title: Methamphetamine suppression and route of administration: precursor regulation impacts on snorting, smoking, swallowing and injecting.
abstract: OBJECTIVE
  The route of drug administration affects risk for dependence and medical harm. This study examines whether routes used by methamphetamine treatment participants were impacted by a major drug suppression policy-federal regulation of the methamphetamine precursor chemicals ephedrine and pseudoephedrine.
  
  
  METHODS
  Autoregressive-integrated moving average (ARIMA) intervention time-series analysis.
  
  
  METHODS
  California (1992-2004).
  
  
  METHODS
  Ephedrine single-ingredient products regulation, implemented August 1995; ephedrine with other active medicinal ingredients regulation, implemented October 1996; pseudoephedrine products regulation, implemented October 1997.
  
  
  METHODS
  Monthly counts of non-coerced methamphetamine treatment admissions reporting snorting, smoking, swallowing or injecting. Findings After rising sharply, snorting, smoking, swallowing and injecting admissions dropped 50%, 43%, 26% and 26%, respectively, when the 1995 regulation was implemented. Snorting also dropped 38% at the time of the 1997 regulation. Snorting, swallowing and injecting remained at lower levels to the end of the study period. Smoking resurged (40%) at the time of the 1996 regulation and continued rising.
  
  
  CONCLUSIONS
  Precursor regulation was associated with changes in the administration of methamphetamine. Injecting, the route with the greatest health risk, entered a long-term reduction. So, too, did snorting and swallowing, two routes with lower risk for dependence. In contrast, smoking, which has a relatively high risk for dependence, dropped, then rebounded and entered a long-term rise. A possible explanation is that injecting, snorting and swallowing were largely linked with US domestic methamphetamine production, which has yet to recover from the regulations. While Mexican production, which was impacted only temporarily by the regulations and has supplanted domestic production, may have helped to diffuse smoking, a route with which it is historically correlated.
authors.affiliation: Department of Family and Community Medicine, The University of Arizona, Tucson, AZ, USA. jkcunnin@email.arizona.edu
authors.forename: James K
authors.initials: JK
authors.lastname: Cunningham
authors.forename: Lon-Mu
authors.initials: LM
authors.lastname: Liu
authors.forename: Myra
authors.initials: M
authors.lastname: Muramoto
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000517:prevention & control*; D002140:California; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D004333:Drug Administration Routes; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D035846:Law Enforcement; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage*; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine