Transcript Of Panel Discussion Hosted

by
Attorney General Alberto R. Gonzales
for National Methamphetamine
Awareness Day
Washington, D.C.
November 30, 2006
10:30 A.M. EST

MS. KATZ: Good morning, everyone. I am Ruth Katz, Dean of the School of
Public Health and Health Services here at the George Washington University
Medical Center, and I bring you a very, very warm welcome. We're delighted to
have you here.

Let me also extend a welcome on behalf of Dr. John F. Williams, the University's
provost and Vice President for Health Affairs. Unfortunately, Dr. Williams is out of
the country, and he obviously could not be with us this morning, but I know how
terribly delighted he is that we are able to host this event here at GW.

We have come together today to educate ourselves about the grave public health
danger of methamphetamine. As many of you know, the Department of Justice has
dedicated today as National Methamphetamine Awareness Day. Discussions similar
to this one are taking place all across the country right now. But we are especially
fortunate, because the Attorney General, Alberto Gonzales, is here to speak with us
and guide our conversation this morning.

It is fitting that GW has been chosen as the site for this exchange here in
Washington, because our medical center trains both clinicians and public health
professionals. As we consider how best to curb the widespread use of a terribly
powerful addictive stimulant, it is obviously that the combined expertise of these
disciplines must be brought to bear.

All of that tells us that we must respond to the meth epidemic with a wise mix of
policies. That includes, at least in part, identifying, prevention and risk reduction
interventions that work, and funding culturally sensitive community-based
approaches with a demonstrated capacity to change norms.

It is also vital, of course, to make treatment readily available to those who are
prepared to fight back against addiction.

Last year the CDC, the Centers for Disease Control and Prevention, hosted a
national consultation of scientists, public health officials and community providers
to talk about some of these issues and to identify needed research and programs.
Putting their ideas and other good ones like those into action requires adequate
resources and a strong national commitment. National Meth Awareness Day and
meetings like this one here at GW are important steps for making that happen.

As we will hear from our distinguished panel this morning, dealing with meth is a
true inner disciplinary problem. To solve it, we must draw not only from public
health and medicine, but also from law enforcement, environment science and other
fields. Local, state and federal agencies all have essential roles to play as well.

To present the panel and set the stage for today's discussion, it is now my great
pleasure to introduce the Honorable Alberto R. Gonzales, Attorney General of the
United States.

Alberto Gonzales has served as the nation's top law enforcement officer since
February 2005 when he was sworn in as our 80th Attorney General. Prior to his
service at the Department of Justice, Attorney General Gonzales was counsel to
President George W. Bush. He also served as a justice on the Texas Supreme Court,
and as Texas Secretary of State, where he was a senior adviser during the younger
George Bush's tenure as governor.

Before entering public service, Attorney General Gonzales practiced law in

Houston, Texas. An Air Force veteran who attended the Air Force Academy, he
was born in San Antonio and raised in Houston. He is a graduate of Texas public
schools, Rice University and Harvard Law School, for which we at GW will greatly
forgive him.

(Laughter.)

MS. KATZ: We are honored, very honored to have him with us today. Ladies and
gentleman, the Honorable Alberto Gonzales.

ATTORNEY GENERAL ALBERTO R. GONZALES: Thank you.

(Applause.)

ATTORNEY GENERAL GONZALES: Thank you, Dean. I am reminded by her

comments, by the dean's comments, that my first acceptance letter to a law school
was George Washington, so, what might have been.
I am indeed pleased to be here to talk, to have a dialogue, a discussion with this
audience, but also primarily with the American people, primarily with parents, about
the dangers of meth.

I've done town hall meetings around the country, talking about methamphetamine,
and I've had a lot of parents come up to me afterwards and say, you know, we had
no idea about the seriousness of this issue, and you really need to do more to
educate the American public. And that's the reason why President Bush has declared
this National Methamphetamine Awareness Day. It is a day where we're going to
spend some time talking about the issues of meth.

We have an outstanding panel today. These are the experts, and they will be doing
most of the talking. I'll try to moderate the discussion by asking what I hope will be
interesting questions. Some of these will be fairly basic questions. Many of you in
the audience have a lot of experience, a lot of knowledge about this area, but we
want to get it down to a fairly basic level, because there are many people in the
American population, quite frankly, that don't know about meth and don't know
about the effects of meth.

So let me begin by introducing our panelists. We are joined by Dr. H. Westley

Clark. He's the Director of the Center for Substance Abuse Treatment at the U.S.
Department of Health and Human Services. Also joined by Robert F. McDonnell,
Attorney General of the Commonwealth of Virginia; Joseph T. Rannazzisi, Deputy
Assistant Administrator for the Office of Diversion Control at the U.S. Drug
Enforcement Administration; Vicki West Sickles, a research counselor with Iowa
Health, Des Moines, and herself a former meth addict, and we obviously look
forward to hearing her insights about that experience; and Dr. Nora D. Volkow,
Director of the National Institute on Drug Abuse at the National Institutes of Health.

I'm going to -- our discussion today will last for about an hour, and we're going to
cover five main areas today, beginning with what is meth and the scope of the
problem. Secondly, a discussion about the production process. Third, the effects
meth has on the mind and body. Fourth, the impact on the community. And finally,
effective prevention and treatment.

So we'll go about an hour. I'll try to keep us on time. And then we'll have about
twenty minutes or so that we'd like to entertain questions from the audience.

So I'd like to begin by focusing on the scope and nature of the problem, and we'll
begin with a question to Dr. Volkow. Now some people are confused about what
kind of drug methamphetamine is. Let's have a general introduction to the
American public about what is it.

DR. VOLKOW: Good morning, everybody. It's a pleasure to be here, and I'm glad
that there has been recognition of the importance of methamphetamine, among other
things, by declaring it Methamphetamine Day.
Methamphetamine is a stimulant drug. And what do we mean by a stimulant? It's a
drug that will activate you. Drugs of abuse, all of them, have a common
characteristic, and that is they increase the concentration of a chemical called
dopamine. And dopamine is a chemical that activates pleasure centers in your brain.
Now the ability of increasing dopamine is different for different types of drugs of
abuse. All of them do it, whether it's alcohol, heroin, marijuana, methamphetamine,
but they do it in different ways.

And of the drugs of abuse, methamphetamine is the one that leads to the highest
concentrations of dopamine in the brain, and this is likely to account for the fact that
probably methamphetamine is one of the most addictive of all of the drugs of abuse.

What happens when you increase dopamine in your brain? Dopamine is there not
for you to take drugs. Dopamine is there to activate the brain and say this is
extraordinarily important. It's not only pleasurable, but pleasure in nature is linked
with a behavior that will ensure survival. In this case, taking methamphetamine is
not going to ensure survival.

But your brain is reading it as this is a signal that says this is important for survival.
So this is actually recorded in your memory very powerfully such that you will next
time you get exposed to a place where you took the methamphetamine, generate the
emotion that it felt having had the drug, and this will likely want you to take it
again.

And this is what initiates, is believed to be what initiates the drive and the interest
in the drug that with repeated administration will result in those that are vulnerable
in physical changes in their brain that will ultimately lead to what we call addiction,
which basically the way that we define addiction is that compulsive use of a drug
despite the fact that the person no longer wants to take and, and despite its
catastrophic consequences.

So, methamphetamine is a drug of abuse. It's a stimulant. It activates, and of the

drugs of abuse, is the one that leads to the highest concentrations of dopamine in the
brain.

ATTORNEY GENERAL GONZALES: Well, we know it's a powerful, addictive

stimulant. Are there legitimate uses for methamphetamine? Is it ever prescribed?

DR. VOLKOW: Interestingly, yes, they were. Methamphetamine is an

amphetamine, and we use amphetamines traditionally for the treatment of attention
deficit disorder, and indeed at one point, methamphetamine was approved for the
treatment of attention deficit disorder.

What happens is that the effects of a drug are a function also not just of its chemical
characteristics, but the way that you take it. So when you were using -- when we
were using methamphetamine for the treatment of attention deficit disorder, we
would use it in a tablet in low concentrations, whereas when people have used
methamphetamine, they take it in much higher doses, and very frequently by other
routes of administration, such as injecting or smoking, which are much more
dangerous both -- vis-a-vis its side effect, adverse consequences to the body, but
also vis-a-vis the dangerousness of addiction.

