DRUGS IN MICRONESIA: INTRODUCTORY COMMENTS

Drugs are an import into Micronesia. The origins of some, like alcohol, sakau, and betelnut are hidden somewhere in the distant past. Others are of recent origin, but there seems to be a pattern: the more recent the introduction to Micronesia, the greater the power and destructiveness. Against the lethal effects of recent methamphetamine ("ice") imports, sakau and betelnut appear relatively benign.

Sakau (kava) and betelnut

Unlike such illegal substances such as marijuana, heroin and cocaine, the drinking of sakau and chewing of betelnut are well situated within the controlled traditions and social structure of many parts of Micronesia, and are even spreading. Sakau drinking, for example, has largely disappeared on Kosrae but is now a significant cash export crop from Pohnpei to Guam and Saipan. Sakau drinking was originally a deeply ceremonial and social event on Pohnpei, and the reconciliation symbolism of publicly drinking sakau has been incorporated into Roman Catholic penance and reconciliation rituals on Pohnpei (McGrath 1973). Now it has also been commercialized, not only through the exports of sakau to Guam, but also with sakau bars sprouting up alongside alcohol bars on Pohnpei. (Lebot, Merlin and Lindstrom 1992:67-171). This commercialization is not without controversy. At a 1995 workshop we conducted in Kolonia, the commercialization of sakau was seen by Pohnpeians as a negative sign of changing values.

Island traffic in quality betelnut is lively and broader geographically than sakau exports, despite sporadic efforts by customs agents to prohibit import into and through Guam.⁽¹⁾ We queried various dentists about the bad side effects of betelnut chewing; the only significant health hazard registered was cracking a tooth when making the first bite into the nut. If there is one widely recognized health hazard, it is the association of betelnut with the deleterious effects of tobacco; betelnut is sometimes chewed with smoking or chewing tobacco. In fact, Mac Marshall found no conclusive evidence that regular chewing of betelnut resulted in physical or mental health problems for most people (1993b:262). He concluded that neither betelnut nor sakau (kava) pose health risks and that they do not have the "negative social and economic consequence for the Pacific Island societies where they are used" (Ibid). Other students of drugs in the Pacific are even more positive about the potential of sakau (kava) as a high quality natural relaxant beverage, even with acknowledged therapeutic properties, that could compete internationally with other stimulants such as cola, coffee and tea (Lebot, Merlin and Lindstrom 1992:199). We discussed the harmful effects of sakau and betelnut with Pohnpeian and Palauan medical specialists; they are not as sanguine in their judgments. Sakau in great doses, they claim, causes scaly skin and internal parasites; it has a negative effect on performance at home and work. The local medical people also think the lime used in betelnut chewing may be carcinogenic (see Lee 1990 on the harmful effects of sakau/kava and betelnut). We think the jury is still out on the harmful effects of these drugs.

The same positive statements are rarely made for alcohol, another old and introduced drug in Micronesia. We will devote a later issue of Micronesian Counselor to alcohol as a distinct social problem in Micronesia.

Introduction of pot, heroin, and "ice"

Marijuana and perhaps heroin were introduced in the 1960s and 1970s (Marshall 1993b:269). In 1984-1985 a serious outbreak of heroin abuse in Palau saw over 50 people under professional treatment and several imprisoned off-island for trafficking in heroin brought in from the Philippines and Thailand (Marshall 1993a:12). At that time most heroin may have been in transshipment through Palau. There are still reported users in Palau and elsewhere, but the heroin traffic, according to federal and local law enforcement officials, is not the mega-problem it was in 1985. In fact, at least one of the convicted Palauans has returned from prison to help keep the new generation drug free. For Guam and the CMNI, the drug of the 1990s is no longer pot or heroin but "ice," a crystalline form of methamphetamine, the abuse of which is now proclaimed to be of epidemic proportions on Guam (Pacific Daily News, Dec. 28, 1995). Ice is not only the most recent but certainly the most potent of the drugs to arrive in Micronesia, although alcohol, because of its widespread use may have the greatest impact on society. Federal and local law enforcement officials now consider the heroin and cocaine traffic to be small in comparison with "ice" imports.

Revisiting Oneisom's 1985 survey of marijuana on Chuuk

In this issue of the Micronesian Counselor, we focus on the use and impact of three drugs during the past 10 years: marijuana, inhalants (glue, gas sniffing) and ice.

Innocente Oneisom's study, Marijuana in Chuuk, was first distributed through the Micronesian Seminar in 1985. We are reprinting it ten years later because Oneisom, now a Chuuk State legislator, thinks marijuana use remains much the same in 1995 as when he did his field research in the early 1980s. The number of users and dealers seems to be the same, according to Oneisom, and the price of a joint has not changed, about $2.00. It is still grown locally and he occasionally still sees families growing plants right outside their homes. In other words, it remains the family affair he described in 1985. At that time some marijuana was brought in from Yap, Palau and Saipan; recently there were Chuuk airport busts of pot from Pohnpei.

Oneisom's statistics for pot use on Chuuk are high compared to other locations in Micronesia; but most of the other studies surveyed select populations such as high school students; Oneisom's convenience sample was drawn largely from males, who are more likely to be users of any drug. An earlier (1980) study of 275 College of Micronesia students, for example, revealed that 34% used marijuana on occasion. A survey of Saipan junior and senior high school students showed 22.5% had used pot in 1987, a drop from 1984 when 34.8% smoked marijuana "sometimes." (Lord 1984; 1987). In the 1993 FSM survey of students between 12 and 18, the Chuuk percentage of marijuana users was still at 20.3%, about the same as the FSM as a whole. Kosrae, however, showed only 13.5% youth users (Reed 1993). A 1993 CMNI survey of high school students identified 24% as at least monthly users of marijuana (Anon 1994:n.p.). The samples in all of these surveys are open to various interpretations, but they offer interesting insights. The percentage of occasional marijuana users on Chuuk probably remains rather constant over the last 10 years, as Oneisom claimed in our 1995 interview. The Chuuk percentage of users is similar to that in most other parts of Micronesia (Saipan, Yap, Pohnpei). Oneisom's study found pot smoking to be largely among males, and this is confirmed in Marshall's later study (Marshall 1991). The gender association for pot matches that for alcohol: men smoke and drink, women significantly less so.

What also persists is a widespread belief that marijuana smoking is relatively harmless. Keith Evans could report from Palau in 1987 that "It is clear that marijuana is not perceived to be a problem substance by users or law enforcement officers. Marijuana is grown openly in Palau" (1987:16). We have found the "is-not-harmful myth" to be still as widespread among high school students today as Oneisom had seen in 1985. But since 1985 more studies have established the long-term physiological effects. If compared only with smoking tobacco, "Tests have shown that marijuana smoke contains 50% more carcinogenic hydrocarbons than tobacco smoke" and "the increased cardiovascular workload induced by marijuana consumption poses a potential threat to persons with hypertension, cerebrovascular disease and coronary atherosclerosis" (Marshall 1991: 358).

In short, Oneisom's 1985 study remains relevant because the patterns he describes remain true for Chuuk and other parts of Micronesia, even though there has been much change in US patterns of pot smoking during this same period.

Glue-sniffing

Oneisom also reported inhalant sniffing on Chuuk, as did Lord's Saipan surveys in 1984 and 1987. Fortunately, gas and glue sniffing on Chuuk, perhaps elsewhere, is limited to children and adolescents (Marshall 1991:359). Unfortunately, the inhalants are not a controlled substance and easily obtained and, more importantly, can cause permanent brain damage and mental retardation. Observers who have seen habitual sniffers can immediately see the damage in their zombie-like facial expressions. We have included excerpts of an article by Mac Marshall and associates on Chuuk gasoline sniffing to highlight, first, the vulnerability of its preadolescent users and second, because the Chuuk pattern fits a pattern found elsewhere in the Pacific.

Methamphetamines ("ice") in the Marianas

The third article, "Chilling the Pacific," comes from a Saipan-based clinical psychologist with first-hand experience in dealing with ice addicts. Dr. Michael Mason makes alarming claims about the social impact of ice addiction on the family structure and social fabric.

Each author of these three studies deals with a different effect of drug abuse. As mentioned before, Mason stresses the impact on family and even an entire culture. Although Oneisom describes marijuana dealing on Chuuk as often being a family business, he does not say much about its impact on the family, the extended family; he focuses on the cultural setting of pot smoking. Marshall, on the other hand, focuses on the harmful effect of inhalant sniffing to individuals. Some of these effects are specific to the drug itself. Gas sniffing, for example, does not have the same impact on the extended family simply because the users are children and not family breadwinners as are many of the ice users. Ice appears to produce a more violent result than marijuana, but both may be linked to thefts for the cash to continue the habit. There is a correlation between increased drug use and violent crime. Methodologically, however, it is very difficult to verify the precise causal relationship between individual drug use and the impact on others. It is certainly tempting to say that the recent rise in burglaries on Guam and Saipan is because users need money for high priced drugs.⁽²⁾ Certainly some of the increase in violent crime is a side effect of high prices for ice. Spouse and child abuse centers are recording new admissions because the husband is on drugs. But causal correlations are hard to prove. The exact cost in human suffering is impossible to measure; perhaps all we can do is paint the broad outlines of the cultural and social cost, as Dr. Mason does for Saipan.

These three articles as a "sampler" of drug problems in Micronesia

Together, these three articles are only a sample of drug abuse in Micronesia. An article like Oneisom's could have been written about marijuana in Palau; one like Mason's could be written about Guam. As Mac Marshall commented in his gas sniffing article, we are looking at abuse patterns that are widespread. Historically drug use has trickled into Micronesia after first becoming popular elsewhere. And although the sheer amount produced or imported in Micronesia is minuscule compared to traffic in Hawaii or the West Coast, Micronesians might look to those bigger spots for clues as to what will happen next, in 1998 or 2000.

