zycnzj.com/ www.zycnzj.com N A T I O N A L I N S T I T U T E O N D R U G A B U S E Research Report S E R I E S The abuse of methamphetamine— a potent and highly addictive psycho- METHAMPHETAMINE stimulant—is a very serious problem in the United States. Initially limited to Hawaii and western parts of the country, methamphetamine abuse continues to spread eastward, with rural and urban areas everywhere increasingly affected. According to one national survey, approximately Abuse and Addiction 10 million people in the United States have tried methamphetamine at least once. What is Methamphetamine abuse leads to devastating medical, psychological, methamphetamine? M and social consequences. Adverse health effects include memory loss, ethamphetamine is a amphetamine a drug with high aggression, psychotic behavior, heart highly addictive stimu- potential for widespread abuse. damage, malnutrition, and severe lant that affects the Methamphetamine is commonly dental problems. Methamphetamine abuse also contributes to increased central nervous system. Although known as “speed,” “meth,” and transmission of infectious diseases, most of the methamphetamine “chalk.” In its smoked form, it from the director such as hepatitis and HIV/AIDS, and can infuse whole communities with used in this country comes from is often referred to as “ice,” new waves of crime, unemployment, foreign or domestic superlabs, “crystal,” “crank,” and “glass.” It child neglect or abuse, and other the drug is also easily made in is a white, odorless, bitter-tasting social ills. The good news is that metham- small clandestine laboratories, crystalline powder that easily phetamine abuse can be prevented with relatively inexpensive over- dissolves in water or alcohol. and methamphetamine addiction can be treated. People do recover, the-counter ingredients. These The drug was developed early but only when effective treatments factors combine to make meth- last century from its parent drug, that address the multitude of problems resulting from methamphetamine abuse are readily available. Primary goals of the National Institute on Methamphetamine Drug Abuse (NIDA) are to apply what our scientists learn from drug abuse research to develop new and enhance existing treatment approaches and to bring these effec- tive treatments to the communities that need them. In this report, we provide an over- view of the latest scientific findings zycnzj.com/http://www.zycnzj.com/ on methamphetamine. Our intent is to enlighten readers about the dam- aging effects of methamphetamine abuse and to inform prevention and treatment efforts. Nora D.Volkow, M.D. Director National Institute on Drug Abuse U.S. Department of Health and Human Services • National Institutes of Health zycnzj.com/ www.zycnzj.com 2 NIDA RESEARCH REPORT SERIES amphetamine, and was used originally in nasal decongestants Primary Methamphetamine/Amphetamine Admission and bronchial inhalers. Like Rates per 100,000 Population Aged 12 and Over amphetamine, methamphetamine causes increased activity and talkativeness, decreased appetite, and a general sense of well-being. However, methamphetamine 1992 1994 differs from amphetamine in that at comparable doses, much higher levels of methampheta- mine get into the brain, making it a more potent stimulant drug. It also has longer lasting and more harmful effects on the 1999 2002 central nervous system. Methamphetamine is a Schedule II stimulant, which Incomplete Data <3 10-23 KEY YEAR: 1992 3-9 24 or more means it has a high potential Source: Treatment Episode Data Set (TEDS), SAMHSA. for abuse and is available only through a prescription. It is indicated for the treatment of U.S., reported in January 2006 methamphetamine use, and narcolepsy (a sleep disorder) that methamphetamine continues 512,000 reported current (past- and attention deficit hyperactivity to be a problem in the West, month) use. Moreover, the 2005 disorder; but these medical uses with indicators persisting at high Monitoring the Future (MTF) are limited, and the doses are levels in Honolulu, San Diego, survey of student drug use and much lower than those typically Seattle, San Francisco, and Los attitudes reported 4.5 percent of abused. Angeles; and that it continues high school seniors had used to spread to other areas of the methamphetamine within their What is the country, including both rural and urban sections of the South lifetimes, while 8th-graders and 10th-graders reported lifetime scope of and Midwest. In fact, metham- use at 3.1 and 4.1 percent, methamphetamine phetamine was reported to be respectively. However, neither abuse in the the fastest growing problem in metropolitan Atlanta. of