Meth Mouth Research

It has been a while since I posted, but a friend passed this along to me.

From: http://www.slate.com/id/2141709/

More Meth-Mouth MisinformationIt's everywhere, it's everywhere!By Jack ShaferPosted Friday, May 12, 2006, at 6:09 PM ETMy sarcasm was as gentle as a chain saw when I first criticized other journalists for their wrong, wrong, wrong descriptions of what causes "meth mouth"—the dramatic tooth loss experienced by many heavy methamphetamine users.
Quoting from the medical literature, I used my column of nine months ago to inform the press that contrary to their reports, meth mouth is not caused by the direct action of "acids" or "contaminants" found in the street drug, nor do the chemicals used in its preparation "eat" away at teeth or "corrode" them. The Minneapolis Star Tribune, the St. Paul Pioneer Press, the Albuquerque Journal, and the Kansas City Star received knocks from me, as did the Associated Press.
To review: The etiology of meth mouth is well understood. Methamphetamine use inhibits saliva production; loss of saliva exposes teeth to bacteria that cause cavities; many users treat their "dry mouth" (xerostomia) symptoms with sugared sodas, which only fuels the bacteria that cause cavities. Combine meth with poor oral hygiene, and soon you'll be ordering dentures. (See the Merck Manual of Medical Information for more about how saliva gland malfunction results in tooth decay and loss.)
But oh, my brothers, the press did not listen to my first report. So, in early November 2005, I goosed my snark to produce a second installment. In January 2006, I added a third. But still the press does not listen.
I come to today's episode with a new medical paper in hand to convince the ignorant of their errors. " 'Meth Mouth': Rampant Caries in Methamphetamine Abusers" from the journal AIDS Patient Care and STDS dismisses the "acid" and "contaminants" theories. The authors, J.W. Shaner, D.M.D., M.S.; N. Kimmes, D.D.S.; T. Saini, D.D.S., M.S.; and P. Edwards, D.D.S., M.S., write that "caries"—dentist lingo for cavities—"is a bacterially mediated disease." Their snarks set only to stun, they continue:
The primary organisms involved in this infectious process belong to a group functionally labeled Streptocooci mutans. The development of a carious lesion is a complex process involving acidogenic bacteria, poor oral hygiene permitting bacterial plaque accumulation to a cariogenic threshold, frequent exposure to refined carbohydrates which are metabolized by S. mutans in the plaque to produce acids, and inadequate saliva that normally serves to buffer any drop in pH at the enamel-plaque interface. Teeth exposed to extrinsic (mainly dietary) and intrinsic acid (gastric acid) develop erosion lesions resulting in a bulk stripping or dissolving of enamel and then dentin. This is frequently seen in long-term lemon suckers involving the facial enamel surface, and in patients with gastroesophageal reflux disorder and bulimia involving the palatal/lingual and occlusal surfaces.
As a further blow to the "contaminant" theory, patients taking prescription MA [methamphetamine] for narcolepsy or attention deficient hyperactivity disorder (ADHD) developed the characteristic carious lesions seen in MA abusers.
So, debate over. Spread the news. Meth causes meth mouth, not "acids" or "contaminants." The first institution that needs to acknowledge this fact is the American Dental Association, whose Web site currently carries this misinformation about meth mouth:
The rampant caries associated with methamphetamine use is attributed to the following: the acidic nature of the drug, the drug's xerostomic effect, its propensity to cause cravings for high calorie carbonated beverages, tooth grinding and clenching and its long duration of action leading to extended periods of poor oral hygiene. [Emphasis added.]
The next institution on my list is the Academy of General Dentistry, whose Web site asserts:
Another reason for the rapid decay of teeth is the caustic nature of the ingredients used to make meth. Ether benzene, Freon and paint thinner are just a few of the extremely dangerous materials to be used in creating meth.
And now on to the popular press dishonor roll:
Chronic meth smokers have teeth rotted to the gum line from the continuous effect of the vapors on tooth enamel. The condition is referred to as "meth mouth."
Even snorting meth causes chemical damage to teeth. Toxic substances drain through the nasal passages and into the mouth, "bathing" the teeth.—Craig (Colo.) Daily Press, Dec. 7, 2005
"I know that meth and crack eat away calcium and make (the teeth) weaker," [Frank, a pseudonym] said. "Sometimes I brushed, but it don't help. The more drugs you do, the worse it gets."—Dubuque, Iowa, Telegraph Herald, Feb. 20, 2006
It also causes "meth mouth," where the user's teeth rot out because chemicals in meth eat tooth enamel. —Fort Wayne Journal-Gazette, March 30, 2006
Meth addicts develop rotten teeth in a condition known as "meth mouth" because meth robs the body of calcium, decreases saliva production and changes the pH of the mouth.—Holmen (Wis.) Courier, April 14, 2006
Methamphetamine is concocted in home laboratories and can contain lye, battery acid, ether or other corrosive agents. These destroy tooth enamel and burn the gum tissue, which becomes infected.—Arizona Republic, April 22, 2006
"Meth mouth" is a condition common in habitual meth users that results in rotting and deteriorating teeth and gums due to chemical ingredients in meth.—Maryville, Tenn. Daily Times, April 25, 2006
In this KHQA Safe Family Health report, KHQA tells you how dentists are dealing with the "Meth Mouth" epidemic.
Bleach, cold tablets, Drano, anhydrous ammonia. It's no wonder someone ingesting these materials would end up with their teeth rotting away.
"Most everything in meth is a corrosive material and they consume enormous amounts of carbonated beverages and they're on highs for so long, they don't brush their teeth or take care of them so the combination is there just to eat up everything," Dr. Bill Esicar said.—KHQA-7 Online (The tri-cities of Keokuk, Iowa; Hannibal, Mo.; and Quincy, Ill.), May 8, 2006
My advice: Don't do meth. Don't believe everything you read about illicit drugs in newspapers or hear over the airwaves. And if your dentist or local police officer likes to talk to the press about meth mouth, tell them to keep up on the medical literature.
******
Dan Wilson of the Appleton (Wis.) Post-Crescent deserves honor-roll treatment for this well-reported, skeptical April 30 story about the "methidemic." I read my e-mail at slate.pressbox@gmail.com. (E-mail may be quoted by name unless the writer stipulates otherwise.) Jack Shafer is Slate's editor at large.

