What Kind of Drug Is It?
Methamphetamine, commonly referred to as "meth," is a synthetic, or laboratory-made, stimulant. Stimulants increase alertness, endurance, and feelings of well-being in the user. Examples of other stimulant drugs include cocaine and caffeine. (Entries on both of these drugs are available in this encyclopedia.) Methamphetamine is considered an especially powerful and addictive substance—far more addictive even than cocaine—because of its powerful effect on the brain.
Methamphetamine was developed by a Japanese chemist in 1919 from amphetamine, another laboratory-made drug. Amphetamine increases energy, reduces appetite, and helps keep users awake. (An entry on amphetamines is also available in this encyclopedia.) The first amphetamine had been made by a German chemist in the late 1880s, but it was not used for medical purposes until decades later. In its earliest form, amphetamine was found to be an effective treatment for asthma (AZ-muh), a lung disorder that interferes with normal breathing. Because of its similar ability to unclog breathing passages, methamphetamine was originally used as a nasal decongestant.
As of 2005, the medical use of methamphetamine was extremely limited. However, illicit, or unlawful, use was quite high worldwide. Like other amphetamines, methamphetamine boosts energy levels and produces an intense rush or high in the user. These properties have made it popular with recreational drug users—those who use a drug solely to get high, not to treat a medical condition. The dangers of methamphetamine lie in its strength and its high potential for addiction. Few people can "try" methamphetamine once without wanting more. Experts in the medical, behavioral, and law enforcement fields considered meth abuse one of the most serious social threats of the early twenty-first century.
Official Drug Name: Methamphetamine (METH-am-FETT-uh-meen), methamphetamine hydrochloride (Desoxyn [des-OK-sinn]); deoxyephedrine (dee-OK-see-ih-FEH-drinn; Methedrine)
Also Known As: Batu, chalk, crank, crystal, crystal meth, glass, ice, meth, poor man's cocaine, shabu, speed, tina, trash, ya ba, zip
Drug Classifications: Schedule II, stimulant
Methamphetamine is a highly addictive stimulant drug. It is closely related to amphetamine but has a longer lasting and more toxic effect on individuals who abuse it. Because of its potentially harmful side effects, methamphetamine is only prescribed by doctors when other
medications have failed to help their patients. Methamphetamine has been used with some success in individuals with attention-deficit/hyperactivity disorder (ADHD). Children and adults who have been diagnosed with ADHD are typically impulsive, somewhat edgy, and have difficulty focusing and controlling their actions. These symptoms often interfere with their ability to function socially and academically. Methamphetamine is also approved for use in treating obesity as well as narcolepsy, a rare sleep disorder characterized by daytime tiredness and sudden attacks of sleep.
What is of great concern to drug-control authorities, however, is the increasingly widespread abuse of methamphetamine. During the 1990s and early 2000s, the illegal manufacture and distribution of the drug increased dramatically in the United States. According to the 2004 "National Synthetic Drugs Action Plan" prepared by the U.S. Office of National Drug Control Policy (ONDCP), the bulk of the methamphetamine sold in the United States is produced illegally in California. "Most of the large super labs in California are run by organizations with ties to Mexico," noted the authors of the "Action Plan." However, record numbers of smaller, independent labs began popping up throughout the American Midwest beginning in 2003. Authorities considered the eastward movement of the methamphetamine problem and the "dramatic increase" in these Midwestern labs to be "particularly troubling."
The illegal use of methamphetamine had reached epidemic proportions in the United States as of 2005. According to the "2003 National Survey on Drug Use and Health (NSDUH)," 12.3 million Americans age twelve and older—more than 5 percent of the U.S. population—have tried methamphetamine at least once in their lives. The majority of users that year were between the ages of eighteen and thirty-four, and more than half of the new users were under eighteen.
Methamphetamine can be manufactured or "cooked" in home laboratories. MSNBC.com special reporter Jon Bonné noted in the online article "Meth's Deadly Buzz" that the drug "is easily manufactured domestically with common household items such as batteries and cold medicine." Meth "cooks" are usually untrained, and the chemicals they use are highly flammable, meaning they are capable of catching fire and burning quickly. This increases the likelihood of accidental explosions in meth labs. Despite the risks, drug traffickers set up their operations in small spaces such as bathrooms, sheds, basements, crawl spaces, motel rooms, and even suitcases. The business has become something of a family tradition in some cases, with parents passing recipes and production tips down to their children.
In order to avoid being caught, some meth cooks set up their equipment in mobile labs. These labs might be assembled in car trunks, vans, travel trailers, motor homes, and even trucks. But because meth production has a great potential for explosions, especially among inexperienced cooks, the mobile labs become toxic time bombs that present a very real threat to police and motorists. In addition to explosions, mobile labs have been known to leak hazardous materials, resulting in road closures while the cleanup work is being done. In many cases, both mobile and non-mobile labs have to be disassembled by hazardous materials (hazmat) crews or law enforcement officers dressed in protective gear.
Abusing Meth Equals Quick Addiction
Methamphetamine produces feelings of euphoria, which is a state of extreme happiness and enhanced well-being. It also increases energy by raising the levels of two neurotransmitters in the brain: 1) dopamine (DOPE-uh-meen), which is a combination
of carbon, hydrogen, nitrogen, and oxygen; and 2) norepinephrine (nor-epp-ih-NEFF-run), which is a natural stimulant. The drug causes excessive amounts of these chemicals to be released, resulting in a spike, or sudden increase, in their concentration in the brain.
Methamphetamine's effect on dopamine levels can help treat patients with ADHD and narcolepsy. Dopamine plays a key role in regulating attention. It acts on the part of the brain responsible for filtering incoming information, making choices, and deciding when and how to act. However, in users who do not have ADHD or narcolepsy, methamphetamine's effect on dopamine increases alertness, brings on a sense of happiness and contentment, and creates an urge for more and more of the drug. That is what makes it so dangerous. As Julia Sommerfeld explained in the article "Beating an Addiction to Meth" on MSNBC.com: "While high levels of dopamine in the brain usually cause feelings of pleasure, too much can produce aggressiveness, irritability, and schizophrenic-like behavior." Schizophrenic behavior refers to exhibiting the symptoms of schizophrenia, a severe mental disease characterized by a withdrawal from reality and other intellectual and emotional disturbances.
Children of Users Suffer Neglect
The growing abuse of methamphetamine has had an enormous impact on users' children. As of 2005, the child welfare issue was particularly problematic in rural areas of the United States. Oklahoma and Kentucky seem to have been hit especially hard. The number of neglected children in these areas has skyrocketed as more and more parents have begun using, making, and selling methamphetamine at home.
According to Kate Zernike in a July 2005 New York Times article, the problem is compounded by the fact that these rural areas lack the kind of social services needed to help youths who have been raised in a drug-using environment. Under such circumstances, children are forced to fend for themselves because their parents are often either high or sleeping off the effects of their last binge. When parents are arrested for their drug activity, their underage kids are typically placed in foster homes.
"Many of these neglected children struggle with emotional, developmental and abandonment issues," noted Zernike. "It has become harder to attract and keep foster parents because the children of methamphetamine arrive with so many behavioral problems; they may not get into their beds at night because they are so used to sleeping on the floor, and they may resist toilet training because they are used to wearing dirty diapers."
