The Devastating Effects of Meth on Health
Lori Verbrugge, Ph.D. Toxicologist Alaska State Public Health Laboratory
The views expressed in this presentation are my own, and do not necessarily represent those of the State of Alaska
Nine Years of Meth Use/Arrests
6 7 8 9
1
2
3
4
5
10
The chemistry of Meth
Forms of Meth
l-Meth Active ingredient in VICKS inhalers Used as directed, poses little health risk Not substantially addictive d-Meth Made from ephedrine Controlled substance and potent CNS stimulant Highly addictive; most potent, widely abused form of Methamphetamine
d-meth
Pharmacokinetics of Meth
Meth is smoked, snorted, injected, or orally ingested Rapidly crosses bloodbrain barrier Half-life is long – over 12 hours Concentrates in breast milk Quickly crosses placenta; half-life longer in fetus than mother
Mechanism of action of methamphetamine
Releases dopamine (& other catecholamines) into the synapse Stimulation of receptors
-adrenergic - vasoconstriction -adrenergic – cardiac excitability
Why is Meth so Addictive?
“High-intensity” drug
dopamine dumped into pleasure centers of brain
Neuroadaptation
Extraordinary rushes damage reward and pleasure centers
Meth Users: Progressive Mental Effects
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Euphoria, giddiness, increased sense of mental acuity Excited speech and incessant talking Agitation, irritability, anxiety, moodiness Increased physical or sexual activity
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False sense of confidence and power Visual or auditory hallucinations Compulsive behaviors Poor impulse control and judgment Aggression Tendency to violence Paranoia
Patterns of Meth Abuse
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Low Intensity Abuse: User’s swallow or snort meth to suppress appetite or to stay awake to work or play.
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Binge Abuse: Bingers smoke or inject meth
and experience intense rushes that are psychologically addictive.
High Intensity Abuse: Addicts use to prevent crashing but experience declining euphoria with each additional smoke or injection.
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Meth Binge Cycle - 1
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Rush: Intense pleasure, Euphoria
5-30 minutes … User’s heartbeat races; metabolism blood pressure and pulse soar.
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High: Unease
4-16 Hours … User often feels aggressively smarter and become argumentative.
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Binge: Out of Control
3-15 days … Repeated binge use brings hyperactivity and increased irritability. Stereotyped behavior - skin picking, pacing. No sleep, rarely eats, ignores body care.
Meth Binge Cycle - 2
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Tweaking: Danger, Isolation, Psychosis.
End of the binge: User adjusts and prolongs high by taking more drug or other drugs
1-3 days: User sleeps deeply; eats ravenously
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Crash: Lifeless. Non-threatening
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Normal: Depression.
2-14 days: As addiction increases, normal phase decreases
Some symptoms … 30-90 days after last use
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Withdrawal:
Withdrawal symptoms
Intense craving for drug Abdominal cramps Fatigue Headache Lethargy Excessively long sleep Mood disorders Profound depression Suicidal behavior
3 years, 5 months on meth
Why is Meth Addiction such a problem?
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High is stronger, faster, lasts longer than many other drugs Onset of dependence more intense and rapid
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Addiction common in days or weeks
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Relatively cheap and plentiful
Synthetic – can be made anywhere Cognitive impairment lasts longer and some cognitive impairment may be permanent
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Signs of Addiction
Behavior changes
Irritability Nervousness Wide mood swings Depression Unreasonable fear Paranoia Withdrawal from family Change in friends
Physical changes
Social changes
Unkempt appearance Significant weight loss Irregular sleep pattern Clogged, runny nose
Economic problems
Job loss Bankruptcy
Effects on the brain
Irreversible destruction of neuron cell endings Irreversible, strokeproducing damage to blood vessels in the brain Agitation Seizures Paranoid psychosis Compulsive repetitive behavior patterns
Some damage to brain tissue and systems may be permanent. MRIs and PET scans of some chronic users look like those of people with stroke, Parkinsons, Alzheimers, epilepsy.
