METHAMPHETAMINE The abuse of methamphet- amine–a potent psychostimulant– is an extremely serious and grow - ing problem. Although use of Abuse and Addiction methamphetamine initially was limited to a few urban areas in the Southwest, several major Western cities and Hawaii have seen dramatic increases in its What is system. The drug is made easily use, and rural areas throughout the country are becoming more methamphetamine? in clandestine laboratories with affected by the drug. In addition, relatively inexpensive over-the- M methamphetamine use among ethamphetamine is a counter ingredients. These significantly diverse populations powerfully addictive factors combine to make meth- has been documented. stimulant that dramati- amphetamine a drug with high As part of our Methamphet- amine Research Initiative, the cally affects the central nervous potential for widespread abuse. National Institute on Drug Abuse (NIDA) has developed this publi- cation to provide an overview of Trends in number of emergency department the latest scientific findings on mentions of methamphetamine, 1997-2001 this drug. Methamphetamine is a powerfully addictive stimulant associated with serious health Methamphetamine 18 conditions, including memory loss, aggression, psychotic Amphetamine behavior, and potential heart and 15 brain damage; it also contributes to increased transmission of hepatitis and HIV/AIDS. 12 One of NIDA’s most impor- tant goals is to translate what scientists learn from research to 9 help the public better understand drug abuse and addiction and 6 to develop more effective strategies for their prevention and treat- ment. We hope this compilation 3 of scientific information about methamphetamine will help inform readers about the harmful 0 1997 1998 1999 2000 effects of methamphetamine abuse and will assist in prevention and Source: Drug Abuse Warning Network, SAMHSA, 2000. treatment efforts. Glen R.Hanson, Ph.D., D.D.S. The Drug Abuse W arning N etwork tra cks the number of times a Acting Director drug is mentioned in connection with emergency room visits in National Institute on Drug Abuse 2 1 metropolitan are as. U . S . D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s ● N a t i o n a l I n s t i t u t es o f H e a l t h 2 NIDA R E S EAR CH R EP O RT S E RIE S Methamphetamine is com- Methamphetamine is a become a substantial drug prob- monly known as “speed,” “meth,” Schedule II stimulant, which lem in other sections of the West and “chalk.” In its smoked form, means it has a high potential and Southwest, as well. There are it is often referred to as “ice,” for abuse and is available only indications that it is spreading to “crystal,” “crank,” and “glass.” It through a prescription that can- other areas of the country, is a white, odorless, bitter-tasting not be refilled. There are a few including both rural and urban crystalline powder that easily accepted medical reasons for its sections of the South and dissolves in water or alcohol. use, such as the treatment of Midwest. Methamphetamine, The drug was developed early narcolepsy, attention deficit traditionally associated with in this century from its parent disorder, and––for short-term white, male, blue-collar workers, drug, amphetamine, and was used use––obesity; but these medical is being used by more diverse originally in nasal decongestants uses are limited. population groups that change and bronchial inhalers. over time and differ by geographic Methamphetamine’s chemical structure is similar to that of What is area. According to the 2000 amphetamine, but it has more the scope of National Household Survey pronounced effects on the central nervous system. Like amphet- methamphetamine on Drug Abuse, an estimated 8.8 million people (4.0 percent amine, it causes increased activity, decreased appetite, and a general abuse in the of the population) have tried methamphetamine at some time sense of well-being. The effects United States? in their lives. of methamphetamine can last 6 to M Data from the 2000 Drug 8 hours. After the initial “rush,” ethamphetamine abuse, Abuse Warning Network there is typically a state of high long reported as the (DAWN), which collects infor- agitation that in some individuals dominant drug problem mation on drug-related episodes can lead to violent behavior. in the San Diego, CA, area, has from hospital emergency depart- ments in 21 metropolitan areas, The preferred method of taking methamphetamine reported that methamphetamine- varies among geographical regions. related episodes increased from approximately 10,400 in 1999 60 Smoking Injecting to 13,500 in 2000, a 30 percent increase. However, there was a Sniffing Other 50 significant decrease in metham- phetamine-related episodes 40 reported between 1997 (17,200) and 1998 (11,500). 