Methamphetamine addiction can occur easily. Users who want to lose weight take methamphetamine to decrease their appetites. Others might try it for the burst of energy it provides to cram for exams or work extra hours. But the effects of the drug are so intense that occasional users or even first-timers often find themselves craving more. KCI: The Anti-Meth Site posts stories of users who have been drawn into the world of addiction. Their accounts illustrate the drug's destructive effects.
"The Meth Epidemic in America"
In July of 2005, a report titled "The Meth Epidemic in America" was released by the National Association of Counties (NACo). Five hundred counties from forty-five states participated in the survey. About 87 percent of responding law enforcement agencies reported increases in meth-related arrests since 2002. In addition, 40 percent of child welfare officials surveyed reported an increase in children needing out-of-home placements due to methamphetamine-related activities.
NACo president Angelo D. Kyle wrote in his executive summary of the survey: "The methamphetamine epidemic in the United States, which began in the West and is moving East, is having a devastating effect on our country. The increasingly widespread production, distribution and use of meth are now affecting urban, suburban and rural communities nationwide."
Impact on the Environment
The illegal manufacture of methamphetamine takes its toll on the environment as well. Statistics from "The Meth Epidemic in America" indicate that for every pound of methamphetamine produced, five to seven pounds of toxic waste are created. The solid wastes are usually dumped down household drains, in yards, or on back roads. The accompanying poisonous gas is released into the air. Chemicals from large-scale methamphetamine laboratory dump sites have killed livestock, contaminated streams, and destroyed trees and vegetation.
According to the ONDCP: "The cleanup operation following the discovery of a dump or … laboratory site is typically an extremely expensive endeavor." California spent nearly $5 million cleaning up meth sites in 2002, and costs are on the rise. As meth makers refine their skills and upgrade their labs, larger amounts of the drug can be produced at a single site. More meth means more toxins, which translates into more expensive cleanup operations. "Some labs are now able to produce 100 pounds or more of methamphetamine per production cycle," notes the ONDCP report. "[T]his increased productivity leaves behind increased amounts of toxic waste." The effect of these chemicals on the nation's water supply—and all the people who drink from it—remains to be seen.
What Is It Made Of?
Methamphetamine is closely related to amphetamine but has longer lasting and more toxic effects on the user's system. Meth is a white, odorless powder that dissolves easily in water or alcohol. Production of the drug begins with common
chemicals, including ephedrine or pseudoephedrine. Ephedrine-containing pills and powders were banned by the U.S. Food and Drug Administration (FDA) in 2004. However, as of mid-2005, illicit supplies were still available through the Internet. Pseudoephedrine is a key ingredient in cold medicines and asthma drugs. (An entry on over-the-counter drugs is available in this encyclopedia.)
Methamphetamine is relatively easy to produce in homemade laboratories. Various newspaper accounts note that meth cooks routinely brew small batches of the drug in their home labs using household goods that they purchased legally in stores. Many use recipes they find on the Internet posted by amateur chemists. As such, the strength and toxicity of each batch can vary considerably. By 2005, more and more Americans were expressing their concern over the ease with which these meth ingredients could be purchased. As a result, lawmakers began to push for crackdowns on the sale of ephedrine and greater restrictions on the sale of pseudoephedrine-containing medicines.
How Is It Taken?
Methamphetamine is swallowed, snorted, injected, smoked, absorbed through the gums, or inserted through the anus.
The prescription form of methamphetamine (Desoxyn) comes in the form of a white tablet. Each tablet contains 5 milligrams of methamphetamine hydrochloride. Its chemical formula is C10H15NHCl.
Illegally produced methamphetamine tablets often contain large amounts of caffeine. The tablets are sweet, brightly colored, and about the size of a pencil eraser. These pills are called ya ba, the Thai term for "crazy drug." Ya ba is especially popular in the Southeast Asian countries of Thailand, Burma, and Laos. It first appeared in the United States in 1999, with use centered in the Southeast Asian communities of California. In a September 2002 article for the North County Times, Louise Chu explained, "Ya ba has become a vague label for any type of meth in pill form, although it specifically refers to the brand produced in Southeast Asia."
The powdered form of methamphetamine is much more common. Users absorb it through mucous membranes in a variety of ways—snorted up the nose, rubbed onto the gums, wrapped in a cigarette paper and swallowed, or even wrapped and inserted into the anus. The powder dissolves quickly and is sometimes added to coffee or alcoholic drinks.
Liquefied methamphetamine is made by adding water to the powdered form of the drug. As a liquid, it can be injected directly into a user's vein or muscle.
Chunks of methamphetamine hydrochloride look like clear crystals and are often referred to as "ice." A common way to smoke ice is in a glass pipe with a bulb on one end. According to G. C. Luna in a 2001 article posted on the SciELO Public Health Web site, "some methamphetamine users break off the tops of light bulbs, put the drug into the glass bulb, heat the underside of the bulb, and inhale the contents."
A quarter of a gram of methamphetamine costs anywhere from twenty to sixty dollars on the black market.Methusersare willing to spend the money to purchase such a small amount of the drug because a long-lasting high can be achieved with very small quantities.
Are There Any Medical Reasons for Taking This Substance?
In the United States, methamphetamine is approved for use in treating certain medical conditions. It is used medically to manage the symptoms of ADHD and narcolepsy. It can also be used as a short-term treatment for obesity.
Methamphetamine was developed in the early twentieth century from amphetamine. Its stimulating effects on the brain and body quickly led to its abuse as a recreational drug.
Was Hitler a User?
During World War II (1939–1945), methamphetamine was one of several stimulant drugs given to soldiers to fight off battle fatigue. Some experts suspect that Nazi dictator Adolf Hitler (1889–1945) used methamphetamine regularly from the mid-1930s until the end of thewar, when he committed suicide in an underground bunker. According to the 2005 History Channel television documentary High Hitler, "In 1938 the king of Italy told his foreign minister that Hitler was being injected [with] narcotics and stimulants. Hitler's valet said that every morning before he got out of bed he had an injection that made him immediately alert and fresh for the day."
Hitler also had symptoms such as tremors, shuffling, and poor eyesight. It is unknown if some of these symptoms were caused by a neurological disorder such as Parkinson's disease, or by a drug habit. It is well documented, however, that Hitler's personal physician, Dr. Theodor Morell, provided him with a variety of daily medications. As noted in "High Hitler," Morell admitted in his diary that he supplied Hitler with a substance called "vitamultin" in both pill and injectable form. Many experts are convinced that Germany's leader was taking methamphetamine. Historians believe that Hitler's drug abuse affected his judgment and may have influenced his decisionmaking abilities during the war.
Methamphetamine in the Second Half of the Twentieth Century
By the 1960s, the availability of injectable methamphetamine had increased, and the rate of addiction grew substantially. In 1970 the U.S. government passed the Controlled Substances Act (CSA), which classified methamphetamine as a Schedule II substance. This meant that it is approved for medical use with a prescription but nevertheless possesses a high potential for abuse. This legislation severely restricted the legal production of methamphetamine. With these restrictions, however, came a huge jump in the number of illegal labs that were manufacturing the drug. In the 1980s, a smokeable form of methamphetamine, known as ice or crank, came into widespread use.
