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Methamphetamine is a powerfully addictive stimulant that dramatically affects
the central nervous system. The drug is made easily in clandestine laboratories
with relatively inexpensive over-thecounter ingredients. These factors combine
to make methamphetamine a drug with high potential for widespread abuse.
Methamphetamine is commonly known as “speed,” “meth,” and “chalk.” In its smoked
form, it is often referred to as “ice,” “crystal,” “crank,” and “glass.” It
is a white, odorless, bitter-tasting crystalline powder that easily dissolves
in water or alcohol. The drug was developed early in this century from its parent
drug, amphetamine, and was used originally in nasal decongestants and bronchial
inhalers. Methamphetamine’s chemical structure is similar to that of amphetamine,
but it has more pronounced effects on the central nervous system. Like amphetamine,
it causes increased activity, decreased appetite, and a general sense of well-being.
The effects of methamphetamine can last 6 to 8 hours. After the initial “rush,”
there is typically a state of high agitation that in some individuals can lead
to violent behavior.
Methamphetamine is a Schedule II stimulant, which means it has a high potential
for abuse and is available only through a prescription that cannot be refilled.
There are a few accepted medical reasons for its use, such as the treatment
of narcolepsy, attention deficit disorder, and––for short-term use––obesity;
but these medical uses are limited.
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Methamphetamine abuse, long reported as the dominant drug problem in the San
Diego, CA, area, has become a substantial drug problem in other sections of
the West and Southwest, as well. There are indications that it is spreading
to other areas of the country, including both rural and urban sections of the
South and Midwest. Methamphetamine, traditionally associated with white, male,
blue-collar workers, is being used by more diverse population groups that change
over time and differ by geographic area.
According to the 2000 National Household Survey on Drug Abuse, an estimated
8.8 million people (4.0 percent of the population) have tried methamphetamine
at some time in their lives.
Data from the 2000 Drug Abuse Warning Network (DAWN), which collects information
on drug-related episodes from hospital emergency departments in 21 metropolitan
areas, reported that methamphetaminerelated episodes increased from approximately
10,400 in 1999 to 13,500 in 2000, a 30 percent increase. However, there was
a significant decrease in methamphetamine- related episodes reported between
1997 (17,200) and 1998 (11,500).
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.
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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
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.
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|Short-term effects may include:
- Increased attention and decreased fatigue
- Increased activity
- Decreased appetite
- Euphoria and rush
- Increased respiration
As a powerful stimulant, methamphetamine, even in small doses, can increase
wakefulness and physical activity and decrease appetite. A brief, intense sensation,
or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion
or snorting produces a long-lasting high instead of a rush, which reportedly
can continue for as long as half a day. Both the rush and the high are believed
to result from the release of very high levels of the neurotransmitter dopamine
into areas of the brain that regulate feelings of pleasure.
Methamphetamine has toxic effects. In animals, a single high dose of the drug
has been shown to damage nerve terminals in the dopamine-containing regions
of the brain. The large release of dopamine produced by methamphetamine is thought
to contribute to the drug’s toxic effects on nerve terminals in the brain.
High doses can elevate body
temperature to dangerous,
sometimes lethal, levels, as well
as cause convulsions.
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|Long-term effects may include:
- Dependence and addiction psychosis
- mood disturbances
- repetitive motor activity
- Weight loss
Long-term methamphetamine abuse results in many damaging effects, including
addiction. Addiction is a chronic, relapsing disease, characterized by compulsive
drug-seeking and drug use which is accompanied by functional and molecular changes
in the brain. In addition to being addicted to methamphetamine, chronic methamphetamine
abusers exhibit symptoms that can include violent behavior, anxiety, confusion,
and insomnia. They also can display a number of psychotic features, including
paranoia, auditory hallucinations, mood disturbances, and delusions (for example,
the sensation of insects creeping on the skin, which is called “formication”).
The paranoia can result in homicidal as well as suicidal thoughts.
With chronic use, tolerance for methamphetamine can develop. In an effort to
intensify the desired effects, users may take higher doses of the drug, take
it more frequently, or change their method of drug intake. In some cases, abusers
forego food and sleep while indulging in a form of binging known as a “run,”
injecting as much as a gram of the drug every 2 to 3 hours over several days
until the user runs out of the drug or is too disorganized to continue. Chronic
abuse can lead to psychotic behavior, characterized by intense paranoia, visual
and auditory hallucinations, and out-of-control rages that can be coupled with
extremely violent behavior.
Although there are no physical manifestations of a withdrawal syndrome when
methamphetamine use is stopped, there are several symptoms that occur when a
chronic user stops taking the drug. These include depression, anxiety, fatigue,
paranoia, aggression, and an intense craving for the drug.
In scientific studies examining the consequences of long-term methamphetamine
exposure in animals, concern has arisen over its toxic effects on the brain.
Researchers have reported that as much as 50 percent of the dopamine-producing
cells in the brain can be damaged after prolonged exposure to relatively low
levels of methamphetamine. Researchers also have found that serotonin-containing
nerve cells may be damaged even more extensively. Whether this toxicity is related
to the psychosis seen in some long-term methamphetamine abusers is still an
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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
Smoking produces a high that lasts 20-30 minutes
50% of the drug is removed from the body in 12 hours
||50% of the drug is removed from the body in 1 hour
|Limited medical use
||Used as a local anesthetic in some surgical procedures
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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
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
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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 onethird 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
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
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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
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 methamphetamineinduced psychoses, short-term use of neuroleptics has proven
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