30 NIDA’s Community Epidemiology Work Group 20 (CEWG), an early warning net- work of researchers that provides 10 information about the nature and patterns of drug use in major 0 cities, reported in its June 2001 San Diego Minneapolis-St. Paul Texas publication that methamphetamine Area continues to be a problem in Note: C alendar year 2000 in Minneapolis/ St. Paul; July–December 2000 in San Diego, Hawaii and in major Western and January–June 2001 in Texas. Source: C ommunity Epidemiology Work G roup. cities, such as San Francisco, NIDA R E S EAR CH R EP O RT S E RIE S 3 Denver, and Los Angeles. most Eastern and Midwestern venously, the user experiences Methamphetamine availability metropolitan areas, such as an intense rush or “flash” that and production are being reported Minneapolis-St. Paul and St. lasts only a few minutes and is in more diverse areas of the Louis, where they accounted described as extremely pleasur- country, particularly rural areas, for approximately 3 percent of able. Snorting or oral ingestion prompting concern about more total admissions, or Baltimore, produces euphoria––a high but widespread use. where no stimulant-related not an intense rush. Snorting Drug abuse treatment admis- treatment admissions were produces effects within 3 to 5 sions reported by the CEWG in reported in the first half of 2000. minutes, and oral ingestion June 2001 showed that metham- produces effects within 15 to phetamine remained the leading drug of abuse among treatment How is 20 minutes. As with similar stimulants, clients in the San Diego area and Hawaii. Stimulants, including methamphetamine methamphetamine most often methamphetamine, accounted for used? is used in a “binge and crash” pattern. Because tolerance for M smaller percentages of treatment admissions in other states and ethamphetamine comes methamphetamine occurs within metropolitan areas of the West in many forms and can be minutes––meaning that the plea- (e.g., 9 percent in Los Angeles smoked, snorted, orally surable effects disappear even and Seattle and 8 percent in ingested, or injected. The drug before the drug concentration in Texas). By comparison, stimu- alters moods in different ways, the blood falls significantly–– lants were the primary drugs depending on how it is taken. users try to maintain the high by of abuse in a smaller percent Immediately after smoking binging on the drug. of treatment admissions in the drug or injecting it intra- In the brain, dopamine plays an important role in the regulation of pleasure. In addition to other regions, dopamine is manufactured in nerve cells within the ventral tegmental area and is released in the nucleus accumbens and the frontal cortex. Methamphetamine Dopamine Methamphetamine stimulates the rele ase of excess dopamine. 4 NIDA R E S EAR CH R EP O RT S E RIE S In the 1980’s, “ice,” a smok- on nerve terminals in the brain. paranoia, auditory hallucinations, able form of methamphetamine, High doses can elevate body mood disturbances, and delusions came into use. Ice is a large, temperature to dangerous, (for example, the sensation of usually clear crystal of high purity sometimes lethal, levels, as well insects creeping on the skin, that is smoked in a glass pipe as cause convulsions. which is called “formication”). like crack cocaine. The smoke The paranoia can result in homi- is odorless, leaves a residue that cidal as well as suicidal thoughts. can be resmoked, and produces Short - term effects With chronic use, tolerance effects that may continue for may include: for methamphetamine can devel- 12 hours or more. op. In an effort to intensify the Increased attention desired effects, users may take What are and decreased fatigue higher doses of the drug, take it more frequently, or change their the immediate Increased activity method of drug intake. In some (short-term) Decreased appetite effects of Euphoria and rush Long- term effects methamphetamine Increased respiration may include: abuse? Hyperthermia Dependence and A s a powerful stimulant, addiction psychosis methamphetamine, even in – paranoia small doses, can increase – hallucinations wakefulness and physical activity What are – mood disturbances and decrease appetite. A brief, intense sensation, or rush, is the long-term – repetitive motor reported by those who smoke or effects of activity inject methamphetamine. Oral ingestion or snorting produces methamphetamine Stroke a long-lasting high instead of a abuse? Weight loss rush, which reportedly can con- L tinue for as long as half a day. ong-term methamphetamine Both the rush and the high are abuse results in many damag- cases, abusers forego food and believed to result from the release ing effects, including addic- sleep while indulging in a form of of very high levels of the neuro- tion. Addiction is a chronic, binging known as a “run,” inject- transmitter dopamine into areas relapsing disease, characterized by ing as much as a gram of the drug