these surveys has documented an overall increase in the abuse United States? zycnzj.com/http://www.zycnzj.com/ According to the 2005 National of methamphetamine over the N IDA’s Community Survey on Drug Use and Health past few years. In fact, both Epidemiology Work (NSDUH), an estimated 10.4 mil- surveys showed recent declines Group (CEWG), an early lion people age 12 or older (4.3 in methamphetamine abuse warning network of researchers percent of the population) have among the Nation’s youth. that provides information about tried methamphetamine at some In contrast, evidence from the nature and patterns of drug time in their lives. Approximately emergency departments and abuse in 21 major areas of the 1.3 million reported past-year treatment programs attest to zycnzj.com/ www.zycnzj.com NIDA RESEARCH REPORT SERIES 3 the growing impact of metham- phetamine abuse in the country. How is intense rush. Snorting produces effects within 3 to 5 minutes, and The Drug Abuse Warning methamphetamine oral ingestion produces effects Network (DAWN), which collects abused? within 15 to 20 minutes. information on drug-related As with similar stimulants, M episodes from hospital emergency ethamphetamine comes methamphetamine most often departments (EDs) throughout in many forms and can is used in a “binge and crash” the Nation, has reported a be smoked, snorted, pattern. Because the pleasurable greater than 50 percent increase injected, or orally ingested. effects of methamphetamine in the number of ED visits related The preferred method of disappear even before the drug to methamphetamine abuse methamphetamine abuse varies concentration in the blood falls between 1995 and 2002, reaching by geographical region and has significantly—users try to main- approximately 73,000 ED visits, changed over time. Smoking tain the high by taking more of or 4 percent of all drug-related methamphetamine, which leads the drug. In some cases, abusers visits in 2004. to very fast uptake of the drug indulge in a form of binging Treatment admissions for in the brain, has become more known as a “run,” foregoing methamphetamine abuse have common in recent years, food and sleep while continuing amplifying methamphetamine’s abuse for up to several days. also increased substantially. In addiction potential and adverse 1992, there were approximately health consequences. 21,000 treatment admissions in The drug also alters mood in How is which methamphetamine/ amphetamine was identified different ways, depending on methamphetamine how it is taken. Immediately as the primary drug of abuse, after smoking the drug or inject- different from representing more than 1 percent ing it intravenously, the user other stimulants, of all treatment admissions during the year. By 2004, the number experiences an intense rush or “flash” that lasts only a few such as cocaine? M of methamphetamine treatment minutes and is described as ethamphetamine is admissions increased to greater extremely pleasurable. Snorting structurally similar to than 150,000, representing 8 or oral ingestion produces amphetamine and the percent of all admissions. euphoria—a high but not an neurotransmitter dopamine, but Moreover, this increased involvement of methamphetamine Methamphetamine vs. Cocaine in drug treatment admissions has Stimulant Stimulant and local anesthetic also been spreading across the Man-made zycnzj.com/http://www.zycnzj.com/ Plant-derived country. In 1992, only 5 states Smoking produces a long-lasting high Smoking produces a brief high reported high rates of treatment admissions (i.e., >24 per 100,000 50% of the drug is removed from 50% of the drug is removed from the body in 12 hours the body in 1 hour population) for primary meth- Increases dopamine release and blocks Blocks dopamine re-uptake amphetamine/amphetamine dopamine re-uptake problems; by 2002, this number Limited medical use Limited use as a local anesthetic in increased to 21, more than a some surgical procedures third of the states. zycnzj.com/ www.zycnzj.com 4 NIDA RESEARCH REPORT SERIES higher concentrations in the Dopamine Pathways synapse, which can be toxic to nerve terminals. What are the immediate (short-term) effects of methamphetamine abuse? A s a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. Methamphetamine can also cause a variety of cardiovas- In the brain, dopamine plays an important role in the regulation of reward and movement. As part cular problems, including rapid of the reward pathway, dopamine is manufactured in nerve cell bodies located within the ventral heart rate, irregular heartbeat, tegmental area (VTA) and is released in the nucleus accumbens and the prefrontal cortex. Its motor