ATTORNEY GENERAL GONZALES: Mr. Rannazzisi, meth has become a

national problem. It's not just a regional problem. Can you talk a little bit about
what is the history of the use of meth in the United States?

MR. RANNAZZISI: Oh, absolutely. Good morning. First of all, I'd like to build on
what Dr. Volkow said. Methamphetamine is a synthetic substance. It's totally
synthetic. It's man-made. We don't have to worry about somebody growing a plant
somewhere in the world and then extract the product. It's man-made, relies on
chemicals. So, obviously, without the chemicals, there is no drug, you can't make it.

Now in the '70s and '80s, methamphetamine was pretty much concentrated in the
West and Southwest. California, a large hotbed for methamphetamine manufacture.
And what we had was biker groups or independents who were making small
amounts, a pound, pound and a half, two pounds, sometimes ounces, in labs. And
these labs were not crude labs. They definitely weren't labs you'd see at major drug
companies, but they had reaction flasks and Reese flux condensers and they were
making the product using a very, very difficult method that required industrial
chemicals. And that went along from the '70s and '80s.

As we approached the '90s, the methods changed. They refined the methods and
actually the method became easier, and that method spread. Several methods using
what they call the Burch reduction method or using iodine spread eastward. You
didn't need glassware anymore. You didn't need chemicals. You could go out into
the retail market and buy chemicals, buy pseudoephedrine, go to your local farm
and obtain anhydrous ammonia or use an ammonia-based fertilizer to get the
chemical you need. Go to the store and buy Duracell batteries and extract the
lithium or remove the lithium strip from the Duracell battery. And that's basically
all you needed to make meth.

So as we saw it spread, we saw places that were traditionally not meth locations, like
Missouri and Kansas, Iowa, explode with methamphetamine. Why? Because I know
longer needed to go to the local dealer, the local biker to obtain my product. I could
just make it myself. And that's exactly what happened.

So that's why places like Missouri had over 2,000 lab incidents in 2003, 2004, 2005.
Now, what happened? The states saw that there was an issue, and the states dealt
with it. The states came out with restrictions, restricting the sale of pseudoephedrine
products. And what we saw was a dramatic reduction. We peaked in 2004. We had
about 17,700 lab incidents in the U.S. Seventeen thousand, seven hundred labs that
had to be -- incidents -- that had to be cleaned up by your local police departments
and federal departments.

Well, since the state restrictions and now with the Combat Meth Act, we went from
17,700 incidents to about 12,500 in 2005. And this year, we don't look to cross
9,000 lab incidents. So the legislation is working.

ATTORNEY GENERAL GONZALES: We'll talk to General McDonnell about state

regulations and whether or not they've been effective, how effective that they've
been. And we know that meth is spreading across the United States. I want to ask
Dr. Clark, who is using meth right now? What are the demographics here?

DR. CLARK: We estimate that there are about 1.4 million people who have used
methamphetamine in the past year. We know that the past month use of
methamphetamine hovers around about 512,000 people. There is ethnic variations in
the use of methamphetamine with Native Americans, Native Hawaiians, Pacific
Islanders, American Indians, Alaska native and white Americans being the groups
that are using methamphetamine the largest.

We also know that there is a lot of use in rural states, states previously that did not
have a problem with stimulant abuse, states like North Dakota and South Dakota,
parts of Tennessee, western parts of Virginia. So, in short, methamphetamine affects
a wide range of ethnic groups, a wide range of socioeconomic groups, and a wide
range of geographic areas.

ATTORNEY GENERAL GONZALES: Is the use and abuse of this drug different
than what you see with other kinds of drugs?

DR. CLARK: It's a stimulant, and those individuals who respond to stimulants are
more inclined to use it. But many people use what we call poly substances. So they
will add methamphetamine to alcohol or add methamphetamine to marijuana. So, in
a sense, once you're in the illicit drug arena, once you know your favorite dealer if
you're not making it yourself, the dealer also brings other drugs that can be used.
But again, it does target specific areas, as Dr. Volkow pointed out. So those
individuals who are looking for reinforcement in those areas would tend to prefer
methamphetamine.

ATTORNEY GENERAL GONZALES: Let's move on to the production process.

Mr. Rannazzisi, as a DEA agent, you've had a lot of experience with illegal sale and
production of meth. We know that meth can be produced in mom and pop labs in
your neighborhoods. We also know it's being imported into the United States. I
don't want to get into specific instructions for how to make meth, but what kind of
ingredients are we talking about?

MR. RANNAZZISI: Well, it depends on the type of lab. Again, as I've said before
with the smaller labs, which is about 20 percent of the meth consumed in the United
States, these small toxic labs, everything is available in the retail sector. I mean, you
could buy just about any chemical you need to manufacture meth or obtain it by
stealing it off of farms or from farm bureau co-ops. But it's readily available.

The larger labs, the larger labs that are run by organizations, produce about 80
percent of the meth consumed in the United States, roughly 80 percent. These large
labs operating in the United States and in Mexico are controlled by large
organizations, Mexican organizations. Those organizations use their trafficking
routes to get the drug out into the market. They're using industrial chemicals.
They're buying their chemicals in bulk. They're using ton quantities of ephedrine or
pseudoephedrine that they obtain from foreign manufactures. They obtain large
amounts of chemicals like iodine from foreign manufactures.

So there's two components here. There's the small labs that rely on retail sale
chemicals and products, and then those larger labs, what we call the super labs, that
ones that produce ten pounds or more on a 24-hour production cycle, that rely on
bulk chemicals, both tableted and bulk powder.

ATTORNEY GENERAL GONZALES: If someone in the audience were walking

around their neighborhood, what would be telltale signs that in fact there's meth
production going on?

MR. RANNAZZISI: That's a very interesting question. It used to be when there

were actually these large labs, and we still have large labs, but there's things we
always looked for. It's raining and the people in the house are outside smoking.
Why? Because a lot of the chemicals they use are volatile and they could explode,
like ether.

We used to see a lot of people covering their windows with like black plastic or
newspaper so you couldn't see in. Chemical odors, really pungent odors that you
wouldn't forget once you smelled it. Things like people dumping or you see like
land that's been colored by waste, red waste. That's basically what we were looking
for.

Traffic in and out of a location late at night or early in the morning, and not very
long stays. Maybe they come in for, you know, a couple of minutes and then leave
two, three, four o'clock in the morning.

That's what we used to see, especially around hotel rooms, we saw a lot of labs
operating in hotel rooms where, you know, you'd see this traffic. And it's a perfect
place to cook because, you know, you cook and then you leave, and the waste is left
behind.

ATTORNEY GENERAL GONZALES: And so what should the American public

do if you're walking around your neighborhood and you come upon a site where it
smells kind of funny, chemical odor, there's some red waste. You notice some odd-
looking folks going in and out of the place. I mean, what should be people do when
they suspect that there is meth production going on?

MR. RANNAZZISI: Well, we always say call your local police department or DEA
office immediately. You know, that's the first thing you should do. If you happen
upon a lab or you happen upon a discarded lab, never touch anything. And you can
tell if it's a discarded lab. You'll see like a propane cylinder that has a discolored
valve that just isn't right with a bunch of big mason jars or dishes that have a cakey
substance that is discolored.

Don't touch anything. If you walk into a place that could potentially have a lab,
don't touch anything. Don't turn off any electricity. Let it sit. Back yourself out,
avoid as much exposure as possible, and call the local police department or the
local DEA office.

Now in the '70s or '80s, there was not very many lab teams. Today, every major
police department, every county sheriff, drug task forces, they all have specially
trained police officers, law enforcement officers, that go out and take care of these
lab sites. That's available to everybody and they're all trained.

ATTORNEY GENERAL GONZALES: Okay. Thank you. General McDonnell, we

talked about what the states have done to combat meth, passage of laws restricting
access to precursor chemicals. The President signed in March of this year the
Combat Meth Act. Can you talk a little bit about whether or not -- how do you see
these laws? Are they effective? Are they helping us in fighting the spread of meth?

MR. McDONNELL: Well, I think they've been enormously effective in the last two
years since these laws at the state and federal level were put into effect. A lot of it's
awareness, and that's why I appreciate the Department of Justice and George
Washington University doing what they're doing today to be able to talk about this.

