To the Editor: In the past decade, methamphetamine abuse has been on the rise throughout the United States (1, 2). Although methamphetamine is generally taken orally or intravenously, crystal methamphetamine or "ice" is smoked. This manner of admission is highly addictive. It is odorless, difficult to detect, and less expensive and longer lasting than crack. Vaporized crystal methamphetamine, when inhaled, is rapidly absorbed through lung capillaries and has pharmacokinetics similar to intravenous amphetamines. With continued abuse, crystal methamphetamine usually leads to paranoid, often violent, psychotic states accompanied by auditory and tactile hallucinations. Many, but not all, patients improve with abstinence and symptomatic treatment with low-dose neuroleptics. Brain damage to dopamine and 5-hydroxytryptamine receptors from the vasoconstriction and neurotoxicity of methamphetamine has been documented in animals (3). Our experience in Hawaii has provided some clinical evidence to support this.