Bibliography

Readers looking for a general introduction into drugs will find Winger et al. (1992) readable, succinct, and authoritative. Mac Marshall (1990, 1991, 1993b) has produced several comprehensive reviews of the literature for drugs in Micronesia as well as studies of abuse in Chuuk. Should readers be interested in sakau and betelnut, Lebot et al (1992) offers a tour of kava use in the Pacific, although Petersen (1996) has an interesting rejoinder to the Lebot et al. interpretation of sakau use on Pohnpei. See Lee (1990) for the controversial health effects of sakau and betelnut.

Anonymous (1994). 1993-1994 CMNI teen behavioral risk survey. Saipan, CNMI: CMNI Public School System and Dept. of Health Services.

Dumat-Ol, Gaynor (1996). FBI says bank employee stole to pay bills, buy ice. Pacific Daily News. March 20. p. 4.

Edman, J. (1980). Alcohol and marijuana use among Micronesian college students. Unpublished report on file at Micronesian Seminar, Pohnpei, FSM.

Evans, K. (1987). Prevention and control of alcohol and drug abuse: Assignment Report, 24 June to 21 July 1987. Wellington, New Zealand: World Health Organization.

Larson, R. B. (1987). Marijuana in Truk. L. Lindstrom (ed.), Drugs in Western Pacific societies: relations of substance, ASAO Monograph 11, (pp. 219-230). New York: University of America Press.

Lebot, V., Merlin, M., & Lindstrom, L (1992). Kava: The Pacific drug. New Haven,CT: Yale University Press.

Lee, H. (1990). The health effects of kava/sakau and betel nut. Portland, OR: Northwest Regional Educational Laboratory.

Lord, D. B. (1984). Preliminary results of the 1984 mental health and substance abuse survey of junior and senior high school students on Saipan. Saipan: Division of Mental Health, Dr. Torres Hospital.

Lord, D. B. (1987). Preliminary results of the 1987 mental health and substance abuse survey of junior and senior high school students on Saipan. Saipan: Mental Health Program, Division of Public Health, Commonwealth Health Center, Saipan, CNMI.

Marshall, M., Sexton, R., & Insko, Lee. (1994). Inhalant abuse in the Pacific islands: Gasoline sniffing in Chuuk, Federated States of Micronesia. Pacific Studies 17, 23-37.

Marshall, M. (1993a). Background briefing paper. A paper prepared for the FSM/WHO Joint Conference on Alcohol-related and Drug-related Problems in Micronesia, Pohnpei, August 9- 12 1993. Pohnpei, FSM, 1993, August 9 : Federated States of Micronesia and World Health Organization.

Marshall, M. (1993b). A Pacific haze. V. S. Lockwood, T. G. Harding, & B. J. Wallace. (eds), Contemporary Pacific societies: studies in development and change, (pp. 260-272). Englewood Cliffs, NJ: Prentice Hall.

Marshall, M. (1991). Beverage alcohol and other psychoactive substance use by young people in Chuuk, Federated States of Micronesia (Eastern Caroline Islands). Contemporary Drug Problems, 18, 331-371.

Marshall, M. (1990). Combining insights from epidemiological and ethnographic data to investigate substance use in Truk, Federated States of Micronesia. British Journal of Addiction, 85, 1457-1468.

Marshall, M. (1987). An overview of drugs in Oceania. L. Lindstrom (ed), Drugs in Western Pacific societies: Relations of substance (Association for Social Anthropology in Oceania Monograph no. 11), Lanham, MD: University Press of America.

McGrath, T. B. (1973). Sakau in town. sarawi in town. Oceania, 64, 64-67.

Petersen, G. (1995). The complexity of power, the subtlety of kava. Canberra Anthropology, 18, 34-60.

Reed, J. (1993). Behavioral risk factor assessment among youth of the Federated States of Micronesia. Palikir, Pohnpei, FSM: Federated States of Micronesia and World Health Organization.

Winger, G, Hofmann, F G, & Woods, J. H. (1992). A handbook on drug and alcohol abuse. New York: Oxford University Press.

MARIJUANA IN CHUUK

Innocente I. Oneisom

When Innocente Oneisom conducted this survey for Micronesian Seminar in 1985, he was the coordinator of Youth Link and was well known for his writings on Chuuk and for the radio programs he wrote and produced. This report was originally circulated by the Micronesian Seminar and later published as an occasional paper of the Micronesian Counselor (1991). It appears here with notes and bibliography added by the editors. Oneisom is now a senator for Chuuk State in the FSM.

Introduction

This report, the outcome of a five-month study done in 1985, looks into the problem of marijuana on Chuuk. Because the objective of this study was exploratory–to gather as much information on marijuana as possible–we formulated three different questionnaires to canvass a wide sample of the population. One set of questionnaires was for habitual marijuana users, those who smoke now as well as those who regularly smoked in the past and have now given up the habit. Another set of questionnaires was for the non-users of marijuana, people who never smoke the material or those who tried it only once and have never picked it up again. The last set of questionnaires was for the dealers, those who make marijuana a source of income. If a person had ever at any time, even for a few days, sold marijuana, he was considered a dealer.

The respondents of the survey were picked randomly.⁽³⁾ There is no criteria for picking the subjects except that they be cooperative and willing to answer the questions asked of them. The study was done on the lagoon islanders, although some of the subjects were outer-islanders residing on Moen.

For a good part of the first month of the study, marijuana information was gathered from the government agencies dealing with illegal substance control. These agencies include the Public Safety Department, the Chuuk State Court, and the Chuuk State Legislature. During this time, information was also gathered based on observations and casual contacts with the Chuukese people.

Maruo

Marijuana is best known to the people of Chuuk as Maruo. It is interesting to note that marijuana, as a name, has a feminine ending, but Maruo is a male name. It is sometimes referred to as the "different" cigarette. Marijuana is a pretty new item to the Chuukese people. Its newness and foreignness is evident in the many vocabulary words that the Chuukese use in association with marijuana. They include such words as "joint," "wrap," "tops," and "seeds."

It is said that marijuana was first introduced to Chuuk by a foreigner who resided on Nama Island towards the end of the 1960s. The person is reported to have had in his possession some marijuana seeds which he sowed and which later grew into healthy plants. By the early 1970s there was a small amount of marijuana filtering into Chuuk. The substance was brought in by students from Palau, Yap, and Saipan who were attending school in Chuuk. As early as 1973 marijuana seeds were brought in from Saipan by a sailor on one of the cargo ships. They were planted on one of the lagoon islands and grew to be extremely healthy plants. It was not until the late 1970s that marijuana invaded the islands in large quantity. With much improved means of communication and transportation, and the increased number of Chuukese leaving the islands for school, marijuana found new and effective means of entering the area.

Today marijuana, grown on every island in Chuuk Lagoon and smoked widely by Chuukese youth, is a common and well-known item. This is well illustrated in the following incident:

Three young boys were drinking coconuts by the road. On approaching them, I asked if I could have one. The youngest one, who was completely naked, probably about the age of five or six, readily offered me one. The other two kids were probably about ten or eleven. Just as the five-year old handed me the coconut and the machete, I smelled the odor of burning marijuana. I then asked how it was that I could smell marijuana. One of the older boys said that his friend, the other older boy, had just finished smoking some. Giggling, the four-year old said it was true. I turned to the younger kid and asked if he smoked. To that he said no. I then asked him if he knew what marijuana was. He quickly replied yes to the question, as though he could not believe I asked him that question. As if to prove his claim, he went on to say that it is like cigarettes which you smoke and then you get "stoned." I asked him what "stoned" meant. He responded by saying that it is when a person laughs and giggles all the time. He then ran off upon seeing that other people were approaching us.

This incident shows that even a five-year old knows what marijuana is and what it does. Yet, the child must have had some idea that what he was talking about was a bad thing, because he stopped what he was talking about and ran off as soon as other people began gathering.

Marijuana and the Law

The Chuuk State Government does not have its own laws and regulations regarding marijuana, or for that matter any illegal drugs or substances. There is a plan to enact legislation soon, according to a legal aid at the Chuuk State Legislature. The Chuuk State Government simply adopted the Federated States of Micronesia Criminal Code, formerly the old Trust Territory Code. It was enacted in 1980 as part of the FSM Code.⁽⁴⁾

In this code it is specifically stated that possession and trafficking of marijuana is illegal. Possession of an ounce or less is punishable by a fine of not more than $50. To possess from an ounce up to a kilo, or 2.2 pounds, is punishable by imprisonment of not more than three months, a fine of $500 or less, or both. Possession of more than a kilo of marijuana is punishable by imprisonment of not more than a year, a fine of not more than $1000, or both. Possession of the same amount is presumed to constitute the crime of trafficking, because it is assumed that this quantity is too much for personal use. This is therefore punishable by imprisonment of not more than five years, a fine of not more than $5000, or both.