of the brain that regulate feelings compulsive drug-seeking and drug every 2 to 3 hours over several of pleasure. use which is accompanied by Methamphetamine has toxic functional and molecular changes days until the user runs out of effects. In animals, a single high in the brain. In addition to being the drug or is too disorganized to dose of the drug has been shown addicted to methamphetamine, continue. Chronic abuse can lead to damage nerve terminals in the chronic methamphetamine to psychotic behavior, character- dopamine-containing regions of abusers exhibit symptoms that ized by intense paranoia, visual the brain. The large release of can include violent behavior, and auditory hallucinations, and dopamine produced by metham- anxiety, confusion, and insomnia. out-of-control rages that can be phetamine is thought to con- They also can display a number coupled with extremely violent tribute to the drug’s toxic effects of psychotic features, including behavior. NIDA R E S EAR CH R EP O RT S E RIE S 5 Although there are no physical manifestations of a withdrawal How is tion and feelings of euphoria experienced by the user. In con- syndrome when methamphet- methamphetamine trast to cocaine, which is quickly amine use is stopped, there are several symptoms that occur different from removed and almost completely metabolized in the body, when a chronic user stops taking other stimulants, methamphetamine has a much the drug. These include depres- sion, anxiety, fatigue, paranoia, such as cocaine? longer duration of action and a larger percentage of the drug aggression, and an intense craving remains unchanged in the body. M for the drug. ethamphetamine is classi- This results in methamphetamine In scientific studies examining fied as a psychostimulant, being present in the brain longer, the consequences of long-term as are other drugs of which ultimately leads to pro- methamphetamine exposure in abuse such as amphetamine and longed stimulant effects. animals, concern has arisen over cocaine. We know that metham- its toxic effects on the brain. Researchers have reported that phetamine is structurally similar to amphetamine and the neuro- What are as much as 50 percent of the transmitter dopamine, but it is the medical dopamine-producing cells in the quite different from cocaine. brain can be damaged after pro- Although these stimulants have complications of longed exposure to relatively low levels of methamphetamine. similar behavioral and physiologi- cal effects, there are some major methamphetamine Researchers also have found that differences in the basic mecha- abuse? serotonin-containing nerve cells nisms of how they work at the M may be damaged even more level of the nerve cell. However, ethamphetamine can extensively. Whether this toxicity the bottom line is that metham- cause a variety of cardio- is related to the psychosis seen phetamine, like cocaine, results in vascular problems. in some long-term methamphet- an accumulation of the neuro- These include rapid heart rate, amine abusers is still an open transmitter dopamine, and this irregular heartbeat, increased question. excessive dopamine concentration blood pressure, and irreversible, appears to produce the stimula- stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body Although both methamphetamine and cocaine are temperature) and convulsions psychostimulants, there are differences between them. occur with methamphetamine overdoses, and if not treated Methamphetamine vs. Cocaine immediately, can result in death. Chronic methamphetamine Man-made Plant -derived abuse can result in inflammation of the heart lining, and among Smoking produces a high Smoking produces a high users who inject the drug, that lasts 8-24 hours that lasts 20-30 minutes damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes 50% of the drug is removed 50% of the drug is removed of violent behavior, paranoia, from the body in 12 hours from the body in 1 hour anxiety, confusion, and insomnia. Heavy users also show progres- Limited medical use Used as a local anesthetic in sive social and occupational some surgical procedures deterioration. Psychotic symptoms 6 NIDA R E S EAR CH R EP O RT S E RIE S can sometimes persist for months or years after use has ceased. among injection drug users primarily through the re-use of What treatments Acute lead poisoning is contaminated syringes, needles, are effective for another potential risk for methamphetamine abusers. A or other paraphernalia by more than one person. In nearly one- methamphetamine common method of illegal third of Americans infected with abusers? A methamphetamine production HIV, injection drug use is a risk uses lead acetate as a reagent. factor, making drug abuse the t this time the most Production errors therefore may fastest growing vector for the effective treatments for result in methamphetamine