The number of crystal methamphetamine-related fatalities on O'ahu plunged to a six-year low in 2006, ending a recent trend of record-high deaths, the city's chief medical examiner said yesterday.

The highly addictive drug claimed 52 lives last year — a 40 percent drop from the 87 deaths recorded in 2005, said Dr. Kanthi De Alwis.

The decline is probably related to law enforcement efforts, De Alwis said. "I must give them credit. People are getting the message," she said.

State and federal law enforcement authorities, prompted by a groundswell of community support four years ago, have aggressively fought the drug, breaking up drug rings and seizing shipments headed for Hawai'i.

Word also got out to the streets that possession of even 50 grams of methamphetamine, its salts or its isomers, will result in a mandatory 10 years in federal prison.

When arrests began to drop last year, police said it meant law enforcement efforts were helping reduce the spread of crystal meth, and that the end of the "ice" epidemic might be in sight.

But De Alwis, who has charted the rise and fall of the drug's fatal use since 1996, said she isn't ready to declare victory in the war on ice — the drug's street name.

In 1996 there were 23 fatalities attributed to ice. It rose steadily, dropping only twice before 2006. De Alwis said she wasn't sure what to expect last year, given how high the toll had become in 2005.

"I didn't know whether we would have a downward trend or see it keep going upward," she said. "We just hoped it would be under control."

TOXIC FACTOR

Studies show most crystal meth victims die from the toxic effects of the drug. De Alwis said she was especially pleased to see a decline in deaths from toxic effects last year.

Toxic effects include 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.

The number of deaths by toxic effect declined by 21 last year.

"That's what I was looking for," De Alwis said. "That's what I wanted to happen and it happened in a big way."

Crystal meth is an indiscriminate killer with no direct correlation to the amount being used or the number of times it's been used, De Alwis said.

It can kill a person after only a few uses, like it did two years ago when an 18-year-old man suffered a heart attack in the shower. Or it can kill an aging addict.

Already this year, the medical examiner has seen the oldest crystal methamphetamine fatality she's ever encountered — a 76-year-old Liliha man who died last month. The man suffered a stroke, one of several he had suffered while using the drug for many years, she said.

The man's age signals that no one is immune, De Alwis said.

"I was so surprised," she said. "When I was told he was 76, I told the investigator please make sure you have the right case."

HEART OF MATTER

Other than the sharp decline in total deaths, the only notable feature in the latest statistics on meth-related deaths last year was a higher number of victims with chronic heart damage, De Alwiss said.

"We were seeing more and more chronic damage to the heart because those were the people who were using over a longer period of time," she said. "Now I wonder if we are going to see a trend of an older age group."

The decline in deaths can't be attributed to addicts being careful about how much they use, De Alwis said.

"This is not a drug that one can be smart in taking just a little bit thinking it won't kill," she said. "The dose is not what determines the toxicity. It is how one's body responds."

Alan Shinn, director of the Coalition for a Drug-Free Hawai'i, said the medical examiner's data could be part of a national trend in declining use of crystal methamphetamine.

Still, he would not have expected the number of deaths to have dropped so much.

"That's incredible," he said. "We should talk this up and say everybody did a great job who was involved in this."

Shinn said he hopes that younger potential crystal methamphetamine users — 18 to 30 — are heeding the ice advice being spread by nonprofit organizations as well as federal, state and county authorities.

"Maybe we are seeing some of those residual effects from our efforts several years ago," he said. "More people are aware of the problem, all across the United States."

And while prevention, law enforcement and treatment programs likely helped in 2006, "a little luck" probably helped as well, Shinn said.

"The problem is obviously not solved, so we have to be cautiously optimistic and continue our efforts," he said.

CUMULATIVE EFFECT

Maj. Kevin Lima, who supervises the Honolulu Police Departments narcotics/vice division, said the decline in deaths likely could be attributed to a variety of efforts, not just law enforcement.

More addicts in treatment programs. More dealers in prison. More drug counselors educating youth.

But the department also busted five major drug rings in 2005, which reduced the supply and purity of ice on the street. Both are factors that could have contributed to the decline in deaths last year, Lima said.

The coming year, though, could be difficult and will require vigilance by law enforcement to stay even with any gains made in 2006, Lima said.

"So far this year we have already seen a slight increase in the supply," he said. "It appears that the purity is going back up and the supply is going back up. But we will plug on and continue to do the best with the resources we have."

Reach Mike Gordon at mgordon@honoluluadvertiser.com.