It Must be Patriotic to Combat Meth

As posed in a previous post, it appears that the federal anti-meth legislation was included in the Patriot Act renewal bill to help its passage.

Below is the text of an email release from Senate Majority Leader Bill Frist (R-TN):

Law enforcement efforts to reduce meth abuse in Tennessee received a tremendous boost today when the Senate voted to reauthorize the U.S.A. Patriot Act. As a result of this reauthorization, local and state officials will receive much needed assistance in their fight against the meth epidemic while our nation’s law enforcement and intelligence communities are guaranteed continued access to the most vital tools they need to fight the War on Terror.
Local law enforcement officials rank methamphetamine abuse as the country’s most significant drug problem, and Tennessee is no exception. As a result, I have made addressing this issue one of my top law enforcement priorities as the Senate majority leader.
The key component of this legislation is the establishment of restrictions on the sale of medicines containing ingredients used to manufacture meth. This new federal legislation will not pre-empt state laws that place even tougher restrictions on access to meth ingredients, but it will ensure that all states abide by the same minimum standards.
As those on the frontlines in protecting Tennesseans from harm – whether in the form of devastating drugs or dangerous people – our state’s law enforcement officials deserve not only our gratitude but also the federal government’s support. I hope you will find the following details about the legislation helpful.
Bill Frist

Combat Meth Act Provisions
Medicines containing pseudoephedrine, ephedrine and phenylpropanolamine (PPA) will be placed behind the counter. Purchasers will be limited to acquiring only enough medication containing meth ingredients as is necessary for legitimate medical use.
This is a meaningful first step in addressing America’s meth abuse crisis. Applying the same minimum standards in all 50 states is a commonsense alternative to the current, easily exploited patchwork of state laws. This legislation will provide additional reinforcement to our state’s efforts to tackle the meth problem by making it difficult for meth cooks to bring large quantities of meth ingredients into the state.
Under the new legislation, local and state officials across the country will benefit from increased funding for personnel, equipment, enforcement, prosecution and environmental clean-up through the Meth Hot Spots program, which is authorized to receive $99,000,000 per year for the next five years under the Combat Meth Epidemic Act. The legislation also authorizes $20,000,000 in grant funding in 2006 and 2007 for Drug Endangered Children rapid response teams.
Funding available in the Combat Meth Act will supplement increased funding Tennessee is already receiving. Last year, Sen. Lamar Alexander, Rep. Zach Wamp and I worked together to secure $3 million to establish a statewide methamphetamine task force and $1 million for the Tennessee Bureau of Investigation (TBI) to develop a statewide crime tracking system. The TBI intelligence and operational law enforcement database will support the task force’s work across the state. The $4 million in total anti-methamphetamine funding will help ensure that all regions of Tennessee have the training and equipment they need to address the state’s methamphetamine crisis.
The Department of Health and Human Services also awarded $17.8 million to Tennessee through the Access to Recovery Program last year. That funding will be distributed over three years to enhance substance abuse clinical treatment and provide recovery support services. In August, the state was awarded an additional $1.5 million over three years to support treatment in six rural counties that have been especially hard hit by methamphetamine.