Methamphetamine trafficking and abuse has been on the rise in the United States and throughout the world since the 1990s. Various sources, including the ONDCP's "Action Plan," have found that the methamphetamine problem is spreading from the western United States to the Midwest and the South. Much of the illegal supply is made and distributed by Mexican drug trafficking organizations. By the early 2000s, meth was being distributed by Mexican traffickers through networks that had been established earlier for cocaine, heroin, and marijuana sales. (Entries on these three drugs are also available in this encyclopedia.) According to the Drug Enforcement Administration's "Statistics: DEA Drug Seizures," more than 118 million doses of methamphetamine were seized in 2002. In addition, the agency's National Clandestine Laboratory Database reported that some 7,000 meth labs were destroyed in 2004. The states of Iowa, Missouri, and Tennessee reported the highest number of meth lab incidents that year.
Is There Such a Thing as a Meth User Profile?
Most methamphetamine users report that they began taking the drug as an experiment. They wanted to have more energy and experience a powerful high. In the late 1990s, meth use in the United States was highest among white, male, blue-collar workers on the West Coast. As of 2005, the user profile had broadened to include diverse groups in all regions of the country. The authors of the 2005 study "The Meth Epidemic in America" noted that more high school- and college-aged students were taking the drug. Use had grown enormously among individuals in their twenties and thirties. There is no longer a definition of a "typical meth user." Use is high among the employed and the unemployed, white-collar workers and blue-collar workers, men and women. Though typically associated with whites, use is spreading among Hispanics and Native Americans as well.
Other groups showing increased use of methamphetamine include homeless and runaway youths, individuals who attend raves, and homosexuals. The gay community is at special risk because of the "party and play" trend developing in homosexual circles. As reported by David J.L. Jefferson in a February 2005 Newsweek article, "party and play" refers to using methamphetamine and then having sex—often without a condom. There is growing concern that this type of abuse will lead to an increase in the spread of acquired immunodeficiency syndrome (AIDS). Jefferson noted that when comparing nonusers and users of methamphetamine, the users were twice as likely to engage in unprotected sex and four times as likely to be HIV positive (carrying the human immunodeficiency virus, which can lead to AIDS).
Teen Use in the United States
The results of the Monitoring the Future (MTF) study were released to the public on December 21, 2004. An annual survey on adolescent drug use and attitudes, it is conducted by the University of Michigan (U of M) with funding from the National Institute on Drug Abuse (NIDA). According to the report, the percentage of eighth, tenth, and twelfth graders who had used methamphetamine in a one-year period decreased over the previous five years. In 1999, some 3.2 percent of eighth graders used methamphetamine at least once during the year, compared to 1.5 percent of eighth graders in 2004. Tenth-grader use in a one-year period decreased from 4.6 to 3 percent, and senior use of methamphetamine dropped from 4.7 to 3.4 percent.
The DAWN Reports
The Drug Abuse Warning Network (DAWN) keeps track of drug-related emergency department (ED) visits throughout the United States. Prior to 2003, statistics on methamphetamine and other amphetamines were grouped together in DAWN reports. The report titled "Amphetamine and Methamphetamine Emergency Department Visits, 1995-2002" showed a rise in the number of ED mentions related to these drugs over the seven-year span. Between 1995 and 2002, methamphetamine and amphetamine ED visits rose from 25,245 to 38,961—an increase of 54 percent. The latest DAWN figures available as of mid-2005 were from the last two quarters of 2003. During that six-month period, methamphetamine use alone accounted for more than 25,000 drug abuse-related ED visits. An additional 18,129 visits were attributed to other amphetamine use. Most of the patients were white males between the ages of eighteen and thirty-four.
Meth Use High Worldwide
Methamphetamine abuse is a global problem. The CBC-TV documentary series The Fifth Estate ran an episode called "Dark Crystal" in March of 2005 that reported on the meth problem in Canada. The number of illegal labs shut down by Canadian authorities in 2003 was nearly ten times higher than the number
shut down in 1998. In addition, methamphetamine-related deaths rose from three in the year 2000 to thirty-three in the year 2004. Most of the deaths resulted from overdoses or car crashes involving a driver high on meth.
According to the 1998 United Nations fact sheet "Amphetamine-Type Stimulants: A Problem Requiring Priority Attention," in Japan nearly 90 percent of all drug-law violations involved methamphetamine. High rates of abuse have also been a problem in Thailand, the Philippines, and Korea since the 1990s. The World Health Organization's "Management of Substance Abuse" report states that "a major epidemic of methamphetamine use … appears to be spreading across the entire Asia Pacific region."
Effects on the Body
When snorted or taken orally, one "hit" of methamphetamine can produce a high that lasts for about twelve hours. In general, the faster the meth is absorbed into the body, the more intense the pleasurable feelings experienced by the user. Injecting and smoking methamphetamine deliver a "rush" that cannot be achieved by snorting powder or swallowing pills, which slows the absorption process. Most addicts inject liquid methamphetamine or smoke crystal meth because the rush is what they're seeking.
Injecting methamphetamine is the most dangerous method of use. When methamphetamine is dissolved in water, dust, germs, and other materials can get into the liquid. The syringe used to inject the drug into the veins may be dirty as well. Any contaminants in the liquid or on the needle will be injected directly into the bloodstream. Users who inject methamphetamine run the risk of contracting both HIV and hepatitis a from sharing needles. The injections can also cause sores at the injection sites.
Methamphetamine is an extremely dangerous and addictive drug. It increases heart and breathing rates, blood pressure, and body temperature. Other effects include nausea, diarrhea, increased talkativeness, and a tendency to engage in repetitive actions. When the drug is injected, the initial rush leads some individuals to report feeling invincible, as if they can take on the world. Throughout the high that follows, users frequently appear more self-assured, "pumped up," and sexually aroused. They also may become extremely aggressive. As time passes, however, the surge of energy begins to fade. At that point, users are said to be crashing. They typically experience: 1) dehydration—an abnormally low amount of fluid in the body; 2) anxiety—feelings of being extremely overwhelmed, restless, fearful, and worried; 3) tiredness; and 4) depression—feelings of hopelessness, loss of pleasure, self-blame, and sometimes suicidal thoughts.
In severe cases, a mental disorder known as methamphetamine psychosis (sy-KOH-sis) develops. Symptoms of psychosis include paranoia, or abnormal feelings of suspicion and fear; hallucinations, or visions or other perceptions of things that are not really present; and uncontrolled anxiety that may lead to rage and violent behavior. And the hallucinations are not only visual. Users may hear voices. They have also been known to tear their skin apart in search of imaginary "crank bugs" that they think they feel crawling all over their bodies.
Because methamphetamine users know what to expect when they crash, their main goal is to avoid coming down by getting high again. This process is referred to as "bingeing." Bingers may continue the drug-taking cycle for so long that they end up staying awake for days. But all meth users eventually reach a point where no amount of the drug will sustain their high. Users in this phase, which is known as "tweaking," become extremely frustrated, irritable, and likely to be involved in a serious fight or accident.
Over time, heavy methamphetamine use takes an extreme toll on the user's body—both inside and outside. A noticeable loss of weight and a tendency to sweat makes them appear ill. They may also develop body odor; yellowing, decay, or loss of teeth; and chalky pale skin. The internal effects of methamphetamine can include an irregular heartbeat, high blood pressure, and possible stroke. Dangerously high body temperatures, convulsions, and even death may occur if a user overdoses. Methamphetamine abuse during pregnancy can lead to premature delivery and harm to the baby.
What Meth Does to the Brain
Research conducted by Dr. Nora D.Volkow and published in the March 2001 issue of the American Journal of Psychiatry indicates that methamphetamine impairs the brain's ability to resist repeated use of the drug. Volkow's research shows that methamphetamine users have fewer dopamine receptors in their brains than nonusers. With continued abuse, the reward center in the brains of meth addicts will not respond to any stimuli—except more meth. In the 2001 Brookhaven National Laboratory article "Methamphetamine Delivers 'One-Two' Punch to the Brain," Volkow noted that such research "may help explain why drug addicts lose control and take drugs compulsively."