The records at Chuuk Public Safety Department indicate that marijuana is a crime that has been increasing yearly. Records show that the first reported case of marijuana took place on Moen late in 1978 when one plant was uprooted. In the following years, the total police raids recorded are:

1979	3 cases
1980	8 cases
1981	13 cases
1982	(for 4 months only) 8 cases
1983	not available
1984	36

This information is based on the individual police officers' daily reports, which unfortunately, yield different figures from the monthly reports. The daily reports do not mention whether the offenders were arrested or not. The monthly reports do. Regrettably, however, the monthly reports only cover 1983 and 1984. They show the following:

YEAR	REPORTED CASES	NUMBER ARRESTED
1983	30	26
1984	56	40

One valuable piece of information that the officers's daily report provides is the quantity of the confiscated substance. The officers' reports did not assign any cash value to the confiscated substance, but they did give the number of plants and weight of the substance. Based on the information given by the dealers and the quantity of the substance recorded in the daily police reports, we have calculated the estimated street value of the confiscated marijuana. According to the dealers, a mature plant (four to seven feet tall) when sold as a whole plant brings in an average of $250. A mature plant, according to our rough calculations, would produce twelve ounces of marijuana.

During the five years from 1979 to 1984 — excluding 1983, for which there are no reports — about $105,000 worth of marijuana was confiscated. This is an average of $21,000 worth of marijuana per year.

None of the individuals arrested on possession or trafficking charges have ever been convicted and very few have even been brought to trial.⁽⁵⁾ The Clerk of Courts told me in response to my inquiry that as of July 1985 there has not been one marijuana case tried at the state level. According to a source associated closely with that department, however, there have been three cases that have reached the court system on the state level. One has been adjudicated and two are still pending. The one marijuana case that has gone through the court system reached the Supreme Court level on July 9, 1982. The offender was charged with trafficking and possession of a kilo or more marijuana on April 26, 1981. This was the only case of marijuana tried by the FSM Supreme Court in Chuuk. This particular case was dismissed on the grounds that the FSM Supreme Court did not have jurisdiction over the case.

Marijuana as a Source of Income

The study does not find enough evidence to assert that the Chuuk marijuana crop is being shipped or sold outside of Chuuk. Nonetheless, in the late 1970s and early 1980s marijuana was reportedly sold to the Marshall Islands. People say that the Marshall Islands crop lacks the extra "kick" of marijuana from Chuuk, or from Yap and Palau.

It seems that marijuana from Palau, Yap, and Saipan has been shipped into Chuuk since the 1970s. There are reports of two marijuana dealers who held responsible positions in the Chuuk government in 1976. At this time, the limited supply of marijuana in Chuuk was unable to meet the growing demand for the substance. Moreover, the marijuana imported from Palau and Saipan that these individuals were selling contained the extra "kick" the smokers were seeking. Consequently, the price was high–$2 per joint and $10 per plastic sandwich bag, later raised to $20 per bag as the demand increased. The Yap crop, which comes into Chuuk regularly, is reported to be just as strong as the Palau and Saipan crop. A former dealer tells that a plant would cost him between $50 and $150 in Yap. He would stuff a briefcase with marijuana and sell it, now wrapped into joints, in Chuuk and would bring in an average of $1000. This fellow is the only one in Chuuk who had a whole network of dealers. His dealers went around the islands of the lagoon, especially Moen, selling marijuana joints. In an effort to keep up the interest of his dealers, he gave a ten percent commission to each of them who sold 50 joints. The most successful dealers were also given a bonus–a plastic sandwich bag of marijuana weighing about an ounce for their own use. His business prospered from 1979 to 1982, when he finally joined the Mwichen Asor⁽⁶⁾ and so took a religious pledge to discontinue his business.

On the whole, marijuana as a business is done very poorly.⁽⁷⁾ Mostly, it is a family undertaking, not a professional one. Many of the dealers who cooperated with us in providing information sell marijuana on a part-time basis. Some do so for a year or two, and others for a couple months only. There are others, however, who have been fortunate enough to gain the publicity necessary to do well in the business.

It was about one o'clock in the afternoon on a payday Friday on Moen. I walked up to two young men wrapping joints of marijuana. I sat down by them and we talked while they went about their business. After talking about some unrelated topics, I asked them how much they made a week. One of them answered, "$80 a week." I commented that that was a lot of money. He smiled, and as if quickly embarrassed, he grabbed the marijuana and the zig-zag wrappers and stuffed them into his backpack. He stood up and told his friend that they would have to finish wrapping later on. They did not leave the area. Neither did I. I hung around, observing the transactions which began the minute the two young men walked into the open. Apparently, they already had wrapped a lot of marijuana joints and had stored them in the backpack. I sat back and counted 22 people buying marijuana joints at a dollar a joint in the one hour that I hung around the area. At least $20 was collected during this hour, with some of the 22 customers buying more than one joint each. These two young men are at it every day of the week except on weekends. This makes me question their claim that they make $80 a week; they seem to be doing much better business than that.

A marijuana dealer makes an average of $100 a week, dealers themselves claim in the questionnaires that were filled out by 15 marijuana dealers ranging in age from 17 to 32. Some of the dealers claim that they make more than $150 a week–a claim that is quite possible if the business is based on Moen. The dealers on the other lagoon islands say they make an average of $50 a week. These dealers either grow their own stuff or buy plants from others. These plants are purchased at $150 and up, and are then wrapped and sold as joints. It is estimated that these dealers bring in a profit of 100% to 200% on their product. All except one of the dealers claim that the marijuana business has helped them in covering the expenses of their daily needs. It has helped them in the purchasing of kerosene, canned goods, soap, mosquito coil, and cigarettes. Those that really do well in the business have been able to buy outboard engines, generators, tape recorders, and motor bikes.

Marijuana and the People

	Males	Females	Total
Users	58	3	61
Non-users	21	23	44
Dealers	14	2	16

In the study I interviewed 121 people ranging from the age of 12 to 72. The breakdown of the interviewees is as follows:

Males Females Total

Users 58 3 61

Non-users 21 23 44

Dealers 14 2 16

Twelve of the 44 non-users have tried the drug at some time or other. Although we can not give a number or percentage of people who have come in direct contact with marijuana, we can say with certainty that a great majority of the interviewees have had some contact with it. Not a single one of the interviewees expressed lack of knowledge of the drug.⁽⁸⁾

Eighty percent of the interviewees believe that marijuana smoking produces certain side effects. These are, in order of the frequency with which people listed them: "craziness";⁽⁹⁾ absent-mindedness; laziness; reproductive process impairment; physical handicap; over-eating; high blood pressure; damaged nerves; irritability; being lost in dreams; and affected lungs. "Craziness" is thought to be the most common side effect of marijuana smoking, as indicated by 22% of those interviewed (users and non-users only). In fact, this belief is cited as the main reason those who have given up smoking finally quit. It is also given as the reason that 16 of the 44 non-users of marijuana do not use the drug. In describing what they mean by "crazy," some of the interviewees have mentioned "keeping silent," "feeling abnormal about oneself," "visualizing things," and "being afraid of people."⁽¹⁰⁾ It might also be noted that several of the recorded Chuukese psychotics regularly use marijuana, according to a survey done on mental illness.

Another of the perceived side effects of marijuana is laziness.⁽¹¹⁾ It is this that has caused some of the regular users to break the habit. Others, who continue to use marijuana, say they prefer taking the drug only at night when they are resting. This is especially true for the older members of the group who have families to take care of or who are responsible members of the community.

Interviewees claim that besides other substances like gasoline fumes and spray paint that are used to produce a "high," they know of other, stronger drugs.⁽¹²⁾ They mention cocaine, heroin, opium, hash, LSD, pills, and Speed. Five percent of those interviewed claimed that they have tried gasoline sniffing, and one individual expressed his preference for the gas fume's high over the marijuana high. Six percent of the interviewees have heard that heroin is used in Chuuk but have not tried it. There is one person who claims he has tried cocaine while in Chuuk. There are two others who have tried heroin and hash, but they did not say where they experimented with these drugs.

Marijuana is seen as the second most common problem of Chuukese youth, after drinking of alcoholic beverages. When the interviewees were asked whether they preferred alcoholic beverages or marijuana, 45% said they prefer taking both, 35% prefer alcoholic beverages, and 20% prefer taking marijuana. Most teenagers–about 70% of those interviewed–prefer marijuana over alcohol. Although alcohol is very different from marijuana in many respects, the two drugs have at least one thing in common–they are used in a similar way. That is, they are consumed in the typical Pacific island consumption pattern. However much there is of the substance available, it must be consumed totally. Nearly half of the regular users of marijuana admit to following this consumption pattern in their own use. The quantity smoked can range from a single joint to a plant. In most cases, the users smoke in a group. In fact, one of the reasons given for smoking marijuana, especially for the first time, is peer pressure. All those interviewed who are now regular users admit that their initiation into marijuana smoking was never done alone, but in the presence of others.

The majority (67%) of the regular users said that they first smoked the substance to satisfy their curiosity about it. For most of the users this led to the regular consumption of the substance, for they have, in their own words, "liked the high," "gotten the feeling," "felt relaxed," "felt happy," and "found pleasure."⁽¹³⁾

Summary

Marijuana is currently a widespread substance in Chuuk. It is not a native Chuukese crop, but first found its way into Chuuk in the late 1960s and became extremely widespread in the later 1970s. From 1979 to 1984 an average of $21,010 worth of marijuana was confiscated each year. For something as widespread and illegal as marijuana, one would expect to find records of many cases in the government judiciary system. Yet, it is surprising to find that there is only one recorded case in Chuuk's courts.

Although there is much buying and selling of marijuana on the local level, little, if any, of the Chuukese crop is sold outside Chuuk. On the other hand, there is strong evidence that Chuuk imports the substance from other areas of Micronesia. The marijuana business in Chuuk has not adopted a professional system, but it remains more of a family venture in which the family members cooperate in growing and selling the substance. The money that comes in is used to provide for the daily needs of the family.