Effects on the cardiovascular system
Constriction of blood vessels High blood pressure Rapid heartbeat Increased force of contraction Irregular heartbeat Insufficient blood supply to heart muscle Irreversible heart disease
Wasting
Potent appetite suppressant weight loss Anorexia
Psychological impacts
Anxiety Psychosis Violent or bizarre behavior Exhaustion Prolonged depression Suicide common
Loss of impulse control Severe depression
Meth Mouth
Corrosives used during manufacturing
Heated, vaporized, and swirl throughout the mouth when meth is smoked Teeth rotted due to effect of vapors on tooth enamel Irritate and burn skin inside the mouth sores and infections
Meth Mouth Symptoms
Dry mouth
Lack of saliva means lost protection of tooth enamel
Tooth decay Cracked teeth
Clenching, grinding of teeth
Blood vessels shrink
Gum disease
Causes of Sudden Death
Heart arrhythmia Intra-cerebral hemorrhage (stroke) Psychosis
Suicide & homicide
Convulsions and hyperthermia rhabdomyolysis (liquefaction of muscles)
Textbook Interpretation of blood meth values (mg/L)
Therapeutic 0.01 – 0.05 Toxic 0.20 – 3.0 Fatal 0.6 - 10
Actual blood levels found in meth-related Drug-Caused Deaths (Logan et al – WA)
Classification Meth-only
Meth & other drugs Meth and disease
# cases Meth range 13
25 14
0.09 – 18.0
0.05 – 68.9 0.09 – 0.47
Top 10 Abnormalities in Meth Abusers at Autopsy
Abnormality 1. Fatty Liver 2. Moderate Coronary Artery Disease 3. Cirrhosis (liver) 4. Pneumonia (lung) 5. Myocardial fibrosis (heart) 6. Triaditis (liver) 7. Severe Coronary Artery Disease 8. AIDS 9. Emphysema (lung) 10. Hepatitis (liver) Percent (%) 16 10 9 8 7 6 6 5½ 5 4
Common Endpoints for Meth Use
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Suicide Long jail terms Physical disability Persistent psychiatric problems Death from violence, accident,
overdose
Children: Meth’s Youngest Victims
13-year old runaway found after a few months of using meth
Teens have heard....
Meth can help control weight Meth can increase endurance, enhancing performance in sports Meth can heighten sexual desire and/or activity
Risks to children in homes where meth is made
Fire, explosion, weapons and accidents Poisoning and toxic exposures:
Respiratory effects, skin & eye irritation, burns Kidney, liver, neurological damage
Poor nutrition, health care and parenting
Hazardous and toxic precursors
Acetone Lantern fuel Paint thinner Drain cleaner Battery acid Other acids & bases Other solvents Toxic/hazardous gases
Chemicals of Concern
Metals/Salts:
explosives, developmental toxicants …. irritation to
eyes, skin, resp. system; damage to liver and kidneys; headache; chest tightness; jaundice
Iodine, Lithium, Phosphorus, Sodium
cause GI, skin, respiratory, eye inflammation, burns, irritation; dizziness, convulsions
Acids / Bases / Corrosives:
Hydrochloric, Sulfuric Acid (Drano), Sodium hydroxide (lye), Anhydrous
Chemicals of Concern
Solvents:
carcinogens; CNS toxicants/depressants …. nausea
and vomiting; skin eyes, nose irritation; damage to liver/kidneys; visual disturbances
Acetone,
Benzene, Ether, Freon, Hexane, Isopropanol, Methanol, Toluene, Xylene
Intermediate / Accidental Products:
explosives, irritants, toxic gases Hydrogen gas, Hydrogen chloride gas, Napthalene, Phosphine
Neglect and endangerment of children living with users
“Meth orphans” – 3000 in U.S. in 2003 alone One study of children in methoriented dwellings observed: 30% sexually abused 28% physically abused 35% positive for heavy metals 30% positive for meth 90% already in the system for drugs, truancy or abuse
Social Risks to Drug-Endangered Children
Cal-DEC, Colo-DEC, Ferguson, Hugart, Miller, Rosas, others
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abuse and neglect (inc., increased risk for accident, drowning, positional suffocation) poor nutrition, healthcare, hygiene chaotic sleep, eat, life patterns exposure to violent events and acts exposure to poly-substance use exposure to pornography, inappropriate sexuality shame, isolation, poor socialization caregivers unable to comply with interventions repeat recidivism leading to repeated trauma
Observed Social Effects in Children from Meth-Making and -Using Environments
Washington Department of Health
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Toddler: violent play
2nd Grade: “talk the talk” 4th Grade: protective & isolated
6th Grade: using
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10th Grade: cooking
Risks to Drug Endangered Children
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Cal-DEC, Colo-DEC, Ferguson, Hugart, Miller, Rosas, Others
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Chemical hazards • second-hand meth smoke • injury from exposure to metals, solvents, corrosives • risk of fire and explosion from mishandled volatiles, toxics; lack of safety equipment Physical and biological hazards • weapons, explosives and booby traps • filth, feces, rodents, pests, contaminated needles • exposure to sexually transmitted and blood borne diseases (HIV/AIDS, E Coli, hepatitis) • inadequate heating, electrical, plumbing • vicious animals
Ten-month-old baby rescued from a house fire in a trailer, where drugs and paraphernalia were found in easy access. This infant and 5 year old sibling positive for Meth.
Meth and Pregnancy
Dr. Angela Rosas, University California, Davis 2004.
Mother Poor prenatal care, nutrition Ruptured placenta Preterm labor Breech delivery STDs (HIV, Hepatitis) Baby Low birthweight Birth defects Drug withdrawal Developmental disabilities
Bottom Line: Meth is a Menace to our Children and our Communities
Children in Meth environments are highly endangered Drug is attractive, accessible, inexpensive, and quickly addictive Community is at risk!
Hazards of clandestine labs Increased crime (larceny and psychotic behavior)