In another study headed by Volkow and published in the December 2001 issue of the Journal of Neuroscience, users with damaged dopamine receptors were reexamined after a period of abstinence from the drug. The participants in the study were longtime abusers of methamphetamine, reporting at least two years of continued use for at least five days per week. Changes in their brains were measured in two ways: 1) using brain-imaging techniques, and 2) using their scores on tests of various physical and intellectual abilities.
In the April 2002 edition of "NIDA Notes," Patrick Zickler summarized the results of this second study. Heavy methamphetamine abusers who managed to remain drug-free "for at least nine months showed substantial recovery from damage to the dopamine transporters but not from impairments in motor skills and memory." In other words, the pictures of the recovered addicts' brains looked more like the brains of non-meth users, but their physical and intellectual performance remained low. Zickler quoted Volkow as saying that the changes in the brains of heavy methamphetamine abusers "are roughly equivalent to 40 years of aging." Furthermore, people who use meth may run a greater risk of developing Parkinson's disease as they age. The bottom line is that methamphetamine abuse can cause lasting brain damage.
|Number of methamphetamine lab seizures* in the United States, 2000 and 2004|
|*Includes all meth incidents, including labs, "dumpsites" or "chemical and glassware" seizures.|
|Notes: In 2000 California had the most incidents (2,198); in 2004, it was Missouri (2,707). The 2000 figures are based on results submitted by 45 states; 47 states participated in 2004. N/A means that the state did not supply results data.|
|source: Compiled by Thomson Gale staff from data reported in "Maps of Methamphetamine Lab Seizures," National Clandestine Laboratory Database, U.S. Drug Enforcement Administration (DEA), U.S. Department of Justice, Alexandria, VA [Online] http://www.usdoj.gov/dea/concern/map_lab_seizures.html [accessed May 25, 2005].|
Reactions with Other Drugs or Substances
Various drugs and substances cause dangerous health effects when taken with meth.
- The use of other stimulants along with methamphetamine has an additive effect, which can damage the heart.
- Methamphetamine mixed with over-the-counter cold medicines can cause a dangerous rise in blood pressure.
- To decrease the negative feelings experienced during tweaking, an abuser often self-medicates with a depressant such as alcohol. But alcohol only masks the effects of methamphetamine, causing the user to crave another "hit."
- Methamphetamines taken in combination with antidepressant drugs may pose life-threatening health risks.
Treatment for Habitual Users
Methamphetamine users experience extreme psychological withdrawal when they stop using the drug. People suffering from psychological withdrawal feel that they need to keep taking the drug because they can't function without it. Sommerfeld quoted drug researcher Douglas Anglin of the University of California at Los Angeles as saying, "There's not severe physical withdrawal with methamphetamine, but rather a feeling of anhedonia … that can last for months and which leads to a lot of relapse at six months." Withdrawal from methamphetamine is characterized by drug cravings, depression, an inability to sleep, and an increased appetite. Users in this stage may become suicidal.
Rehab: Difficult but Possible
Methamphetamine addicts often resist any form of treatment or intervention, according to Luna. They feel that they'll be able to quit on their own when they're ready. Among addicts who do seek help, the treatment process is typically lengthy. It can continue for months or even more than a year after the user has quit the drug. Antidepressant medications may be used to help battle the depression that can accompany withdrawal.
However, drug therapy usually is most helpful when combined with cognitive behavioral therapy (cbt). According to the Drug-Rehabs.org Web site, the most effective treatment for methamphetamine addiction consists of behavioral interventions such as individual and group counseling. These treatments help addicts establish a new circle of non-using friends and improve their coping skills to deal with everyday stressors.
NIDA Fights Against Meth Abuse
NIDA is pursuing research on drugs that could help with the treatment of methamphetamine addiction. Dr. Nora D. Volkow, the head of NIDA, appeared before the U.S. Senate to talk about methamphetamine abuse in 2005. She stated: "To further speed medication development efforts, NIDA has … established the Methamphetamine Clinical Trials Group (MCTG) to conduct clinical (human) trials of medications for [methamphetamine addiction] in geographic areas in which … abuse is particularly high, including San Diego, Kansas City, Des Moines, Costa Mesa, San Antonio, Los Angeles, and Honolulu." Among the drugs being tested are medicines used to treat high blood pressure, an anti-nausea drug, several antidepressants, and an anti-epilepsy drug. (Epilepsy is a disorder involving the misfiring of electrical impulses in the brain, sometimes resulting in seizures and loss of consciousness.) In addition, NIDA is funding research on a substance to treat meth overdoses.
Oregon Takes Action
To combat the illegal production of methamphetamine in Oregon, the state's lawmakers moved to make various over-the-counter (OTC) medications available only by prescription. Through such actions, occurring in mid-2005, Oregon became the first state in the nation to pass legislation to reclassify OTC cold and allergy products containing pseudoephedrine as prescription drugs. The bill was signed into law and made effective starting in mid-2006. The news was met with enthusiasm by some citizens and concern from others.
Meth is one of the biggest drugs of abuse in Oregon. As such, lawmakers looked for ways to make it more difficult for meth cooks to obtain the ingredients needed to make it. While the bill passed by a large margin in both Oregon's House and Senate, some citizens believe that the new law will create a hardship for the state's citizens who do not have health insurance or can't afford to go to a doctor. Plus, others contend that they are being punished because of the illegal actions of a few criminals. Cold and allergy drug makers also have concerns about the new law, claiming that it will drive up the price of the once-inexpensive OTC drugs.
Those favoring the bill point out that pseudoephedrine-free cold and allergy products are beginning to enter the market. In addition, doctors will be able to phone in prescriptions of the drug, so a visit to one's physician may not be necessary. Whether the measure will curb illegal meth production in Oregon will be studied by various lawmakers, police officers, and other researchers in the years ahead.
The consequences of illicit methamphetamine use include lowered productivity among addicted workers, increased health care costs, higher accident and death rates, and more crime and violence.
Crime and Meth
The increase in methamphetamine abuse by Americans has led to a surge in methamphetamine-related crimes, including theft, domestic violence, and child neglect. In 2001, Luna reported that there were "more persons incarcerated in the United States for drug-related 'crimes' than in any other country in the world." According to "The Meth Epidemic in America," law enforcement agencies in the Southwest reported a 96-percent increase in methamphetamine-related arrests between 2002 and 2005. The Northwest saw a 90-percent increase. "With the growth of this drug from the rural areas of the western and northwestern regions of this country and its slow but continuing spread to the east, local law enforcement officials see it as their number one drug problem," the report concluded.
The ONDCP's "Action Plan" refers to "drug-endangered children" as "the darkest side of the entire methamphetamine problem." In 2003 alone, more than 3,500 children in the United States were involved in meth lab incidents. The authors of the plan noted that "forty-one of these children were reported injured and one child was killed by explosions or fires" at illegal lab sites.
