demic of illicit methamphetamine. Methamphetamine is a potent psychostimulant with a high dependence liabil- ity and consumption is linked to high-risk HIV ...
EDITORIAL
Methamphetamine: drug use and psychoses becomes a major public health issue in the Asia Pacific region
Most people think of the Asia Pacific region as the traditional heartland of opium production, but today this has been substantially swept aside by a sustained epidemic of illicit methamphetamine. Methamphetamine is a potent psychostimulant with a high dependence liability and consumption is linked to high-risk HIV behaviours, family and social problems and acute and chronic psychological disturbance, including psychosis. Use of methamphetamine has a long history in Japan. In the late 1940s and early 1950s in Japan, for example, there were thought to be around 550 000 methamphetamine users, of whom some 55 000 had methamphetamine psychosis (WHO 1997). However, in recent years the focus of illicit manufacture and concern has broadened to other nations in the region including China, Indonesia, Malaysia, Myanmar, the Philippines, Singapore and Thailand. In Thailand methamphetamine was available first as a pharmaceutical product (methedrine), known colloquially as ya-khayan (which translates to ‘diligence pill’). Use was popular among long-distance lorry drivers and other occupational groups but abuse led to strict government controls. Illicit manufacture and distribution followed the restrictions and an illegal trade grew; the drug was renamed ya-ma (‘horse pill’) in view of a horse’s head logo being stamped on each tablet. By the mid1990s methamphetamine became re-branded as ya-ba (‘mad/crazy pill’), referring to its adverse psychological effects, and it was estimated that there were over 250 000 people with methamphetamine dependence across Thailand. Initially the major proportion of drug production was based domestically but the focus of production is now thought to be on the Thai/Myanmar border and in the Yunnan Province in China. As a consequence of these developments, the Thai Ministry of Health has reported a dramatic rise in numbers seeking help for methamphetamine dependence. Services report a sudden rise over the past few years with over 50% of new cases presenting for help with methamphetamine dependence (Verachai et al. 2001). The mental health services report informally that over 10% of psychiatric hospital admissions are for methamphetamine-related psychosis. Anecdotal reports about many small villages in the Northern Province suggest © 2002 Society for the Study of Addiction to Alcohol and Other Drugs
that up to one-half of villagers have used ya-ba. The Thai government has now instituted a national prevention strategy to tackle the problem with increased resources for specialist treatment. In this issue of the journal Sattah et al. (2002) report on a survey of educational institutions where, according to self-reported history, urine test or both, 41.3% of male students and 19.0% of female students used methamphetamine. This use was linked to increased rates of other forms of risk-taking behaviour. This level of reported ever use is also associated with relatively high rates of current use. There are currently very limited data to indicate what proportion of current users are dependent. It is likely that dependence and chronic usage is associated with methamphetamine psychosis and related adverse consequences and that the high rates of usage are dramatically increasing levels of presentation of methamphetamine psychosis to mental health services. Overall the picture seems bleak, with a major epidemic of methamphetamine use in Thailand that appears to be spreading across the entire Asia Pacific region. There is a need to map out this epidemic to assess the scale of the problems, consequences and responses. In 1999, the World Health Organization convened an international meeting of experts in Bangkok to discuss the problem and data collection for two collaborative studies on methamphetamine-induced psychosis in Australia, Japan, the Philippines and Thailand (Ali et al. 2000) and functional/instrumental methamphetamine use among drivers, factory workers, sex workers and students in China, Nigeria, Philippines and Thailand (Marsden et al. 2000) has been completed recently. The evaluation and further development of HIV prevention (Vongsheree et al. 2001) and in-patient and community relapse prevention intervention efforts must now be a priority. The real question at this point is just how large and how problematic can this global epidemic become? MICHAEL FARRELL & JOHN MARSDEN
National Addiction Centre 4 Windsor Walk London SE5 8AF UK Addiction, 97, 771–772
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Editorial
ROBERT ALI
Drug and Alcohol Services Council/University of Adelaide Australia WALTER LING
Integrated Substance Abuse Programs University of California Los Angeles USA
REFERENCES Ali, R., Marsden, J., Srisurapanont, M., Sunga, A., Wada, K., Farrell, M. & Monteiro, M. (2000) WHO MultiSite Project on Amphetamine Induced Psychotic Disorder: Study Protocol and Instrumentation. Geneva: World Health Organization. Marsden, J., Ali, R., Adelekan, M., Perngparn, U., Liu, T., Sunga, A., Farrell, M. & Monteiro, M. (2000) WHO Multi-Site Project on Functional/Instrumental Use of Amphetamine-Type
© 2002 Society for the Study of Addiction to Alcohol and Other Drugs
Stimulants: Study Protocol and Instrumentation. Geneva: World Health Organization. Sattah, M. V., Supawitkul, S., Dondero, T. J., Kilmarx, P. H., Young, N. L., Mastro, T. D., Chaikummao, S. & Manopaiboon, C. & van Griensven, F. (2002) Prevalence of and risk factors for methamphetamine use in Northern Thai youth: results of an audio-computer-assisted self-interviewing survey with urine testing. Addiction, 97, 801–808. Verachai, V., Dechongkit, S., Patarakorn, A. & Lukanapichonchut, L. (2001) Drug addicts treatment for ten years in Thanyarak Hospital (1989–98). Journal of the Medical Association of Thailand, 84, 24–29. Vongsheree, S., Sri-Ngam, P., Ruchusatsawat, N., Thaisri, H., Puangtabtim, W., Phutiprawan, T. & Sawanpanyalert, P. (2001) High HIV-1 prevalence among metamphetamine users in central Thailand. 1999–2000. Journal of the Medical Association of Thailand, 84, 1263–1267. World Health Organization (WHO) (1997) Amphetamine-Type Stimulants. A report from the WHO meeting on amphetamine, MDMA and other psychostimulants, Geneva, 12–15 November 1996. Geneva: WHO.
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