Since the late 1980s, use of methamphetamine, a powerful central nervous system stimulant, has been a problem in western areas of the United States. More recently, NIDA's drug abuse monitoring systems and surveys show that use of the drug has been increasing in these areas and spreading to other areas of the country.

To counter this serious threat to the public health, NIDA has launched a comprehensive Methamphetamine Initiative that is stimulating research to fill gaps in the scientific knowledge about the pharmacology, toxicity, epidemiology, prevention, and treatment of methamphetamine abuse. At the same time, the Initiative is providing the public and health care practi-tioners with the latest available research information about methamphetamine to enable them to take action against methamphetamine use.

The Methamphetamine Initiative builds on and complements the substantial body of knowledge yielded by previous NIDA-supported methamphetamine research. That research shows that smoking, snorting, ingesting orally, or injecting methamphetamine produces a long-lasting euphoria by stimulating excessive levels of the neurotransmitter dopamine in areas of the brain related to pleasure. Use of this powerful stimulant is associated with serious health consequences including addiction, memory loss, and potential heart and brain damage. Other damaging effects of use include aggression and violent and psychotic behavior. In addition, methamphetamine use is associated with increased transmission of hepatitis and HIV/AIDS.

We launched our Methamphetamine Initiative in San Francisco with a regional symposium on methamphetamine abuse, prevention, and treatment issues in December 1996. This symposium was an important step toward one of NIDA's most important goals for the Initiative - to translate the knowledge developed through research into a better public understanding of methamphetamine abuse and the implementation of more effective methamphetamine prevention and treatment strategies in the community.

Last year, NIDA received $4.2 million from the White House Office of National Drug Control Policy to broaden our ongoing program of methamphetamine research. This year, the Director's Office of the National Institutes of Health awarded NIDA an additional $2 million in special funds for additional methamphetamine research. The funds were devoted particularly to the development of new medications for methamphetamine overdose and addiction. (For full details of the Initiative, see "NIDA Initiative Tackles Methamphetamine Use")

Our Initiative includes basic animal and human neuroimaging studies that will increase our understanding of the neurobiological mechanisms and consequences of methamphetamine use. Previous research has shown that prolonged exposure to relatively low levels of methamphetamine can damage as much as 50 percent of the dopamine-producing nerve cells in the brains of animals. NIDA-funded scientists now are studying whether, as we suspect, similar damage occurs in the brains of humans. These researchers also are looking at how such brain damage might affect the physiological functions and behavior of chronic methamphetamine abusers. One of the important questions this research will try to answer is whether such brain damage is linked to the hallucinations, paranoia, and violent behavior that sometimes accompany chronic methamphetamine use.

NIDA also is expanding its epidemiology research to help us answer questions about who is using methamphetamine and what promotes or inhibits the use of the drug. We need to know why methamphetamine use has been an ongoing problem in the western United States and Hawaii but not in eastern cities. We need to identify factors that underlie the apparent recent spread of methamphetamine use to other areas of the country, including rural and urban areas of the South and Midwest. We also need to understand why methamphetamine use traditionally has been associated with white, male blue-collar workers and to determine what factors are now spurring its use by more diverse groups.

To answer such questions, NIDA recently launched a multisite study in cities where methamphetamine use is high and cities where use is low. The results of this research will provide the scientific base for developing more effective targeted methamphetamine prevention approaches. This will help forestall the spread of methamphetamine use and its harmful consequences to new groups and areas of the country.

We know that methamphetamine injection increases risk for contracting and transmitting HIV because injection drug use is a risk factor in nearly one-third of Americans infected with HIV. Furthermore, use of methamphetamine is associated with an increase in high-risk sexual behaviors that can contribute to the spread of HIV/AIDS. These behaviors represent a significant public health problem among gay and bisexual methamphetamine abusers in cities such as Los Angeles, San Francisco, and Seattle. Therefore, our Initiative is supporting a number of new and expanded studies to develop methamphetamine treatment interventions that target these populations. Using information gleaned from past treatment research, these studies are testing behavioral interventions, such as contingency management and relapse prevention. These approaches are designed to help modify methamphetamine abusers' thinking and behaviors, to increase their coping skills, and to reduce both methamphetamine abuse and associated HIV-risk behaviors.

In conjunction with our behavioral therapies development, the Initiative also is working to develop medications to reduce methamphetamine use. This effort is capitalizing on knowledge provided by our previous neurobiological research. We also are supporting research to develop medications that would ameliorate the harmful consequences of chronic methamphetamine abuse. For example, antidepressant medications are helpful in combating the depressive symptoms often seen in methamphetamine users who have recently stopped using the drug.

To help disseminate useful scientific information about methamphetamine abuse and its consequences that our research has given us, NIDA has developed a new research report on methamphetamine abuse and addiction. The report will provide the general public, policymakers, health care practitioners, and prevention and treatment service providers with an overview of the latest research findings on methamphetamine.

Recently, I was appointed to serve on a Methamphetamine Interagency Task Force, chaired by Attorney General Janet Reno and Office of National Drug Control Policy Director General Barry McCaffrey, that is working to enhance the Federal Government's education, prevention, and treatment practices and strategies to address methamphetamine abuse. The broad range of new research activities now being conducted under NIDA's Methamphetamine Initiative will provide the additional scientific knowledge we need to develop more effective prevention and treatment approaches that can be disseminated to help communities respond more effectively to all aspects of this complex public health problem.