In the Pacific Northwest, lawmakers have stepped up legislation to combat the meth problem there. They aim to reduce the number of meth labs and the sale of the drug. But, they also have other issues to contend with regarding the use of methamphetamines. In 2005, police in several communities reported that a few teens had exchanged sex for meth. Law enforcement officials also announced that meth addicts had begun to support their habit by stealing metal and selling it for scrap at recycling centers. The addicts use the money to buy more meth. Thieves had stolen metal from irrigation systems, roadways, bridges, and even a historic train. They had removed guard-rails on various back roads, particularly those in heavily forested areas. The guardrails protect drivers from going over the edge of bridges or driving off the edge of mountainous roads. Police in many communities participate on meth task forces to find ways to combat the problems of meth-related crime and abuse. Students, parents, and teachers also work to educate the public about the dangers of meth.
"The Faces of Meth"
In Multnomah County, Oregon, Sheriff 's Deputy Bret King noticed some differences when looking at a batch of mug shots taken of repeat meth offenders. What he saw was shocking. When looking at images taken just a few years apart, King discovered just
how much meth abuse had changed people's appearances. Some users looked like they had aged ten to fifteen years in just a couple of years. In order to educate people about the meth problem and its devastating effects, King put together a presentation called "The Faces of Meth." In creating the program, he interviewed meth users to learn what advice they would give to young people who might be tempted to try meth. According to "The Faces of Meth" Web site, in his presentation, King wanted "to be honest with kids, let them hear directly from the inmates." The program is presented in schools and on the Internet.
A connection has been established between methamphetamine use and AIDS. In the MSNBC.com article "Hooked in the Haight: Life, Death, or Prison," Jon Bonné quoted San Francisco-based meth abuse counselor Michael Siever. "If you're at a party where a lot of people are injecting, when you put your needle down, someone else may pick it up." Sharing used needles greatly increases the risk of transmitting HIV (the human immunodeficiency virus, which leads to AIDS). Meth's reputation for lowering inhibitions and enhancing sexual pleasure often leads users to engage in unprotected sex—another major reason for the spread of HIV and other sexually transmitted diseases.
Methamphetamine is a Schedule II drug under the Controlled Substances Act (CSA) of 1970. The CSA established five schedules, or lists, of controlled medications and substances. Substances in Schedule I have the highest potential for abuse, while those in Schedule V have the lowest abuse potential. A Schedule II substance is approved for medical use with a prescription but nevertheless has a high potential for abuse.
Unless obtained by prescription, the possession, use, or distribution of methamphetamine is prohibited in the United States. Each of these offenses carries a maximum ten years in prison and $10,000 fine. Repeat offenders receive much harsher jail sentences and fines of up to several million dollars.
To fight the illegal manufacture of methamphetamine, some of the chemicals used in its production are included in the Comprehensive Methamphetamine Control Act of 1996 (MCA). The MCA increased penalties for the trafficking and manufacturing of methamphetamine along with the chemicals used to produce the drug. Illegal labs can produce about 1.5 pounds (0.68 kilograms) of meth from 2.2 pounds (1 kilogram) of ephedrine. Pseudoephedrine,
a substance found in cold medicines, can be used for the same purpose. Stores that sell pseudoephedrine are required to report to authorities any large-volume sales of the chemical.
By mid-2005, about thirty states had either passed or were considering passing laws that would limit the sale of pseudoephedrine. Some retailers have voluntarily moved these "over-the-counter" medicines "behind-the-counter" to the pharmacy area. There, the products are locked up and distributed only in limited amounts to customers showing picture identification. Federal and state laws restricting the sale of pseudoephedrine-based cold medicines are leading drug companies to reformulate their products with a substance called phenylephrine (FENN-uhl-EFF-reen or FENN-uhl-EFF-rin). Phenylephrine has been used in the past as an ingredient in eye drops and decongestants. It cannot be converted to methamphetamine in a home laboratory. As of mid-2005, cold products that contain phenylephrine were being sold in Europe.
For More Information
Clayton, Lawrence. Designer Drugs. New York: Rosen Publishing Group, 1998.
McDowell, D., and Henry Spitz. Substance Abuse: From Principles to Practice. Philadelphia: Taylor & Francis, 1999.
Olive, M. Foster. Designer Drugs. Philadelphia: Chelsea House, 2004.
Pennell, S., and others. Meth Matters: Report on Methamphetamine Users in Five Western Cities. Washington, DC: U.S. Department of Justice, 1999.
Weatherly, Myra. Ecstasy and Other Designer Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, 2000.
Jefferson, David J. L. "Party, Play—and Pay." Newsweek (February 28, 2005): p. 38.
Klee, Hilary. "The Love of Speed." Journal of Drug Issues (Winter, 1998): pp. 33-55.
Kowalski, Kathiann. "Stimulants: Fast Track to Disaster." Current Health 2 (February 1, 2001).
Mapes, Jeff. "House Votes to Restrict Meth Ingredient." Oregonian (July 21, 2005): pp: A1, A5.
Mapes, Jeff. "Lawmakers Score Pills to Cook Up Support for Prescription Bill." Oregonian (July 20, 2005): pp: A1, A7.
Murray, John B. "Psychophysiological Aspects of Amphetamine-Methamphetamine Abuse." Journal of Psychology (March, 1998): pp. 227-237.
Snell, Marilyn Berlin. "Welcome to Meth Country." Sierra Magazine (January/February, 2001).
Volkow, Nora D., and others. "Association of Dopamine Transporter Reduction with Psychomotor Impairment in Methamphetamine Abusers." American Journal of Psychiatry (March, 2001): pp. 377-382.
Volkow, Nora D., Linda Chang, and others. "Loss of Dopamine Transporters in Methamphetamine Abusers Recovers with Protracted Abstinence." Journal of Neuroscience (December 1, 2001): pp. 9414-9418.
Zernike, Kate. "A Drug Scourge Creates Its Own Form of Orphan." New York Times (July 11, 2005): p. A1.
"2003 National Survey on Drug Use and Health (NSDUH)." U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).http://www.oas.samhsa.gov/nhsda.htm (accessed August 5, 2005).
"Amphetamine-Type Stimulants: A Problem Requiring Priority Attention" (Fact Sheet No. 3, June 8-10, 1998). United Nations International Drug Control Programme: U.N. General Assembly, Special Session on the World Drug Problem.http://www.un.org/ga/20special/presskit/themes/ats-3.htm (accessed August 5, 2005).
Bonné, Jon. "Hooked in the Haight: Life, Death, or Prison." MSNBC.com, February, 2001. http://msnbc.msn.com/id/3071769 (accessed August 5, 2005).
Bonné, Jon. "Meth's Deadly Buzz." MSNBC.com, February, 2001. http://msnbc.msn.com/id/3071772 (accessed August 5, 2005).
"Brain Shows Ability to Recover from Some Methamphetamine Damage" (December 1, 2001). Brookhaven National Laboratory.http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr120101b.htm (accessed August 5, 2005).
"Children Suffer from Parental Meth Addiction." MSNBC.com, March 30, 2005. http://msnbc.msn.com/id/7297846/ (accessed August 5, 2005).
Chu, Louise. "Sweeping into California Communities." North County Times, September 21, 2002. http://www.nctimes.com/articles/2002/09/22/export18876.txt (accessed August 5, 2005).
"The DAWN Report: Amphetamine and Methamphetamine Emergency Department Visits, 1995-2002" (July, 2004). Drug Abuse Warning Network: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).http://dawninfo.samhsa.gov/old_dawn/pubs_94_02/shortreports/files/DAWN_tdr_amphetamine.pdf (accessed August 5, 2005).
"Drug Abuse Warning Network, 2003: Interim National Estimates of Drug-Related Emergency Department Visits" (December, 2004). U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).http://dawninfo.samhsa.gov/files/DAWN_ED_Interim2003.pdf (accessed August 5, 2005).