This is one of those law enforcement problems that kind of snuck up on the states.
Nobody heard much about this back four or five years ago, but I know in Virginia,
we went from one lab incident to 78 in a period of just a few short years.

MR. McDONNELL: -- In Virginia, we passed a couple of important laws. One was

a precursor law that created a new felony offense for the possession of the precursor
elements, such as Sudafed and other things, with the intent to distribute.

It gave law enforcement the ability to go in without actually having manufacture

completed but with the core elements in place with the intent to manufacture. And
then secondly, we passed a law as further implemented by a governor's executive
order to require -- and this is what's been most effective, I think, General -- is to
require that these precursor elements, pseudoephedrine containing elements, be put
behind the counter.
Many stores, Wal-Mart and others, were doing it voluntarily before that, but this
required the items that are not scheduled substances -- they're not controlled
substances, but they still were subject to abuse, and so they were required to be put
behind the counter and for those customers who purchased it to actually have to sign
for it -- how many they bought, the date, their name, their address, and so forth --
which puts a little more accountability on the part of the buyer if they were going to
go in and buy certain amounts.

The other thing that was done is a limit on the amount of the substance that could be
purchased. In Virginia, we limited it to nine grams per day. Now the federal act --
and I appreciate the General's leadership on that -- that passed in -- I think the
President signed it in March of this year -- limited that to 3.6 grams per day and, I
believe, 9 grams in a 30-day period and also required these additional registration
requirements.

That has had a huge effect, the combined state and federal action over the last year.
In Virginia alone, from fiscal year 2004 to -- from 2005 to 2006, we've gone from
79 lab incidents down to 23, almost a 75 percent reduction in the number of labs
that have been discovered in Virginia. And a lot of it is because they just can't get
access to the high volume of Sudafed and/or ephedrine containing products.

And so it is working. The combined state-federal approach is working. It's

something that needs to continue because the nature of the addiction is so acute. It's
cheap and easy to manufacture if you can get your hands on the precursor elements.
You can get the recipes off the internet. Up until a couple years ago, you could get
as much of the product that you wanted to make the methamphetamine inside any
pharmacy or Wal-Mart, and it was highly profitable.

But I think we're -- these laws now that were passed in the last couple of years,
General, have been very successful. And Virginia is, I think, reflective of what's
happening nationally. I was just at the National Association of Attorneys General
meeting yesterday down in Florida, and this was a huge issue that we discussed. We
see these programs being implemented at state to state level as well to tighten up
their meth laws in every state.

ATTORNEY GENERAL GONZALES: I couldn't agree more. I have to commend

states for the leadership they've shown on this issue. They were out front and very
early on identified the problem. And many of them passed laws dealing with
limiting access to precursor chemicals. And obviously those of us at the federal
level saw that it was working effectively, and that was the impetus for having some
federal legislation.

I want to move now to a discussion on the effects of meth on mind and body. Dr.
Volkow, you spoke already about some of the effects on the brain. I don't know
whether or not you want to elaborate on the short-term and long-term effects of
that. But I'd also like you to talk a little bit about the toll on a person's body that
occurs when someone uses meth, both long term and short term.

DR. VOLKOW: Yes. And indeed, again, I was commenting before that
methamphetamine is considered to be one of the most addictive of the drugs -- of
abuse. But it's also considered to be one of the most toxic, and I'll go into an
explanation about why there is concerns in the scientific world about these.

I was commenting about the fact that methamphetamine is a drug that induces the
largest increases in dopamine. Now dopamine, being a chemical that's indispensable
for your brain to learn that something is important for survival, triggers and
facilitates learning. And it is believed that the physical changes that are linked with
addiction actually relate to these physical changes akin to those that your learn when
you memorize something. But it's a memory of an emotion; it's a memory of an
experience.

And when these become so ingrained in your brain, this can take over other
motivations. Now what we've also come to recognize is that not all of the drugs are
the same. And they are not the same in their ability to produce addiction.

Cocaine has been recognized for many years to be very addictive, and yet when
they look at the clinical data, for example, over all in average -- there is variation
between one person and the other -- but in average, it may take a person two or
three years to become addicted to cocaine. In the case of methamphetamine, the
addiction can proceed within one year, and this highlights the importance and the
seriousness of the effects of methamphetamine in the brain.

The other thing about methamphetamine is that the increases in dopamine are so
large that they actually damage the cells that are producing that dopamine itself,
which does not happen with other drugs like cocaine, heroin, or marijuana. So at
that level, methamphetamine is much more toxic to the brain than these other ones
because ultimately it is disrupting, damaging the cells that allow us ultimately to feel
pleasure.

And indeed, one of the things that happens across all addictions but even more
marked in the people that are addicted to methamphetamine is that though even
when they get initially taking the drug they feel great, as they continue to take it,
they take it no longer to feel great, but to feel normal because if they don't take it
they feel horrible.

The dopamine, which is what gives us our excitement, our motivation, our drive to
do things, has been basically -- those cells have been damaged and so you normally
no longer respond to everyday events, so that -- vis-a-vis the consequences in the
brain.

In the brain also, as in the rest of the body, methamphetamine, being a stimulant,
has the characteristics of producing blood vessels to constrict. It's called vessel
constriction. Now there are certain organs that are very sensitive to the delivery of
blood; if blood is not delivered properly, they suffer very rapidly damage.

The number one organ for that is the brain. If blood is not properly delivered that
can result in a stroke. What are the consequences? Well, it depends where the
stroke happens. So if it happens in the back part of your brain, you may become
blind from taking methamphetamine. If it happens in the areas of the brain that are
involved with movement, you may become paralyzed from taking
methamphetamine. So the consequences are pretty dire.

If it happens in your heart, what can happen? You can develop a myocardial
infarction. And indeed, what these communities where methamphetamine is very
prevalent are observing is that the number one reason for admissions with cardiac
problems in young people is because they are taking methamphetamine.

There are many other body organs that suffer from it. We know that skin, for
example, is very damaged. We all heard about the issue of the -- and the meth
mouth. And that is, in part, a function not just of the adverse chemicals that are used
in order to produce a methamphetamine, but also by vascular constriction. Your skin
as well as your gums require proper delivery of blood to them, and if its not they
start to damage themselves. So these can affect, as I say, organs that we see but also
organs that we do not see.

And finally, there is another aspect about methamphetamine that has been very
problematic, and that is the notion that methamphetamine -- being a stimulant, one
of the things that it does is it increases sexual arousal. Not only does it increase
sexual arousal, but evidently it decreases inhibitory control, and as a result of that,
people take this drug and engage in practices and behaviors that they would have
not done otherwise. This puts them at very high risk of risky behaviors that can turn
out to result in HIV/AIDS or Hepatitis C vaccine [sic].

And this property of methamphetamine of increased sexual arousal is utilized -- is

used -- people use it for that specific purpose, and that has made methamphetamine
play a very important role in terms of continuing in the dissemination of the HIV
epidemic. Not, in this case, because people are injecting it -- if they are injecting
contaminated materials, yes -- but because the drug itself is producing changes in
their mental state that leads them to very risky behaviors.

ATTORNEY GENERAL GONZALES: Thank you, Doctor. Blindness and possible

heart problems, using your ability to appreciate pleasure -- you can really see how
powerful a stimulant -- how powerfully addictive a drug this must be to have
people risk all of that in order to enjoy meth.

I want to introduce Miss Sickels, who is with us. We are fortunate to have a one-
time meth user who managed to beat it, and even better, to dedicate herself to
helping others beat it. So I would invited Miss Sickels to talk a little bit about her
own personal experience with meth.

MS. SICKELS: Good morning. It's a privilege to be here this morning.

When I first used methamphetamine in 1988, I'd never heard of it. I didn't know
what it was. I had experimented with drugs in college and became addicted to
cocaine for a time when I was in college, but I graduated from college in '86, and
then was very careful to avoid hard drugs after that.

But in 1988, I had just lost my father, and I was grieving, and I had -- I was sort of
at loose ends, didn't quite know what to do with myself, didn't have any goals -- had
some goals, but they didn't make any sense. And I met a man who asked me if I
wanted to try some crank. And I asked him what it was, and he said, "Oh, it's like
speed, sort of like coke. I'll chop it up. You can snort a line."

