge of surviving in the “urban wild”.64 When living on the streets, youth connect with a new peer group where drug use is prevalent. On the street, some consider it more safe to sleep during the day and stay up all night, so youth will use methamphetamine to get them through the night and help make it more fun.13,18,19 Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 11 of 31 Stress For adolescents, it is likely both daily hassles and major life events that contribute to the stress encountered during this time of physical, mental and social change.59,65 In response to stress, some adolescents may experience depressed moods and anxiety—perhaps more so than their adult counterparts.59 Adolescents may search for new, “mature” ways to cope with all the stress in their lives.59 Some youth may turn to drugs as a way to manage problems and stress.59 To an adolescent, methamphetamine may at first seem like a drug that could help solve problems, like being overweight, being shy, not fitting in, difficulty keeping up with school, or feeling down. Level of stress does appear to be a factor related to drug use and abuse. 59 Although drug use itself may directly or indirectly cause stress, researchers are also exploring the possibility that stress may affect the decision-making abilities of youth, including decisions related to drug use.59 Other Factors Related to High Risk Behaviors Although peer group and stress are related to drug use, there are some other factors related to high-risk behaviors. • Adolescents who have experienced physical or sexual abuse are more likely to abuse alcohol or drugs.66 • Adolescents with families who have had alcohol problems or used drugs are more likely to abuse these substances themselves.66 • Adolescents engaging in other high-risk behaviors, such as alcohol, tobacco, and marijuana use, and early sexual activity may be more likely to use methamphetamine.9 • Adolescents not living with both natural parents may have higher incidences of hard drug use (e.g. cocaine, methamphetamine).3 • Adolescents without a close family relationship may be more likely to use methamphetamine.9 • The likelihood of high-risk behaviours may increase with each tattoo or body piercing, and multiple body piercings are related to a higher incidence of hard drug use.67 • Youth who attend alternative high schools (schools for students whose needs are not addressed in regular schools) also have a higher incidence of high-risk behaviours (average of 5.4 high risk behaviours compared to 3.6 among students attending a traditional high school).68 This is not to say that attending an alternative high school will cause students to engage in high-risk behaviours; it may well be that such schools attract at-risk youth. Although the above factors may be related to high-risk behaviors, they will not necessarily lead to highrisk behaviors. These factors may indicate an opportunity for further discussion with youth about drug use and other high-risk behaviors, but it is important to remember that youth in general are at risk for engaging in high risk behaviours.59 However, these factors can help policy makers decide which youth are more likely to engage in high-risk behaviors and thus which should be targeted more intensely with prevention efforts. Prevention A moderate amount of risk-taking behavior is considered adaptive by some professionals as it may help youth explore adult life and behavior and help them acquire the skills they will need once they reach adulthood—if they can avoid long-term negative consequences of certain behaviors.59 The reality, though, is that drug use is potentially even more dangerous for teenagers, as the time from initial drug exposure to substance dependency is often shorter in adolescents than in adults.69 However, youth may not recognize the negative consequences of using a particular drug, like methamphetamine. Perhaps youth have never heard of the drug and its effects, have been misinformed, or feel invincible despite everything they have been told about the drug.70 Or perhaps youth have grown up in environments where drug use occurred and are consequently more likely to develop an addiction.66 Whatever the case may be, it is clear that initiatives to prevent youth from using methamphetamine and other drugs are needed— ones that target risk factors, build resiliency, and promote healthy development in youth. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 12 of 31 Education Judges, law enforcement officials, medical staff, social service personnel, and recovered methamphetamine addicts agree that more education to youth and to the general public is needed in order to prevent the use, sale and production of methamphetamine.6,13,18-20,22,51 Programs in North America Drug Abuse Resistance Education (DARE) has been one of the most popular in-school drug education programs in North America.71,72 However, the original version of the program has been shown in multiple studies to be ineffective at changing drug use behavior in the long term.72-77 Modifications to the DARE program, such as including a peer-led component and developing extracurricular activities, may show some promise in changing actual student behaviors.73 Exclusively school-based programs alone are limited in their effectiveness to keep students away from drugs. Longer-lasting effects and impressions are made when classroom-based drug education is partnered with community-wide initiatives and multicomponent education programs.61,73 Many prevention programs have been evaluating outcomes to determine if they are effective at preventing risk behaviors. In fact, the Centers for Disease Control and Prevention in the United States has compiled a list of “Registries of Programs Effective in Reducing Youth Risk Behaviors”.78 This is a list of federal agencies in the United States who have developed registries for research-based prevention programs that have been found to be effective or promising. Considering that some