"Drug Firms Rushing to Change Cold Medicines." MSNBC.com, June 22, 2005. http://msnbc.msn.com/id/8322753 (accessed August 5, 2005).
"Drug Intelligence Brief: Club Drugs: An Update" (September, 2001). U.S. Department of Justice, Drug Enforcement Administration (DEA). http://www.usdoj.gov/dea/pubs/intel/01026 (accessed August 5, 2005).
"Drugs of Abuse: Uses and Effects Chart" (June, 2004). U.S. Department of Justice, Drug Enforcement Administration (DEA).http://www.usdoj.gov/dea/pubs/abuse/chart.htm (accessed August 5, 2005).
"The Faces of Meth." Multnomah County Sheriff 's Office.http://www.facesofmeth.us/ (accessed August 10, 2005).
Hargreaves, Guy. "Clandestine Drug Labs: Chemical Time Bombs." FBI Law Enforcement Bulletin, April, 2000. http://www.fbi.gov/publications/leb/2000/apr00leb.pdf (accessed August 5, 2005).
"Indepth: Go-Pills, Bombs & Friendly Fire." CBC News, November 17, 2004. http://www.cbc.ca/news/background/friendlyfire/gopills.html (accessed August 5, 2005).
Kyle, Angelo D., and Bill Hansell. "The Meth Epidemic in America" (July 5, 2005). National Association of Counties (NACo).http://www.naco.org/Content/ContentGroups/Publications1/Press_Releases/Documents/NACo-MethSurvey.pdf (accessed August 5, 2005).
Luna, G. C. "Use and Abuse of Amphetamine-Type Stimulants in the United States of America." SciELO Public Health Web site (2001). http://www.scielosp.org/pdf/rpsp/v9n2/4306.pdf (accessed August 6, 2005).
"Management of Substance Abuse." World Health Organization.http://www.who.int/substance_abuse/facts/psychoactives/en/ (accessed August 6, 2005).
"Maps of Methamphetamine Lab Seizures" (from National Clandestine Laboratory Database [January 1, 1999, to December 31, 2004]). U.S. Department of Justice, Drug Enforcement Administration (DEA).http://www.usdoj.gov/dea/concern/map_lab_seizures.html (accessed August 6, 2005).
Mathias, Robert. "NIDA Notes: Rate and Duration of Drug Activity Play Major Roles in Drug Abuse, Addiction, and Treatment" (March/April 1997). National Institutes of Health, National Institute on Drug Abuse (NIDA).http://www.drugabuse.gov/NIDA_Notes/NNVol12N2/NIDASupport.html (accessed August 6, 2005).
"Meth Addiction." Drug-Rehabs.org.http://www.drug-rehabs.org/faqs/FAQ-meth.php (accessed August 6, 2005).
"Methamphetamine Abuse: Stories and Letters." KCI: The Anti-Meth Site.http://www.kci.org/meth_info/links.htm (accessed August 6, 2005).
"Methamphetamine Delivers 'One-Two' Punch to the Brain" (December 1, 2001). Brookhaven National Laboratory.http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr120101a.htm (accessed August 6, 2005).
"Mind over Matter: Teaching Guide—Methamphetamines." NIDA for Teens: The Science behind Drug Abuse.http://teens.drugabuse.gov/mom/tg_meth1.asp (accessed August 6, 2005).
Monitoring the Future.http://www.monitoringthefuture.org/ and http://www.nida.nih.gov/Newsroom/04/2004MTFDrug.pdf (both accessed August 6, 2005).
"Myths about Meth." Methamphetamine Awareness Project.http://www.methawarenessproject.org/cgi-bin/display.cgi?page=myths (accessed August 6, 2005).
National Institute on Drug Abuse (NIDA).http://www.nida.nih.gov/ and http://www.drugabuse.gov (both accessed August 6, 2005).
"National Synthetic Drugs Action Plan" (May 23, 2004). Executive Office of the President, Office of National Drug Control Policy (ONDCP).http://www.whitehousedrugpolicy.gov/publications/national_synth_drugs (accessed August 6, 2005).
"An Overview of Club Drugs: Drug Intelligence Brief" (February, 2000). U.S. Department of Justice, Drug Enforcement Administration (DEA), Intelligence Division. http://www.usdoj.gov/dea/pubs/intel/20005intellbrief.pdf (accessed August 6, 2005).
"Pulse Check: Drug Markets and Chronic Users in 25 of America's Largest Cities" (January, 2004). Executive Office of the President, Office of National Drug Control Policy (ONDCP).http://www.whitehousedrugpolicy.gov/publications/drugfact/pulsechk/january04/january2004.pdf (accessed August, 2005).
"Researchers Document Brain Damage, Reduction in Motor and Cognitive Function from Methamphetamine Abuse" (March 1, 2001). Brookhaven National Laboratory.http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr030101.htm (accessed August 6, 2005).
"Selected Intelligence Brief: Methamphetamine Myths." U.S. Department of Justice, Drug Enforcement Administration (DEA), Office of Forensic Sciences, Microgram Bulletin, February, 2005. http://www.usdoj.gov/dea/programs/forensicsci/microgram/mg0205/mg0205.html (accessed August 6, 2005).
Sommerfeld, Julia. "Beating an Addiction to Meth." MSNBC.com, February 2001. http://msnbc.msn.com/id/3076519 (accessed August 6, 2005).
"Statistics: DEA Drug Seizures" (1986-2002). U.S. Department of Justice, Drug Enforcement Administration (DEA).http://www.usdoj.gov/dea/ statisticsp.html (accessed August 6, 2005).
Volkow, Nora D. "Methamphetamine Abuse: Testimony before the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies—Committee on Appropriations" (April 21, 2005). National Institutes of Health, National Institute on Drug Abuse (NIDA). http://www.drugabuse.gov/Testimony/4-21-05Testimony.html (accessed August 6, 2005).
Zickler, Patrick. "NIDA Notes: Methamphetamine Abuse Linked to Impaired Cognitive and Motor Skills Despite Recovery of Dopamine Transporters" (April 2002). National Institutes of Health, National Institute on Drug Abuse (NIDA).http://www.drugabuse.gov/NIDA_Notes/NNVol17N1/Methamphetamine.html (accessed August 6, 2005).
"Dark Crystal." The Fifth Estate. CBC-TV, March 23, 2005. http://www.cbc.ca/fifth/darkcrystal/canada.html (accessed August 6, 2005).
"High Hitler." The History Channel, 2005. http://www.thehistorychannel.co.uk/site/tv_guide/full_details/People/programme_2603.php (accessed August 6, 2005).
See also: Adderall; Amphetamines; Cocaine; Dextroamphetamine; Ephedra; Herbal Drugs, Over-the-Counter Drugs; Ritalin and Other Methylphenidates
OFFICIAL NAMES: Methampethamine
STREET NAMES: Meth, speed, crank, zip, chalk, ice, crystal
DRUG CLASSIFICATIONS: Schedule II, stimulant
Methamphetamine is a powerful stimulant of the central nervous system. Ordinarily it is a white, odorless powder that can be taken orally, smoked, or injected. It was developed early in the twentieth century from amphetamine, which was synthesized in 1887. Methamphetamine, which is more powerful than amphetamine, was first manufactured in Japan in 1919. It originally was used as a nasal decongestant and bronchial dilator for people with asthma.