And so I thought it's what you did when you couldn't find any cocaine. And the first
time I did it -- it was October 19th, 1988 -- I was intoxicated. I would consider that
alcohol was probably my gateway drug. I was intoxicated when I tried almost
anything else that I did. But so I didn't feel it right away, but I woke up in the
morning, sat straight up in bed at six o'clock in the morning and felt fantastic, and
wanted to jump up and grab my journals and write poetry, and I felt so creative and
energetic. And I loved it.

Right from then, it was odd and fantastic and I loved it. But I didn't have to go out
and do it again the next night, though I was really looking forward to seeing this guy
again the next weekend -- and did it again. And did it weekends for about a couple
of months, maybe a month, and then he and I started using together every day and
injecting meth.

And rapidly it became the only thing that I did. I quit working. I was just using
meth, and it pretty much took over my being. At first, you know, it gave me energy.
I had energy for my creative projects. I wasn't depressed about my father. I felt
great.

You know how you always wish -- there's not enough hours in the day to do what
you think you need to get done? Well, this makes every one of the 24 hours of the
day available to you, and that was attractive to me. I wanted all that time, and I
wanted all that energy.

But eventually I couldn't get anything done without it. I couldn't get off the couch
unless I had some meth. And so it quickly became -- I needed it for energy, and I
needed it for motivation, and it took me quite some time and quite a little effort to
get off of it, more than one treatment, in fact.

And mentally, you know, I was stimulated, I was confident, I felt great at the
beginning. At the end mentally, I was obsessive, I was compulsive, I was looking
for bugs that weren't there. I was staring out the windows at things that weren't
there. I mean it really kind of made me lose my mind, and my main focus was then
using and getting more meth and dealing with the projects that I had in mind.

And physically I would say -- physically I was fortunate. I lost a lot of weight. I had
the bug thing going on, but I resisted the picking, so I didn't pick scars onto my face.
I didn't see a dentist for the last five years I was using, so I had some periodontal
stuff going on, but I didn't lose any teeth.

I ended up with Hepatitis C though. I am -- I was an injecting drug user. And what
they say about Hepatitis C is that if you inject for even one year, you have an 80
percent likelihood of ending up with Hepatitis C, so I came away with that.

ATTORNEY GENERAL GONZALES: You mentioned some signs, and other

panelists have mentioned it as well, but what would you look for in terms of
identifying someone as a meth user?

MS. SICKELS: I would say hyperactive kind of energy is the first giveaway, a
noticeable increase in the level of energy. And a change in sleeping patterns,
somebody who has pushed their bedtime way back into the middle of the night
somewhere and then gets up at the crack of dawn, that's a pretty good sign.

ATTORNEY GENERAL GONZALES: That's what I do every day. (Laughter.)

MS. SICKELS: Is that with coffee?

ATTORNEY GENERAL GONZALES: A lot of caffeine.

MS. SICKELS: Well, it would be a change from what their usual behavior was -- is
what you would look for.

You would look for a change in their usual -- the company that they keep, if their
friends -- a lot of times when someone starts using, they find friends who are doing
the same thing that they are. Their old friends drop by the wayside. They stop
calling mom; they stop showing up for holidays -- that would definitely be a
giveaway.

You know, a lot of people are --

ATTORNEY GENERAL GONZALES: how many people -- you talked about -- is

it called crank bugs?

MS. SICKELS: Yes.

ATTORNEY GENERAL GONZALES: -- where they imagine the sensation of bugs

either on top of their skin or underneath their skin, they scratch and scratch, and
they develop sores.
MS. SICKELS: Mm-hmm.

ATTORNEY GENERAL GONZALES: Do you happen to know or any of the

panelists happen to know what percentage of users develop this kind of symptom?

MS. SICKELS: I don't have any numbers, but the -- what I see in the clinic where I
work, about half of the people who come in have sores on their arms or on their face
that they've scratched at.

I actually -- we talked about medical profession as being a point of intervention. I

once -- I thought that I had -- I had been digging in the carpet. I had to have
marijuana to take the edge off of my high because I didn't like the anxious edge. So
if I didn't have any marijuana, I would dig in the carpet or in the furniture looking
for it obsessively.

And I thought that I had parasites under my fingers. I was certain that I had just dug
them in -- like dust mites. And I went to a doctor and said, "I'm certain that I have
parasites in my skin." And he said -- he looked at me, he said, "Those are calluses."
I said, "No, no. I'm certain they're parasites."

So he took a razor -- he was a kindly older gentleman -- he cut a little bit of my

skin off, what I thought was a parasite, put it under the microscope, said, "Look
there, that's skin." So I looked in the microscope. I said, "No. I see a spine. That's a
parasite." He said, "Parasites do not have spines. Go home and go to bed."

ATTORNEY GENERAL GONZALES: Any other signs, panelists, we ought to be

looking for?

DR. VOLKOW: I think one that is pretty frequent is a loss of weight. One of the
things that methamphetamine does -- all of the amphetamines remove your weight
and your hunger. And indeed, that's important too, from another perspective, in that
sometimes some girls will start using methamphetamine because they want to lose
weight and not per se because they want to get high. And they get hooked, and
indeed that may keep them taking the drug.

So yes, methamphetamine makes you lose weight pretty rapidly. It also -- the more
you take the more evident this becomes -- people become very suspicious and
paranoid.

And I agree with you. The main sign that you get when someone has shifted into a
pattern of abuse, a change in their personality. So if you've always been very
compulsive and wake up at five in the morning, I wouldn't worry. But if that is
something that's all of a sudden different, then you want to understand what
happened.

DR. CLARK: Also, especially in the workforce, this issue of the paranoia can
become problematic. Individuals who are at work start to suspect other employees
of threatening or plotting, and so the notion of workplace violence becomes an
issue, and we need to be very careful about that. I think that's one of the reasons that
we have workplace drug testing, because the person's judgment becomes impaired,
particularly if they're operating heavy equipment, large motor vehicles. Their
reaction time is altered and with the impaired judgment they're liable to increase
their risk for accidents.

ATTORNEY GENERAL GONZALES: Okay.

MS. SICKELS: there's a physical thing that happens, too. There's a lot of kind of
twitchy, fidgety thing that goes on, picking things up, putting them down, taking
things apart, trying to put them back together. There's a thing that happens with the
jaw where the jaw is working back and forth, and even a change in the posture
because your muscles tense up, so there can be a change in the way somebody
stands or walks or the way their face moves. So there's physical characteristics as
well.

ATTORNEY GENERAL GONZALES: Thank you. Let's have a brief discussion

now on the impact on the community. I want to begin with Mr. Rannazzisi.

We talked about the dangers of producing meth, and can you elaborate about the
environmental problems caused by domestic meth production?

MR. RANNAZZISI: Yes, sir. Well, they say that one pound -- the manufacture of
one pound of meth produces between five and six pounds of hazardous waste. And
the labs I've been -- the waste is -- there's a lot of waste in there. The fact is that
they have to get rid of it somehow, so what they usually do is either they dump it in
a rural area -- they dump it in a park or they'll pour the waste down the sewer
system.

Well, I don't know if it's -- if it's put in a park, the soil will be contaminated. If it
goes into the sewer system, it could get into our water system, and obviously you
have contaminated water.

When we go in and clean up a lab, we don't do what's called a remediation. We do a

gross contaminant removal. We remove all of the gross contaminant from the lab,
but that does not mean there's no toxic substance left in the lab; there is residual
toxicity in that lab. And to remove that residual toxicity, you'd have to pull down the
walls and pull out the carpet or the floors, and that's a problem.

We leave that to the landowner. The fact is that it's his property; he's got to remove
that contaminant. So you could buy a place that -- buy property that had a lab on it
and walk in there and not know that you're living in a place where there's residual
contamination. We've had instances where residual contamination has caused
respiratory problems for the new owners. They didn't know why, and later they
found that the residual contamination was the cause of their respiratory problems.

So environmentally and also the health of the individuals in these labs or in these
former labs -- it creates a major impact on the environment and on the citizens.

ATTORNEY GENERAL GONZALES: Dr. Clark, as I've traveled around the

country, I've heard some heartbreaking stories about the effect on children who are
in these homes. How does meth use and production affect children?