More than half of the regular marijuana users first smoked the drug to test the substance that they had heard so much about. It is feared that the people who have heard of other substances besides marijuana might do the same with these other substances. The majority of the interviewees have heard of the other substances, but very few have actually tried them. This could be attributed to the very small influx of these substances up to the present. Many of the people interviewed believed that "craziness" was a side effect of marijuana smoking. This belief has led many of them to avoid the substance.

Bibliography

Two other researchers have studied marijuana use in Chuuk. Bruce Larson's work (1987), which focuses on the subculture of pot use in Chuuk, largely complements Oneisom's. Mac Marshall's first study (1979) was based on field work conducted over 20 years ago; he returned for additional extensive fieldwork in 1985 and conducted a brief series of on-site interviews in 1995. Marshall used both the observation and interview techniques of anthropology (1979) and the more statistical, epidemiological methods of health science workers (1990). His works thus have the advantages of different sampling methods and of considerable time depth. Research data on marijuana use as far back as a quarter of a century ago exists for other Micronesian islands and atolls, but the works of Larson, Oneisom and Marshall give us a richer, more in-depth and better long-term view of pot use in Chuuk. This certainly does not mean that marijuana use is heavier on Chuuk or that it is more of a social problem there than elsewhere in Micronesia.

We find the general English language literature on marijuana difficult to summarize, simply because there is debate on every issue involving pot–except perhaps that teens should not be smoking it. The pot debate may go the way of alcohol prohibition. Pot smoking may eventually gain enough acceptability to take marijuana off the controlled substance list, but we doubt that this move is coming soon. The American literature clearly shows that pot is still a potent symbol, even a national icon of the left and the right, the conservatives and liberals.

The English language literature on pot has shifted from the 1960s alarmist cries of "burned-out-brains" to pleas for legalization and arguments for the positive medicinal value of marijuana (see Grinspoon & Bakalar 1995; Sullum 1993; Voelker 1994), although an equally vocal opposition insist the health hazards are real and strong (see Hearn 1995). At the first National Conference on Marijuana use, US Human Services Secretary Donna Shalala insisted that the message to young people must be that "marijuana is illegal, dangerous, unhealthy and wrong" (as quoted in Dorgan 1995; see also Anonymous 1995).

There is, on the other hand, considerable alarm in the literature on the recent rise in teenage use of pot (Ravage 1994; Wickelgren 1994). One fear is that pot is a "gateway" drug to stronger substances (Anon 1994). Another fear is that teenage use stunts the adolescent growing experience; teen pot users take a flight from reality to a dream world precisely at that period in life when the adolescent should be confronting reality (Tunving 1985).

Curiously enough, precious little popular literature deals with the bad effects of long-term chronic marijuana use, although the medical journals abound in such studies. The National Institute on Drugs and Alcohol claims that pot irritates the lungs, impairs learning, perception and judgment and also diminishes drive and ambition (Dorgan 1995). But whether the question is damage to the brain or impairment of psychological functioning, there is controversy. Most studies agree that chronic use damage short-term memory capacity (Schwartz 1991; Deahl 1991), and a significant correlation between marijuana use and schizophrenia is noted (Leon-Carrion 1990). The doctors are not in complete agreement regarding many other neurophysiological effects (eg, brain damage).

Psychological effects, similar to those popularly described by Oneisom and NIDA are also claimed, psychotic reactions ("feel like am going crazy") and amotivational syndrome ("laziness") being the most noteworthy. But here again, the doctors are split. Winger et al. (1992: 128), for example, insist that "Laboratory studies have not produced any evidence for an amotivational syndrome…," but Maugh (1974) describes the case for it. We suspect that this and similar debates about pot will continue because the war on drugs has politicized the issue. After all, what agency is going to fund a study to show the harmless effects of pot after the US has spent billions ferreting it out of all the Americas and imprisoning its dealers and users?

Readable summaries on marijuana are Chapter Seven of Winger et al. (1992) and Cohen (1981 and 1986). A popular account of the controversy between NIDA and the medical experts is nicely summarized in Dorgan (1995).

Anonymous. (1995). Administration attacks increasing use of marijuana. Journal of the American Medical Association, 274, 598-599.

Anonymous. (1994). Study finds statistical links in children's drug use. Alcoholism & Drug Abuse Weekly, 42, 1.

Anonymous. (1992). Tobacco, alcohol, and other drug use among high school students — United States, 1991. Journal of the American Medical Association, 268, 1841-1842.

Buckley, W. F. (1996). The war on drugs is lost. National Review 48, 34-48.

Cohen, S. (1981). Adverse effects of marijuana: Selected issues. Annals of the New York Academy of Sciences, 362, 119-124.

Cohen, S. (1986). Effects of long term marijuana use. Alcohol, Drugs and Driving Abstracts and Reviews, 2, 155- 163.

Deahl, M. (1991). Cannabis and memory loss. British Journal of Addiction, 86, 249-252.

Dorgan, M. (1995, November 12). Advocates, foes disagree on pot's effects on health. San Jose Mercury News

Evans, K. (1987). Prevention and control of alcohol and drug abuse: Assignment Report, 24 June to 21 July 1987. Wellington, New Zealand: World Health Organization.

Grinspoon, L., & Bakalar, J. B. (1995). Marihuana as medicine: A plea for reconsideration. Journal of the American Medical Association, 273, 1875-1876.

Hearn, W. (1995) Drug agency warns that public is ignoring pot's hazards. American Medical News 38: 12.

Hollister, L. E. (1988). Cannabis–1988. Acta Psychiatrica Scandinavica, 78, 108-118.

Larson, R. B. (1987). Marijuana in Truk. L. Lindstrom (ed.), Drugs in Western Pacific Societies: Relations of Substance, ASAO Monograph 11, (pp. 219-230). New York: University of America Press.

Leon-Carrion, J. (1990). Mental performance in long-term heavy cannabis use: A preliminary report. Psychological Reports, 67, 947-952.

Marshall, M. (1993). Background briefing paper. A paper prepared for the FSM/WHO Joint Conference on Alcohol-related and Drug-related Problems in Micronesia, Pohnpei, August 9- 12 1993. Pohnpei, FSM, 1993, August 9 : Federated States of Micronesia and World Health Organization.

Marshall, M. (1990). Combining insights from epidemiological and ethnographic data to investigate substance use in Truk, Federated States of Micronesia. British Journal of Addiction, 85, 1457-1468.

Marshall, M. (1979). Weekend warriors: alcohol in a Micronesian culture. Palo Alto, CA: Mayfield Publishing.

Martindale, M., & Miller, L. A. (1995, August 6). Teen-age drug use skyrocketing in suburbs. The Detroit News, p. A10.

Maugh, T. H. (1974). Marihuana (II): Does it damage the brain? Science, 185, 775-776.

Morgan, J. P., & Zimmer, L. (1995). At issue: Is marijuana a 'gateway' drug, that leads users to try more dangerous drugs like cocaine? CQ Researcher, 5, 673.

Oneisom, I. I. (1991). Marijuana in Chuuk. The Micronesian Counselor, Occasional Paper No. 3, Micronesian Seminar and FSM Mental Health Program.

Ravage, B. (1994). Marijuana update. Current Health, 21, 6- 12.

Schwartz, R. H. (1991). Heavy marijuana use and recent memory impairment. Psychiatric Annals, 21, 80-82.

Shenk, J. W. (1995, October). Why you can hate drugs and still want to legalize them. The Washington Monthly, 32-37.

Sullum, J. (1993). Selling pot. Reason, 25(2), 20-28.

Tunving, K. (1985). Psychiatric effects of cannabis use. Acta Psychiatrica Scandinavica, 72, 209-217.

Voelker, R. (1994). Medical marijuana: A trial of science and politics. Journal of the American Medical Association, 271, 1645-1648.

Wickelgren, I. (1994). Drug use rises among teens. Current Science, 1994(80), 4-7.

Wickelgren, I. (1993). More young teens say they use drugs. Current Science, 79, 6-7.

Winger, G., Hofmann, F. G., & Woods, J. H. (1992). A handbook on drug and alcohol abuse. New York: Oxford University Press.

GASOLINE SNIFFING

Mac Marshall, Rocky Sexton, and Lee Insko

Mac Marshall teaches anthropology at the University of Iowa and has been doing field work in Chuuk for over two decades. He is the leading authority on drug and alcohol abuse in Micronesia. His works include not only monographs on alcohol abuse (Weekend Warriors 1979 and Silent Voices Speak: Women and Prohibition in Truk, with Leslie Marshall, 1990), but also summaries of drug use in Micronesia and the Pacific (see 1987, 1993a, 1993b). Lee Insko teaches social science at Eastern Oregon State College and also taught in Chuuk; Rocky Sexton was a Chuukese student at the University of Iowa at the time this was written. This article originally appeared in Pacific Studies (1994) and appears here in edited form with the kind permission of the authors and editor.

We here address a substance abuse issue in the Federated States of Micronesia (which we strongly suspect will be found elsewhere in the Pacific) that so far has "fallen through the cracks": the sniffing of volatile inhalants, particularly gasoline. Inhalant abuse has not yet received attention in part because it seems to be a relatively new practice in the islands, but also because the substances that are abused by sniffers are legal, easily obtainable and normally not viewed as drugs.