Like its parent compound amphetamine, methamphetamine soon began to be used by people for its stimulating properties on the body and brain. During World War II, it was used extensively by both the Allied and Axis soldiers to fight fatigue on the battlefield.
After World War II, there was a huge increase in use of methamphetamines, when supplies of the drug for military use became available to the public. Initially, the use of methamphetamines for its stimulating properties was limited to college students, truck drivers, and athletes. However, in the 1960s, injectible methamphetamine was introduced into society, creating a large group of addicts. In 1970, the Controlled Substances Act (CSA) severely restricted the legal production of methamphetamines, causing the illegal manufacturing and distribution of methamphetamine to increase. In the 1980s, a smokeable form of methamphetamine, known as ice or crank, came into widespread use.
Today, illegal use of methamphetamine is one of the United States' leading drug abuse problems. Methamphetamine is both highly addicting and highly destructive to its users. Methampethamine trafficking and abuse has been on the rise, causing a devastating impact on communities across the nation. Illegal production of methamphetamine accounts for almost all of the methamphetamine abused in the United States. Large-scale production of methamphetamine is centered in California; however, more and more methamphetamine is being manufactured in Mexico and smuggled into the United States by organized crime groups. Because they already have well-established distribution networks and operators for their cocaine, heroin, and marijuana trafficking, Mexican drug lords have found it easy to tap into, and increasingly control, the illegal methamphetamine market.
Methamphetamine is a white, odorless, bitter-tasting powder that dissolves easily in water or alcohol. Methamphetamine production begins with a common chemical known as ephedrine. After using several toxic chemicals, including hydriodic acid, chemical solvents, and heavy metals such as mercury and lead, methamphetamine is produced. Chronic users often combine methamphetamine with cocaine or heroin; this combination is known as a "speedball."
Methamphetamine, when used as a legal medication, is taken as tablets. When used illegally, it is taken in pill form orally, powered form for injection, or crystalline form to be smoked.
Until the 1970s, methamphetamines were used for a variety of medical conditions in the United States. However, with the growing abuse of these powerful drugs, the federal government imposed strict controls on their usage and prescription. Currently, the use of methamphetamines in medicine are restricted for only a few types of medical conditions, including weight reduction for obese patients, narcolepsy, and attention-deficit disorder (ADD).
Methamphetamines and amphetamines are both used for treatment of obesity since they decrease hunger in patients. It is thought that both methamphetamines and amphetamines decrease the urge to eat by affecting certain areas of the brain that are associated with appetite and eating behaviors. While methamphetamines work reasonably well in controlling hunger, they are not indicated for long-term control of obesity because tolerance to the drug develops rapidly. Therefore, more and more methamphetamine has to be taken in order to achieve appetite suppression. Patients usually take methamphetamines or amphetamines for a maximum of six to eight weeks at a time, during which period most people will lose 6–10 lbs (2.7–4.5 kg).
Narcolepsy is a rare condition in which people literally fall asleep, quite suddenly, with no conscious control. This may occur only once or twice a day, but may occur up to 100 times a day. Low doses of methamphetamine or amphetamine are given to these patients on a very controlled basis to help keep the multiple episodes of sleeping under reasonable control.
Attention-deficit disorder (ADD) is widely diagnosed in school-aged children, although the disorder is seen well into adulthood. It is characterized by impulsive behavior, inability to concentrate, and short attention span. Methamphetamines and amphetamines, when given to people with this disorder, have the paradoxical effect of increasing the attention span, decreasing hyperactive behavior, and increasing the ability to concentrate. There are several types of methamphetamine and amphetamine available to treat this condition, including long-lasting, once-a-day preparations.
Methamphetamine is also used in other medical situations. People with severe depression are sometimes given short courses of a stimulant such as methamphetamine or amphetamine. However, physicians need to be cautious when giving a person with depression methamphetamine, since there can be a "let-down" period after stopping the drug that may cause the depression to actually worsen. Methamphetamines are also sometimes used to treat severe cases of epilepsy or Parkinson's disease in which the normally prescribed medications have failed.
Until approximately 10–15 years ago, illegal methamphetamine use was predominately a problem in California and surrounding western states. Outlaw motorcycle gangs significantly controlled methamphetamine manufacturing and distribution. However, drug lords from Mexico began to become involved. Through
their nationwide distribution and transportation networks of other illegal drugs, the Mexican drug traffickers were easily able to expand methamphetamine to all corners of the United States.
There are a variety of reasons that people use and abuse methamphetamine. Various studies report that about 10% of methamphetamine users were first introduced to the drug by family members. Most users state that they began using the drug as an experiment, to get more energy, and to get high. Around half of methamphetamine users state they use the drug either by smoking it or snorting it, with people under the age of 18 preferring to smoke it. People who use other drugs such as cocaine generally (64% of the time) state a preference for methamphetamine, due to its long-lasting nature and powerful high.
A significant percentage of methamphetamine users have had legal trouble. From multiple studies, a full 40% of adult methamphetamine users have been charged with a drug or alcohol violation, while 25% have been booked for theft and 16% have been arrested for violent behavior. About one-third of methamphetamine users report to have been engaged in illegal drug activity besides use, with selling drugs the most common activity. Forty percent of juveniles who are methamphetmine users reported also being involved in drug dealing. Most methamphetamine users who are also dealers report they became dealers to support their own drug habit.
Scope and severity
Methamphetamine is a dangerous, highly addictive drug that can be manufactured with commonly available, inexpensive chemicals. With a street price of $3,000 per pound (per half kilogram), making and selling methamphetamine can be a lucrative, albeit deadly, industry. While methamphetamine abuse has been a problem in California for decades, it was not the 1990s that it began to be a nationwide problem.
There have been numerous studies over the past few years trying to gauge the extent of methamphetamine use. According to the 1998 National Household Survey on Drug Abuse, an estimated 4.7 million people had tried methamphetamine at some point in their lives. That same survey, done again in the year 2000, showed that the number of methamphetamine users had grown to8.8 million.
The Drug Abuse Warning Network, which collects information on drug-related episodes from the nation's emergency rooms, showed that methamphetamine-related visits to emergency rooms more than tripled between 1991 and 1994, rising from 4,900 to more than 17,000. That number stayed the same until the late 1990s, and actually decreased somewhat (to 13,500) by 2000.
The Treatment Episode Data Set collects usage data from drug treatment centers around the country. Between 1993 and 1999, it was reported that methamphetamine addicts made up about 5% of the 1.6 million admissions to publicly funded substance abuse treatment center facilities. The survey also showed that in 1993, most methamphetmaine users were concentrated in three Western states—California, Oregon, and Nevada. By 1996, the treatment rate for methamphetamine abuse had increased 79%. By 1999, high methamphetamine admission rates to treatment centers were seen in most states west of the Mississippi River.
Age, ethnic, and gender trends
Methamphetamine use and abuse was traditionally believed to be one of white, blue-collar males. However, that has rapidly shifted in the past decade, with methamphetamine being used by a very diverse population.
A study of the ethnicity of methamphetamine users done between 1996 and 1997 shows that they are multi-cultural. In Los Angles, 30% of users were white, 5% were Hispanic, and only 2% were black. However, that same survey showed that in Portland, Oregon, whites made up 94% of all methamphetamine users; 54% of these were male, while 46% were female. In Los Angles, 88% of the methamphetamine users were male, with only 12% being female.