functions are linked to a separate pathway, with cell bodies in the substantia nigra that manufacture and increased blood pressure. and release dopamine into the striatum. Hyperthermia (elevated body temperature) and convulsions may occur with methampheta- it is quite different from cocaine. although both methamphetamine mine overdose, and if not treated Although these stimulants have and cocaine increase levels of immediately, can result in death. similar behavioral and physiolog- the brain chemical dopamine, Most of the pleasurable effects ical effects, there are some major animal studies reveal much of methamphetamine are believed differences in the basic mecha- higher levels of dopamine to result from the release of nisms of how they work. In con- following administration of very high levels of the neuro- trast to cocaine, which is quickly methamphetamine due to the transmitter dopamine. Dopamine removed and almost completely different mechanisms of action is involved in motivation, the metabolized in the body, within nerve cells in response to experience of pleasure, and methamphetamine has a much zycnzj.com/http://www.zycnzj.com/ these drugs. Cocaine prolongs motor function, and is a common longer duration of action and a dopamine actions in the brain mechanism of action for most larger percentage of the drug by blocking dopamine re-uptake. drugs of abuse. The elevated remains unchanged in the body. While at low doses, metham- release of dopamine produced This results in methamphetamine phetamine blocks dopamine by methamphetamine is also being present in the brain longer, re-uptake, methamphetamine thought to contribute to the which ultimately leads to pro- also increases the release of drug’s deleterious effects on longed stimulant effects. And dopamine, leading to much nerve terminals in the brain. zycnzj.com/ www.zycnzj.com NIDA RESEARCH REPORT SERIES 5 What are the insects creeping under the skin). Psychotic symptoms can some- imaging studies have demon- strated alterations in the activity long-term times last for months or years of the dopamine system that are effects of after methamphetamine abuse has ceased, and stress has been associated with reduced motor speed and impaired verbal methamphetamine shown to precipitate spontaneous learning. Recent studies in abuse? recurrence of methamphetamine chronic methamphetamine psychosis in formerly psychotic L ong-term methamphetamine methamphetamine abusers. abuse has many negative With chronic abuse, tolerance consequences, including Short-Term Effects to methamphetamine’s pleasura- May Include: addiction. Addiction is a chronic, ble effects can develop. In an relapsing disease, characterized effort to intensify the desired Increased attention and by compulsive drug seeking and effects, abusers may take higher decreased fatigue use, accompanied by functional Increased activity and doses of the drug, take it more and molecular changes in the wakefulness frequently, or change their brain. In addition to being Decreased appetite method of drug intake. With- addicted to methamphetamine, drawal from methamphetamine Euphoria and rush chronic abusers exhibit symptoms occurs when a chronic abuser Increased respiration that can include anxiety, con- fusion, insomnia, mood distur- stops taking the drug; symptoms Rapid/irregular of withdrawal include depres- heartbeat bances, and violent behavior. They also can display a number sion, anxiety, fatigue, and an Hyperthermia of psychotic features, including intense craving for the drug. paranoia, visual and auditory Chronic methamphetamine hallucinations, and delusions abuse also significantly changes Long-Term Effects (for example, the sensation of the brain. Specifically, brain May Include: Addiction Psychosis, including: Recovery of Brain Dopamine Transporters • paranoia in Chronic Methamphetamine (METH) Abusers • hallucinations • repetitive motor activity Changes in brain structure and function zycnzj.com/http://www.zycnzj.com/ Memory loss Aggressive or violent behavior Mood disturbances Normal Control METH Abuser METH Abuser Severe dental (1 month abstinence) (24 month abstinence) problems Source: Volkow ND et al., Journal of Neuroscience 21:9414–9418, 2001. Weight loss zycnzj.com/ www.zycnzj.com 6 NIDA RESEARCH REPORT SERIES abusers have also revealed to the NSDUH, less than 1 per- infection with HIV and other severe structural and functional cent of pregnant women aged infectious diseases is spread changes in areas of the brain 15–44 had used methampheta- primarily through the re-use of associated with emotion and mine in the past year, any use contaminated syringes, needles, memory, which may account among