ไอซ์: มหันตภัยโลก (The burden of crystal Methamphetamine use worldwide) ดร. ดรุณี ภุ่ขาว B.Sc. (Nursing), MS (Mental health),MN (Mental Health), PhD (Addiction Studies) ภาควิชาสังคมและสุขภาพ คณะสังคมศาสตร์และมนุษยศาสตร์ มหาวิทยาลัยมหิดล dphukao@hotmail.com

ประเทศอเมริกา กว่า 23.2 ล้านคน 1. UNODC, 2011 (. ATS Global Assessment 2011) ประเทศอเมริกา กว่า 3.9 ล้านคน 4.Task Force on Crystal Meth The South Los Angeles Crystal Meth Task Force (http://www.nationalmethcenter.org) 3. ศูนย์ยาไอซ์แห่งชาติอเมริกา 5. GPAC Ad Hoc Committee on Methamphetamine 2005 for the full membership of the Governor’s Prevention Advisory Council (GPAC). 2.. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2009 ประเทศอเมริกา กว่า 23.2 ล้านคน 1.5 ล้าน 6. the Rand Corporation – a non-profit research group - 2005. สถานการณ์ ตัวเลข การเข้าถึงบริการบำบัดรักษาในกลุ่มผู้ที่มีพฤติกรรมเสพติด Principles of drug Addiction Treatment, NIDA, NIH, 2009

รู้จักไอซ์ รู้จักไอซ์ (Brain & Behaviour) 4 นาที http://www.methinsideout.com/animations/bb_pleasure.html ผลกระทบที่บุคคลได้รับอันเกี่ยวเนื่องจากการเสพ ไอซ์ (Human Impact) 5 นาที การฟื้นฟูสภาพ (Windows to recovery) 5 นาที http://www.methinsideout.com/animations/relapse.html Meth Inside Out is being produced jointly by the UCLA Integrated Substance Abuse Programs (ISAP) and Eyes of the World Media Group. Expert researchers, treatment professionals and filmmakers have combined their efforts to produce an accurate, engaging and effective series.

ชมคลิปจาก ศูนย์ยาไอซ์แห่งชาติอเมริกา (http://www. nationalmethcenter ชมคลิปจาก ศูนย์ยาไอซ์แห่งชาติอเมริกา (http://www.nationalmethcenter.org) Meth Inside Out" (from UCLA Integrated Substance Abuse Program Meth Inside Out equips users, their families, and the professionals who assist them with a solid understanding of the biological basis of addiction, effective tools for recovery, and, most importantly, hope for the future.

สรุปจากการชมคลิป 20-50% ของการกระทำความผิดเกี่ยวเนื่องมาจากการเสพไอซ์ รัฐสูญเสีย กว่า 20 พันล้านต่อปี 4 เท่าถูกกว่า ถ้าคนเข้ารับการรักษา (เทียบกับผู้ที่ไม่ได้เข้ารับการบำบัดรักษา $ 21,000 : $ 90,000)

UNODC While seizures of heroin, cocaine and cannabis remained largely stable between 2005 and 2009, ATS seizures, excluding ecstasy, showed a clear increase over the same period. In South-East Asia, for example, the number of methamphetamine pills seized grew significantly Methamphetamine may also be expanding into Europe with several countries reporting an increase in its use and production.

UNODC, 2011: Europe: seizures of methamphetamine 2005-2009 There are also signs that the drug may be replacing amphetamine in some parts of Europe.

The number of methamphetamine pills seized in South-East Asia, (ล้านเม็ด)

Methamphetamine use and availability in the US is on the rise!

US: Past Month Methamphetamine Users By Year 126,951 161,120 145,985 SOURCE: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2009 findings.