of these registries contain numerous programs, Substance Abuse and Mental Health Services Administration (SAMHSA) outlined the essential elements of programs registered with their organization that have been found to be effective.79 According to SAMHSA, programs that were effective: • focused on generic life skills rather than knowledge and skills related to substances only • allowed students to practice using these skills and information • were school-based, delivered over short time periods, and usually involved weekly sessions • had a consistent message delivered through many channels, including those outside the school • addressed factors that put youth at risk for substance use • were integrated into naturally occurring social contexts (e.g. schools, churches) • focused on strengths of youth and families • adhered to the program curriculum • trained facilitators • used credible facilitators known to the students • used peers to deliver some content • involved parents by developing parenting skills and increasing involvement in their children’s lives.79 Some particularly notable programs in the SAMHSA registry appear to reduce youth substance use for three years after the program: Across Ages, LifeSkills Training, Project SUCCESS, and Project Toward No Drug Abuse.79 A more extensive review of these programs and the methods used to evaluate them would be required before using such programs to further develop drug prevention strategies in Alberta. In terms of Canadian programs currently in use and considered exemplary, outcome evaluations will help determine how effective these programs are in changing youth behavior.80 One program that is currently being researched for its effectiveness is The Fourth R, developed by David Wolfe and his team from the University of Toronto. The Fourth R includes many of the essential elements noted by SAMHSA and particularly emphasizes the development of relationship skills and decision-making skills.81 This program is currently being evaluated in 20 Ontario schools through a randomized controlled trial and when completed will provide useful information for Canadian strategies to prevent or reduce high-risk behaviors. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 13 of 31 Programs Used in Alberta Two programs currently used in Alberta for preventing risk taking behaviours and injuries are the Preventing Alcohol and Risk-Related Trauma in Youth (PARTY) Program (developed in Toronto in 1986) and the Heroes Program (developed by SmartRisk in Alberta in 1986). Ù PARTY is a full day program in a hospital setting where students attend talks and presentations about traumatic injuries resulting from high-risk behavior. A brain injury survivor also tells his or her story and answers students’ questions.82,83 Ù Heroes takes place in the school, is an hour long, and uses multimedia presentations. It too includes a presentation from a survivor followed by a question period.82,84 An evaluation of Heroes showed that the program may have an influence on the immediate decisions that teens make but likely has no longer terms effects.85 An evaluation of the PARTY program could not be located, but other research also indicates that single intervention programs, like PARTY or Heroes, will not have a major long-term impact on behaviour or attitudes even though they may increase knowledge and awareness.79,82 It is possible, however, that integrating such units into a program delivered over many sessions may have more long-lasting effects. AADAC has also developed a school-based curriculum for grades 3 to 7, 9, and 11.86 Evaluating the effectiveness of this curriculum on changing youth behaviors would allow for further development of prevention initiatives in Alberta. Educating Youth Outside of the School System As a note of caution, although schools provide a natural way to target youth, homeless youth are at a particularly high risk of adverse health practices and outcomes and are often an overlooked population in health promotion and health care.64,87 As an Alberta Member of the Legislative Assembly aptly stated, society cannot overlook the problems of a particular group of people because these problems will inevitably grow to affect those outside of the group.88 Thus, prevention efforts should be directed at youth who are in school and those who are not. Along the same line, it is also important to remember that keeping teens in school and engaged in school programs is fundamental to keeping them off the streets and hopefully off of drugs.13,19 Certainly, some children are not inclined in the traditional academic sense, but options with a more direct-to-career focus, such as home economics, industrial arts, art and design, etc. may keep these students in school. Research suggests that participation in high school art and/or athletics programs may be related to a lower drop-out rate.89 Community Education Drug education is not just for youth; the whole community benefits from awareness and knowledge about this problem.61,79,90 In particular, the general public needs information about drugs, like methamphetamine, that are not well known or understood. Some stakeholders feel that if the general public is informed about what methamphetamine is, its effects, and how it is produced, they can watch for signs of a problem in their own community.6,20,51 By informing the public about this drug, various segments of the population can work together to prevent use and abuse of methamphetamine. Some police services have already started running education sessions about methamphetamine production with stores and businesses around the city, so owners and staff can watch for suspicious purchases of precursor chemicals and report any irregular activity to the police.19 Some policy makers are also calling for new regulations around precursor chemicals in Alberta.37 Judges in the Canadian justice system may require more information about the dangers of methamphetamine and its production, to help in planning appropriate sentences people who are found guilty of producing methamphetamine.57 Furthermore, many parents may be unaware of the prevalence of methamphetamine among their local adolescent population, making them less likely to understand its threat to their community.91 Thus, it is important that prevention efforts include a community education component targeting various segments that may be indirectly affected by methamphetamine use in Alberta. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 14 of 31 Social Marketing Some youth may only require information (i.e. education) to make healthy lifestyle choices.92 Others, however, require motivation (i.e. marketing) to choose a particular behaviour.92 The power of marketing is clear. Corporations would not spend billions on advertising if they did not believe that it influences buying behaviour. As a case in point, the United States spends $333 million on nutrition education in a year.93 However, compared to the $2.8 billion spent in 1997 on ads for breakfast cereals, candy, gum, beer, and pop, it is not surprising that elaborate, high priced and well-researched marketing schemes aimed at children and youth have more of an impact than education campaigns promoting healthy choices.93,94 Offering an Alternative Product Marketing can motivate youths to choose a particular behavior by providing something of value in return for this choice, but all too often social marketing initiatives lack this exchange.92 If no clear product is offered in a social marketing initiative, youths will not know what to “buy” and the opportunity to change their behaviour is limited.72,92 Although social marketing strategies can complement education strategies in a drug prevention program, a social marketing strategy can only be effective if it promotes an alternative behaviour or “product”. For example, if the social marketing message is simply “don’t do drugs” and youth are not provided with a choice of other activities they should be doing instead, there is limited change in behaviour. This is a significant consideration in the fight against drugs because if youth spend more time engaging in an alternative activity, they have less time to devote to experimentation and possible abuse of drugs. Alternative activities should be developed and marketed to youth, but these activities must also provide immediate benefits that youth value. Immediate and short-term benefits that appeal to youth are more likely to change their behaviour than vague long-term benefits (e.g. living longer and good health).95,96 A social marketing effort that demonstrates how to offer an alternative “product” is a binge drinking prevention program at the University of Wisconsin.97 This effort focused on developing alternative activities that were alcohol-free and strategically offered on evenings when binge drinking typically occurred.97 This approach represents a radical shift from the typical “information only” strategies most commonly associated with social marketing. The strength in this approach may be reflected in the change in binge drinking patterns at the University of Wisconsin. Since 1999 when 67% of students at the university reported binge drinking in the past two weeks, there has been a decreasing trend in binge drinking with 59% who reported the same in 2004.98 The Importance of Planning and Research Because social marketing is consumer-oriented, social marketing efforts following planning and research: • consumer research – identifying (a) the needs, values, and desired benefits of the youth population; (b) barriers or costs to changing behaviour; and (c) when and where benefits could be offered • competitive analysis – identifying (a) other choices youth have and (b) social, environmental, and economic forces that may influence behaviour • segmentation – developing groups of youth based on similarities in demographics and psychological or behavioral factors • targeted programs – programs that meet the unique needs of each segment identified.97 aimed at youth require the Immediate and short-term benefits that appeal to youth are more likely to change behaviour than vague long-term benefits, like living longer and good health. Successful social marketing strategies also design promotion strategies and use media channels that will reach the intended group and convey the intended message.96 It is important to consider lifestyle habits of the target group. For instance, on average Canadian children and teenagers spend over an hour each day on the Internet and about 2 hours per day watching television.99,100 More details, such as which television programs are watched and which web sites are visited, would be valuable in ensuring the target group is reached with promotional messages that “sell” a particular type of behavior or activity. The importance of selecting the appropriate media is emphasized by a couple of examples. First of all, when smoking is shown in movies, youths are perhaps more likely to report an intent to smoke in the future Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 15 of 31 although anti-smoking advertisements shown before the movie may combat this tendency.101 Another example is the case of 4-H in the United States. Although textbook covers, rulers, stickers and posters are used successfully by food advertisers, such modes of communication did not prove effective for recruiting new 4-H members.94,102 Instead, the Internet and word-of-mouth were most influential for achieving this 4-H objective. Although social marketing initiatives may influence behaviour, they cannot control for other forces in the environment and thus any change in behaviour could potentially be explained by social marketing as well as other forces (e.g. law enforcement).97 Even so, one of the most important elements of a social marketing strategy is measuring outcomes to help determine if the strategy met its objectives. A good example of measuring outcomes comes from the