Methamphetamine

Methamphetamine is a stimulant in the phenethylamine and amphetamine class of drugs that is highly addictive. It is normally a white, odorless, bitter-tasting crystalline powder; crystal meth is a form that appears like fragments of glass or crystal. It is rarely used medically to treat attention deficit hyperactivity disorder and other conditions, but is more commonly abused illegally as a recreational drug.

• ALSO KNOWN AS: Crank; crystal meth; meth; speed
• LEGAL STATUS/CLASSIFICATION: Legal status varies depending on whether methamphetamine is approved for medical use. Schedule I drug in Canada, Hong Kong, the Netherlands, and New Zealand. Schedule II drug in the United States because of its medicinal use. Class A drug in the United Kingdom.
• SOURCE: Commonly synthesized in a laboratory, although it can be found naturally in the traditional herb Ephedra sinica, or ma huang. Illegal methamphetamine labs range from large-scale operations to small, one-room labs. Methamphetamine production also occurs at the microscale, in which meth is produced with no more than a soda bottle and ingredients found in a convenience store. Individual methamphetamine production has become popular because the synthesis requires no special skills or instruments.
• TRANSMISSION ROUTE: Ingestion; inhalation; insufflation (snorting); intravenous; suppository (anal and vaginal)

History of Use

A Japanese scientist first synthesized methamphetamine in 1919, building on the discovery of amphetamines in the late nineteenth century. Experiments with these drugs increased in the 1930s. Both amphetamine and methamphetamine were given to both Axis and Allied soldiers during World War II as performance aids and to counteract sleep deprivation. However, negative effects such as irritability, aggression, dependence, and withdrawal quickly became apparent. An early wave of widespread methamphetamine abuse was seen in Japan after the war, with some spread to certain Pacific Islands and the West Coast of the United States.

Illegal use of methamphetamine in the United States began to rise in the 1960s, initially mainly in the Southwest. By the 1980s, growing quantities of the drug were produced by labs in Mexico and smuggled into the United States. Methamphetamine became increasingly popular in rural parts of the West, Midwest and Southern US, partially because of the availability of fertilizer that could be used as an ingredient in methamphetamine production.

Methamphetamine use increased in some other parts of the world as well through the late twentieth century. Southeast Asia, in particular, became another major hotspot for production, trafficking, and abuse of the drug. As rates of methamphetamine use rose and new methods of production were developed, many governments imposed stricter regulations on both the drug itself and chemicals that could be used in its production. For example, in 1996 the US Congress passed the Comprehensive Methamphetamine Control Act, which included measures intended to prevent bulk purchases of precursor chemicals for illicit purposes.

Despite such efforts, methamphetamine abuse remained a growing problem into the twenty-first century. By the early 2000s, public health experts noted that in some US states, admission rates to rehabilitation centers for methamphetamine addiction surged higher than for cocaine or even alcohol abuse. Further initiatives such as the US Combat Methamphetamine Epidemic Act of 2005 showed more success in decreasing illegal methamphetamine production and consumption. However, the rate of overdose deaths in the US linked to methamphetamine began to increase steadily again by the mid-2010s, a trend that many observers linked to both increased production by drug cartels and the parallel rise of a major epidemic of opioid abuse.

One of the methods of coping with the rising methamphetamine problem has been a slow but progressive change in treating people with methamphetamine addiction. Many prison officials, psychologists, and legislators have advocated for reforms so that incarcerated people addicted to methamphetamine can safely go through detoxification and receive further treatment. Treatment for methamphetamine addiction has also become specialized. The matrix model includes cognitive-behavioral therapy, family education and support, positive reinforcement for behavior change and treatment compliance, and a twelve-step program. No ideal medication has been found for treatment of methamphetamine addiction.

Effects and Potential Risks

The physical effects of a methamphetamine high resemble those of the body in a fight-or-flight, hyperarousal response. Heart rate and blood pressure increases, and awareness is heightened with increased self-confidence.

Chronic methamphetamine use and methamphetamine overdose lead to extremely dangerous physical conditions, including myocardial infarction, cardiopulmonary arrest, seizures, hypoxic brain damage, hyperthermia, and intracranial bleeds. Psychiatric symptoms are extremely common and include insomnia, mood disorders, violent and aggressive behavior, paranoia, and hallucinations.

Methamphetamine increases the release of and blocks the body’s reuptake of dopamine, which increases the levels of dopamine in the brain. The inability of the brain to release the excess dopamine creates the user’s rush or high. Chronic methamphetamine use leads to a change in the activity of the dopamine system, specifically a decrease in motor skills and impaired verbal learning skills. Chronic use also affects emotions, memory, and general cognitive abilities. Because methamphetamine is highly lipophilic, it enables a rapid and extensive transport across the blood-brain barrier. It is highly neurotoxic and can stay in the body’s system for eight to thirteen hours.

Even after a methamphetamine user stops using the drug, the damage to his or her brain continues. There is evidence of impairment of the anterior cingulate cortex, the area of the brain that influences cognitive functions and emotions and regulates behavior. The drug disables the ability to choose between healthy and unhealthy behaviors. Enhanced cortical gray matter volume also declines with age, leading to an accelerated rate of mental functioning, primarily because of a reduction in the number of neurons rather than shrinkage of gray matter. Methamphetamine users are at a greater risk for degenerative or cognitive diseases, and persons who are comorbid with depression are at a higher risk for dementia.

Methamphetamine use also increases the risk of transmission of the human immunodeficiency virus (HIV) and the hepatitis virus. Shared-needle use and higher risk sexual behavior increase the chances that a user will be infected with a sexually transmitted disease. Methamphetamine users who are HIV positive tend to suffer more neuronal injury and cognitive impairment.

A common physical trait of a chronic methamphetamine user is poor oral hygiene, or meth mouth. Methamphetamine use can cause a decrease in saliva output, leading to chronic dry mouth. Users will often drink large amounts of sugary carbonated soft drinks, which leads to severe dental decay. Many methamphetamine users also may grind or clench their teeth, causing tooth fractures.

Bibliography

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Nakama, Helena, et al. "Methamphetamine Users Show Greater Than Normal Age-Related Cortical Gray Matter Loss." Addiction 106.8 (2011): 1474–83.

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