this population is of or other paraphernalia by more for many of the emotional and concern. Unfortunately, our than one person. However, cognitive problems observed in knowledge of the effects of regardless of how it is taken, the chronic methamphetamine methamphetamine during preg- intoxicating effects of metham- abusers. nancy is limited. The few human phetamine can alter judgment Fortunately, some of the studies that exist have shown and inhibition and lead people effects of chronic methamphet- increased rates of premature to engage in unsafe behaviors. delivery, placental abruption, amine abuse appear to be, at Methamphetamine has become fetal growth retardation, and least partially, reversible. A associated with a culture of risky heart and brain abnormalities. recent neuroimaging study sexual behavior, both among However, these studies are showed recovery in some brain men who have sex with men difficult to interpret due to regions following prolonged (MSM) and heterosexual popula- methodological issues, such as abstinence (2 years, but not 6 tions. This link may be due to small sample size and maternal months). This was associated the fact that methamphetamine use of other drugs. Ongoing with improved performance on and related psychomotor research is continuing to study motor and verbal memory tests. stimulants can increase libido. developmental outcomes such However, function in other Paradoxically, long-term as cognition, social relationships, brain regions did not display methamphetamine abuse may be motor skills, and medical recovery even after 2 years of status of children exposed to associated with decreased sexual abstinence, indicating that some methamphetamine before birth. functioning, at least in men. methamphetamine-induced The combination of injection and changes are very long-lasting. sexual risk-taking may result in Moreover, the increased risk of Are HIV becoming a greater problem stroke from the abuse of methamphetamine among methamphetamine methamphetamine can lead to irreversible damage to the brain. abusers at risk abusers than among opiate and other drug abusers, something for contracting that already seems to be occur- What are HIV/AIDS and ring, according to some epidemi- ologic reports. For example, the risks of hepatitis B and C? while the link between HIV methamphetamine zycnzj.com/http://www.zycnzj.com/ I ncreased HIV and hepatitis B infection and methamphetamine abuse during and C transmission are abuse has not yet been estab- consequences of increased lished for heterosexuals, data pregnancy? methamphetamine abuse, not show an association between P renatal exposure to only in individuals who inject the methamphetamine abuse and the methamphetamine may drug, but also in noninjecting spread of HIV among MSM. also be a problem in the methamphetamine abusers. Methamphetamine abuse may United States. Although according Among injection drug users, also worsen the progression of zycnzj.com/ www.zycnzj.com NIDA RESEARCH REPORT SERIES 7 HIV and its consequences. In for nondrug-related activities, house for Alcohol and Drug animal studies, methamphetamine has been shown to be effective Information (NCADI) at increased viral replication; in in reducing methamphetamine 800–729–6686. Information human methamphetamine abuse. Contingency management specialists are available to help abusers, HIV caused greater interventions, which provide you locate information and neuronal injury and cognitive tangible incentives in exchange resources. impairment compared with for engaging in treatment and Fact sheets, including maintaining abstinence, have InfoFacts, on the health effects of nondrug abusers. also been shown to be effective. methamphetamine, other drugs NIDA-funded research has There are currently no specific of abuse, and other drug abuse found that, through drug abuse medications that counteract the topics are available on the NIDA treatment, prevention, and effects of methamphetamine or Web site (www.drugabuse.gov), community-based outreach that prolong abstinence from and and can be ordered free of programs, drug abusers can charge in English and Spanish reduce the abuse of metham- change their HIV risk behaviors. from NCADI at www.health.org. phetamine by an individual Drug abuse can be eliminated addicted to the drug. However, and drug-related risk behaviors, there are a number of medica- such as needle-sharing and tions that are FDA-approved for Access information unsafe sexual practices, can other illnesses that might also be on the Internet be reduced significantly, thus useful in treating methampheta- • What’s new on the NIDA Web site decreasing the risk of exposure mine addiction. Recent