National Highway Traffic Safety Administration and the Wisconsin Department of Transportation, which undertook a project to reduce driving after excessive drinking. SafeRide is a social marketing effort that provided an alternative way of getting home after drinking and resulted in an estimated cost savings of almost $1 million because of alcohol-related crashes that were avoided.103 However, few social marketing efforts are evaluated to determine if they meet their objectives.96 In the same way that corporations measure outcomes that could be attributed to advertising efforts (e.g. revenue), social marketing initiatives should also measure outcomes (e.g. behaviour change) that could be attributed to its efforts. Designing a Message Often public service campaigns tend to focus only on the negative aspect of drug use and use emotionally charged messages.96 The use of such scare tactics has been widely criticized by many prevention scientists, and it is generally agreed to be an ineffective method of prevention.96,104-106 There may be many reasons why scare tactics appear to be ineffective: • If teens know of someone who is using the drug and the user does not experience all the effects that have been emphasized, the information may seem overstated and less credible.106 • Fear of drugs may be rated low among reasons why teens choose not to use drugs.107 • Continual negative reinforcement may actually make a behaviour seem more attractive instead of discouraging its practice, as appears to be the case with warnings about violence on television programs.108 A balanced approach to drug education that presents both the positive and negative aspects of the drug is thought to be more effective.13,106 In reality, methamphetamine use leads to a euphoric state, which means many people find the initial experience pleasurable. On the other hand, youth also need to know that repeated use of the drug may quickly lead to an addiction and eventually land the person either in jail, the hospital or the morgue.88 An effective prevention program would also explain why some people choose to use methamphetamine and teach youth skills to make healthier decisions in light of this.79 Presenting the drug simply as a bad choice without information about its positive and negative effects may make students question the reliability of the information.61 According to focus groups and youth who were formerly addicted to methamphetamine, prevention messages should also be relevant and capture the attention of the youth.13,95,109 Sharing the shocking realities of drug use and abuse may capture the attention of youth, as long as they also present a balanced story.13,22,109 Real-life stories from people who youth can relate to and have dealt with issues youth can relate to are thought to provide more salient messages.13,95,109 Some of the following ideas were given by people who were addicted to methamphetamine in the past: • taking classes to a treatment facility to see a detoxification13 • taking classes to see an overdose at the hospital13 • taking classes to the homeless shelter to see what kind of life drug abuse can lead to13 • having an ex-dealer talk about how they tricked kids into using their products.110 Also, some youth who were addicted to methamphetamine in the past write poetry as part of their healing and recovery process, often writing about the drug and their experiences with it.62 Perhaps these poems or experiences could be communicated to youth. However, to our knowlege no research has looked at the effectiveness of prevention efforts that use recovered addicts to communicate to youth. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 16 of 31 Another aspect to consider is the messenger. Some youth consider police officers to be credible sources for drug information, but other youth, particularly those most at risk for drug abuse, may not.13,22,111 Furthermore, although youth may consider a messenger to be credible, the level of influence of the messenger among youth, including those most at risk for drug abuse, should be considered when designing education or marketing strategies. Treatment Treatment of adolescent drug addictions is a difficult process because the drug has essentially taken over the life of the youth and prevented their normal maturation and development. Some believe that treatment of adolescents should be looked at not as rehabilitation, but as an initial habilitation.22,112 In particular, overcoming a methamphetamine addiction often involves a lengthy detoxification period and relapse is common.21,113,114 Youth Treatment in Alberta In Alberta, a few different treatment services are available for drug addictions in general. Alberta Alcohol and Drug Abuse Commission (AADAC) has been the province’s primary treatment resource since 1951.115 Youth outpatient services are offered free of charge by 37 AADAC offices and 15 services funded by AADAC across Alberta.116 Youth clients go to AADAC offices seeking help for their addictions, which shows they have recognized they have a problem by the time they arrive at AADAC. Based on an assessment, AADAC clients are matched up with the appropriate treatment options, which could include information sessions and counseling in one-to-one, group and family settings. Clients may also be referred to a self-help group specific to their addiction and are encouraged to participate in 12 step programs such as Alcoholics Anonymous or Narcotics Anonymous both during and after their treatment.115 The philosophy at AADAC is to focus is on the person, not the drug.115 AADAC has also opened two provincial youth detoxification and residential programs—one in the Calgary region and one in the Edmonton region. These services provide a total of 24 additional treatment beds, with four detoxification beds and eight residential treatment beds in each city, for youth ages 12 to 17 years. There are two different types of residential programs being offered. The Edmonton site is an