Inhalation of volatile solvents for the purpose of getting intoxicated has been recorded for most major world areas, but this practice has not been widely reported in Oceania. We have found few sources in the literature mentioning inhalant use by Pacific Islanders, and these articles all date from the 1980s. Available sources document that benzine sniffing was "widespread" in Kiribati in 1982 (Daniels and Fazakerly 1983) and that sniffing of gasoline fumes, spray paint, and glue vapors all apparently occurred in Chuuk and Palau during the 1980s (Evans 1987; Larson 1987; Marshall 1991; Oneisom 1985; Rubinstein 1980). It seems likely that inhalant abuse is much more widespread in the Pacific Islands than the dearth of literature on the subject suggests. What we do not know at present is how widespread the abuse may be.

Because of the serious public health consequences of inhalant abuse, especially for youth, one of our goals here is to call attention to the paucity of data on this topic in the Pacific in hopes that researchers will begin to give it the attention that it deserves. As a background to what we hope will be further work on this topic, we review the major health risks associated with inhalant abuse and then discuss general patterns of use revealed in the literature for other parts of the world. Finally, we provide some findings on gasoline sniffing by young people in Chuuk.

Background

Inhalant abuse is defined as the repeated, intentional inhalation ("sniffing," "huffing") of solvent vapors for the purpose of intoxication. Many of the physiological and behavioral effects of inhalants are similar to those produced by beverage alcohol, except that hallucinations are common with inhalant intoxication (Barnes 1979). For this and other reasons, Brady argues that petrol (gasoline) sniffing leads to an altered state of a quite different order than alcohol intoxication (1985). Gasoline appears to be the most commonly abused substance, although model airplane glue, paint thinner, nail polish remover, butane and propane cigarette light fuel, ether, and aerosol propellants also are popular. There are various methods for using these substances: intravenous injections, direct inhalation from the commercial containers, putting the solvent in a large bowl to increase the fumes, filling a bathtub with paint thinner and closing the bathroom door, or drinking solvents in concoctions called "moose milk" and "marsh wine" (Barnes 1979).

Health Risks of Inhalant Use

A wide range of medical problems stem from extended inhalant abuse. For example, benzene depletes bone marrow by arresting their maturation, and there is a position statistical relationship between chronic exposure to benzene and the development of leukemia (Gilman et al. 1985). Tetraethyl (the principal additive in leaded gasoline) has a particular affinity for nervous tissue and has been determined to cause nervous irritability, anorexia, pallor, tremor, nausea, vomiting, and occasional acute toxic delirium (Boeckx, Postl, and Coodin 1977). Prolonged abuse has caused epidemic mental retardation in various populations throughout the world (Westermeyer 1988). A specific example of such deterioration comes from a Native community in Canada:

Alicia started sniffing gas when she was three years old. She's burnt out now [at age six], and the brain damage is permanent. In class, she can't concentrate and she's lost her retention ability. She has lost her sense of balance. She sways all over the place and topples over her chair. She falls down sixty times a day, like a Raggedy-Ann doll. She has constant bruises on her arms and legs just from falling down on the floor all the time. (Shkilnyk 1985:44)

More immediate harm can come from severe burns due to accidental ignition of volatile solvents during sniffing. Sudden death can occur from respiratory failure as a consequence of central nervous system depression combined with respiratory irritation and bronchiolar obstruction (Nurcombe et al. 1970). Deaths caused by inhalant abuse have been reported from numerous countries.

A special concern in Oceania is the risk posed from sniffing leaded gasoline, to the extent that leaded, rather than unleaded, gasoline is the fuel available in some island areas.⁽¹⁴⁾

A common effect of tetraethyl poisoning is a central-nervous-system syndrome termed lead encephalopathy, a condition that is much more common in children than adults (Gilman et al. 1985:1608); cf. Coulehan et al. 1983). Early signs of the syndrome may be clumsiness, vertigo, ataxia, falling headache, insomnia, restlessness, and irritability. As Gilman et al. report, "Lead poisoning in children is more dangerous than in adults, primarily because of the greater incidence of encephalopathy. The mortality rate of untreated, severe lead encephalopathy may approach 65%" (1985:1610).

These findings should be of special concern in Micronesia since it appears that leaded gasoline is one of the major substances being sniffed there. Although their data must be viewed with great caution–because of the small numbers involved and because it is not clear how accurate self-reports by purported schizophrenics might be–Daniels and Fazakerley (1983) commented that nine of the fourteen schizophrenics under age 35 they questioned at Tungaru Central Hospital on Tarawa had sniffed benzine "at some time." Given the central-nervous-system damage that can result from tetraethyl in leaded gasoline and from prolonged abuse of other inhalants, this association may be more than fortuitous. Researchers who have studied schizophrenia in parts of Micronesia other than Kiribati have not considered the possibility that some cases seen in the inlands may be partially related to drug abuse (Dale 1981; Kauders, MacMurray, and Hammond 1982). Although they do not mention inhalants as a possible contribution factor (not surprising in view of the paucity of information on this topic), Hezel and Wylie (1992) do entertain the possibility that alcohol and drug abuse may play a significant role in schizophrenia and other mental health problems in Palau, the Federated States of Micronesia, and the Marshall Islands. Quite clearly, the relationship of substance abuse to mental health in the Pacific calls for greater attention and researchers need to investigate patients' possible history of inhalant use along with other substances.

Populations at Risk

Most studies suggest that inhalants are the only known drug for which use decreased with age. "Inhalant use is the only substance to show greater use among younger students," note the authors of a trend analysis of drug use by students in Ontario from 1977 to 1991 (Smart, Adlaf, and Walsh 1991:46). A survey of public-school children between the ages of 9 and 18 in Sao Paulo, Brazil, found the prevalence of recent solvent use to be highest among those aged 9 to 11, and that it decreased significantly among older students. An opposite tendency was found for marijuana, tobacco, and alcoholic beverages (Carlini-Cotrim and Carlini 1988). A similar study of Toronto schoolchildren found inhalant use peaked around the grade six or seven level (Smart et al. 1989, cited in Barnes 1979).

It is relatively easy for young children to obtain inhalants such as gasoline, considering the fuel's use in automobiles, outboard motors, and farm machinery in most contemporary societies. In addition, the ready availability of glues, paint thinners, butane lighter fuel, and other solvents adds to the accessibility of potentially lethal inhalants. Inhalant use by very young children, and a corresponding decreased use with age, suggests that inhalants might serve as "gateway drugs" in an escalation towards tobacco, alcohol, or marijuana use (Carlini-Cotrim and Carlini 1988). However, if one accepts the definition of escalation as "the use of a relatively mild mood altering substance early on with the addition of other relatively strong mood altering substances at a later time" (Coombs, Fawzy, and Gerber 1984:63), then viewing inhalants as gateway drugs is problematic. This is because the degree of intoxication with inhalants can be stronger and more dangerous than with drugs such as alcohol or marijuana. In extreme cases of inhalant abuse a child's mental and physical abilities may be permanently damaged long before "escalation" to another drug.

Methods of the Chuuk Survey

During a one-week period in late April 1985, two college classes comprising schoolteachers from Chuuk were briefed by Insko and then carried out a drug survey in several schools on Weene Island under his general supervision. Despite certain methodological difficulties with this survey (e.g., respondent's sex was not recorded), it represents the only questionnaire-based study for the Pacific Islands that provides data on inhalant abuse (gasoline sniffing) by schoolchildren. The questionnaire included queries on the use of alcoholic beverages, marijuana, tobacco, and gasoline sniffing. Data on the first three substances will be reported elsewhere. For the last of these substances, the specific questions asked were: Have you [ever] sniffed gasoline? How often have you sniffed it in the last week?

Results and Discussion of the Chuuk Survey

The responses to the first of these two questions are summarized in Table 1. Nearly 10 percent of the total sample had sniffed gasoline. Although in the overall percentage of users gasoline was the least used of the four substances survey, among the fourth, sixth, and eighth graders who responded to the questionnaire sniffing gasoline was the second most common drug experience after smoking tobacco. Fourth and twelfth graders, while gasoline sniffing still occurred, it ranked last among the four drugs in the number of those who used it. This finding suggests that in Chuuk, as in other parts of the world, inhalant use is especially likely to occur in young age groups and that education and prevention programs should be targeted at them.

Students on Weno, Chuuk, Who Had Ever Sniffed Gasoline (1985)

GRADE	NO. OF STUDENTS	PERCENTAGE OF  TOTAL SAMPLE	PERCENTAGE  WHO SNIFFFED
Four	152	18	Four
Six	168	20	11.3*
Eight	147	17	13.6
Ten	136	16	4.4
Twelve	249	29	13.7
Total	852	100	9.9

*By comparison, Evans reports that a "study carried out by the Mental Health Programme of the Health Services Bureau . . . in one of Palau's elementary Schools showed that of 97 children 21% had experimented with alcohol, 10.8% with marijuana and 29.2% with sniffing materials. These children were aged 11 and 12 years" (1987:16).

With an important qualification, the Chuuk data also suggest that gasoline sniffing declines with age. Note in Table 1 that the percentage of eighth graders who had ever sniffed is basically the same as the percentage of twelfth graders who had ever done so. The low reported percentage of tenth graders who ever sniffed (approximately one-third that of eighth and twelfth graders) probably can be accounted for by a flaw in the study design. All grade levels sampled except tenth graders included only public-school students. The tenth grade sample comprised students from both a public junior high school and a Protestant mission-sponsored school, and unfortunately there is no way to desegregate the data. Inclusion of students from a church school, where there was parental, peer, and institutional pressure on students to meet more strict standards of social behavior, is likely to have contaminated the tenth-grade results by leading to an underreporting of substance use.

