This marked the beginning of parity for mental health/substance use disorders and medical/surgical benefits covered by Medicare in the United States. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Before this time Medicare beneficiaries were required to pay up to 50% of the approved amount for mental health and substance use disorder services as opposed to 20% copayment for most other outpatient services. This marked the end of the five-year phaseout of the mental health treatment limitation effectively providing nondiscriminatory outpatient mental health coverage to the millions of Medicare recipients throughout the country.
United Kingdom
Mindfulness Solution for Symptom Relief
The University of Oxford in partnership with the Mental Health Foundation found that practicing mindfulness online can reduce stress, anxiety and depression. These researchers reported on BMJ Open that participants in the their study had a 58% reduction in anxiety, 57% reduction in depression and a 40% reduction in perceived stress. In addition there continued to be a reduction in symptoms of stress, anxiety and depression one month after the course was completed indicating that participants continued to practice the techniques they had learned during the study.
The mindfulness class used in this study was developed at the Centre for Mindfulness Research and Practice, Bangor University, UK. It can be found here.
Another useful and free online course, Mindfulness-Based Stress Reduction, has been developed by the University of Massachusetts Medical School in the the United States and can be found here.
March
Mental Health System at a Crossroads, Australia
A new report by Inspire Foundation based upon a collaboration between EY and ReachOut.com assessed the demands on and provision of services for Australians with mental health issues. It estimated that if the mental health system remains the same in Australia it will require 9 billion dollars to increase services in order to meet the current needs of the population. The good news is that the report recommends an overhaul of the entire mental health system with a refocus on prevention and early intervention as well as promotion of self-help options. In this case efficiency and sustainability could translate into more services that help people help themselves and their peers at earlier stages of distress. Sounds like a winning combination.
A new media guide, Mindset: Reporting on Mental Health, was launched. It is a guide for journalists by journalists and promotes more factual and less stigmatizing coverage of mental health issues. It also encourages journalists to address systemic issues in mental health. It has been issued in both English and French versions. The Canadian Journalism Forum on Violence and Trauma led the effort with additional funding from the Mental Health Commission of Canada.
Methamphetamine is a central nervous system stimulant. It can be ingested, inhaled, smoked or injected. When taken, it initially provides an intense sensation of euphoria, increased motor activity and a decrease in appetite. Methamphetamine can be psychologically addictive and episodes of high risk sexual and violent behavior are not uncommon. With sustained methamphetamine use a person can begin to experience psychotic symptoms such as delusions and tactile hallucinations.
Global Methamphetamine Trafficking
According to the United Nations Office on Drugs and Crime 2014 World Drug Report, North America (Mexico, the United States and Canada) accounts for almost two-thirds of methamphetamine seizures worldwide while another third is confiscated in East and South-East Asia. Mexico, the United States, China, Thailand and Iran, in that order, report the highest amounts of seizures. There has been a noticeable increase in methamphetamine trafficking from 2011 to 2012 in West and Central Africa and Oceania, although the quantities of methamphetamine are much smaller than in the top four countries. There has also been an increase in seizures in Australia, Brunei, Darussalam, Cambodia, Singapore and Viet Nam. For the first time, a seizure of methamphetamine was reported in Tajikistan. In a national survey in Pakistan, 19,000 people (0.02 percent of the population) reported that they had used the drug in the past year. Generally, there are growing methamphetamine markets in Central Asia and Transcaucasia. Methamphetamine is increasingly becoming a global presence. (Figure 1.)
Figure 1. Seizures of Amphetamine-type Substances (including methamphetamine and amphetamine and excluding ecstasy-type substances) Source: UNODC Annual Report questionnaire data, 2012.
Methamphetamine Production in the United States and Mexcio
There had been a decrease in “home grown” labs in the United States after controls on the sale of the methamphetamine precursors, ephedrine and pseudoephedrine, were instituted during the 1990’s. Further controls were instituted with the passage of the Combat Methamphetamine Epidemic Act of 2005. However small labs have continued to produce methamphetamine through a process called “smurfing” whereby a number of people purchase ephedrine and pseudoephedrine products up to the legal daily limit and then pool these supplies to manufacture methamphetamine. These labs can be found throughout the United States but are largest in number and most problematic in parts of the midwest extending down into the the southeast region. (Figure 2.) Most of the methamphetamine produced in this manner is consumed locally.
Figure 2. Total of All Methamphetamine clandestine Laboratory Incidents, Calendar Year 2012. Source: El Paso Intelligence Center, National Seizure System, Query Date, January 27, 2013.
Presently most of the methamphetamine in the United States is manufactured in Mexico (Figure 3.) despite restrictions that were instituted there in 2005 on the sale of epinephrine and pseudoepinephrine and improvements in these controls in 2009. Perhaps in response to these efforts, researchers have found that alternative precursors are also being used to manufacture a less potent form of methamphetamine in what is called the P-2-P method (phenylacetic acid > 1-phenyl-2-propanone > methamphetamine). It is estimated that up to 70% of methamphetamine being sold in the United States is now in this less potent form.