In USA http://www.nationalmethcenter.org/STATISTICS_main.html Source: SAMHSA Treatment Episode Data Set (TEDS); Click for state-level information

Percentage of drug treatment admissions for methamphetamine Year All admissions Meth admissions Pct. meth 2002 1,895,657 123,013 6.5% 2003 1,868,191 133,874 7.2% 2004 1,823,840 144,174 7.9% 2005 1,895,503 172,247 9.1% 2006 1,932,098 161,120 8.3% 2007 1,918,914 145,985 7.6% 2008 2,016,077 126,951 6.3% 2009 (data not yet published, will be posted as soon as it is available) Source: SAMHSA Treatment Episode Data Set (click here for state and national statistics) Source: SAMHSA Treatment Episode Data Set

1.5 ล้าน

ร้อยละของผู้เข้ารับการบำบัดรักษาจำแนกตามช่วงกลุ่มอายุ http://www.nationalmethcenter.org/STATISTICS_three.html 8th grade H.S. seniors College Age 18-29

ประเภทของการเข้ารับการรักษา: จำแนกตามเข้ารับการรักษาครั้งแรก, ครั้งที่ 2 US: Admissions for Any Methamphetamine Abuse SOURCE: SAMHSA, Office of Applied Studies, Treatment Episode Data Set, 2007 findings.

ร้อยละของการเข้ารับการรักษา จำแนกตาม วิธีในการเสพ US: Percentage of Admissions for Meth By Route of Administration SOURCE: SAMHSA, Office of Applied Studies, Treatment Episode Data Set, 2007 findings.

ผลกระทบ 1. ค่าใช้จ่ายที่รัฐต้องสูญเสียอันเกี่ยวเนื่องจากการใช้ไอซ์ 2. วิกฤติสาธารณสุขอเมริกา The Public Health Crisis of Methamphetamine Use and the HIV Epidemic Wisconsin HIV Prevention Community Planning Council Summer 2005 Crisis among gay men: Crystal methamphetamine use linked to rising HIV and STD rates.

Tallying the cost of methamphetamine abuse http://www.nationalmethcenter.org/STATISTICS_three.html Tallying the cost of methamphetamine abuse The total adjusted for inflation: 2005 dollars 23.4 billion / 2011 dollars 26.4 billion The breakdown SEGMENT Cost (millions) 1.Drug treatment $545.5 2.Health care 351.3 3.Intangibles/premature death 16,624.9 4.Productivity 687.0 5.Crime and criminal justice 4,209.8 6.Child endangerment 904.6 7.Production/environment 61.4 Total 23,384.4 This amount is based on estimates from a variety of sources and includes both actual out-of-pocket expenses and the price of premature death, child abuse and other variables. Researchers took a middle-ground approach to the estimate, noting it could actually be as high as $48.3 billion.

Drug treatment $545.5 TREATMENT EXPENSES Costs (in millions) http://www.nationalmethcenter.org/STATISTICS_three.html Drug treatment $545.5 TREATMENT EXPENSES Costs (in millions) Hospital-based treatment $4.9 Specialty treatment sector 491.2 Total for community-based treatment 506.1 Federally provided specialty treatment Dept. of Defense 0.2 Indian Health Service 24.4 Federal Bureau of Prisons 5.7 Veterans Administration 9.1 Total for federally provided treatment 39.4 Total cost of drug treatment 545.5

HOSPITAL EXPENSES (real dollars) HEALTH CARE Costs (in millions) HOSPITAL EXPENSES (real dollars) Meth-induced hospital stays $27.1 Meth-involved hospital stays-incremental only 14.3 Suicide attempts 14.2 Emergency department visits 45.9 Health administration 249.8 Total 351.3 Fetal dependence $426,756 Neuropathy 20,677 Meth-induced 9,938,985 psychosis Infections 1,400,6075 Injury-mental health-drug screen 125,126 Injury-poisoning 1,569,863 Total 27,057,567 http://www.nationalmethcenter.org/STATISTICS_three.html

Lost income due to incarceration 305.3 OTHER MISC.. Costs (in millions) FOSTER CHILD CARE Costs (millions) Suicide attempts $14.2 Emergency room costs 45.9 Lost productivity (absence etc.) 686.9 Lost income due to loss of job 62.5 Lost income due to incarceration 305.3 Cost to jurisdictions for meth arrests 892.5 Foster care $402.8 Medical-mental health-quality of life 501.8 Total 904.6 http://www.nationalmethcenter.org/STATISTICS_three.html

ผลกระทบ 1. ค่าใช้จ่ายที่รัฐต้องสูญเสียอันเกี่ยวเนื่องจากการใช้ไอซ์ 2. วิกฤติสาธารณสุขอเมริกา The Public Health Crisis of Methamphetamine Use and the HIV Epidemic Wisconsin HIV Prevention Community Planning Council Summer 2005 Crisis among gay men: Crystal methamphetamine use linked to rising HIV and STD rates.

