"Crystal methamphetamine" is a crystalline form of amphetamine, the abuse of which is growing rapidly in popularity in Japan, Hawaii and the West Coast. Drug experts and law enforcement officials say that the use of crystal meth is spreading east from California. It may produce permanent addiction and can produce violent schizophrenic behavior. Introduced along the Leeward Coast of Hawaii about 3 years ago, it is now being used throughout Oahu and is starting to rival cocaine as the illicit drug of choice in Hawaii. It is also the major drug problem in Japan, where the powder form is called "shabu." The smoking of crystal ("ice") in a glass pipe is more common in Hawaii, whereas other routes of administration, such as snorting or intravenous use, are more common on the West Coast. We present the case of a young woman who was admitted to Kaiser Moanalua Medical Center with near fatal acute pulmonary edema consequent to the use of crystal meth.