Deaths from crystal methamphetamine rose 27 percent last year in Honolulu, setting a record for fatalities for the second year in a row, the city's chief medical examiner said.

The drug was responsible for 85 deaths in 2005, much higher than the 67 lives it claimed in 2004. The previous benchmark was 62, reached in 2002.

Users of crystal methamphetamine, or ice, have failed to comprehend the deadly game of chance they play each time they smoke the highly addictive drug.

"Obviously, they are not getting the message," said Chief Medical Examiner Dr. Kanthi De Alwis. "For that instant satisfaction, they are not considering the damage that drug does to their bodies."

The record number of deaths reflects the widespread use of the drug, De Alwis said.

"It's frustrating to me," she said. "I didn't think it would go up this much. And I'm concerned. I'm concerned for the safety of the community. This is a direct reflection of what is out there in our community."

Alan Shinn, director of the Coalition for a Drug-Free Hawai'i, said the trend indicates that a lot of drug education still is needed. "We were getting alarmed when it was one a week, and that was two years ago," Shinn said. "We were saying: 'What are we going to do?' "

Shinn isn't sure anyone has a solution.

"I think we really need to look at what we are doing in terms of coordinating our prevention and law enforcement efforts," he said. "We want to see those statistics go in the other direction."

The medical examiner groups the deaths into four categories: toxic effects, homicides, suicides and accidents.

Toxic effects has led all categories for the past five years, growing from 22 deaths in 2001 to 48 deaths last year. Victims in this category die of heart attacks from coronary arteries narrowed by the drug, fatal irregular heart rhythms, ruptures of blood vessels in the brain from high blood pressure, and suffocating asthma attacks.

But what stood out last year for De Alwis were the four cases of "methamphetamine-induced excited delirium." These were cases in which agitated ice users displayed wildly irrational behavior, hallucinating and thrashing about as their body temperatures soared to 105 degrees or more before dropping dead, she said.

In that state, the oxygen demand to the brain is very high. They die absolutely exhausted.

BODY IN OVERDRIVE

The stress that crystal methamphetamine puts on a body is intense.

Use of the drug has been linked to enlargement of the heart, blocked blood vessels and high blood pressure, conditions that can lead to death from heart attack, stroke and bronchial asthma attack.

The more a person uses ice, the greater the chance that these deadly complications will surface.

But everyone reacts differently to a hit of ice, De Alwis said.

De Alwis has seen cases in which teenagers died after using it once and cases in which older addicts damaged their bodies for decades before they finally died.

And the trauma it can produce has nothing to do with the size of the dose, she said.

"When it comes to crystal methamphetamine, tolerance can develop very quickly, and death can result even with a very small amount that can be toxic to one person and not toxic to another," De Alwis said. "Although one thinks he's taking a very small amount, that person can die of a sudden heart attack and another person wouldn't be affected."

Dr. Paul C. Ho, chief of cardiology for Kaiser Permanente Moanalua Medical Center, said ice shocks a person's cardiovascular system. The drug puts a body into "overdrive," he said.

"It is like a surge of adrenaline," Ho said. "Your heartbeat goes up. Your blood pressure goes up. Your heart beats faster and harder, and it causes damage in several ways."

In many cases, a person's body might be able to cope with that stress once or twice, but not much longer, Ho said.

"If your heart is beating really fast against high blood pressure, it is doing a lot of work and will drive itself to death," he said.

IRREVERSIBLE DAMAGE

Chronic ice users are not an uncommon sight in the emergency room at The Queen's Medical Center, said Dr. Dan Smith, the hospital's chief of emergency medicine.

"Many of them may have stopped by the time we see them," Smith said. "They are often people in their 40s who have used crystal meth for a while and have a dim future."

Their hearts resemble those of 70-year-old people with heart disease, said Smith, who sees at least one ice user a day in the emergency room.

"There is no cure," he said. "There are medications we can give them to alleviate symptoms. But in the end, it tends to be gradually progressive and typically fatal."

Not included in the final tally for 2005 are a handful of deaths in which former ice users died when their damaged bodies succumbed to an ailment directly caused by the drug, the medical examiner said.

Most of them died of dilated cardiomyopathy — a condition in which the heart was enlarged and weakened — and their doctors made the connection to crystal methamphetamine, De Alwis said. But the victims had not used the drug in years.

"What it shows is that if one keeps on using the drug and stops using the drug, still the damage has been done," she said.

At least one family last year vehemently objected to the connection made by a family doctor and the medical examiner, because of the stigma: "Cause of death was due to heart disease related to prior history of drug use, although they have been off crystal meth for a number of years."

'THIS DESTROYS FAMILIES'

Meeting with a victim's family is the hardest part of every case.

De Alwis has sat with grieving families and explained how ice killed their loved ones. Her goal is to educate the community, one victim's family at a time. Her message: These deaths are preventable.

But many of them will struggle to openly discuss what happened, because of the stigma of drugs.

"This destroys families. It not only destroys the person, it destroys everyone around them," De Alwis said. "And I know the pain they go through."

De Alwis knows because of the bond between them, one forged by ice and unbreakable for all time. It's her signature on the bottom of the death certificate.

WHY CRYSTAL METH IS SO DANGEROUS

Most of the ice-related deaths in Hawai'i were caused by the drug's toxic effects. Here's a look at the drug's effect on the human body.

Source: Honolulu medical examiner

Reach Mike Gordon at mgordon@honoluluadvertiser.com.