urban-based model while the Calgary-based location provides a wilderness adventure therapy program. Both programs include individual and group therapy, family centred programming, on-site school and extensive recreational activities to promote group co-operation and constructive use of leisure time. The programs are designed to teach the youth skills to stay clean and sober, to improve their interpersonal skills, and to educate the youth on how alcohol and other drugs affect the users and people around them. AADAC has developed a crystal methamphetamine treatment protocol designed specifically for youth experiencing crystal methamphetamine abuse problems. This protocol allows for the capacity to provide flexible individualized treatment response within the detoxification or residential setting. With the addition of youth detox and residential programs, AADAC is able to offer the full spectrum of voluntary treatment services to Alberta youth and their families. Plans to expand the number of AADAC’s youth detox and residential beds throughout the province are in progress. For more information on youth treatment services offered by AADAC, please visit www.aadac.com. Another program offered in Alberta through The Alberta Adolescent Recovery Centre (AARC) is specifically for youth under 21 years of age and is considered innovative in its approach. AARC mainly deals with youth who are at late stage addiction and will use any available drug to achieve a high.18,112 One of AARC’s central beliefs is that a youth’s drug addiction affects the whole family, so the whole family must be involved in the recovery process.112 As such, the program is an intensive, structured, long-term program that incorporates the following elements: • Twelve Step Recovery Model, like Alcoholics Anonymous or Narcotics Anonymous; • Positive peer influence, including the use of peer counselors; Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 17 of 31 • • Group, family, and individual therapy; and Use of “recovery homes,” where new participants stay in the home of another participant who is farther along in the program and their family. A treatment program in the United States similar to AARC recently found that 25% of all its clients (including those who did not complete treatment) had not used drugs or alcohol since completing treatment and 51% had not returned to their former level of use.117 In particular, the AARC program and others that use peer counselors believe this is helpful in the recovery of adolescents who are addicted to drugs. Having been in the same position of recovery themselves, peer counsellors cannot be deceived as easily by the youth undergoing recovery and may also be able to relate more readily.106,112 In light of funding pressures that many drug treatment programs experience, one or two psychologists and psychiatrists supervising a team of peer counselors, while providing fewer one-on-one sessions themselves, could present a financially viable method of treatment.88 Policy makers are hoping Youth treatment of drugs addictions is also changing in Alberta. In April that 5 days of mandatory 2005, Bill 202, the Protection of Children Abusing Drugs Act, was 118 detoxification will provide passed. When this Bill comes into force in July 2006, parents can apply to the Provincial Court to have their child placed in a mandatory an opportunity for some of five day detoxification program.118 Although some experts believe that these youth to realize they detoxification can take up to 45 days,113 policy makers are hoping that 5 need help. days will provide an opportunity for some of these youth to realize they need help; perhaps for some this will be a first step in treatment by preparing youths to engage in the rest of the recovery process.22,88 Though some express concern about the freedoms of youth under this Bill, as one Member of the Legislative Assembly of Alberta stated, “Addiction is an abdication of one’s autonomy. By being addicted, one has already surrendered control over his or her life to someone or something else, in this case a chemical substance and the people who provide it or urge the use of it”.119 Currently, there is no known research comparing the effectiveness of mandatory and voluntary drug treatment among youth and thus no basis to argue their relative effectiveness among youth. Among adults addicted to methamphetamine, one study to date suggests that mandatory treatment may be as effective as voluntary treatment over the long term although early relapse may be an area of concern.120 In the absence of such research involving youth, Bill 202 provides an opportunity to evaluate the effectiveness of mandatory detoxification among youth. Research into Youth Treatment Overall, there is a lack of research into the treatment of drug addictions among adolescents, especially when compared to the amount of addictions research involving adults.121 With a lack of research, there is no evidence to date about which treatments are most effective for which type of youth.121 However, there is some indication that outpatient family based treatments for youth may be more effective than other types of outpatient treatments.121,122 There is also some general addictions research that, if found promising, could be tested with youth addictions. Some researchers are investigating the potential use of drug therapy in the treatment of methamphetamine addictions.123 Other research in Vancouver, British Columbia, is exploring the use of acupuncture to reduce drug cravings and withdrawal symptoms, which may prove to be useful during detoxification. 