การจัดการ 1. เฝ้าระวัง คนทั่วไป เยาวชน ( U of Michigan) 2. จัดตั้งหน่วยงานศูนย์ยาไอซ์แห่งชาติอเมริกา (http://www.nationalmethcenter.org) ที่ทำหน้าที่จัดการความรู้ ทำความเข้าใจ ศึกษา การออกฤทธิ์ของสาร เผยแพร่ข้อมูลผ่านทางหลายช่องทาง สนับสนุนงบประมาณโดย the Community Oriented Policing Services (COPS) , the Congress in its annual budgets., Senator Patty Murray ทำความเข้าใจรูปแบบการใช้ ในกลุ่มประชากร 3. จัดตั้ง task force เรื่องนี้โดยเฉพาะ (Task Force on Crystal Meth, Public policy recommendations. ) The South Los Angeles Crystal Meth Task Force is committed to forging a compassionate response to the growing concerns around crystal Meth in the South Los Angeles area. This working taskforce is developed to proactively engage in community mobilization. http://www.crystalmethbc.ca/modules.php?name=CM_Taskforce&wv_goto=training_materials 4. GPAC Ad Hoc Committee on Methamphetamine 2005 for the full membership of the Governor’s Prevention Advisory Council (GPAC). 5. แนวทางการบำบัดเฉพาะผู้ที่เสพติดไอซ์

Methamphetamine: What is the connection between use, sexual risk, and HIV? ทำความเข้าใจรูปแบบการใช้ ในกลุ่มประชากรเฉพาะ

The injecting use of methamphetamine and its associated negative health consequences is reported as a growing problem in the South east Asia region.

วิธีการเสพไอซ์ The injecting use of methamphetamine and its associated negative health consequences has been reported as a growing problem in East and South-East Asia. Lao People’s Democratic Republic and Malaysia, Reported the injecting use of crystalline methamphetamine for the first time in 2008 and 2009, respectively. In Thailand, injecting is the second most common mode of administration for crystalline methamphetamine and the third most common mode of administration for methamphetamine pills. In New Zealand, methamphetamine is the most commonly injected drug and in Japan, injecting is the primary mode of administration for crystalline methamphetamine. High rates of amphetamines injection are also reported in the Czech Republic as well as Sweden, Estonia, Finland, Latvia, Lithuania, Georgia and Ukraine.

Drug and Alcohol Use among MSM, January 1, 1999 – December 31, 2007 Reback, Shoptaw and Grella, 2008

Q.2: My sexual drive is increased by the use of …

Q.8: My use of … has made me become obsessed with sex and/or made my sex drive abnormally high.

Q.12: I am more likely to practice “risky” sex under the influence of … (e.g., not use condoms, be less careful about who you choose as a sex partner, etc.)

Q.13: I have become involved in sex acts that are unusual for me when I am under the influence of … (e.g., marathon masturbation, go to “peep” shows, cross-dress, voyeurism, expose yourself, etc.)

Special Populations: MSM, Sexual Risk and HIV Methamphetamine is closely connected to sexual identity and sexual expression for many gay-identified MSM Sexual behaviors associated with meth use present extreme HIV risks Changes in sexual behaviors Changes in decision-making processes Non gay-identified MSM may have less exposure to prevention messages, placing both themselves and their sex partners at extreme risk

ข้อสรุปจากคณะทำงาน GPAC Ad Hoc Committee on Methamphetamine 1 ข้อสรุปจากคณะทำงาน GPAC Ad Hoc Committee on Methamphetamine 1. The Committee found evidence that meth use continues to be a major problem. Researchers estimate that up to 500,000 Californians currently abuse meth; California has the largest meth population in treatment in the U.S. representing 50,000 out of a national total of 137,000 meth admissions. A recent survey by the National Association of Counties reveals that meth is the leading drug-related problem both nationally and in California. According to federal estimates, more than twelve million Americans have tried meth and 1.5 million are regular users. Police officers nationwide rank meth the number one drug they battle today. In a survey of 500 law enforcement agencies in 45 states released in July, 2005, by the National Association of Counties, 58 percent said meth is their biggest drug problem.