The percentages of those sixth, eighth, and twelfth graders from Chuuk who have ever sniffed gasoline are very similar to findings reported for two different populations of schoolchildren in the United States. Johnson et al. (1971) surveyed 2,752 Oregon high school students and reported that between 12.3 and 18.7 percent of the boys and 2.0 and 10.5 percent of the girls had ever used inhalants. More recently, Chavez and Swaim (1992) compared 3,384 Mexican-American and 3,790 white non-Hispanic eighth and twelfth graders regarding "lifetime prevalences" of substance use. The percentage of students who had ever used inhalants of any sort ranged from 12.1 to 16.5.

Preventive measures used in various parts of the world to try to halt inhalant abuse include legislating against the sale of solvents to children. For example, a recent childcare bill in Ireland includes a one-year jail sentence and a $2000 fine for shopkeepers who knowingly sell products to youth such as butane and propane cigarette lighters, paint thinner, nail polish remover, solvent based glues and adhesives, and most products in aerosol containers (Birchard 1988). In Mexico, measures have been taken to replace the benzene in thinners with less-toxic ingredients (Kerner 1988). Also educational campaigns that target parents, children, manufacturers have been instituted. Other measures include doctoring products to make sniffing unappealing, or altogether eliminating the intoxicating elements in commercial solvents. Legislation against the sale of such things as paint thinner or nail polish remover may be effective, but similar efforts to regulate the purchase and use of gasoline would be well nigh impossible from a practical point of view. In the case of gasoline, the best form of prevention may involve educating parents and children about its potentially harmful effects so that inhaling its fumes becomes recognized as a dangerous and possibly lethal practice. Presently, there are no educational programs for either parents or children in Chuuk that provide information about serious health risks posed by gasoline sniffing.

Conclusions

Inhalant abuse is a worldwide problem found especially among preadolescent and early adolescent youth. Recurrent inhalation of volatile solvents, including unleaded or leaded gasoline, poses serious immediate physical and mental health risks, and may lead to long-term health care costs due to permanent impairment. Based upon our literature review and the survey of schoolchildren in Chuuk, there is strong reason to believe that inhalant abuse is a problem among Pacific Islands youth, as it is in most other parts of the world.

The limited data that we report on gasoline sniffing by schoolchildren in Chuuk suggest that the general patter of abuse found in other populations holds for Chuuk as well. This pattern involves experiments with inhalants by preadolescent children with substitution of other psychoactive substances (e.g., alcohol, tobacco, marijuana) as they mature. Unfortunately, given the neurotoxicity and other potential problems posed by the abuse of most inhalants, young people who regularly use these substances run a serious risk of permanently damaging themselves and adding to the physical and mental health burden of their societies. It is imperative that we obtain more and better data on inhalant use in Pacific Islands societies that can be used to develop effective community based public health prevention programs. Future researchers are strongly urged to explore this topic along with the related issues of drug studies, mental health, pediatrics, and juvenile and adolescent social problems.

Bibliography

Barnes, G. (1979). Solvent abuse: a review. International Journal of the Addictions, 14, 1-26.

Birchard, K. (1989). Irish aim at sniffers. The Journal (Addiction Research Foundation, Toronto), 18, 1.

Boeckx, R. L., Postl, B., & Coodin, F. J. Gasoline sniffing and tetraethyl lead poisoning in children. Pediatrics, 60, 140-145.

Brady, M. (1985). Children without ears: Petrol sniffing in Australia. Parkside, South Australia: Drug and Alcohol Services Council.

Carlini-Cotrim, B., & Carlini, E. (1988). The use of solvents and other drugs among children and adolescents from a low socioeconomic background: A study in Sao Paulo, Brazil. International Journal of the Addictions, 11, 1145- 1156.

Chavez, E. L., & Swaim, R. C. (1992). An epidemiological comparison of Mexican-American and White Non-Hispanic 8th- and 12th-grade students' substance use. American Journal of Public Health, 82, 445-447.

Coombs, R. H., Fawzy, I., & Gerber, B. E. (1984). Patterns of substance use among children and youth: A longitudinal study. Substance and Alcohol Actions/Misuse, 5, 59-67.

Coulchan, J. L., Hirsch, W., Brillman, J., Sanandria, J., Welty, T. K., Colaiaco, P., Koros, A., & Lober, A. (1983). Gasoline sniffing and lead toxicity in Navajo adolescents. Pediatrics , 71, 113-117.

Dale, P. W. (1981). Prevalence of schizophrenia in the Pacific Island populations of Micronesia. Journal of Psychiatric Research, 16, 103-111.

Daniels, A. M., & Fazakerley, R. C. Solvent abuse in the Central Pacific. Lancet, (No. 8314), 75.

Evans, K. (1987). Prevention and control of alcohol and drug abuse: Assignment Report, 24 June to 21 July 1987. Wellington, New Zealand: World Health Organization.

Frawley, P. J., & Smith, J. W. (1992, September). One-year follow-up after multimodal inpatient treatment for cocaine and methamphetamine dependences. Journal of Substance Abuse Treatment, 9(4), 271-286.

Gilman, A. G., Goodman, L. S., Rall, T. B., & Murad, F. (eds). (1985). Goodman and Gilman's The Pharmacological Basis of Therapeutics. (7th Edition), New York: Macmillan.

Hezel, F. X., & Wylie, A. M. (1992). Schizophrenia and chronic mental illness in Micronesia: an epidemiological survey. Isla, 1(2), 329-354.

Johnson, K., Donnelly, H., Scheble, R., Wine, R. L., & Weitman, M. (1971). Survey of adolescent drug use. American Journal of Drug and Alcohol Abuse, 61, 2418-2432.

Kauders, F. R., MacMurray, P. J., & Hammond, K. W. (1982). Male predominance among Palauan schizophrenics. International Journal of Social Psychiatry, 28, 97-102.

Kauders, F.R., J.P. MacMurray, and K.W. Hammond. (1982). Male predominance among Palauan schizophrenics. International Journal of Social Psychiatry 28: 97-112.

Larson, R. B. (1987). Marijuana in Truk. L. Lindstrom (ed.), Drugs in Western Pacific societies: relations of substance, ASAO Monograph 11, (pp. 219-230). New York: University of America Press.

Marshall, M., R. Sexton, and L. Insko. Inhalant abuse in the Pacific islands: Gasoline sniffing in Chuuk, Federated States of Micronesia. Pacific Studies 17:23-37.

Marshall, M. (1993a). Background Briefing Paper. A paper prepared for the FSM/WHO Joint Conference on Alcohol-related and Drug-related Problems in Micronesia, Pohnpei, August 9- 12 1993. Pohnpei, FSM, 1993, August 9 : Federated States of Micronesia and World Health Organization.

Marshall, M. (1993b). A Pacific haze. V. S. Lockwood, T. G. Harding, & B. J. Wallace (eds), Contemporary Pacific societies: studies in development and change, (pp. 260-272). Englewood Cliffs, NJ: Prentice Hall.

Marshall, M. (1991a). Beverage alcohol and other psychoactive substance use by young people in Chuuk, Federated States of Micronesia (Eastern Caroline Islands). Contemporary Drug Problems, 18, 331-371.

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Marshall, M. (1979). Weekend warriors: Alcohol in a Micronesian culture. Palo Alto, CA: Mayfield Publishing.

Marshall, M., & Marshall, L. B. (1990). Silent voices speak: Women and prohibition in Truk . Belmont, CA: Wadsworth.

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CHILLING THE PACIFIC: ICE IN THE COMMONWEALTH OF THE NORTHERN MARIANAS

Michael Mason

Ice–the great stimulant

Crystal methamphetamine is what I refer to. Although it is not a new drug, it is relatively new out here.⁽¹⁵⁾ Put rather simply, it is a very powerful stimulant, activating a number of systems within the body so that users become highly energized.⁽¹⁶⁾ Compared to cocaine, ice is a much more powerful stimulant. It can be injected or smoked; most users on Saipan smoke ice. Users describe it not as a high but a pleasant feeling. Ice produces an enormously pleasurable state of hyper alertness that can last for eight hours from a single hit.⁽¹⁷⁾

Three Stages in use

We find that users can move through three different stages. The first stage is recreational and occasional use at parties or gatherings. This stage introduces the user to the euphoria and feelings of well-being. Ice causes chemicals of the central nervous system to be released in great quantity, and this produces the euphoria. With this mood alteration also comes increased alertness and renewed energy, quite an attractive package for tired or bored workers. Here is a description of the euphoria that fits our CMNI users at this first stage:

Ice is not a drug that makes you high. It doesn't make you drunk like alcohol or stoned like pot. It doesn't give you a rush, take you on a trip or even bend reality. In the beginning, before the toxic effects build, the thing that ice does is make you feel bright, awake, happy. You feel good about yourself, no matter how bad things may be. You can work and produce on ice, be rewarded for your efforts. You don't mind getting up in the morning. You don't care anymore that your job is boring or that your boss is a schmuck. You see the goodness in others. You see your place in the universe and the golden possibilities of things to come. Just a few hits of ice and all is well; you can get on with the life you already own. (Sager 1990: 57)

At the second stage, what I call aggressive use, the feelings of euphoria continue but usage shifts from occasional to being a part of the user's lifestyle. At the first stage, ice is helpful in mood elevation; at the second stage, it is needed to keep that mood elevated to the euphoric state. Obviously we are here moving into dependence and addiction. Family members tell me that the users now spend much time away from their families–something quite foreign to Chamorro culture–and associate only with other drug users. Users tend to go on binges to maintain the state of euphoria.