spread of HIV in the nation. methamphetamine addic- contaminated with lead. There Research also indicates that tion are cognitive behavioral have been documented cases of methamphetamine and related interventions. These approaches acute lead poisoning in intra- psychomotor stimulants can are designed to help modify the venous methamphetamine increase the libido in users, in patient’s thinking, expectancies, abusers. contrast to opiates which actually and behaviors and to increase Fetal exposure to metham- decrease the libido. However, skills in coping with various life phetamine also is a significant long-term methamphetamine use stressors. Methamphetamine problem in the United States. At may be associated with decreased recovery support groups also present, research indicates that sexual functioning, at least in appear to be effective adjuncts methamphetamine abuse during men. Additionally, methamphe- to behavioral interventions that pregnancy may result in prenatal tamine seems to be associated can lead to long-term drug-free complications, increased rates of with rougher sex, which may lead recovery. premature delivery, and altered to bleeding and abrasions. The There are currently no partic- neonatal behavioral patterns, such combination of injection and ular pharmacological treatments as abnormal reflexes and extreme sexual risks may result in HIV for dependence on amphetamine irritability. Methamphetamine becoming a greater problem or amphetamine-like drugs abuse during pregnancy may among methamphetamine abusers such as methamphetamine. The be linked also to congenital than among opiate and other current pharmacological approach deformities. drug abusers, something that is borrowed from experience with already seems to be occurring in treatment of cocaine dependence. Are methamphet- California. NIDA-funded research Unfortunately, this approach has not met with much success amine abusers at has found that, through drug since no single agent has proven abuse treatment, prevention, efficacious in controlled clinical risk for contracting and community-based outreach studies. Antidepressant medica- HIV/AIDS and programs, drug abusers can change their HIV risk behaviors. tions are helpful in combating the depressive symptoms fre- hepatitis B and C? Drug use can be eliminated and quently seen in methamphetamine drug-related risk behaviors, such users who recently have become I ncreased HIV and hepatitis B as needle-sharing and unsafe abstinent. and C transmission are likely sexual practices, can be reduced There are some established consequences of increased significantly thus decreasing the protocols that emergency room methamphetamine abuse, particu- risk of exposure. Therefore, physicians use to treat individuals larly in individuals who inject the drug abuse treatment is also who have had a methamphetamine drug and share injection equip- highly effective in preventing overdose. Because hyperthermia ment. Infection with HIV and the spread of HIV, hepatitis B, and convulsions are common and other infectious diseases is spread and hepatitis C. often fatal complications of such NIDA R E S EAR CH R EP O RT S E RIE S 7 overdoses, emergency room A list of fact sheet topics follows: treatment focuses on the immedi- ate physical symptoms. Overdose Health Effects of Specific Drugs Access information • Cigarettes and other patients are cooled off in ice tobacco products on the Internet baths, and anticonvulsant drugs • Crack and cocaine may be administered also. • What’s new on the • Ecstasy Acute methamphetamine NIDA Web site • Heroin intoxication can often be handled • Inhalants • Information on by observation in a safe, quiet • LSD drugs of abuse environment. In cases of extreme • Marijuana excitement or panic, treatment • Methamphetamine • Publications and with antianxiety agents such as • Pain medications communications benzodiazepines has been helpful, • PCP (including NIDA N O TE S ) and in cases of methamphetamine- • Ritalin induced psychoses, short-term • Calendar of events • Rohypnol and GHB use of neuroleptics has proven • Steroids (anabolic) • Links to NIDA successful. Drug Abuse and AIDS, Lessons organizational units Where can I get from Prevention Research, and Treatment Research • Funding information further scientific • Treatment methods (including program announcements and • Treatment medications information about • Treatment methods for d ea d l i nes ) methamphetamine women • Behavior change through • International activities abuse? treatment • Links to related T o learn more about metham- Trends and Surveys Web sites (access to phetamine and other drugs • Costs to society from Web sites of many of abuse, contact the drug abuse other organizations National Clearinghouse for • High school and youth in the field) Alcohol and Drug Information trends (NCADI) at 1-800-729-6686. • Hospital