Different Strokes for Different States

Illinois Gov. Blagojovich is pushing for Meth prisons which would focus on treatment and rehabilitation rather than seclusion. Shouldn't we be focusing on rehab in all the prisons, regardless of the offense?

New Mexico is working on a bill that would make it a first-degree felony to distribute meth within 1000 feet of a school. Apparently, meth was not included under NM's previous drug laws, nor were parochial and private schools covered under the drug zone laws.

Virginia Gov. Mark Warner announced that putting pseudoephedrine behind drug store counters has helped reduce the number of meth labs in the state, citing a decrease of labs found from 30 labs from Oct. 04-Jan. 05 to 9 during Oct. 05-Jan. 06.

A personal observation: many convenience stores have replaced pseudoephedrine products with non-pseudo medicines.

Meth Matcher, Meth Matcher, Show Me a Match

The Tennessee Bureau of Investigation has implemented a Meth Offender Registry Database so that anyone can look online for people who were arrested on meth-related charges. The Tennessee General Assembly decided that landlords across the state should have access to a database to determine if an applicant has a history with meth. In a society where we have been taught to spy on our neighbors and report "suspicious activity" for national security and an example set by the federal government of doing so, the database is another way to brand a segment of the population that, in all reality, may have rejected their former lifestyle. However, their name stays on an easily accessible, public database for the remainder of their life. Perhaps it is better (for liability's sake) for someone who continues to manufacture meth even after arrest, to do it on their own property.

Granted, the database will help a small segment of the population in their career (as far avoiding possible future problems), but perhaps a more important database would be a listing of places where meth was manufactured. How many future home owners will fall in love with a house where meth was made, wonder at the affordable price, and purchase a home without ever knowing that dangerous chemicals are present?


Props to eBay

Randomly searching eBay for Sudafed and pseudoephedrine has yielded no results so far in the new year (or over the last two months or so). Doing a great job of monitoring.

Media Menagerie

There have been hundreds of stories in the media since my last post almost a month ago (How has it passed so quickly?). So, in the vein of VH-1's Best Week Ever, here are some of them. In case you missed it:

Meth Chemicals Found in Smithville Water Tower
Apparently, someone needed a hiding spot for their meth lab. What better place than the town water tower? Although it is believed that the chemicals have not contaminated the water supply (the water is stored at the top of the tower and the lab materials were stored at the bottom), the water is being tested just in case.

Canadian Anti-Meth Commercial
Not new to the media, but new to me.

The New Moonshine
A thorough description of the meth problem in the south, including a 22-year-old's recollection of his experience of trying meth as a 16-year-old.

Part of the Patriot Act
Senate Majority Leader Bill Frist helps secure anti-meth legislation by including it in the Patriot Act. My question is: Which does this action really do: make the pseudophedrine controls more palatable or some of the policies under the Patriot Act?

Doctor receiving TennCare arrested for fraud

WSMV-Nashville aired a story about a TennCare doctor (Tennessee's version of Medicaid) who may be been falsely prescribing pseudoephedrine for some of his patients. I realize that too much control by government is detrimental to society, but it seems that some people in society have set the bar for personal accountability and personal responsibility so low that they either justify their behavior or blame an outside entity for it.

Meth Destroys

While I was away from the site, Tennessee started a public awareness campaign called "Meth Destroys" (Lives, Families, Communities) which targets students to make them aware of the hazards of methamphetamine. It's the same web location of the state's previous site, but it is much more interactive and media intensive. But don't take my word for it...

H.R.2862 Conference Committee

Checking Congress's Thomas locator, I found that there was a conference committee on the appropriations bill that includes the Anti-Meth language yesterday. JoinTogether.org has a little more information. According to Oregon Live, the Senate version and House version have some major points of contention. The House's version has a stricter limit (3.6g vs. 7.5g) and focuses also on international controls of pseudoephedrine. Here is a factbox comparing the two.

I think The Oregonian is quickly becoming one of my favorite newspapers.

According to the story above, some form of national anti-meth legislation should pass this year. Is it too early to say, "Merry Christmas"?