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Methamphetamine |
Methamphetamine Abuse and Addiction
Introduction
- What is methamphetamine? Methamphetamine is commonly known as "speed," "meth," and "chalk." In its smoked form it is often referred to as "ice," "crystal," "crank," and "glass." It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. The drug was developed early in this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine's chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent behavior. Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. There are a few accepted medical reasons for its use, such as the treatment of narcolepsy, attention deficit disorder, and -- for short-term use -- obesity; but these medical uses are limited. What is the scope
of methamphetamine use in the United States? According to the 1996 National Household Survey on Drug Abuse, an estimated 4.9 million people (2.3 percent of the population) have tried methamphetamine at some time in their lives. In 1994, the estimate was 3.8 million (1.8 percent), and in 1995 it was 4.7 million (2.2 percent). Data from the 1996 Drug Abuse Warning Network (DAWN), which collects information on drug-related episodes from hospital emergency departments in 21 metropolitan areas, reported that methamphetamine-related episodes decreased by 39 percent between 1994 and 1996, after a 237 percent increase between 1990 and 1994. There was a statistically significant decrease in methamphetamine-related episodes between 1995 (16,200) and 1996 (10,800). However, there was a significant increase of 71 percent between the first half of 1996 and the second half of 1996 (from 4,000 to 6,800). NIDA's Community Epidemiology Work Group (CEWG), an early warning network of researchers that provides information about the nature and patterns of drug use in major cities, reported in its June 1997 publication that methamphetamine continues to be a problem in Hawaii and in major Western cities, such as San Francisco, Denver, and Los Angeles. Increased methamphetamine availability and production are being reported in diverse areas of the country, particularly rural areas, prompting concern about more widespread use. Drug abuse treatment admissions reported by the CEWG in December 1996 showed that methamphetamine remained the leading drug of abuse among treatment clients in the San Diego area and was second only to marijuana in Hawaii. Stimulants, including methamphetamine, accounted for smaller percentages of treatment admissions in other states and metropolitan areas of the West (e.g., 5 percent in Los Angeles and Seattle and 4 percent in Texas and San Francisco). By comparison, stimulants were the primary drugs of abuse in less than 1 percent of treatment admissions in most Eastern and Midwestern metropolitan areas, except in Minneapolis-St. Paul and St. Louis, where they accounted for approximately 2 percent of total admissions. How is
methamphetamine used? Immediately after smoking the drug or injecting it intravenously, the user experiences an intense rush or "flash" that lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria -- a high but not an intense rush. Snorting produces effects within 3 to 5 minutes, and oral ingestion produces effects within 15 to 20 minutes. As with similar stimulants, methamphetamine most often is used in a "binge and crash" pattern. Because tolerance for methamphetamine occurs within minutes -- meaning that the pleasurable effects disappear even before the drug concentration in the blood falls significantly -- users try to maintain the high by binging on the drug. In the 1980's, "ice," a smokable form of methamphetamine, came into use. Ice is a large, usually clear crystal of high purity that is smoked in a glass pipe like crack cocaine. The smoke is odorless, leaves a residue that can be resmoked, and produces effects that may continue for 12 hours or more. What are the immediate (short-term) effects
of methamphetamine abuse? Methamphetamine has toxic effects. In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. The large release of dopamine produced by methamphetamine is thought to contribute to the drug's toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions. What are the long-term
effects of methamphetamine abuse? With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some cases, abusers forego food and sleep while indulging in a form of binging known as a "run," injecting as much as a gram of the drug every 2 to 3 hours over several days until the user runs out of the drug or is too disorganized to continue. Chronic abuse can lead to psychotic behavior, characterized by intense paranoia, visual and auditory hallucinations, and out-of-control rages that can be coupled with extremely violent behavior. Although there are no physical manifestations of a withdrawal syndrome when methamphetamine use is stopped, there are several symptoms that occur when a chronic user stops taking the drug. These include depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug. In scientific studies examining the consequences of long-term methamphetamine exposure in animals, concern has arisen over its toxic effects on the brain. Researchers have reported that as much as 50 percent of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. Researchers also have found that serotonin-containing nerve cells may be damaged even more extensively. Whether this toxicity is related to the psychosis seen in some long-term methamphetamine abusers is still an open question. Short-term effects can include:
Long-term effects can include:
How is methamphetamine different
from other stimulants, like cocaine? Although both methamphetamine and cocaine are psychostimulants, there are differences between them. Methamphetamine
Cocaine
What are the medical complications
of methamphetamine abuse? Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes of violent behavior, paranoia, anxiety, confusion, and insomnia. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased. Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent. Production errors may therefore result in methamphetamine contaminated with lead. There have been documented cases of acute lead poisoning in intravenous methamphetamine abusers. Fetal exposure to methamphetamine also is a significant problem in the United States. At present, research indicates that methamphetamine abuse during pregnancy may result in prenatal complications, increased rates of premature delivery, and altered neonatal behavioral patterns, such as abnormal reflexes and extreme irritability. Methamphetamine abuse during pregnancy may be linked also to congenital deformities. Are methamphetamine abusers at risk
