Beautiful Boy

by David Sheff

  Then Charles died on the eve of his fortieth birthday.

  Alcohol and heroin are metabolized by the liver, meth by the kidneys. At forty years old, Charles's finally succumbed.

  May the good Lord shine a light on you, Charles. Warm, like the evening sun.

  When I hear the Stones, I think of him.

  And when I hear about meth. So I am sickened that Nic says he has used it.

  Integral to my writing is the research I compulsively undertake. Now that I know that Nic is using meth, I try to learn what I can about the drug. It's more than an attempt to understand it. I sense that there is power in the knowledge of an adversary. The more I learn, however, the more discouraged I am. Meth appears to be the most malefic drug of them all.

  The German chemist who first synthesized amphetamine, the forebear of methamphetamine, wrote in 1887, "I have discovered a miraculous drug. It inspires the imagination and gives the user energy." Amphetamine stimulates the part of the nervous system that controls involuntary activity—the action of the heart and glands, breathing, digestive processes, and reflex actions. One effect is the dilation of the bronchial passages, which led, in 1932, to its initial medical use—as a nasal spray for the treatment of asthma. Later studies showed that the drug was also helpful in treating narcolepsy, calming hyperactive children, and suppressing the appetite. In addition, it enabled individuals to stay awake for extended periods of time.

  By experimenting with a simple change to the molecular structure of amphetamine, a Japanese pharmacologist first synthesized methamphetamine in 1919. It was more potent than amphetamine and easier to make, plus the crystalline powder was soluble in water, so it was possible to inject it. Methedrine, produced in the 1930s, was the first commercially available methamphetamine. In an inhaler, it was marketed as a bronchodilator; in pill form, as an appetite suppressant and stimulant. An ad read, "Never again feel dreary or suffer the blues."

  Meth was widely used in World War II by the Japanese, German, and U.S. military to increase their troops' endurance and performance. Beginning in 1941, relatively mild formulations of methamphetamine were sold over the counter as Philopon and Sedrin. A typical advertising slogan: "Fight sleepiness and enhance vitality." By 1948, these drugs were used in Japan by about 5 percent of the country's sixteen- to twenty-five-year-olds. About fifty-five thousand people had symptoms of what doctors first termed meth-induced psychosis. They ranted and raved. They hallucinated. Some became violent. Mothers ignored or, in some cases, abused their babies.

  In 1951, the U.S. Food and Drug Administration classified meth-amphetamine as a controlled substance. A prescription was required. According to a report published that year in Pharmacology and Therapeutics, methamphetamine was effective for "narcolepsy, post-encephalitic parkinsonism, alcoholism, certain depressive states, and obesity."

  The illegal speed craze, including the first crank, a meth derivative that is a pale yellow powder that is snorted, and crystal meth, a purer form, the first to be injected (it is snorted, too), hit in the early 1960s. Illicit meth labs emerged in San Francisco in 1962, and speed inundated the Haight Ashbury, presaging the first national epidemic in the middle to late 1960s. When my research takes me to the San Francisco office of David Smith, the doctor who founded the Haight Ashbury Free Clinic, he recalls the drug's arrival to the neighborhood: "Before meth, we saw some bad acid trips, but the bad tripper was fairly mellow, whereas meth devastated the neighborhood, sent kids to the emergency room, some to the morgue. Meth ended the summer of love."

  Prior to founding the clinic, Smith had been a student up the hill from the Haight at the University of California Medical School. When the hospital emergency room began to see overdoses of this new drug, he started the first clinical research on its effects. He administered small doses to rats, and every one of them died of massive seizures. Rats caged together died when given even smaller doses of meth—the effect was quicker, and the cause of death changed. The rats had interpreted normal grooming behavior as an attack, and, as Smith recalls, "they tore each other apart."

  In 1967, Smith came down from Parnassus Hill to work in the community. (He went on to become the president of the American Society of Addiction Medicine and is now the executive medical director of a rehab facility in Santa Monica.) When he arrived in the Haight, he says, "I found a big rat cage—people shooting speed, up all night, paranoid, total insanity, violent, dangerous." Smith issued the original "speed kills" warning in 1968 at a time of meth "shoot-offs" at the Crystal Palace, a bar. A circle of users passed around a needle. "I'd get calls at seven in the morning, when the guy who was the fastest draw was totally psychotic," Smith remembers. The shared needles led to a hepatitis C epidemic. "When I warned the meth addicts about hep, they said, 'Don't worry. That's why we put the yellow guy last.' "

  Use of methamphetamine in America waned, waxed, and waned again since the days of the drug's initial heyday. Now many experts say that it's more potent and pervasive than ever. Whereas a few years ago it was concentrated in western cities, meth has now crept across the country, inundating the Midwest, the South, and the East Coast. Meth use is an epidemic in many states, but the enormity of the problem has only recently been acknowledged in Washington, partly because of the lag between the time it took for the newest wave of addicts to fill up the nation's hospitals, rehab facilities, and jails. Former Drug Enforcement Administration chief Asa Hutchinson called methamphetamine "the number-one drug problem in America." It is overwhelming law enforcement, policymakers, and health-care systems.

  As recently as early 2006, the Bush administration provoked a political furor when officials at the Office of National Drug Control Policy downplayed the results of a National Association of Counties survey in which five hundred local law enforcement officials nationwide called meth their number-one problem. (Cocaine was a distant second, and marijuana third.) Later in 2006, the National Drug Intelligence Center published results from a larger, random sample of thirty-four hundred drug enforcement agencies nationwide. For the first time since the organization began conducting the survey, a plurality (40 percent) considered meth their most significant drug problem.

  Meth users include men and women of every class, race, and background. Though the current epidemic has its roots in motorcycle gangs and lower-class rural and suburban neighborhoods, meth, as Newsweek reported in a 2005 cover story, has "marched across the country and up the socioeconomic ladder." Now, "the most likely people and the most unlikely people take methamphetamine," according to Frank Vocci, director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at the National Institute on Drug Abuse (NIDA).

  Internationally, the World Health Organization estimates thirty-five million methamphetamine users compared to fifteen million for cocaine and seven million for heroin. The various forms of the drug go by many names, including crank, tweak, crystal, lith, Tina, gak, L.A., P., and speed. A particularly devastating form, ice, which is smoked like freebase cocaine, had rarely been seen in U.S. cities other than Honolulu, but it is now turning up on the mainland. Another variety, called ya ba—"crazy medicine" in Thai—is manufactured by the hundreds of millions of tablets in Myanmar, smuggled into Thailand, and, from there, to the West Coast of the United States, where it is sold in clubs and on street corners, sometimes in sweet, colorful pills that are ingested or ground up and smoked.

  The most ubiquitous form on the mainland is crystal, which is often manufactured with such ingredients as decongestants and brake cleaner in what the DEA has called "Beavis and Butt-head" labs in homes and garages. Mobile, or "box," labs in campers and vans, and labs in motels, have been discovered in every state. In 2006, Bill Maher quipped, "If Americans get any dumber about science, they won't even be able to make their own crystal meth." For now, however, all it takes is a visit to the Internet where, for thirty dollars plus shipping, I purchased a thick how-to book called Secrets of Methamphetamine Manufacture. The revised and expanded sixth edition of "the class
ic text on clandestine chemistry" has a disclaimer on the title page: "sold for informational purposes only." This information includes step-by-step instructions on manufacturing a variety of forms and quantities of meth, plus advice about evading law enforcement.

  Home meth brewers get the drug's key ingredient—pseudoephedrine—from nonprescription cold pills, prompting many states to initiate restrictions, including limits on the number of packages of Contac, Sudafed, and Drixoral that can be purchased at a time. As a result, the makers of these drugs are reportedly working to change the formulas so that they can no longer be used to make meth. In the meantime, Wal-Mart, Target, and other stores have moved them behind the counter.