DR. CLARK: I'm glad you asked that. It's an important thing for us to keep in mind
that many of these home labs -- parents are -- they have the kids in the next room or
in the very room while they're producing methamphetamine. You've got a lot of
toxic substances being produced, so the children are exposed to the noxious fumes.
Some of these fumes not only can cause respiratory damage; they can also cause
behavioral and neurologic damage in the children.

Some of these labs explode. You've got kids in the labs who then are exposed to the
risk of explosion and burns. You've got children whose parents are so preoccupied
with the production and consumption of the methamphetamine that they really don't
have much time left to nurture and protect their children. So you've got neglected
children, physically or sexually abused because parents -- as Joseph pointed out,
you've got a lot of traffic coming in and out, and while the parents may not be
sexual predators, sexual predators avail themselves to the children because the
parents are preoccupied with the manufacturing and the consumption of
methamphetamine.

So a lot of concern about children. Most jurisdictions -- actually all fifty

jurisdictions now have drug-endangered children teams that are working with child
welfare in order to protect kids. And they work with law enforcement when they go
in -- drug-endangered children teams, and in order to mitigate the damage done.

And then of course, you've got the issue of burdening the foster care system by
increasing the demand with children who are in meth homes or have parents who
are on methamphetamine and can't parent.

MS. SICKELS: I would like to speak to that as well. I've seen, from my personal
experience, and also in the clinic now where I work, that it's become a multi-
generational problem where if the parent's addiction is allowed to continue
unabated, eventually those children are pretty much destined to follow in their foot
steps because it's a way of life in their household.

I've had young people come to me who can't go home for support from their family
because their parents and everyone in their household is using. And I've had people
who have told me that they started using as young as nine years old with siblings or
even step-parents that are there in the house. So it's become a multi-generational
problem.
ATTORNEY GENERAL GONZALES: What about the effect of meth on crime,
General? What kind of crimes -- people who engage in meth, how does that affect
the crime in a local community?

MR. McDONNELL: Because the epidemic proportions of the meth phenomenon are
so new, we don't have great statistics at the state or the national level on it yet.
There's been some surveys I know in Illinois, and Oregon and others that indicate
that as much as 30 to 40 percent of the total jail population is in for meth-related
crime. But most jurisdictions don't keep separate statistics about the link between
meth and the criminal act.

But based on what you've heard from both of the doctors about the nature of meth
and how it affects the body, I think there's three categories anecdotally that we can
say -- and we've seen it in Virginia -- that have increased. One is the garden variety
property crimes: larceny, burglars, forgery and entering, bad checks, things like that
-- people that just need money because of the nature of the addiction and the
amount of money that it takes to support that addiction if they're not manufacturing
themselves. If they've got to buy, they're engaged in a significant amount of
property crime.

The second would be domestic violence and child abuse. You heard Dr. Clark just
speak about that. It goes into really two categories. One is having young children
being around the manufacture of the product itself is a very abusive environment.
And secondly, the compulsion of the user to do other things has them to neglect the
child. And we've seen an increase in particularly the western part of Virginia of
child neglect charges.

And thirdly, and this is a new phenomenon. It's gotten some national articles written
about it. And that is the rise in the link of internet-related crimes with
methamphetamine use because you can stay up for extended periods of time, as you
heard from everybody, and you have -- there's great energy and a compulsive nature
of the addiction that we're seeing -- again, anecdotally, an increase in various types
of internet crime like identify theft and fishing and farming and some of these new
types of internet crimes that are going on because people can stay at that computer
screen for 12, 15, 24 hours at a time if they're high on meth and looking for new and
creative ways to try to scam somebody else out of their money, their identity, or
their property via the internet.

So even though it's anecdotal, I don't think we have any great national numbers.
Those are the categories generally that we see in Virginia.

ATTORNEY GENERAL GONZALES: Okay. Thank you. Now the final topic,
which is prevention and treatment. Miss Sickels, I understand that meth addiction
can be very, very difficult to treat, but it can be treated. Can you talk to us about
your experience in treatment?
MS. SICKELS: Certainly. First of all, even though I became tired of doing it and
what it was doing to my life, I could never make the decision that I'm sick of this
and I want to quit and get myself to where I needed to be. That was never able to
happen for me.

What had to happen was somebody noticed that I wasn't -- the first time I went to
treatment was in 1993, and it was my family who noticed I wasn't taking good care
of my son, who was three years old at the time, and they told me that they were
going to remove him from my care if I didn't get some help. So at that time, I
checked myself into treatment. I was 28-day inpatient.

They suggested a halfway house. I said, "No, I have a house. I'll just go home and
go to 12 Step meetings and do what needs to be done." And I did that, and I stayed
clean for six months. And at the end of that six months, I was as depressed as I'd
ever been, and actually feeling like if this is all there is, I don't really care to go on.
But I had a child, so I didn't actually become suicidal.

What I did was relapse on sex is the way I tell the story because I was going to 12
Step meetings and I started to get involved with somebody who was there, and the
sexual activity really stoked me in my brain again.

Dr. Volkow has some great slides that show the regular dopamine in a person's brain
as big red spots, and then at six months into recovery there are no red spots in the
brain. The dopamine is not -- the brain hasn't started to produce it again on its own.

So at six months into recovery, when I was thinking that things should be getting
better, I still felt like hell, and so I looked for another way to feel better. And I
started with sex, and within a couple of weeks I was using again, and injecting. And
I knew I didn't want to live that way.

And I would tell people -- I would go to the 12 Step meetings and say, "I've had a
spiritual awakening now," as a result of my relapse, and I did feel better because I
now had dopamine in my brain again.

But I knew I didn't want to live that way, and I kept saying, "This is my relapse
vacation. I'm going to get myself together and get off it again." Well, it took five
years before I could get that done, and in that five years, I went places in my
addiction that I never wanted to go -- homeless, and fired from jobs, and evicted,
and jailed for hitting someone. It was then my addiction got really ugly.

And at the end of that five years, when I could finally get into treatment again, it
was legal intervention. Actually, it was in 1998 when the labs started exploding on
the scene and we were hanging around with people who were cooking. So when the
whole little village of us who were manufacturing meth were raided, I was able to
get out of that situation and into treatment, and into treatment that lasted.
The last time I went to treatment in 1998, I said, "Put me on the list for a halfway
house because if that's what it takes I never want to have to go on another relapse
vacation." So that time, in 1998, I did the inpatient treatment. I did the 90 days at a
halfway house. I'm fortunate to have a sister who is clean and productive, and she
allowed me to live with her for a couple of years.

And it took me that amount of time to really start feeling good about life and myself
and be able to set goals and learn how to live again. It was that long-term, extended
-- attending meetings and going to aftercare, and really getting the support that I
needed for -- it was over a year; it was almost two years.

ATTORNEY GENERAL GONZALES: What would you tell others to do to prevent

their families and their friends from getting introduced to meth or getting addicted
to meth?

MS. SICKELS: I would tell them, for one thing, be aware. That's why I think that
this day is so important. I was completely unaware of what meth was and what it
did to people and how it impacted their lives. I had no idea about it when I started
using it. And I like to think that if I'd been aware of what methamphetamine was
and what it entailed, I would have avoided it.

The other thing is, when I became vulnerable to it was a time when I was not coping
with things that were going on in my life. And just in terms of prevention in general
for all kinds of substance abuse, I think we need to do a better job of educating
people about how to cope with the trials and tribulations that life throws at all of us.

I got to college, and I hadn't experienced anything, and then when I was in college
and things started occurring that were upsetting and caused me to be depressed, I
didn't have any coping skills. So I think that we as a society need to do a better job
of helping one another learn how to deal with things.

ATTORNEY GENERAL GONZALES: Okay. Dr. Clark, in your experience, what

types of treatment programs have proven to be most effective in dealing with meth?

DR. CLARK: One of the things that I want to acknowledge, first off, is the
importance that law enforcement has played in terms of treatment process, and that
is drug courts. And law enforcement has actually been very useful in referring
people to treatment. I think Vicki's point is well taken.

It's treatment approaches then with drug court, with law enforcement referrals. We
use various psychological, psycho-social treatments, nothing inherently unique to a
methamphetamine.

