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Although it may have gained popularity at raves, meth has moved well beyond that culture. This doesn't mean ravers aren't still using it--they might just not know it. Analysis by the RCMP's Vancouver-based drug-awareness program shows that almost 60 percent of ecstasylike pills seized locally contain meth. The tablets, a random and dizzying concoction of chemicals, often contain such additional ingredients as cocaine, ephedrine, pseudoephedrine, and ketamine, an anaesthetic used on animals.

According to the Pacific Community Resources Society's 2002 "Lower Mainland Drug Use Survey", which interviewed about 2,000 youth aged 12 to 24, 19 percent had tried meth and nearly eight percent had used it within the past 30 days. The average age of first use was 14.5, and 45 percent of respondents said they could obtain the drug within 24 hours. Family Services of Greater Vancouver reported that in a six-month period in 2001, 14 to 34 youths sought detox for crystal meth. A year later, that figure jumped to 32 to 59 for the same period.

MARC members note that some adolescent girls are taking meth to lose weight, ending up not just skinny but skeletal. It's increasingly popular among the gay/bisexual/lesbian/transgendered community, and even with so-called soccer moms, some of whom take it to keep up with the demands of working and parenting. There are also stories of everyone from lawyers to software developers to longshoremen using meth.

A SYNTHETIC CENTRAL-nervous-system stimulant, meth increases stimulation of the dopamine, serotonin, and norepinephrine receptors in the brain. It can be swallowed, smoked, injected, or snorted. It provides a sense of focus and euphoria. Meth can cause hallucinations like the ones Jake described; users may also hear voices telling them to harm themselves or others, or think people are following them. Coming down, users often experience an intense craving for the drug, anxiety, confusion, fatigue, headaches, and profound depression. They may be irritable, unpredictable, and suddenly violent.

"Aggression wasn't really a problem on the streets a few years ago," Smith says. "You need a whole new bag of tricks dealing with kids on crystal meth. Psychosis is one thing, but drug-induced psychosis is another."

Drug-induced psychosis is what interests Bill MacEwan. He started the Fraser Health Authority's Early Psychosis Program ( and, like so many other health professionals, has been seeing more and more kids on meth.

"I have patients who are 16 years old, in high school, who are psychotic," MacEwan says at a downtown restaurant. "They hear voices when they're partying, but those voices haven't gone away. It's very frightening, and the numbers are rapidly rising. It's not like cocaine or heroin....Methamphetamine causes symptoms that are almost exactly like [those of] schizophrenia."

What puzzles people like MacEwan is this: does crystal meth trigger psychosis in those who are already prone to mental illness (perhaps schizophrenia runs in the family), or does its use cause psychosis? It's a classic chicken-or-the-egg mystery.

A 2001 publication by the WHO, "Systematic Review of Treatment for Amphetamine-Related Disorders", found that five to 15 percent of meth users who develop a related psychosis fail to recover completely. Most users, the organization also reports, become psychotic within a week after continuous meth administration.

Making matters worse is that users who need medical help tend to fall through the cracks. "What do we do with the kid who's psychotic on the street?" asks Dr. Ian Martin, who splits his time between Vancouver Hospital, Dusk to Dawn, and Three Bridges Health Clinic. That clinic (1292 Hornby Street) is located in the heart of the Vancouver's crystal-meth central. He sees kids who snort meth, "hoop" it (insert it rectally), or "parachute" it (wrap it in a rolling paper and swallow it).

Those who have hit the bottom are often stuck there, Martin explains in a West End coffee shop. If a user in a psychotic state goes to emergency, he'll likely be sent right back out a few hours later because he's high. But most detox centres and mental-health organizations lack the resources and knowledge to handle meth-induced psychosis. In response, Martin has started giving seminars to health professionals on how to deal with users. (He also formed a crystal-meth-anonymous group, which meets every Friday at Three Bridges [604-633-4242].)

"There may be tactile hallucinations; they [users] have a sense of bugs crawling on their skin," Martin says. "They'll say, 'Look doc, it's right here,' and they're pointing to a hair on their arm, thinking it's a spider. They think they have scabies so they will pick at their skin."

Consequently, users are prone to skin infections. They're also susceptible to tooth decay. Users grind their teeth, and the drug decreases the saliva's pH level, allowing more bacteria to grow in the mouth. "I had one 21-year-old patient who had had all her teeth taken out. They were all rotten."

When the high starts to fade, the accompanying depression can be severe to the point of suicide. What also distresses Martin is that meth use significantly boosts the chances of contracting HIV, AIDS, and other sexually transmitted illnesses. The drug delays ejaculation, often leading to rougher sex as a result. (Infection spreads easily when skin is torn.) "And if someone's high, they might not engage in safe sex," Martin says.

He notes that even though the amount of anecdotal evidence related to meth is staggering, more research is needed. But getting hard facts can be tough. It's difficult to get people with an addiction and a mental illness to take medication regularly and comply with doctors' orders. "If they get better, we never see them again. If they get a lot worse, we never see them again," Martin says.