At the third stage, users become violent. Their behavior would be classified by a psychologist as paranoid schizophrenic, delusional and psychotic. The paranoia is particularly noticeable. The simplest events and occurrences are interpreted as a threat, as someone spying on them. An ordinary parked car becomes the police watching, etc. A user from Hawaii described the paranoia this way: "It's like whatever I'd be doing, the voices would tell me what I was doing. . . It would be your thoughts but in somebody else's voice. Or I'd think something, and then they'd say, 'Oh, I heard what you just thought.' They were playing with you. They were always teasing you. Sometimes you think it's your friends. Sometimes you think it's undercover" (Sager 1990:56).⁽¹⁸⁾

Ice became popular in Saipan around 1990. The behavior patterns which fall into the three stages have been very difficult for us to deal with at the clinic. For example, when users move into the binge use of Stage Two, they typically go on two to four day bouts, then go of the stuff and sometimes experience very serious depression.⁽¹⁹⁾ Another pattern which we are just starting to encounter is the use of other drugs to get the user through the depression of the down cycle. If a user has been alert for two or three days, the body sometimes revolts and demands to rest and eat. Users will then develop a secondary addiction to a drug which will calm them down enough to get some sleep. We are now seeing this pattern more and more. Valium is commonly that second drug.

What concerns me most as a clinician are users in the Third Stage of use, that is, the twilight zone, the schizophrenic-like state. It is not clear what will terminate that state, if anything can. Some literature suggests that some organic processes may change permanently, although it is not clear what areas of the brain are affected. The long-term effects are a real unknown to us. One of the most alarming aspects of ice is that users can progress through the three stages very quickly. Recreational use to paranoid psychotic state can occur within a year.

The high price of pleasure

Associated with the increase in ice usage is a rise in violent crime in Saipan — murder, crimes against property.⁽²⁰⁾ The reason is clear: ice is very expensive.

One gram goes for approximately $1,000 on the street. A gram is a very minuscule amount but it is enough to give six or seven users a high for eight hours or so. On the other hand, ice is very cheap to make. That same gram can be manufactured, and manufactured very easily for only $3 to $4 per gram.⁽²¹⁾

The price in 1994 came down to about $400 a gram, perhaps because there is so much of it on the street.⁽²²⁾ The demand is great but the supply is even greater, so the price came down. My educated guess is that with the recession in Japan, not as much cash is flowing into the CMNI; so the dealers can lower the price and still make a tremendous profit.

The Yakuza are involved.⁽²³⁾ They are very visible in Saipan and there are many indications that they are directly tied up with the ice traffic. As such they are a conduit for Hawaii and the West Coast. Saipan, however, is only on the edge of a big market and big flow of drugs; some of the flow trickles down into the CMNI.

How much comes into Saipan is a real question. One estimate is about $20 million a year is consumed at street prices on Saipan. That is probably as accurate a figure as possible. Customs officers would like to interdict 10 percent of any drug coming into a given jurisdiction. In 1993 they interdicted $3 million. If in fact they seized 10 percent, then about $30 million at street price came into the CMNI in 1993.

Profile of users in the CMNI – societal repercussions

Who uses what comes in? Saipan has a population of about 45,000. The predominant indigenous ethnic groups are Chamorros and Carolinians, with Chamorros constituting about 10,000. Carolinians are not yet heavily involved in ice, so clinically we deal primarily with the Chamorro population. Within that population, the users are mostly males between 25 and 45, that is, about 2,000 Chamorro males.⁽²⁴⁾ My estimate — and this is a very rough estimate — is that 800 of that age cohort have used ice. I estimate that 300 are at Stage Two: the Aggressive Use. Now that might first appear as a rather small number, but on closer examination the societal repercussions are great. Those 300 males in the ages of 25 to 45 are typically heads of households, possibly the primary breadwinners of an extended family with 6 to 20 members. Thus, if an average of 10 family members are affected by each of the 300 males at Stage Two, then ice immediately impacts on 3,000 — almost a third of the Chamorro population. That is an awesome number. The impact figure is even greater because ice usage reverberates through the entire society. Many of the users are influential, powerful, rich, visible, leaders of the community, directors and teachers.⁽²⁵⁾

I would also estimate that there are about 20 in Stage Three: paranoid psychotic.⁽²⁶⁾ Some were still walking the streets in 1994. But these are not the people who come in for treatment.

Treatment and prevention

Users seek help only if driven, and that frequently means a judge. Most are not busted for possession. A highly placed user from one of the prominent families will be arrested for other offenses.

At the Commonwealth Health Center on Saipan, we are a very small complement of three staff clinicians. Very often I encourage abusers to seek treatment off-island. I do not believe that serious ice usage can be treated here on an out-patient basis. We do have an in-patient psychiatry ward, but it cannot be used for ice patients. In 1994, 90 percent of the mental health budget went to maintain this ward of six chronic schizophrenics who have been in the ward for 20 to 25 years. Ice patients cannot be put with the schizophrenics. The attending physician might typically give the ice patient Haldol and put them back on the street. If they cause trouble, they are jailed.

Ice usage has begun to filter down below the 25 to 45 age group. In addition to the core group that have used ice for years, we now see cases from the high school and some students from as low as the sixth grade.⁽²⁷⁾ As mentioned before, we really do not know the long term effects of ice on an adult brain, much less on an adolescent brain.

The public school system on Saipan has initiated a recertification program so that all school counselors have to be certified and be trained for group therapy, peer counselor training, and just getting people to talk about their problems and express their feelings. We are using public media presentations to get information out to the population; we are developing programs of prevention, early detection, and primary prevention in dealing with high-risk students.

Bibliography

For a general introduction to amphetamines, Winger et al. (1992) is concise and readable, as is Cho (1990). Two articles from Rolling Stone (Lovett 1994 and Sager 1993) offer valuable descriptions by users of the motives and attraction of ice. Ramon (1994) tells the ice story in Saipan with attention to arrest records.

Anonymous 1993-1994. CMNI teen behavioral risk survey. Saipan, CNMI: CMNI Public School System and Dept. of Health Services.

Brooks, A. M. (1992, December). Danger on 'ice'. Current Health, 19(4), 20-21.

Cho, A. K. (1990, August 10). Ice: A new dosage form of an old drug. Science, 249(4967), 631-634.

Gillman, T. J. (1995, January 6). Seizures of ephedrine on the rise: Drug is key ingredient in methamphetamine. The Dallas Morning News, p. 1A.

Hart, B. (1995, July 29). Meth epidemic is no surprise in hard-wired U.S. The Phoenix Gazette, p. B1.

Lovett, A. R. (1994, May 5). Wired in California. Rolling Stone, (681), 39-40.

Marshall, M. (1993a). Background Briefing Paper. A paper prepared for the FSM/WHO Joint Conference on Alcohol-related and Drug-related Problems in Micronesia, Pohnpei, August 9-12, 1993. Pohnpei, FSM, 1993, August 9 : Federated States of Micronesia and World Health Organization.

Marshall, M. (1993B). A Pacific haze. V. S. Lockwood, T. G. Harding, & B. J. Wallace (eds), Contemporary Pacific societies: studies in development and change, (pp. 260-272). Englewood Cliffs, NJ: Prentice Hall.

Ramon, B. S. (1994). Crystal methamphetamine use in the CMNI. Umanidat, 2, 75-83.

Sager, M. (1993, February 8). The ice age. Rolling Stone, (533), 53-57;110,114,116.

Walker, S. (1995, October 27). Drugs 'speed' west to east–law enforcement officials fight new wave of methamphetamines. Christian Science Monitor, p. 3.

Winger, G., Hofmann, F. G., & Woods, J. H. (1992). A handbook on drug and alcohol abuse. New York: Oxford University Press.

1. A direct-link, causal connection between crime rates and drug use is always difficult to establish. Evidence certainly does surface, however, in individual cases. The Pacific Daily News of Guam, for example, reported on an FBI affidavit which describes the case of a Saipan woman pocketing $130,000 in bank money to buy ice (Dumat-Ol 1996).

2. Strictly speaking, this is not a statistically random survey; it is a convenience sample based on the researcher's knowledge of the community and the willingness of the users to cooperate. Although less statistically predictable than a random survey, this sample should not be written off as merely anecdotal. It is a sample based on participant observation and interview data. Mac Marshall used this method in his 1976 study of substance abuse in the Chuuk village of Moen (1979). In 1985 he again made a substance abuse study of Moen but based it on a broader, general population survey of 1000 respondents, equivalent to 1/6 of the resident population of Moen. The sample was stratified according to age, gender and residence, based on the 1983 census. The findings of the Marshall studies largely complement each other and are not at variance with the Oneisom study; Marshall's 1985 survey (1990), however, does pinpoint more precisely why people drink and use drugs. A common theme linking all these studies, including Oneisom's, is the dimension of social exchange and camaraderie in Chuuk drinking and drug user; it is not for loners, the solitary users.

3. Persistent pleas have been entered to legalize pot in the US, at least since the hippies of the 1960s The most recent pleas can be classified as the medical, the cost-benefit, and the recreational arguments. The leading voices for marijuana as medicine are physicians Lester Grinspoon and James Balakar, who make their case in a journal of no less repute than the Journal of the American Medical Association (1995:273, 1875, 1876). The cost-benefit argument is now championed by conservative standard bearer, William F. Buckley, Jr. (1996:34-48). He focuses on the great cost of the war on drugs with its concomitant cost in human suffering: ". . . more people die every year as a result of the war against drugs than die from what we call, generically, overdosing "(1996:36). Writes Buckley, ". . . it is outrageous to live in a society whose laws tolerate sending young people to prison for life because they grew, or distributed a dozen ounces of marijuana. I would hope that the good offices of your vital profession [New York Bar Association] would mobilize at least to protest such excesses of wartime zeal, the legal equivalent of a My Lai massacre" (1996:38; see also Shenk 1995: 32-36). The third argument, that from recreational users, is rather pragmatic: pot is less dangerous than alcohol, is still widely used, despite the war on drugs, and is as impossible to control as was alcohol through prohibition (see Sullum 1993).