There is no targeted model, but different models like the matrix model -- it's a
manualized treatment strategy originally developed to address cocaine. It's put
together, is fostered by NIDA. SAMPS has also played a role in promoting the
matrix model. It's a combination of integrated strategies: individual counseling,
cognitive behavioral treatment, motivational interviewing, family intervention,
toxicology screen, urine testing, participation in 12 Step programs.

The other treatment that we're using now is called recovery focus. That's getting
community organizations, faith-based organizations involved in the recovery from
the use of methamphetamine.

I think Miss Sickels's point was well taken. After you've done the detox, after you've
done the acute treatment, what do you do then? And by relying on entities like 12
Step programs, faith-, community-, and recovery-oriented strategy, we're able to
normalize that person's existence and get beyond the acute effects -- and then
dealing with some of the psychological walls that people run into down the road.

So these are the things that we are involved in. There's no specific medication that
you can give a person. People are using antidepressants for some effects and Dr.
Volkow can comment about some of the medication development strategies that
NIDA is promoting, but the key issue is we're working with our states.

Our state governors' organizations are trying to include some of these developments
like motivational incentives in the strategies. For instance, Christy Dye in Arizona
has put together a nice little demonstration project where people are given
incentives to stay in treatment, stay in the recovery process.

ATTORNEY GENERAL GONZALES: Dr. Volkow?

DR. VOLKOW: I will comment on that treatment -- but before I get into that,
because I think that it's so extraordinarily important that it was mentioned is the
notion of how important it is to do prevention because ultimately if you can prevent
drug abuse, you then don't have to worry about all of the consequences, and the
earlier you can do that, the more likely you are to succeed.

Why? Because a lot of the drug experimentation, we know, happens during

adolescence, and unfortunately, as it was commented, sometimes during childhood.
Why do kids take drugs? They take drugs because they are curious. They take drugs
because their friends are doing it, because they want to have a good time, without
really a clear understanding of the consequences. And as a society, we need to
know what works in prevention or not.

And one of the things from research that has come across consistently is that one of
the most important elements in that algorithm about what works is the family. And
most of the prevention programs -- therefore emphasize the involvement of the
parents and the family in the prevention process against the use of drugs.

So that's -- I did want to highlight that because it can never, ever, ever be
underestimated -- the importance of prevention.
In treatment, there are currently, as Dr. Clark was commenting -- we do not have
currently any medications for the treatment of methamphetamine. However, we're
working on different strategies that look very promising.

One of them is the possibility of developing a vaccine against methamphetamine.

This has been successful. We are actually at the stages of doing phase three clinical
trials both for nicotine vaccine -- the pharmaceuticals involved with that -- and also
for a cocaine vaccine. We're also working on a heroin vaccine.

Methamphetamine has been harder to do. We have succeeded on developing the

antibodies itself but not through a vaccine, and that's very useful when you get a
patient that has intoxicated with serious arrhythmia on their heart or where you need
to do an intervention right away. The antibodies will basically allow you to get rid
of the methamphetamine.

But we want to be able to do that for someone who, for example, goes to
rehabilitation and then is out there -- you protect them by the vaccine so that, if they
relapse because they have a stressor in their life, they'll have the vaccine; they will
not feel the drug. That's one.

Then we are working with a medication that has been shown to be quite effective in
improving the ability of your brain to exert control of your emotions and your
desires, which is one of the functions that is eroded, is damaged by the use of
chronic drugs. So -- all of us are always in position maybe throughout the day, of "I
want this," "I want the chocolate," but I catch myself saying it; I don't want to do it,
and I exert cognitive control to say I shouldn't do it. Well, that is one of the areas
that's damaged by drugs, very much damaged by methamphetamine, so we're
developing medications there.

Another type of medications that has shown already in clinical studies promise for
methamphetamine -- most studies -- is anti-epileptics. Certain anti-epileptic
medications evidently are able to decrease the craving and the desire for the drug
that a person may feel when they get exposed to a place where they have taken the
drug, or when they feel depressed, or when they feel stress.

And finally, interestingly, this is data that has come from Europe where they show
that methylphenidate, which is a medication that we use Ritalin for the treatment of
attention deficit disorder, showed promising results in amphetamine injection drug-
users. And there was a study in Amsterdam -- so these are different types of
medications that we're working with.

At the same time, we are optimizing and trying to take advantage of methodologies
and technologies to be able to tailor behavioral interventions that can increase the
likelihood that a person will stay clean of drugs. So we're working on both fronts.

And the other big initiative that we have, because Dr. Clark mentioned it, but it is
incredibly important, is the opportunity that we have when an individual that has a
problem with substance abuse ends up in the criminal justice system. That's an
extraordinary opportunity to institute treatment. And it will, as has been heard --
and I've heard it many, many times. It has made a difference in a person's life
because it allowed them to have treatment that was of a sufficient long duration at
an aftercare that made the difference between being able to stay drug free or fall out
or going back.

And the treatments in the criminal justice system have shown to be effective not just
in what you said, on helping people stop taking the drugs, but in significantly
decreasing the rate of incarceration, and that's why another aspect that is very, very
important.

DR. CLARK: One final thing on that is screening and brief intervention involving
healthcare practitioners, making sure that we increase awareness among physicians,
nurses, nurse practitioners, physician assistants, dentists, and anybody else in the
primary care delivery system -- I think Vicki's point was well taken that she had
problems with gingivitis -- and we need to make sure that dentists are aware about
not only meth mouth but ask the question -- if people show up in the emergency
room, asking the questions, people showing up in the healthcare centers, asking the
questions.

So part of what we're trying to do with the Office of National Drug Control Policy -
- is promoting is making sure healthcare providers are knowledgeable about
addiction. Too often we find that they're not knowledgeable and there's a missed
opportunity. And by the time its written on the wall, in the newspaper, and on TV,
it's sort of after the fact. What we're trying to do is identify these issues early.

ATTORNEY GENERAL GONZALES: General, I understand that you're engaged

in an excellent cooperative effort with the U.S. Attorney's Office in the Western
District. Can you talk a little bit about that?

MR. McDONNELL: Sure. We've done some of the traditional law-enforcement

cooperation, like looking at the penalty structures between state and federal law.
And we realized we had some work to do at the state level, and we've bumped up
the penalties to get it closer to what the federal law requires.

We talk about cases where there's joint state police or federal authority
investigations to see whether they ought to go to state or federal court, and so that's
been helpful. But I think we realized also that we have a role to play in the
prevention side.

I think the panel has been very clear about getting a message, particularly to
adolescents, young people, about not getting started. There's a lot of ways to do that.
One I just discovered a couple days ago is this little bracelet to get to young kids,
sort of like the Lance Armstrong approach. This says, "not even once." It's a black
arm band to kind of remind kids don't ever start.

You heard Miss Sickels's example, just the first time was so good she kept coming
back. Well, John Brownlee, who is the U.S. Attorney for the Western District of
Virginia, do an outstanding job, but as part of your Project Safe Neighborhood
program, General Gonzales -- decided he would created a video with a very clear
message. It's called Meth Kills.

And he invited me to be a part of that, and we really took an approach to try to get
the message to young kids starting not in high school, but in the middle schools with
a tough love message about the legal consequences, and what you heard today, the
medical consequences of using meth, because kids care about their appearance and
kids think their future is forever. But what they don't understand is what six months
on meth will do to you.

And so this video -- it's about 15 minutes long. It's actually a DVD that's been
produced over the last couple months. We just stared distributing it to schools all
over Virginia just about a month ago. But it's got some healthcare providers talking
about what you heard today, about the physical impact on your body in a very short
order of methamphetamine.

It's got Mr. Brownlee and I and the state police superintendent talking about the
legal consequences of using, manufacturing drugs, and what a felony will do to a
young person for the rest of your life. And then, very powerfully is, we got folks
like Miss Sickels, three folks who are recovering methamphetamine users telling
their story about what methamphetamine has done to their life. So we think it is a
very powerful, tough love message.

He's raised some public and private money to get this all over the state. We think it's
going to be very powerful. It's gone to all the schools, all the PTAs, to educate both
parents and kids about this, and I think it's going to have an impact.

We've also cooperated on something called Meth Watch. Many states have
programs like this to be able to enlist the help of the private sector in discovering
methamphetamine laboratories such as just training -- commonsense things like
training cleaning personnel in hotels and motels around the state so they look for
the evidence of -- the remnants of a meth lab, the folks that pick up the trash so that
they know if they find things in the trash that look like they're a discarded
methamphetamine cooking apparatus they can promptly notify law enforcement,
and then the investigation can start.