124 Such treatment approaches would need to be integrated with psychosocial approaches for long-term recovery. Research in Taiwan suggests that social pressure to use methamphetamine may be the main reason that adolescents relapse and use methamphetamine again.114 This indicates the impact that peer relationships can have on youth and how important it may be for them to develop skills to cope with social pressure. Treatment outcomes in adolescents may also be affected by psychiatric disorders, so treating youths with substance use and psychiatrics disorders is another area for further research.125 Although there is limited research into the general treatment of drug addictions among youth, there is even less research into the treatment of methamphetamine addictions among youth. All in all, further research is required to determine which treatments are most effective for which types of youth and which types of addictions. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 18 of 31 Moving Forward Policy Implications Policy makers in the province of Alberta are concerned about the spread of methamphetamine in Alberta. This April, the Protection of Children Abusing Drugs Act was passed in the Alberta Legislature.118 It was the first private members bill in Alberta Legislature history to gain unanimous consent to move the bill ahead to the Committee of the Whole and the third reading while waiving the usual proceedings of the legislature.88 Members of the Legislative Assembly were in agreement that some sort of action must be taken to protect children, youth and families from the effects of methamphetamine. However, further planning and policies around this issue are necessary. Policy Principles • Approach the problem of methamphetamine in Alberta holistically. Policies around methamphetamine will be most effective if together they reflect the scope of the problem. Methamphetamine is not just a youth addictions issue. Adult addictions may also impact infants, children, youth, and the community. Thus, multi-pronged strategies aimed at helping youth and adults addicted to methamphetamine as well as children, families, and communities affected by the addiction will address the problem more comprehensively. • Balance Alberta policy between prevention, enforcement, treatment, and harm reduction. Canada’s Drug Strategy emphasizes a need to approach to the issue of harmful substance use with a balance between prevention, enforcement, treatment, and harm reduction efforts.126 Recently, many proposed policies have focused on enforcement issues. For instance, there has been a change in federal policy regarding the penalties for offences involving methamphetamine, and there is debate provincially and federally on how to best control precursor chemicals used in the production of methamphetamine. Although such enforcement is necessary, prevention, treatment and harm reduction are other policy areas worth exploring further. The call for a balanced approach to the methamphetamine issue was also reinforced by participants at the Alberta Workshop on Methamphetamine: An Environmental Scan , that took place in September 2004 in Red Deer, Alberta. Stakeholders who completed a pre-workshop survey believed that “resources should be relatively evenly split between activities related to prevention and education (about 40% of available resources), treatment (30% of available resources), and enforcement (30% of available resources)”.127 • Work towards integrating various Alberta systems that encounter people involved with methamphetamine. Systems that methamphetamine users often come in contact with operate as fairly separate entities. If someone turns up at the hospital for treatment of a methamphetamine-related problem, they are treated for that specific problem and released.5 Sometimes they are given information about available detoxification and drug addiction resources, but this is not standard practice and there is no follow-up with the patient after they have left the hospital. Consequently, many methamphetamine addicts are repeat patients in the emergency room.5 In the law enforcement sector, a similar scenario exists. Anyone caught with methamphetamine is released almost immediately until their court date.20 It is not police policy to inform their clients of any treatment or counseling options although some officers choose to do so.20 Once in court, the judge can order an individual to get treatment but cannot order anyone to pay for the treatment, so treatment is only ordered in cases where there is someone willing to pay.22 Government funding for court-ordered treatment (ranging from $65-$85 per session for up to 10 sessions) is insufficient to cover the time needed to overcome a methamphetamine addiction.18,20,22 Evidently, there is a need for greater collaboration among the law enforcement, judicial, medical, social services and rehabilitation sectors to more readily address the Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 19 of 31 issues related to methamphetamine production and usage.5,19,20,22 The need to develop a “coordinated provincial response“ was also recognized in 2004 by participants in the Alberta Workshop on Methamphetamine: An Environmental Scan.127 • Engage youth, families, and communities in identifying strategic directions in program and policy development. Youth, families and community members have ground level perspective on the issues around methamphetamine use and production. Perspective from these groups must be gathered and used to develop effective strategic directions. Prevention • Ensure prevention efforts in Alberta aim to reduce the use of drugs overall, with the reduction of methamphetamine use contributing to this goal. Although methamphetamine is a drug that can be powerfully addictive, it is one drug among many that are affecting Alberta’s children, youth and families. Furthermore, an addiction to one drug puts a person at risk for developing an addiction to another drug. A goal to reduce drug use overall then encompasses a reduction in methamphetamine use. • Ensure prevention efforts target all relevant segments. Many segments of society can make a unique contribution to reducing overall drug use if they are targeted in prevention efforts. For instance, prevention efforts aimed solely at youth in school miss those youth who are not in school (i.e. street-involved youth). However, youth not in school are at a particularly high risk of drug abuse and are often overlooked in health promotion strategies.64,87 Also, communicating with various community segments (e.g. parents, store owners, etc.) about drug abuse and drugs that are not well-known, like methamphetamine, may develop partners who watch for and respond to signs of a problem in their own community. • Support the development of more comprehensive prevention programs for students in Alberta. Research has shown that single intervention drug prevention programs, like many that exist in Alberta, will not have a major long-term impact on behaviour or attitudes.79,82 Longer-lasting effects and impressions are made when classroom-based drug education is partnered with community-wide initiatives and multi-component education programs.61,73 Thus, advocating for the development of more comprehensive programs, even ones that perhaps build on the single intervention drug prevention programs currently in use, would mean advocating for a longer-lasting impact on youth. To maximize effectiveness, programs will also consider the level of influence among youth of the people who deliver the program. A comprehensive program will involve numerous strategies beyond traditional methods for delivering its message and achieving behavior change. • Support the development of alternative activities for youth and the development social marketing strategies that may be required to promote these alternative “products”. Youth need a reason to avoid drugs.13,19 Adolescents who have something of value in their life – a passion for a sport, art or drama, strong family ties, established beliefs or values - are less likely to trade that for drugs like methamphetamine. This is why it is important to develop alternative activities, choices, or “products” that have immediate and valued benefits to youth. For instance, research has shown that participation in high school art and/or athletics programs is related to a lower drop-out rate.89 At present, with more of a focus on sending young adults to university and school board budget difficulties, these programs are slowly losing funding and being eliminated.128,129 Those youth who placed value on coming to school for non-traditional classes and programs will be more likely to drop out if those classes and programs are no longer offered; if they are not in school, they will be Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 20 of 31 more inclined to turn to drugs as a way to fill their extra time.13 Thus, funding programs that help engage students in the school experience or funding alternative social events may be just as important as formal drug education programs. Social marketing expertise could aid in the development and success of these alternative “products”. Treatment • Ensure outcomes of the Protection of Children Abusing Drugs Act are evaluated and use these results to inform future policy. Before the passing of the Protection of Children Abusing Drugs Act, Evaluating outcomes of parents could do little to stop their child from using drugs except wait 88,119 for him or her to get arrested and have the Court get involved. the mandatory five-day This Act provides a new way that parents can try to help their children. detoxification will Evaluating outcomes of the mandatory five-day detoxification will provide insight into how provide insight into how this legislation is reducing the drug abuse this legislation is behaviours of youth and will contribute to a base of research into the reducing the drug abuse effectiveness of mandatory detoxification among youth. Such evidence will be particularly informative as policy for the next steps in treatment behaviours of youth. of drug addictions are considered (e.g. mandatory treatment program for youth following the five days of detoxification or mandatory detoxification of addicts over 18 years of age).88 • Ensure a continuum of treatment options are available for addicted youth. It is important, for example, that outpatient treatment be available to youth as well as residential treatment, as some may find this more effective as a first option versus residential treatment. As well, outpatient treatment should be available to provide support after discharge from residential treatment programs. • Support the development of research into youth drug addictions. To date, there has not been enough research conducted to determine which treatments are most effective for which types of youth and which types of drug addictions. However, such research is critical to obtain maximum levels of success of treatment, which is why it is important that policy makers support the development of research in the area of youth drug addictions. Future Research Research into issues involving methamphetamine and youth will help to inform policy and practice around the prevention and treatment of addictions to this drug. Effects of Methamphetamine • Gain a better understanding of the effects of methamphetamine exposure during pregnancy on fetal development and child development. Research has been fairly conclusive as to the short- and long-term effects of using methamphetamine on the adult brain and body.21,27,29,130,131 However, the short- and long-term effects on a methamphetamine-exposed fetus are difficult to discern, and there are also few long-term follow-up studies of school-aged children who have been exposed to methamphetamine in utero. Further research in this area is merited to work towards identifying such children and developing appropriate interventions. • Research possible links between methamphetamine and the development of later medical/psychological conditions. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 21 of 31 Symptoms caused by long-term methamphetamine use can be like those found in Parkinson’s disease and schizophrenia. Although research is starting to explore a possible link between methamphetamine addiction and the development of later medical/psychological conditions, exploratory research should be followed to determine if this is an area that requires further study. Prevention • Improve estimates of the proportion of methamphetamine use in various segments as well as understanding of the risk factors and reasons for using drugs and/or methamphetamine. It is difficult to estimate the prevalence of methamphetamine use among various segments of the population, though this data is important in planning a strategy to counter the spread of methamphetamine. Good, reliable surveillance data is necessary to track the trend of methamphetamine use and identify risk factors and reasons for use among Alberta youth. AADAC will be conducting another survey of students to follow-up The Alberta Youth Experience Survey in 2002, which will assist in monitoring drug use trends among youth in school. Estimating the proportion of Alberta youth not in school who use and/or abuse methamphetamine remains a potential, albeit challenging, area of research.5,22 Other data is also needed. For instance, one emergency room doctor hypothesizes that some methamphetamine users are probably not detected by medical personnel if they come in with a complaint not related to drugs. Data about the use of emergency rooms by methamphetamine addicts are not readily available although research using a rapid urine test might be able to help estimate prevalence among emergency room patients.5,9 • Review research-based prevention programs that have evidence of effectiveness to provide insight into the development of more comprehensive programs in Alberta. Research has shown that single intervention drug prevention programs, like many that exist in Alberta, will not have a major long-term impact on behaviour or attitudes.79,82 Longer-lasting effects occur when classroom-based drug education is partnered with community-wide initiatives and multicomponent education programs.61,73 Currently, most Alberta initiatives are classroom-based. A review of research-based prevention programs that appear to be effective, including Across Ages, LifeSkills Training, Project SUCCESS, Project Toward No Drug Abuse, and The Fourth R, would be worthwhile. Reviewing the research conducted on these and other programs would provide information for the development of comprehensive programs in Alberta that perhaps expand on the strengths of existing programs in the province. In addition, evaluating the effectiveness of the recently developed AADAC school curriculum will be informative. • Research the potential effectiveness of developing and promoting alternative activities for youth using social marketing methods. Because some youth may require motivation rather than education to choose not to take drugs, research investigating the effectiveness of using social marketing to develop and promote alternative activities for youth will help determine how social marketing may be able to contribute to prevention efforts. Treatment • Evaluate the outcomes of the Protection of Children Abusing Drugs Act. As mentioned previously, evaluating the effectiveness of the Protection of Children Abusing Drugs Act will help determine its potential impact on drug addictions in youth. Research into the effectiveness of longer-term mandatory treatment programs for youth would also be informative as policy makers consider the next steps in policy.88 • Develop much-needed research comparing various forms of drug addiction treatment among youth. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 22 of 31 Research into the treatment of drug addictions among adolescents is critical given the lack of evidence to date about which treatments are most effective for which type of youth and which types of addiction. Based on limited research, some methods of treatment for youth, like outpatient family based treatments, may be more effective than other types, but further research is required to more confidently determine their effectiveness among youth. Drug therapy in the treatment of methamphetamine addictions and alternative therapies, like acupuncture, are currently being explored and may present other areas of exploratory research. Relapse in methamphetamine addictions and the general impact of psychiatric disorders on drug addictions treatment are other areas to be considered in such research. In the End Methamphetamine is the latest in a long line of addiction problems in Alberta as well as other parts of Canada and the world. It has been criticized by many as being the next “drug-du-jour,” a phase among drug users that will go by the wayside in a few years time. Certainly, illicit drug use shows trends based on what drug is popular. Methamphetamine was popular once before, but this time it has surfaced as a more potent type (d-methamphetamine) that is also much easier to produce and can be taken in a variety of ways, signaling that methamphetamine may be a bigger and longer-lasting problem this time around. The ideal situation would be a world which was free from the harms of substance use and abuse. People of influence, such as educators, law makers and enforcers, medical personnel and researchers, as well as communities share a duty to take measures to control the use, production, and sale of methamphetamine and other drugs to work towards this vision. Great care and initiative in the areas of policy, research, and practice must be taken to help children, youths and families affected by methamphetamine addictions and to empower youth to resist the drug’s temptations. Methamphetamine in Alberta: A Focus on Children, Youth and Families Page 23 of 31 References (1) Anglin MD, Burke C, Perrochet B, Stamper E, Dawud-Noursi S. History of the methamphetamine problem. Journal of Psychoactive Drugs. 2000;32:137-141. (2) United Nations Office on Drugs and Crime. 2005 World Drug Report. 2005. http://www.unodc.org/unodc/world_drug_report.html. (3) Malcolm C. 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