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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 2001 publication that methamphetamine continues to be a problem in Hawaii and in major Western cities, such as San Francisco, Denver, and Los Angeles. Methamphetamine availability and production are being reported in more diverse areas of the country, particularly rural areas, prompting concern about more widespread use.
Drug abuse treatment admissions reported by the CEWG in June 2001 showed that methamphetamine remained the leading drug of abuse among treatment clients in the San Diego area and Hawaii. Stimulants, including methamphetamine, accounted for smaller percentages of treatment admissions in other states and metropolitan areas of the West (e.g., 9 percent in Los Angeles and Seattle and 8 percent in Texas). By comparison, stimulants were the primary drugs of abuse in a smaller percent of treatment admissions in most Eastern and Midwestern metropolitan areas, such as Minneapolis-St. Paul and St. Louis, where they accounted for approximately 3 percent of total admissions, or Baltimore, where no stimulant-related treatment admissions were reported in the first half of 2000.
How is methamphetamine used?
Methamphetamine comes in many forms and can be smoked, snorted, orally ingested, or injected. The drug alters moods in different ways, depending on how it is taken.
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)
Methamphetamine is classified as a psychostimulant, as are other drugs of abuse such as amphetamine and cocaine. We know that methamphetamine is structurally similar to amphetamine and the neurotransmitter dopamine, but it is quite different from cocaine. Although these stimulants have similar behavioral and physiological effects, there are some major differences in the basic mechanisms of how they work at the level of the nerve cell. However, the bottom line is that methamphetamine, like cocaine, results in an accumulation of the neurotransmitter dopamine, and this excessive dopamine concentration appears to produce the stimulation and feelings of euphoria experienced by the user. In contrast to cocaine, which is quickly removed and almost completely metabolized in the body, methamphetamine has a much longer duration of action and a larger percentage of the drug remains unchanged in the body. This results in methamphetamine being present in the brain longer, which ultimately leads to prolonged stimulant effects.
Although both methamphetamine and cocaine are psychostimulants, there are differences between them.
Smoking produces a high that lasts 8-24 hours
50% of the drug is removed from the body in 12 hours
Limited medical use
Smoking produces a high that lasts 20-30 minutes
50% of the drug is removed from the body in 1 hour
Used as a local anesthetic in some surgical procedures
Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and if not treated immediately, can result in death.
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 therefore may 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.
Increased HIV and hepatitis B and C transmission are likely consequences of increased methamphetamine abuse, particularly in individuals who inject the drug and share injection equipment. Infection with HIV and other infectious diseases is spread among injection drug users primarily through the re-use of contaminated syringes, needles, or other paraphernalia by more than one person. In nearly one-third of Americans infected with HIV, injection drug use is a risk factor, making drug abuse the fastest growing vector for the spread of HIV in the nation.
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.
At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Methamphetamine recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery.
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.
To learn more about methamphetamine and other drugs of abuse, contact the National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686. Information specialists are available to assist you in locating needed information and resources. Information can be accessed also through the NIDA Web site (http://www.nida.nih.gov/) or the NCADI Web site (http://www.health.org/).
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.
Addiction: a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use and by neurochemical and molecular changes in the brain.
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.
"Blood Level of Intravenous Drug Users," by R.L. Norton, B.T. Burton, and J. McGirr. Journal of Clinical Toxicology 34(4):425-30, 1996.
Epidemiologic Trends in Drug Abuse: Vol. I. Highlights and Executive Summary of the Community Epidemiology Work Group, June 2001. NIH Pub. No. 01-4916A. National Institute on Drug Abuse, 2001.
Epidemiologic Trends in Drug Abuse: Vol. II. Proceedings of the Community Epidemiology Work Group, June 2001. NIH Pub. No. 01-4917A. National Institute on Drug Abuse, 2001.
"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). National Institute 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.
Summary of Findings from the 2000 National Household Survey on Drug Abuse. Substance Abuse and Mental Health Services Administration, 2000.
Detailed Emergency Department Tables 2000, Drug Abuse Warning Network. Substance Abuse and Mental Health Services Administration, available online at www.samhsa.gov/oas/dawn.htm.
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