  Controlling the supply of cold pills and other sources of ephedrine and pseudoephedrine has had an effect on the domestic supply of meth, and many STLs—small toxic labs—have shut down. But the domestic successes have handed a new business over to Mexican and other international drug cartels, which now smuggle in meth along the routes used for cocaine, heroin, marijuana, and other drugs. While the drug is still often made in garages, basements, and kitchen laboratories, the majority comes from superlabs operated by these cartels. The Oregonian published an exposé by reporter Steve Suo that reveals that the government could have contained (and could still contain) the meth epidemic. Only nine factories manufacture the bulk of the world's supply of ephedrine and pseudoephedrine, but pharmaceutical companies—and legislators influenced by them—have stopped every move that would have effectively controlled the distribution of the chemicals so they could not be diverted to meth superlabs. Suo's report suggests that until the government takes on the pharmaceutical companies, the war on this drug will remain something of a joke. The proof? Users who want meth can find it virtually anywhere.

  The government maintains that overall drug use is down in the United States, but it depends where you look. In many communities, there are more addicts and alcoholics than ever. According to the Los Angeles Times, in California, overdoses and other drug-related deaths may soon surpass automobile accidents as the state's leading cause of non-natural death. Numerous barometers indicate a sharp rise in meth abuse. In many cities, meth is behind increasing numbers of addicts entering treatment, showing up at emergency rooms, and committing crimes. From 1993 to 2005, the number of admissions to rehab for treatment of meth addiction more than quintupled, from twenty-eight thousand a year to about one hundred and fifty thousand, according to James Colliver, Ph.D., of the National Institute on Drug Abuse. In its 2006 report, the Substance Abuse and Mental Health Services Administration reported a "surging" of treatment admissions for meth abuse. Crime rises dramatically in communities inundated with meth. Eighty to 100 percent of crime in some cities is meth-related. In some states, law enforcement officials have attributed increased murder rates to the drug. In cities where meth is the predominant drug problem, there are high incidences of spousal and child abuse—indeed, tragic stories of child abuse are common.

  As many as half of all meth users, and a larger percentage of ice users, tweak. That is, at some point they experience the type of meth psychosis first identified in Japan in the late 1940s. It is characterized by auditory and visual hallucinations, intense paranoia, delusions, and a variety of other symptoms, some of which are indistinguishable from schizophrenia. The hyperanxious state of tweaking can lead to aggression and violence, hence the following, from a report for police on how to approach meth addicts: "The most dangerous stage of meth abuse for abusers, medical personnel, and law enforcement officers is called 'tweaking.' A tweaker is an abuser who probably has not slept in 3-15 days and is irritable and paranoid. Tweakers often behave or react violently.... Detaining a tweaker alone is not recommended and law enforcement officers should call for backup."

  The report includes Six Safety Tips for Approaching a Tweaker, including: "Keep a 7-10 ft. distance. Coming too close can be perceived as threatening. Do not shine bright lights at him. The tweaker is already paranoid and if blinded by a bright light he is likely to run or become violent. Slow your speech and lower the pitch of your voice. A tweaker already hears sounds at a fast pace and in a high pitch. Slow your movements. This will decrease the odds that the tweaker will misinterpret your physical actions. Keep your hands visible. If you place your hands where the tweaker cannot see them, he might feel threatened and could become violent. Keep the tweaker talking. A tweaker who falls silent can be extremely dangerous. Silence often means that his paranoid thoughts have taken over reality, and anyone present can become part of the tweaker's paranoid delusions."