All that is very helpful from an investigative side, too. So he's done a great job with
the Project Safe Neighborhood implementation in this area, General, and we think
it's going to have an impact with kids in Virginia.

ATTORNEY GENERAL GONZALES: Thank you. We have found meth labs in

homes and apartments, in penthouses, and vehicles, in parks -- they're all over the
place. So that concludes the panel portion of this morning's program.

I would now like to invite the audience to ask questions. I think we have mics
available if you want to ask a question. Please give us your name, who you were
with, and, if you can, specify which panel member you would like to answer your
question. So why don't we begin?

QUESTION: Hi. I'm Marcia Lee Taylor from the Partnership for a Drug Free
America. I was interested to hear the panel talk today about the changing trends in
meth use in the country from the production by the biker gangs to the mom-and-pop
labs, and now, with the effectiveness of the federal and state laws, the decrease in
the mom-and-pop labs.

I'm wondering, as we're still seeing meth coming over the border now in more
traditional distribution routes, if, Mr. Rannazzisi, you could talk a little bit about
what you're seeing in the future. Do you think this is going to be more of an urban
problem in the future than a rural one, it is now?

MR. RANNAZZISI: I don't think we could characterize it as a rural problem

anymore. We've seen labs in New York City. We've seen -- two or three years ago
we had a lab in a vehicle right in D.C. It's not a rural -- it's not only a domestic
problem; it's a global problem. Meth is everywhere.

Now we are seeing a dramatic decrease in the small labs, which is great for us, but
we are also seeing these large organizations taking up the slack and actually
flooding the market in many areas, both rural and urban, with methamphetamine.

So what are we doing? Well, we know the organizations, for the large part, are
Mexican organizations. We're working very closely with the government of Mexico.
We're training their officers to detect labs, to understand how to develop these
investigations.

We've trained Mexican law enforcement officers in all aspects of methamphetamine

clandestine lab activity. We're putting clandestine lab trained Mexican officials in
what we call the "lab hot spots" in Mexico, Sinaloa, Sonora, Baha Norte, Michocan,
so we are training them. We are working closely with them. We have task forces on
both sides of the border that are working together, trading information. Together we
are going to address the problem.

Meth is going to be on the street ‑‑ just because we see a downturn in the small
labs ‑‑ meth is going to be there. We have to work with our counterparts in Mexico
and Canada. But remember, it's a global problem ‑‑ Oceania, Europe, Southeast
Asia, all have meth problems. Canada has got labs. Mexico has got labs. Labs are
pretty much all over the place.
So I think that working with the Mexican government, we should be able to slow
down the process of meth coming into the country, but we also have to look past
Mexico. We have to look at Southeast Asia. It has become a major meth
manufacturing area.

ATTORNEY GENERAL GONZALES: Let me just say that on this particular issue,
several months ago the Mexican Attorney General and I went to a conference in
Texas that focused on dealing with this issue of meth, and there we announced a
series of initiatives to try to address it, and I have had a number of conversations
with the Mexican Attorney General about this issue. He is likewise very concerned
about the issue.

We have also had conversations in my travels, say, for example with China,
discussions about limiting, trying to discourage or at least get some help from the
Chinese government with respect to their exportation of precursor chemicals which
finds its way into Mexico and creates a problem for the United States.

So we realize we have a problem, an issue a challenge with respect to importation

of meth through our southern border and we are working with our Mexican
counterparts to try to deal with it.

Other questions? We have got one back here. We have one over there. Also have
got one back here.

QUESTION: Thank you. It was a fascinating discussion this morning. My name is

Leroy Charles. I am a vice president here at the George Washington University
Medical Center, and the young lady sort stole over to my questioning, but I'll sort of
ask in a different way.

What is the, let's say, the pecking order for illicit drug use in the United States with
meth? And the reason why I asked that question, if you go up 95 North, 45 minutes,
we know that Baltimore has a serious heroin population. We know here in the
District of Columbia back in the late '80s, early '90s, we had a crack cocaine
problem. So where would you rant meth? Is it an epidemic in this country?

Again, we have talked about demographics, but what is the geography of meth? Is it
urban? Is it suburban? Is it rural? What is it exactly?

DR. CLARK: Well, the answer to that is yes.

(Laughter.)

DR. CLARK: And I think it's an important thing to keep in mind, so what we are
trying to do is promote through prevention and detection the individual experience
in the specific jurisdiction, so whereas Baltimore may have more of an opioid,
heroin problem, D.C. also has one, but D.C. has a subpopulation, gay-lesbian, of
gay and bisexual men who use methamphetamine for sexual purposes, as Dr.
Volkow pointed out.

We have got methamphetamine in western Virginia, but not necessarily in

northeastern Virginia, so what we all have to do is work with the health authorities
and the law enforcement to understand what is going on in the respective
communities.

We just funded a grant in Boston, Massachusetts has a low prevalence of

methamphetamine problem but again in the gay community there is a higher
prevalence. South Dakota has a high prevalence of methamphetamine use among
adolescents relative to the rest of the country, so not only is it peculiar to particular
geographic areas, but also certain age groups where the use is more prevalent, so we
need to be working with state authorities, governors, law enforcement and public
health people, rather than assuming it's not going to happen.

It's low prevalence in the African American community, but it is not zero prevalence
in the African American community ‑‑ something that people need to keep in mind,
so with increasing sophistication you are able to address these issues.

MR. McDONNELL: And I think the reason for that, if you look over the last couple
of decades about drug use, and I think it's generally true across the country, is
marijuana has generally been sort of, along with alcohol, been one of the gateway
drugs to other types of drug use. Cocaine kind of burst on the scene a couple of
decades ago, and was along with LSD became kind of the hard core drug of choice.
Then crack became the poor man's cocaine, and now methamphetamine has become
the poor man's crack, because of the price out there in the market, because up until
these most recent laws to take the precursor elements off the shelf, it was so easy to
make.

The recipes are on the internet. You could cook it yourself. And so that's why I
think it's become such an issue, as Dr. Clark pointed out, in northern Virginia ‑‑ it
really does differ. In rural Virginia, the whole I-81 corridor is where we see most of
the labs and most of the use of methamphetamines in Virginia. The inner cities is
primarily still crack, so some of it is a cultural thing in terms of what the drug of
choice is, but until we make the availability of the precursor elements extremely
tight, it is still going to be a huge problem in virtually any community based on
what their choice of the drug is.

ATTORNEY GENERAL GONZALES: Yes?

QUESTION: Ed Hutcheson of the National Sheriffs Association.

My question is actually directed toward Mr. Rannazzisi, with the DEA.

MR. RANNAZZISI: Yes, sir.

QUESTION: And we'd heard from Attorney General McDonnell in regards to how
we are curbing access to the amphetamine portion of making methamphetamine.

Could you go into some more detail about perhaps how other, the other elements,
the precursor elements, are being curbed at the national level?

MR. RANNAZZISI: Well, to start off, the government as a whole is working in the
international community to stop large amounts of precursors from going into
production countries like Mexico and the United States through the International
Narcotics Control Board. We have held many meetings with the source countries,
and we are trying to get a strong control over where precursor chemicals are
transiting throughout the world.

That is the key. If we can control those precursor chemicals, the ephedrines,
pseudoephedrine, ephedra-alkaloids, those types of chemicals, we won't have a meth
problem.

Now locally iodine is a major problem, where we have steps in place to regulate
iodine now, making it a List 1 chemical. We also have, we are looking at ‑‑ you
know, the solvents are very difficult to control because solvents are widely used.
Same thing with the acids and the drain cleaners and things like that.

So our concentration is mostly with the precursors. Now there have been ‑‑ some of
the states have worked with anhydrous ammonia, which is a major component to
one of the manufacturing processes, using an additive in the anhydrous ammonia to
try and limit the amount of methamphetamine that can be produced. I believe Iowa
is working on that project, and I believe they are seeing successes with that.

We are working internationally with the major precursor chemicals with the
production countries and then locally ‑‑ the states, with the help of the federal
government, are trying to control chemicals like anhydrous and iodine, things like
that.

ATTORNEY GENERAL GONZALES: Questions ‑‑ here, here, here. Back here as

well.