A US government effort to reduce the supply of methamphetamine precursors successfully disrupted the methamphetamine market and interrupted a trajectory of increasing usage. The price of methamphetamine tripled Purity declined Methamphetamine-related hospital and treatment admissions dropped 50 percent and 35 percent Felony methamphetamine arrests fell 50 percent

…Despite these efforts, use and availability in the US is on the rise!

ตัวอย่างการจัดการ การฟื้นฟูสภาพ (Windows to recovery) 5 นาที http://www.methinsideout.com/animations/relapse.html ชมคลิปจาก ศูนย์ยาไอซ์แห่งชาติอเมริกา (http://www.nationalmethcenter.org) Meth Inside Out" (from UCLA Integrated Substance Abuse Program Meth Inside Out equips users, their families, and the professionals who assist them with a solid understanding of the biological basis of addiction, effective tools for recovery, and, most importantly, hope for the future. Meth Inside Out is being produced jointly by the UCLA Integrated Substance Abuse Programs (ISAP) and Eyes of the World Media Group. Expert researchers, treatment professionals and filmmakers have combined their efforts to produce an accurate, engaging and effective series.

ประมาณการผู้เสพไอซ์ 1.5 ล้าน (USA) In Treatment ~160,000 ( 2,300,000) LOTS Addiction ~ ……… (23,000,000) (Focus on Treatment) Before we talk about the specific priorities in the Strategy it is important to understand the full spectrum of the Substance USE problem in our country; different policies are needed for different parts of the overall problem This pyramid describes this very well 1 – As represented by the broad base of this pyramid –most people in the US either do not use substances or use them very very few times - Here the best policies are prevention – to keep use low 2 – As you go up the pyramid to the wavy dotted line – this shows when “use” becomes “harmful use” – either to an individual’s health or their productivity or their relationships. It is NOT a diagnosis and people can go back and forth across that line – but there are a lot of these folks about 65 – 70 million They are the people who drink and drive, or make their asthma problem worse by smoking marijuana, or are failing school because of too much weekend partying with drugs. Here we need convenient, attractive, potent but probably brief interventions to reduce use and prevent problems from becoming worse 3 –The bright solid line means that the frequency and intensity of use has reached a DIAGNOSTIC threshold – there are 23 – 25 million adults who meet diagnostic criteria for the most serious problems “SUSTANCE ABUSE AND DEPENDENCE” - Click – In comparison, most people think there is an “epidemic” of diabetes and there is - about 24 million people are diabetic. 4 - The orange pinnacle shows the number of people who are receiving any kind of treatment – about 2.3 – 2.5 million or only 1/10 of those who meet the diagnosis – even smaller proportion of those with “harmful use” – This is the “Treatment GAP” that we want to close – the worst in all of medicine 5 – The OVAL indicates that we need policies and interventions that will reach a FAR broader range of people with “substance use problems” “Harmful Use” – 68,000,000 (Focus on Early Intervention) Little or No Use (Focus on Prevention) LITTLE 41

เอกสารอ้างอิง 1. ATS Global Assessment 2011: UNODC, 2011 1. SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2009 2. ศูนย์ยาไอซ์แห่งชาติอเมริกา (http://www.nationalmethcenter.org) 3.Task Force on Crystal Meth, Syphilis and HIV (2004). Confronting crystal methamphetamine use in New York City: Public policy recommendations. ) 4. GPAC Ad Hoc Committee on Methamphetamine 2005 for the full membership of the Governor’s Prevention Advisory Council (GPAC).

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