Study determines rural meth users at greater risk

Kathleen Grant, M.D.

A new study has determined that rural methamphetamine users are younger when they start using meth, are more likely to use intravenously, have more psychoses, smoke more cigarettes and are more likely to be alcoholic than urban methamphetamine users. The findings were reported in the April issue of the American Journal on Addictions.

The one-year study of 172 adults in Nebraska with methamphetamine abuse or dependence found that rural meth users begin using the drug more than three years earlier than urban users (21.3 years in rural areas compared to 24.9 years in urban areas).

Rural meth users also were 22 percent more likely to inject meth (54 percent compared to 32 percent). Injection drug use is a risk factor for hepatitis C and HIV infection and has been linked to psychopathology. Rural meth users reported a 16 percent higher rate of meth-related psychotic disorders (e.g. paranoia, hallucinations) than urban meth users (44.8 percent vs. 28.7 percent).

In addition, rural meth users were 27 percent more likely to become alcohol dependent (72 percent compared to 45 percent) and smoked nearly five more cigarettes a day (16.41 compared to 11.70) than urban meth users.

“Methamphetamine has long been characterized as a rural drug,” said Kathleen Grant, M.D., assistant professor in the pulmonary section in UNMC Department of Internal Medicine and the principal investigator on the study. “The study results show quite dramatically that rural meth users are at significantly greater risk than urban meth users. We often believe that rural areas are ‘protected’ from ‘hard drug’ use so these findings are particularly unexpected. The greater intravenous use and psychoses in rural meth users are especially concerning.”

The study participants were admitted to one of five substance abuse treatment centers in central and eastern Nebraska with participants enrolled between July 2004 and June 2005. Three of the centers were located in Omaha with one each in Lincoln and Grand Island.

Methamphetamine, also known as “crank,” “speed,” and “ice,” can be smoked, snorted, swallowed or injected. It is synthetically produced in meth labs, using ingredients such as anhydrous ammonia and over-the-counter medicinal products such as ephedrine and pseudoephedrine (now regulated in Nebraska and only available in limited quantities from pharmacies).

The majority of meth labs seized by law enforcement officials have been in rural settings. Manufacturing meth generates a pungent odor, which is more likely to go unnoticed in isolated rural settings than in the city.

Amphetamine and methamphetamine are the most widely abused illicit drugs in the world after marijuana. More than 35 million people worldwide regularly use or abuse amphetamine or methamphetamine as opposed to cocaine (15 million) and heroin (less than 10 million).

“Meth addiction progresses more rapidly than cocaine addiction with faster succession through drug use milestones,” said Dr. Grant, who also has an appointment with the VA Nebraska-Western Iowa Health Care System in Omaha, one of the five study sites. Other sites included: Catholic Charities Campus for Hope, Omaha; Journeys, Omaha; Bryan-LGH Independence Center, Lincoln; and St. Francis Medical Center, Grand Island.

Methamphetamine is perceived to elevate mood, increase energy, suppress appetite and enhance libido. The drug can cause an abnormally fast heartbeat, sweating, loss of appetite, hallucinations, anxiety, paranoia, trouble sleeping and dizziness. Chronic use can cause numerous health problems including dramatic weight loss, social dysfunction and poor dentition (also known as meth mouth).

“The study shows that rural meth users are more likely to inject the drug, which places them at higher risk for the infectious complications associated with IV drug use,” Dr. Grant said. “The medical risks associated with greater cigarette use and alcoholism may contribute to a higher frequency of infectious diseases, chronic lung diseases and alcohol-related liver disease.

“These complex rural methamphetamine users may need more specialty care. Given the limited substance abuse, mental health and tertiary medical care available in rural communities, methamphetamine use disorders present significant challenges to the local medical providers. I hope this study will alert state and local rural communities of the need to enhance these services especially in rural settings where treatment may be currently limited.”

The research was supported by a grant from the State of Nebraska, Department of Health and Human Services, Nebraska Cancer and Smoking Disease Research Program.