Figure 3. Methamphetamine Transportation Routes. Source: U.S. Department of Justice National Drug Intelligence Center, National Drug Threat Assessment 2011.
Forty-four tons of methamphetamine were seized in Mexico and 29 tons in the United States in 2012. Half of the methamphetamine seizures in the United States occur at the Mexican border. In 2012 the number of methamphetamine seizures at the border exceeded the number of cocaine seizures according to the United States Border Control.
Methamphetamine Problems in the Lower 48
According to the Community Epidemiology Work Group (CEWG), in the first half of 2013, methamphetamine indicators* were among the most concerning if not the most concerning of all drug trends in 11 out of the 20 areas that are monitored across the United States. There had been a general trend downward in methamphetamine use in the United States in the mid 2000’s, however methamphetamine remains an increasing problem in most areas of the west and in certain areas of the midwest and south. The northeast has relatively low rates of methamphetamine problems.(Figure 4.)
Figure 4. Greatest Drug Threat Represented Regionally As Reported by State and Local Agencies. Source: National Drug Threat Survey, 2009
Methamphetamine in the California Corridor
The CEWG monitors drug indicators in the Western Region. This includes California which historically and generally has been experiencing the highest level of methamphetamine problems in the United States. San Diego (41.7%), San Francisco (37.8%) and Los Angeles (32.8%) have the highest level of methamphetamine seizures as percentage of total drugs seized among all areas of the United States. Most of the methamphetamine coming into the United States from Mexico comes in over the southern border of California. In 2014 many of the methamphetamine seizures, other than those at the border, have been along the route 99 corridor from Bakersfield to Sacramento (Figure 5.) and the route 101 corridor north of San Francisco to the Oregon Border.
Figure 5. Central Valley High Intensity Drug Trafficking Area. Source:National Drug Intelligence Center, 2007.
Community Epidemiology Work Group Area Reports
In their January and June 2014 meeting the CEWG representatives reported on the methamphetamine trends in each of their respective areas.
San Diego Area
Methamphetamine was identified as 41.8 percent of all drugs identified in the first half of 2013 compared with 37.7 percent of total drug reports a year previously putting methamphetamine first among all drug reports. Admissions with methamphetamine as the primary drug of abuse were 29 percent for the first half of 2013 which was an increase from 2012 levels (25 percent). Urine testing positive for methamphetamine among arrestees rose from 26 percent in 2011 to 31 percent in 2012 for adult males and from 39 percent to 47 percent for adult females.
San Francisco area
Methamphetamine was identified as 37.8 percent of all drugs identified in the first half of 2013 compared with 32.1 percent of total drug reports a year previously putting methamphetamine first among all drug reports. Admissions with methamphetamine as the primary drug of abuse rose from 2012 to the first half of 2013 putting methamphetamine a close fourth among all treatment admissions just below cocaine admissions. Methamphetamine admissions have been increasing as cocaine admissions have been decreasing and will exceed cocaine admissions if this trend continues.
Los Angeles area
Methamphetamine was identified as 32.8 percent of all drugs identified in the first half of 2013 compared with 25.2 percent of total drug reports a year previously. This placed methamphetamine first among total drug reports. Admissions with methamphetamine as the primary drug of abuse were 18.8 percent for the first half of 2013 which was an increase from 2012 levels (16.9 percent). Methamphetamine was ranked first among illicit drugs for calls to the poison control system for Los Angeles county. Coroner toxicology cases with methamphetamine detected were projected to increase in the reporting period from 560 cases in 2012 to an estimated 687 cases in 2013.
In Conclusion
Methamphetamine trafficking is a global phenomenon, however most of the supply is trafficked to the United States from Mexico and into California. Consequently, the criminal justice and treatment systems in California are experiencing a rise in methamphetamine-related problems. Despite interdiction and prevention efforts, California has increasingly become ground zero for the many harms related to methamphetamine.
REFERENCES
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California Attorney General, Kamala D. Harris. March 2014. California and the fight against transnational organized crime. Retrieved from: https://oag.ca.gov/transnational-organized-crime/ch2
Community Epidemiology Work Group. January 2014. Epidemiologic trends in drug abuse: Proceedings of the Community Epidemiology Work Group, Highlights and Executive Summary. National Institute of Drug Abuse. Retrieved from: http://www.drugabuse.gov/sites/default/files/cewg_jan2014_execsumm.pdf
*The CEWG is a network of researchers from sentinel sites throughout the United States. It meets semi annually to provide ongoing community-level public health surveillance of drug abuse through presentation and discussion of quantitative and qualitative data. CEWG representatives access multiple sources of existing data from their local areas to report on drug abuse patterns and consequences in their areas and to provide an alert to potentially emerging new issues. Local area data are supplemented, as possible, with data available from federally supported projects, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), Drug Abuse Warning Network(DAWN); Drug Enforcement Administration (DEA), National Forensic Laboratory Information System (NFLIS); the Arrestee Drug Abuse Monitoring (ADAM) II program; and the DEA, Heroin Domestic Monitor Program (HDMP). This descriptive and analytic information is used to inform the health and scientific communities and the general public about the current nature and patterns of drug abuse, emerging trends, and consequences of drug abuse.
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