visits and deaths Information specialists are • Nationwide trends available to assist you in locating • Pregnancy and drug abuse NIDA Web Sites needed information and resources. trends www.drugabuse.gov Information can be accessed • Treatment trends www.steroidabuse.org through the NIDA Web • Workplace trends www.clubdrugs.org site (www.drugabuse.gov) or the NCADI Web site News Releases on Research (www.health.org). Findings and Information National Clearinghouse Fact sheets on health effects about NIDA for Alcohol and Drug of drug abuse and other topics • Web page Information (NCADI) can be ordered free of charge, in • Mission and structure Web Site: www.health.org English and Spanish, by calling • Opportunities for special Phone No.: 1-800-729-6686 NIDA INFOFAX at 1-800- populations NIH-NIDA (1-800-644-6432) • Funding opportunities or 1-888-TTY-NIDA (1-888-889- • Upcoming events and 6432)for the hearing impaired. conferences 8 NIDA R E S EAR CH R EP O RT S E RIE S Glossary Addiction: a chronic, rela psing D et o xi f i c at i o n : a process of Rush: a surge of euphoric ple a- dise ase, chara cterized by compul- a llowing the body to rid itself of a sure that ra pidly follows a dminis- sive drug-seeking and drug use drug while mana ging the symp- tration of a drug. and by neurochemic al and molec- toms of withdrawal; often the first ul ar changes in the brain. step in a drug tre atment program. Serotonin: a neurotransmitter that has been implic ated in states of Analog: a chemic al compound Dopamine: a neurotransmitter consciousness, mood, depression, that is simil ar to another drug in present in regions of the bra in and anxiety. its effects but differs slightly in its that regul ate movement, emotion, chemical structure. motivation, and feelings of ple a- Tolerance: a condition in which sur e . higher doses of a drug are B enz o di az epi nes : drugs that required to produce the same relieve anxiety or are prescribed Narcolepsy: a disorder chara cter- effect as experienced initially; as sed atives; among the most ized by uncontroll a ble atta cks of often le a ds to physic al depen- widely prescribed medic ations, deep sleep. dence . including valium and librium. Physical dependence: an a d a p- Toxic: temporary or permanent Central nervous system (CNS): tive physiologic al state that occurs drug effects that are detrimental the brain and spinal cord. with regul ar drug use and results to the functioning of an org an or in a withdrawal syndrome when group of organs. Craving: a powerful, often drug use stops. uncontroll a ble desire for drugs. Wi t hdrawal : a variety of symp- Psychosis: a mental disorder toms that occur after use of an Designer drug: an ana log of a chara cterized by symptoms such a ddictive drug is reduced or restricted drug that has psycho a c- as delusions or hallucinations that st o p p e d . tive properties. indic ate an imp aired conception of re ality. Resources “Blood Level of Intravenous Drug Users,” by R.L. Methamphetamine Abuse (NIDA Capsules). National Detailed Emergency Department Tables 2000, Drug Norton, B.T. Burton, and J. McGirr. Journal of Institute on Drug Abuse, September 1997. Abuse Warning Network. Substance Abuse and Clinical Toxicology 34(4):425-30, 1996. National Methamphetamine Strategy. U.S. Mental Health Services Administration, available Epidemiologic Trends in Drug Abuse: Vol. I. Department of Justice, 1996. online at www.samhsa.gov/oas/dawn.htm. Highlights and Executive Summary of the National Survey Results on Drug Use From the Community Epidemiology Work Group , June 2001. Monitoring the Future Study, 1975-1994, Vol. I: NIH Pub. No. 01-4916A. National Institute on Secondary School Students . NIH Pub. No. 93- Drug Abuse, 2001. 3498. National Institute on Drug Abuse, 1995. Epidemiologic Trends in Drug Abuse: Vol. II. National Survey Results on Drug Use From the Proceedings of the Community Epidemiology Work Monitoring the Future Study, 1975-1994, Vol. II: Group, June 2001. NIH Pub. No. 01-4917A. College Students and Young Adults . NIH Pub. No. National Institute on Drug Abuse, 2001. 96-4027. National Institute on Drug Abuse, 1995. “Integrating Treatments for Methamphetamine Abuse: “NIDA Survey Provides First National Data on Drug A Psychosocial Perspective,” by A. Huber, W. Ling, Abuse During Pregnancy,” by R. Mathias. NIDA S. Shoptaw, V. Gulati, P. Brethen, and R. Rawson. Notes 10:6-7, 1995. Journal of Addictive Diseases, 16(4):41-50, 1997. NIH Publication Number 02-4210. Summary of Findings from the 2000 National “Like Methamphetamine, Ecstacy May Cause Long- Printed April 1998, Reprinted Household Survey on Drug Abuse. Substance Term Brain Damage,” by R. Mathias. NIDA Notes January 2002. Abuse and Mental Health Services Administration, 11:7, 1996. Feel free to reprint this publication. 2000.
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