study to HIV and other infectious • Information on drugs of abuse findings reveal that bupropion, diseases. Therefore, drug abuse the anti-depressant marketed • Publications and communications treatment is HIV prevention. as Wellbutrin, reduced the (including NIDA Notes) methamphetamine-induced • Calendar of events “high” as well as drug cravings • Links to NIDA organizational units What treatments elicited by drug-related cues. • Funding information are effective for This medication and others are (including program announcements currently in clinical trials, while methamphetamine new compounds are being and deadlines) • International activities abusers? developed and studied in • Links to related Web sites preclinical models. A t this time, the most (access to Web sites of many other effective treatments for organizations in the field) methamphetamine addic- Where can I get tion are behavioral therapies further scientific NIDA Web Sites such as cognitive behavioral zycnzj.com/http://www.zycnzj.com/ www.drugabuse.gov and contingency management information about www.steroidabuse.gov interventions. For example, the methamphetamine www.clubdrugs.gov www.hiv.drugabuse.gov Matrix Model, a comprehensive behavioral treatment approach abuse? www.inhalant.drugabuse.gov T that combines behavioral therapy, o learn more about NCADI family education, individual methamphetamine and Web Site: www.health.org counseling, 12-Step support, other drugs of abuse, Phone No.: 800-729-6686 drug testing, and encouragement contact the National Clearing- zycnzj.com/ www.zycnzj.com 8 NIDA RESEARCH REPORT SERIES Glossary References Addiction: A chronic, relapsing disease, Chang L, Ernst T, Speck O, Grob CS. 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National Lichtman AM, Bramen J, Shinn AK, Miotto K, Learn J, regions of the brain that regulate movement, Dong Y, Matochik JA, Kurian V, Newton T, Woods R, Admissions to Substance Abuse Treatment Services, emotion, motivation, and feelings of Rawson R, Ling W. Mood disturbances and regional DASIS Series: S-31, DHHS Publication No. (SMA) 06- pleasure. cerebral metabolic abnormalities in recently abstinent 4140, Rockville, MD: DHHS, 2006. methamphetamine abusers. Arch Gen Psychiatry Thompson PM, Hayashi KM, Simon SL, Geaga JA, Hong Narcolepsy: A disorder characterized by 61:73–84, 2004. MS, Sui Y, Lee JY, Toga AW, Ling W, London ED. uncontrollable attacks of deep sleep. National Institute on Drug Abuse. Epidemiologic Trends Structural abnormalities in the brains of human in Drug Abuse: Advance Report, Community subjects who use methamphetamine. J Neurosci Psychomotor stimulants (psychostimu- Epidemiology Work Group, January 2006. NIH Pub. 24:6028–6036, 2004. lants): Drugs that increase or enhance the No. 06-5878, Bethesda, MD: NIH, DHHS, 2006. Volkow ND, et al. Association of dopamine transporter activity of monoamines (such as dopamine National Institute on Drug Abuse. Epidemiologic Trends in reduction with psychomotor impairment in and norepinephrine) in the brain. Drug Abuse: Vol. I., Proceedings of the Community methamphetamine abusers. Am J Psychiatry Psychostimulants increase arousal and Epidemiology Work Group, Highlights and Executive 158(3):377–382, 2001. Summary, January 2006. NIH Pub. No. 06-5879, activity, as well as heart rate, blood pressure, Bethesda, MD: NIH, DHHS, 2006. Volkow ND, et al. Loss of dopamine transporters in and respiration. methamphetamine abusers recovers with protracted National Institute on Drug Abuse. Epidemiologic Trends in abstinence. J Neurosci 21(23):9414–9418, 2001. 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N Z Med J 117:U1180, Tolerance: A condition in which higher prize-based incentives on outcomes in stimulant 2004. doses of a drug are required to produce the abusers in outpatient psychosocial treatment same effect as experienced initially. zycnzj.com/http://www.zycnzj.com/ programs: a national drug abuse treatment clinical trials network study. Arch Gen Psychiatry Toxic: Damage to an organ or group of 62(10):1148–1156, 2005. organs. Rawson RA, Marinelli-Casey P, Anglin MD, Dickow A, Frazier Y, Gallagher C, Galloway GP, Herrell J, Huber Withdrawal: A variety of symptoms that A, McCann MJ, Obert J, Pennell S, Reiber C, Vandersloot D, Zweben J. A multi-site comparison NIH Publication Number 06-4210 occur after chronic abuse of an addictive of psychosocial approaches for the treatment of Printed April 1998, Reprinted January 2002. drug is reduced or stopped. methamphetamine dependence. Addiction Revised September 2006. 99:708–717, 2003. Feel free to reprint this publication.
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