QUESTION: Good morning. My name is Dr. Christina Catlett, and I am an

emergency physician here at GW. I trained actually at Hopkins in Baltimore, so I
can spot heroin and crack a mile away, no problem. If you had asked me how many
cases of methamphetamine abuse I have seen here at GW, I would have said
probably three to five, and I thought that was because it wasn't a problem in this
particular area of Washington, D.C. We have a fairly white collar crowd at GW.

What I am realizing is that I think we are just not recognizing it, and I wanted to say
thank you to Ms. Sickels for pointing out some of the psycho-motor clues that
might help us detect somebody who is either intoxicated with methamphetamine or
a chronic methamphetamine abuser.

I am wondering if there aren't some more physical clues that I need to be looking
for. Pupillary either dilatation or constriction. Is there an acute withdrawal syndrome
that I need to be recognizing? Changes in blood pressure or pulse? Anything that
might be helpful to those of us that are clinicians that need to recognize this in the
field.

DR. VOLKOW: Yeah, well, what you will -- well, the are physical symptoms and
signs that you will see in the patient will depend of course whether the patient is
intoxicated or whether it's on withdrawal, and if it's intoxicated, it would be akin to
what you see with other stimulant drugs at high doses.

So you will see increases in blood pressure. Methamphetamine increases blood

pressure, produces significant increases in heart rate, produces vasoconstriction, and
that's what you will see. And the element of paranoia, suspiciousness, agitation,
anxiety ‑‑ that restlessness is very, very typical in the intoxication state, and the
person may be diaphoretic.

In the withdrawal, on the other hand, you see a very different picture, and you see
someone that is much more anergic. Sometimes it's actually even difficult to arouse
them. They fall asleep and you cannot wake them up, so it is a completely almost
opposite picture one and the other.

At the end of the day, though, I mean, you are going to ask the question, but if you
definitely have a suspicion, you do a drug toxicology test. You can screen. That's
one of the advantages in terms of methamphetamine, that methamphetamine is a
drug that we can screen, number one, and number two, because it takes a long time
for your body to detoxify, you'll be able to pick it up. And I think that's one of the
elements that we should be more proactive perhaps on starting to do -- testing for
methamphetamine in those situations where you suspect that.

Very important, for example, one of the things that to me has been very frustrating
as the director of NIDA is to get a perspective about the impact of drugs in car
accidents, because most emergency rooms are not testing for the drugs if you a
person in an accident, since the insurance will not pay then for the treatment.

Well, that's utterly wrong. We need to start to recognize that we need to treat the
patient. That's our obligation as physicians, but at the same time, we need to
understand the nature of what brought them there. So we cannot have both of them
together.

So I would encourage when you suspect based on the physical signs, that you screen
for drugs, for the methamphetamine.

DR. CLARK: You've got individuals who are presenting, as was previously
mentioned, with dermatologic lesions, individuals who are presenting, especially if
they're relatively young, with renal functions or with coughs, with evidence of
strokes, with paresthesias, you may want to ask about that, particularly between the
ages of 18 and 45, where, as some of the emergency literature points out, anybody
who comes in who's 30 years old with chest pain, you better rule out a stimulant,
because unless that person has a family history of early cardiac dysfunction,
disrhythmias, it's more likely some exogenous precipitant. So these are the kinds of
things that you'll want to check out.

Someone who's brought in, as Vicki pointed out, she goes to her doctor and says,
look, you know, I've got these things under my hands. And you examine them and
there's nothing there. You may want to -- you want to rule out substance use. And
so we are promoting routine screening with the objective of helping that person deal
with the problem. This whole notion of screening and brief intervention, early
intervention, so that indeed we start communicating the message that it is not
something that's purely organic. It's something associated with your substance use.

ATTORNEY GENERAL GONZALES: Okay. There's a question back here.

QUESTION: Thank you very much. My name is Dr. David Goldsmith. I'm on the
faculty in the School of Public Health. One of the things that has arisen in some of
our thinking about this was discussed very briefly, and I just would like to raise it
again.

We have heard about concerns about the -- and was mentioned, the solvents and the
other chemicals that are used in the meth cooking process. And I am wondering if
there are guidelines and suggestions for protecting the law enforcement personnel.
In some cases, it's going to be first responders, in other cases, fire department
personnel who may be the first people on the scene of finding a meth lab.

And as an extension of that, a question about remediation of some of the cooked

chemicals, the meth chemicals that are flushed down the toilet or disposed of in
backyard waste areas and things like that. Is there more guidance with regards to
how communities can do a better job of remediating some of these hazardous
materials?

MR. RANNAZZISI: Well, let's take the second question first. There is a book that
was just published this year. It's an update called The Clandestine -- Guidelines for
Clandestine Laboratory Clean-Ups. I believe it's on the DEA website. That basically
sets out what the guidelines are for cleaning up a clandestine lab and how agencies
should approach cleaning up a clandestine lab.

As far as remediation, again, remediation is a very, very difficult task. A special

company has to come in to do the remediation. There was a study done, was it
National Jewish Hospital study? But there was a study done on lab toxicity. I can't
remember the study. I believe it was National Jewish Hospital study, and it showed
residual contamination in labs at certain points in time. It's a study that you really
should look at.

Again, law enforcement goes in and we do gross contaminant removal. We take

away all the immediate waste. We can't do a residual cleanup, we can't do a
remediation, because we just don't have the resources nor -- it's just a very difficult
process to do. And when you're dealing with 17,700 incidents, it becomes an
impossible task.

Health departments are notified when we go in and do a lab cleanup. Health

departments, local county agencies, and we expect that with their notification,
they'll take the proper steps with the home owner.

Now as far as first responders, DEA trains many police officers throughout the year,
clandestine lab response, first responder and train the trainer for first responder. We
try and get local officers trained so then they can turn around and train their
departments in what to look for.

Now if you've gone through the clandestine lab training course, the lab safety and
lab investigation course, you're perfectly trained to go out and dismantle one of
these labs, to go in and operate safely and effectively. You should not have any
issue -- you're issued all the equipment to safely go in and dismantle.

Now, obviously, fire departments are usually, especially in a lab explosion, they'll
be the first on the scene. We're hoping that those train the trainers, those trainers that
we've trained, go out and not only do the police departments but do the fire
departments as well.

And our divisions have -- our division officers, our clandestine lab safety officers
and our clandestine lab coordinators in our divisions throughout the United States
have actually gone out and trained fire departments.

So we're trying to get the word out. We're trying to get everybody to understand the
dangerous nature of these labs and what to do when you get in there. It's just, you
know, we need help. There's only 5,000 DEA agents, and there's a very small
portion of them that are lab trained, so that's why we use the train the trainer
program.

DR. CLARK: We have been working with the DEA. SAMSA, ONDCP, with
governor summits. And I think the DEA has been very assertive in not only the
hands-on, but also getting the message out at the governors level where you've got
prevention people, environmental health people, as well as law enforcement and
first responders. So I think this ongoing dialogue heightens the awareness and
provides access to information. It isn't just a one-shot we're going to train five
people.
So I want to remind Joseph that the DEA has been active in the governors summit,
and we've had these summits in multiple jurisdictions across the country, and it's an
ongoing commitment, and we're working most recently with Scott Burns at ONDCP
to continue to foster that. So that information is an ongoing thing, because we know
people come and go in the workforce. But with the ongoing top-to-bottom kind of
exposure of the information, that awareness persists.

ATTORNEY GENERAL GONZALES: Well, we've come to the end of our time,
and I apologize to those who have been unable to ask questions, but I want to be
respectful of the panelists' time.

I want to thank the panelists for participating in today's forum. I also of course want
to thank George Washington for hosting today's forum. I also want to acknowledge
our dedicated partners who are here today from the Partnership for a Drug Free
America, the Community Anti-Drug Coalitions of America, the Fraternal Order of
Police and the National District Attorneys Association. So, your participation, your
involvement in this issue, being here today, sends a very strong signal.

The information we gather here today, sharing it with people in the communities, is
probably the best deterrent for meth use and meth addiction, and this is the
beginning of the dialogue. It's certainly not the end of the dialogue. It's very, very
important that we take the information that we've learned today and share it with the
communities around the country. And that will be the most effective way in dealing
with this problem.

So, again, thank you for coming.

###