History of the methamphetamine problem.

Methamphetamine, called meth, crystal, or speed, is a central nervous system stimulant that can be injected, smoked, snorted, or ingested orally; prolonged use at high levels results in dependence. Methamphetamine (MA) is a derivative of amphetamine, which was widely prescribed in the 1950s and 1960s as a medication for depression and obesity, reaching a peak of 31 million prescriptions in the United States in 1967. Until the late 1980s, illicit use and manufacture of MA was endemic to California, but the MA user population has recently broadened in nature and in regional distribution, with increased use occurring in midwestern states. An estimated 4.7 million Americans (2.1% of the U.S. population) have tried MA at some time in their lives. Short- and long-term health effects of MA use include stroke, cardiac arrhythmia, stomach cramps, shaking, anxiety, insomnia, paranoia, hallucinations, and structural changes to the brain. Children of MA abusers are at risk of neglect and abuse, and the use of MA by pregnant women can cause growth retardation, premature birth, and developmental disorders in neonates and enduring cognitive deficits in children. MA-related deaths and admissions to hospital emergency rooms are increasing. Although inpatient hospitalization may be indicated to treat severe cases of long-term MA dependence, optimum treatment for MA abusers relies on an intensive outpatient setting with three to five visits per week of comprehensive counseling for at least the first three months. The burgeoning problems of increased MA use must be addressed by adequate treatment programs suitable for a variety of user types.

The 1988 anesthesia survey of the Southern California Society of Oral and Maxillofacial Surgeons.

The results of the fourth anesthesia morbidity and mortality survey of the members of the Southern California Society of Oral and Maxillofacial Surgeons is presented. A questionnaire was mailed to 203 active members in February 1988. All responded or were contacted by Society staff and a response obtained. Results were compared with the three previous studies and revealed trends in training, length of time in practice, modes of practice, equipment used, medications used, numbers of anesthetic procedures performed, and specific instances of morbidity and mortality. Over the 20-year period from 1968 through 1987, seven deaths occurred in more than 4,700,000 anesthetics given, a rate of one death in each 673,000 anesthetics administered.