  Tweaking or not, meth addicts are more likely than other drug users (with the possible exception of crack addicts) to engage in antisocial behavior. A successful businessman took the drug to work longer hours, became addicted, and murdered a man who owed him drugs and money. An addict shot his wife, another fatally bludgeoned his victim, and another murdered a couple for a car and seventy dollars. A couple, both meth abusers, beat, starved, and then scalded their four-year-old niece, who died in a bathtub. A Pontoon Beach, Illinois, man was under the influence of meth when he murdered his wife and then killed himself. In Portland, a woman on meth was arrested for killing her eighteen-month-old child, strangling her with a scarf. In Texas, a man high on meth, after arguing with a friend, tracked him down and murdered him—shooting him six times in the head. In Ventura County, California, a man under the influence of meth raped and strangled a woman. Also in California, a meth-addicted mother was convicted of keeping her two young children locked in a cold, cockroach-infested converted garage. An Omaha man was recently sentenced to forty years for murdering his girlfriend's child after shooting meth. The child had been smothered and had numerous broken bones. There have been trials in Phoenix, Denver, Chicago, and Riverside County, California, of mothers accused of murdering their babies because they nursed them while they were on meth. The mother in Riverside, during her trial, said, "I woke up with a corpse."

  In addition to crime, methamphetamine causes significant environmental damage in the places where it is made. The manufacture of one pound of methamphetamine creates six pounds of corrosive liquids, acid vapors, heavy metals, solvents, and other harmful materials. When these chemicals make contact with the skin or are inhaled, they can cause illness, disfigurement, or death. Lab operators almost always dump the waste. The implications for the Central Valley in California, a source of a large percentage of America's fruits and vegetables—and much of its meth—are significant. In the early 2000s, hospitals in the valley were treating many children, often of undocumented immigrants, for conditions related to the chemical by-products of meth production. As an FBI agent there told me, "Millions of pounds of toxic chemicals are going into the fruit basket of the United States. The chemicals are turning up in alarming levels in ground-water samples."

  The health effects of using meth are disastrous. The drug lands more people in emergency rooms than any other club drug, including ecstasy, ketamine, and GHB combined. (And in a laboratory test conducted at the University of California at Los Angeles, eight out of ten tablets sold as ecstasy at clubs in that city contained meth.) Those who don't overdose on the drug may still die from it. Meth causes or contributes to fatal accidents and suicides. After conducting a survey of suicidal tendencies in drug users, psychiatrist Tom Newton, a researcher at UCLA, concluded that "meth-amphetamine is a uniquely potent drug for inducing depression so severe that people feel like committing suicide."

  Many other health risks are related to chronic meth abuse. A doctor who works at a San Francisco emergency room told me about the stream of meth addicts who come in with "blown-out"—literally ruptured—aortas. Addicts may cough up chunks of the lining of their lungs. Many meth addicts lose their teeth. Chronic meth use can cause Parkinson's-like cognitive dysfunction, including deteriorating memory and mental acuity and physical impairment, including paralysis—results of meth-induced strokes. Onetime use of the drug can be fatal. It can cause the body temperature to sharply rise,
leading to lethal convulsions, death from hyperthermia, "arrhythmic sudden death"—the heart no longer has a functional beat—or fatal aneurysms. Serious or fatal conditions may be more likely to occur because of the extended periods of activity that many users engage in. Meth users may not sleep or eat for days. The combination of the drug and fatigue has been shown to contribute to paranoia and aggression. The cycle tends to compound physical, psychological, and social problems; and these all may be further compounded by existing mental health issues, which are common among users.

  Nic has used meth. In spite of his protests and promises, I increase my pleas for him to go into rehab, but he will not yield. I learn that now that he is over eighteen, I cannot commit him. If he were a threat to himself or someone else, there's a complicated process by which I could commit him for a brief evaluation at a mental hospital, but a parent concerned about a child's drug use doesn't qualify. Had I seen this coming, I would have forced Nic into rehab when I still could have made the decision for him. There is no way to know if it would have helped—he may not have been ready to hear the message of rehab—but at least it may have slowed him down. Now he has to go in on his own.

  He sleeps for as much as twenty hours a day for the next three days. After that, he is depressed and withdrawn. Then, without warning, on a cold spring afternoon, he disappears again.