for contracting HIV/AIDS and hepatitis B and C? Research also indicates that methamphetamine and related psychomotor stimulants can increase the libido in users, in contrast to opiates which actually decrease the libido. However, long-term methamphetamine use may be associated with decreased sexual functioning, at least in men. Additionally, methamphetamine seems to be associated with rougher sex which may lead to bleeding and abrasions. The combination of injection and sexual risks may result in HIV becoming a greater problem among methamphetamine abusers than among opiate and other drug abusers, something that already seems to be occurring in California. NIDA-funded research has found that, through drug abuse treatment, prevention, and community-based outreach programs, drug abusers can change their HIV risk behaviors. Drug use can be eliminated and drug-related risk behaviors, such as needle-sharing and unsafe sexual practices, can be reduced significantly thus decreasing the risk of exposure. Therefore, drug abuse treatment is also highly effective in preventing the spread of HIV, hepatitis B, and hepatitis C. What treatments
are effective for methamphetamine abusers? There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs such as methamphetamine. The current pharmacological approach is borrowed from experience with treatment of cocaine dependence. Unfortunately, this approach has not met with much success since no single agent has proven efficacious in controlled clinical studies. Antidepressant medications are helpful in combating the depressive symptoms frequently seen in methamphetamine users who recently have become abstinent. There are some established protocols that emergency room physicians use to treat individuals who have had a methamphetamine overdose. Because hyperthermia and convulsions are common and often fatal complications of such overdoses, emergency room treatment focuses on the immediate physical symptoms. Overdose patients are cooled off in ice baths, and anticonvulsant drugs may be administered also. Acute methamphetamine intoxication can often be handled by observation in a safe, quiet environment. In cases of extreme excitement or panic, treatment with antianxiety agents such as benzodiazepines has been helpful, and in cases of methamphetamine-induced psychoses, short-term use of neuroleptics has proven successful. Where can I get further scientific
information about methamphetamine abuse? Fact sheets on health effects of drug abuse and other topics can be ordered free of charge, in English and Spanish, by calling NIDA INFOFAX at 1-888-NIH-NIDA (1-888-644-6432) or 1-888-TTY-NIDA (1-888-889-6432)for the hearing impaired. Glossary Analog: a chemical compound that is similar to another drug in its effects but differs slightly in its chemical structure. Benzodiazepines: drugs that relieve anxiety or are prescribed as sedatives; among the most widely prescribed medications, including valium and librium. Central nervous system (CNS): the brain and spinal cord. Craving: a powerful, often uncontrollable desire for drugs. Designer drug: an analog of a restricted drug that has psychoactive properties. Detoxification: a process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal; often the first step in a drug treatment program. Dopamine: a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure. Narcolepsy: a disorder characterized by uncontrollable attacks of deep sleep. Physical dependence: an adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use stops. Psychosis: a mental disorder characterized by symptoms such as delusions or hallucinations that indicate an impaired conception of reality. Rush: a surge of euphoric pleasure that rapidly follows administration of a drug. Serotonin: a neurotransmitter that has been implicated in states of consciousness, mood, depression, and anxiety. Tolerance: a condition in which higher doses of a drug are required to produce the same effect as experienced initially; often leads to physical dependence. Toxic: temporary or permanent drug effects that are detrimental to the functioning of an organ or group of organs. Withdrawal: a variety of symptoms that occur after use of an addictive drug is reduced or stopped. References Epidemiologic Trends in Drug Abuse: Vol. 1. Highlights and Executive Summary of the Community Epidemiology Work Group, June 1997. NIH Pub. No. 98-4207. National Institute on Drug Abuse, 1997. Epidemiologic Trends in Drug Abuse: Vol. 1. Highlights and Executive Summary of the Community Epidemiology Work Group, December 1996. NIH Pub. No. 97-4204. National Institute on Drug Abuse, 1997. "Integrating Treatments for Methamphetamine Abuse: A Psychosocial Perspective," by A. Huber, W. Ling, S. Shoptaw, V. Gulati, P. Brethen, and R. Rawson. Journal of Addictive Diseases, 16(4):41-50, 1997. "Like Methamphetamine, Ecstacy May Cause Long-Term Brain Damage," by R. Mathias. NIDA Notes 11:7, 1996. Methamphetamine Abuse (NIDA Capsules). NationalInstitute on Drug Abuse, September 1997. National Methamphetamine Strategy. U.S. Department of Justice, 1996. National Survey Results on Drug Use From the Monitoring the Future Study, 1975-1994, Vol. I: Secondary School Students. NIH Pub. No. 93-3498. National Institute on Drug Abuse, 1995. National Survey Results on Drug Use From the Monitoring the Future Study, 1975-1994, Vol. II: College Students and Young Adults. NIH Pub. No. 96-4027. National Institute on Drug Abuse, 1995. "NIDA Survey Provides First National Data on Drug Abuse During Pregnancy," by R. Mathias. NIDA Notes 10:6-7, 1995. "Preliminary Results from the 1996 National Household Survey on Drug Abuse". Substance Abuse and Mental Health Services Administration, 1997. Year-End Preliminary Estimates from the 1996 Drug Abuse Warning Network. Substance Abuse and Mental Health Services Administration, November 1997. This information is available courtesy of the NIDA. It is in the public domain and can be downloaded, reproduced, or copied without permission. For more information go to http://www.nimh.nih.gov/practitioners/patinfo.cfm |