4. Although perceived as a problem, one wonders how seriously the problem is considered on Chuuk and elsewhere in Micronesia. Note that Evans (1987) raised similar questions about taking the problem seriously on Palau.

5. Mwich is the Chuuk word for an association; the religious Mwich have been particularly important in the countering drug and alcohol abuse.

6. Here again is a significant difference with the U.S. Pot growing and selling is big business in the US. A corollary of the big business status is the corruption of law enforcement agencies by bribes and payoffs from dealers and distributors. Cops shake down dealers, steal their cash, and sometimes deal themselves. Even retired Kansas City Police Chief Joseph D. McNamara laments that "police scandals are the untallied cost of the drug war in the U.S.: The FBI, the Drug Enforcement Administration, and even the Coast Guard have had to admit to corruption. The gravity of the police crimes is as disturbing as the volume. In New Orleans, a uniformed cop in league with a drug dealer has been convicted of murdering her partner and shop owners during a robbery committed while she was on patrol. In Washington, D.C., and in Atlanta, cops in drug strings were arrested for stealing and taking bribes. New York State troopers falsified drug evidence that sent people to prison" (Buckley 1996: 43). Thus Chuuk appears as a remote paradise where the worst scenario is only widespread pot smoking. But the scene as described by McNamara is emerging elsewhere in Micronesia — in Guam and the CMNI, with recent arrests of cops using and dealing in drugs.

7. If the incidence of pot smoking on Chuuk has remained much the same since the 1985 Oneisom survey, as he observes a decade later, the same cannot be said of the U.S. Marijuana use among American high school seniors, for example, peaked in 1978 or 1979 and steadily declined since 1980 (Winger et al 1992: 122), with a slight increase since 1991 (Winckelgren 1994).

8. "Craziness," in Chuukese (umwes) carries a wide range of possible meanings that do not always coincide with the English word, as Larson noted in his study of marijuana use (1987).

9. These descriptions by Chuuk islanders correspond well to the known effects of marijuana. In particular, an "acute brain syndrome" can occur in which the user is disoriented and troubled by visual and auditory hallucinations. Users can also experience panicky and depressed reactions or-"feeling abnormal about themselves," as Oneisom says, or feelings of transient paranoia, "Being afraid-of people" (Winger et al 1992: 127).

10. In the academic literature, this laziness is described as the "a motivational syndrome" widely observed in pot smokers though not considered an inevitable consequence of marijuana smoking (Winger et al 1992: 128).

11. The relationship between drugs is problematic in at least two ways. First, many users use several different drugs together or within the same day. The short-time and long-term adverse effects of multidrug use is not well known. (Winger et al. 1992: 12). Second, tobacco, alcohol and marijuana are claimed to be "gateways" leading to other drugs. The 1994 report from Columbia University's Center on Addiction and Substance Abuse cites the statistic relationship: 89% of cocaine-users first used all three gateway drugs; 99.9% of the cocaine users first used a gateway drug. 60% of children who smoke pot before age 15 move on to cocain but only 20% of those who smoke pot after age 17 use cocaine. The report carefully states that this strong correlation does not establish causality but does offer a clear statistical message: "The younger an individual uses any gageway drug (cigarettes, alcohol or marijuana), the more often an individual uses any gateway drugs, the more gateway drugs an individual uses, the likelier that individual is to experiment with cocaine, heroin and other illicit drugs and the likelier that individual is to become a regular adult drug user and addict" (Morgan & Zimmer 1995: 673).

John Morgan and Lynn Zimmer, on the other hand, challenge the statistical relationship claimed by the Columbia University report. "The high risk factor obtained is a product not of the fact that so many marijuana users use cocaine but that so many cocaine users used marijuana previously . . . . The obvious statistic not publicized by CASA is that most marijuana users – 83 percent – never use cocaine" (Ibid). The debate thus continues on the "gateway" drugs. For Chuuk the problem of gateway drugs is not pot to cocaine or heroin, because very little of these more potent drugs trickle into the islands, perhaps because of their high cost. But the problem of gateway drugs does apply to Guam, CMNI, and perhaps Palau. The problem on Chuuk, if indeed a relationship could be established, would be between gas-sniffing and marijuana. In fact, this may also be the growing pattern in the United States, that is, inhalants joining pot, alcohol and tobacco as a gateway drug for young users. "Almost one-third of all Michigan eighth-graders surveyed," for example, "say they have used an inhalant at least once" (Martindale and Miller 1995:A10).

12. When Oneisom conducted his field work, the long-term physiological damage from regular smoking of marijuana was either not widely known or accepted. It still may not be well-known in the Pacific. The awareness of the potential for physiological damage has come in those countries where tobacco smoking has first been viewed as a health hazard. A higher-percentage of Pacific Islanders smoke tobacco than in developed countries and many developing countries. Marshall's survey of Weno Chuuk found that 53% of the men and 11% of the females, age 15 or over, were smokers. Three-fourths of these smoke between 9 and 20 cigarettes per day (1993:7).

13. Most gasoline used for outboard motors in the Federated States of Micronesia is leaded rather than unleaded. Marshall was told in 1993 by reliable sources of a miniepidemic of gasoline sniffing on Pingelap Atoll, and of recent sniffing incidents on Romonom Island and Namoluk Atoll. This suggests that gasoline sniffing in the Federated States is more widespread than has been recognized and that it occurs in communities away from the urban areas as well as in the towns.

14. Amphetamines have been used as stimulants for thousands of years. During World War Two, synthetic amphetamines were widely distributed by the US, German, British and Japanese military. After the war they were medically prescribed as dieting pills and became popular in the US as pep pills (Benzedrine or "bennies"). A more recent version was called "speed." (See Cho 1990:631; Sager 1990:57).

15. The methamphetamines and their cousin, cocaine, are stimulants to the central nervous system, with caffeine as the least deleterious member of the group. Pot and inhalants, on the other hand, are depressants of the central nervous system, with alcohol as their legalized cousin (Winger et al 1992). In street language the stimulants are "uppers" and the depressants "downers."

16. A journalist described in this way the great potential and advantages of ice over other drugs: (1) Price. Ice is cheap, and in some places cheaper than pot (this is not true in Guam or Saipan!); (2) Packaging — no needles and threat of HIV; (3) Smart marketing: it can be snorted, smoked (the Saipan favorite) or taken in pill form; (4) Performance: "You can work like a dervish all day and then rush to take care of the kids and still have the juice to party"; (5) Long-term payoff: hyperactivity, aggression, paranoia, violence — the qualities necessary to get ahead in modern America, the qualities paraded in our sports and entertainment (Hart 1995:B1).

17. Pot smoking can also produce feelings of paranoia, but of a less serious nature. The National Commission on Marijuana and Drug Abuse found that "marihuana was usually found to inhibit expression of aggressive impulses by pacifying the user. . . and generally producing states of drowsiness, lethargy, timidity and passivity (National Commission On Marijuana and Drug Abuse 1972,: 72 as quoted in Winger et al. 1992: 129).

18. The severe depression accounts, in part, for the addiction. The depression associated with coming down (off) ice makes going back up with another hit all the more desirable. Tolerance to the drugs grows quickly, so users up the dosage to get the same high. (Lovett 1994)

19. In the United States, law enforcement agencies associate ice with rising violence. In Phoenix, Arizona police blame ice use for a 40 percent jump in 1994 homicides. In Contra Costa County, near San Francisco, police have found ice abuse a factor in 89% of domestic abuse cases (Walker 1995:3). Directors of child and spouse abuse centers on Guam have no hard and fast figures to offer but agree that ice is a factor in the cases they handle.

20. Federal and local law enforcement official have not found production labs in Saipan or Guam, despite the simplicity of production. "If you've got a kitchen and a bathtub and some simple glassware, you can do it relatively easily," according to Purdue professor of pharmacology, Dr. Roger Maickel. It doesn't take a million-dollar lab" (Gillman 1995). One wonders, then, why no production on Guam or Saipan, if production is simple and needs little more than a bathtub and sink. The problem is the residue which is relatively easily to trace in drain water, especially on small islands like Guam and Saipan.

21. According to Federal law enforcement officials, the high street price has made Guam and Saipan a point of destination from both the West (Hawaii and the West Coast) and the East (Japan, Korea, Philippines and Thailand). Ice fetches a higher price in the Marianas; in California in 1994, for example, a gram sold for $100 to $150. Guam and CMNI can no longer be considered a point of transshipment elsewhere, according to the same officials. But recent literature still talks about Micronesia as a transshipment point (Marshall 1993b:270;1993a:12).

22. Federal law enforcement officials also find "localized" organized crime in the ice traffic, that is, local networks of Chamorros or Filipinos importing ice.

23. In Hawaii, however, the loss of appetite and attendant weight loss has attracted female users (See Sager 1990).

24. This fits the profile of users elsewhere. In Hawaii, for example, users are described as mainstream, middle class Americans, not the marginalized criminal types associated with other drugs (Sager 1990:57).

25. Cho notes that the amphetamine psychosis is similar to the more familiar paranoid schizophrenia and that some do recover from the psychosis even after detoxification (1990:249).

26. A 1993 survey of three Saipan high schools, identified 9.6% as having used ice (Anonymous 1994:n.p.). In the same year, 12 teenagers were treated for problems with ice at the Commonwealth Health Center (Ibid.).