Six of the nine methamphetamine users interviewed reported instances of violence or a propensity toward violence. Among the common effects of methamphetamine are paranoia and the hallucinations that often accompany the paranoia. Among those interviewed for the study, there were several mentions of circumstances under which paranoia set the stage for what could have been deadly encounters. This study describes the epidemiology of methamphetamine use and of methamphetamine-related violence across counties of different sizes in Illinois, with an emphasis on use and violence in rural areas. Study findings have several implications for policy and practice. First, although violence resulting from the physiological effects of methamphetamine may not be common, the risk of violence exists and is probably greater than for other drugs. Second, violence associated with the drug business is probably less frequent for methamphetamine than for other drugs in the Midwest. Third, because methamphetamine users are often polydrug users, violence linked with involvement in a drug subculture may be comparable to that for other illicit drugs. Fourth, an understanding of the nature and extent of the methamphetamine problem requires accurate data on who uses, how the drug is acquired, and the consequences of its use. Fifth, it appears the association between methamphetamine and violence is similar in both the largest and the smallest Illinois counties. Sixth, most users avoided police detection by limiting their interactions with those outside of their drug-using social world. Nine probationers were interviewed for this study, and these interviews were supplemented with interviews of knowledgeable officials in each county. 113 references and appended interview questions for users and officials