The 1999 Monitoring the Future study examined drug use among high-school students. This study found that the use of methamphetamines has been steadily increasing since 1990 in this age group. Almost 5% of high school seniors stated to being methamphetamine users, up from 2.7% in 1990. In high-use methamphetamine areas such as the Midwest, the use of methamphetamine among teenagers is even higher. A survey done in 1998 in Marshall County, Iowa, showed that almost one third of the 1,600 students in the county high school had tried methamphetamine.
When discussing the mental and psychological effects of methamphetamine, it is useful to examine the two main types of abuse patterns of this substance, since each pattern has distinct psychological consequences. The two main abuse patterns of methamphetamine are low-intensity use and binge, or high-intensity use.
Low-intensity users of methamphetamine are typically described as occasional users of the drug, and so are not classified as true methamphetamine addicts. Lowintensity users generally swallow or snort methamphetamine for the extra mental stimulation it provides and are not necessarily using the drug to get high. Low-intensity users include truck drivers, high school or college students, and other people who need to stay alert and be able to concentrate for long periods of time without sleep. When methamphetamine is used in this manner, most people will experience increased mental alertness, focus, and concentration, enhanced self-confidence, and greater energy. Most low-intensity users will not experience the euphoria associated with binge or high-intensity users.
Binge users, or high-intensity users, of methamphetamine generally smoke or inject the drug for the express purpose of getting high. Almost immediately after injecting or smoking the drug, the user will experience what is called a "rush," a euphoria that quickly becomes psychologically addictive. During this rush, the user will have feelings that are similar to having a sexual orgasm, along with increased heart rate and blood pressure. This psychological and physiological rush is caused by methamphetamine's effect of causing a release of epinephrine into the body and brain. Epinephrine is one of the body's hormones that is released when someone is very excited or frightened. There is also a release of a chemical in the brain called dopamine, which is naturally released in the brain when a person feels great pleasure. All the feelings a user has during a rush will last anywhere from five to 30 minutes.
After the rush, a binge user of methamphetamine will experience a high lasting four to 16 hours. This high is also known as the "shoulder," during which time a methamphetamine user will feel aggressive, smarter, and can be quite argumentative. After the high, many users will continue to smoke or inject methamphetamine for days on end. As the binge continues, they generally become more argumentative, combative, and mentally hyperactive. A binge episode can last from three to 15 days.
After a long binge, a period known as "tweaking" can set in. Tweaking occurs at the end of the binge when no amount of methamphetamine can bring back the rush or high. The user generally experiences mental symptoms of emptiness, depression, and paranoia; they also often suffer a form of methamphetamine-induced schizophrenia. Users who experience this will have visual or auditory hallucinations as well as the feelings of bugs crawling underneath their skin. Often, methamphetamine users will take heroin or drink alcohol during this stage to try to combat the negative mental effects.
An episode known as "crashing" finally occurs when the methamphetamine user falls into a deep exhaustive sleep. Crashing happens when all the body's stores of epinephrine have been used up. A crash can last from one to three days.
Methamphetamine is a very powerful stimulant that affects the central nervous system (CNS). The CNS is associated with thought and emotions, and movement, along with basic body functions such as heart rate and breathing rate. The brain and spinal cord are the major anatomical components of the CNS. Any substance, like methamphetamine, that can cause major changes in the CNS can most certainly have major and sometimes deadly consequences.
Two neurochemicals that are vitally important for the proper functioning of the CNS are dopamine and serotonin. By alternating the levels of both dopamine and serotonin in the CNS, methamphetamine is able to cause a wide range of physiological effects.
By directly affecting the central nervous system, methamphetamine initially causes a generalized feeling of energy, increased concentration, and lack of appetite. However, the initial feelings of mental enhancement soon give way to anxiety, depression, confusion, paranoia, and hallucinations. Seizures and convulsions are common side effects of methamphetamine use.
Methamphetamines indirectly cause side effects to many other areas of the body through their actions on the CNS. Concerning the heart, methamphetamine use can cause an increased and/or irregular heart rate; heart pains that a user may believe is a heart attack (and may actually be a heart attack); skipped heart beats, or palpitations; high or low blood pressure; and the bursting of blood vessels in the heart called an arterial aneurysm.
Methamphetamine can have damaging effects on the lungs. Its use can cause shortness of breath, wheezing, and asthma. There have been reports of a condition called pneumothorax among methamphetamine users that occurs when the lining of the lung actually rips away from the chest wall, causing a part of the lung to collapse.
Further into the body, methamphetamine has been implicated in damages to the kidney and liver. In the kidney, methamphetamine use has been shown to cause acute kidney failure by constriction of the blood vessels that nourish the kidney. In the liver, methamphetamines have been shown to cause direct liver damage both through the drug itself and through the many contaminants street methamphetamine often contains.
Harmful side effects
Through its action on the dopamine and serotonin neurons in the brain, methamphetamine can cause paranoia, hallucinations, and severe mood disturbances. Methampethamine can also cause stroke through an increase in blood pressure, along with seizures. Other commonly seen side effects include irregular heart rate, damage to small blood vessels in the brain and eyes, and hyperthermia, which is an unregulated increase in the body's temperature.
The effects of methamphetamine on unborn babies in pregnant women can be significant. Methamphetamine has been known to cause spontaneous abortions or severe birth defects. Babies born to mothers who use methamphetamine often have low birth weights, tremors, excessive crying spells, along with behavioral disorders that can last well into late childhood.
Long-term health effects
The most problematic long-term health effect of methamphetamine use is addiction, which can be considered a chronic, hard-to-treat disease characterized by chronic drug-seeking behavior and drug use. Methamphetamine is known to cause long-term changes to the brain, and scientists are just now beginning to understand how damaging these changes can be. Chronically addicted methamphetamine users can exhibit antisocial symptoms such as erratic violent behavior. Other long-term mental and behavioral changes that are seen include confusion, paranoia, auditory and visual hallucinations, and the sensation of insects crawling on the skin that is called "formication."
There can be such extensive damage to the brain from long-term use that it is often difficult to recognize a methamphetamine abuser from a person who has chronic schizophrenia.
Several recent studies have used brain-imaging studies to show the damaging effects of long-term methamphetamine use. In a study of 26 long-term metamphetamine users in California, magnetic resonance spectroscopy showed that the brains of these users had extensive damage as compared to people who were not long-term methamphetamine users. Another study in 2001 showed through the use of positron emission tomography (PET) scanning that the brains of long-term users of methamphetamine had significantly less neurons (brain cells) involved in the manufacture and transport of dopamine as compared to nonmethamphetamine users.
In addition to brain damage, long-term methamphetamine users suffer from other health effects. Chronic users of methamphetamine can damage their heart, resulting in inflammation of the heart lining. Long-term methamphetamine users, especially those that inject the drug, are commonly seen with skin ulcers and skin infections. Also, by using needles to inject the drug, chronic methamphetamine abusers are at high risk of developing hepatitis B and C, along with HIV and AIDS.
REACTIONS WITH OTHER DRUGS OR SUBSTANCES
Methamphetamine is often combined with other illegal drugs. A common combination is mixing methamphetamine with heroin, either in an injection or in smoking. This mixture is called a speedball. Methamphetamine users will also mix in cocaine to increase the initial rush. Methamphetamine addicts are often alcoholics.
Methamphetamine also changes the level of some commonly used legal medications. With the high levels of HIV and AIDS that are seen in intravenous drug users, many will be on anti-HIV medication. Methamphetamine increases the blood level of some anti-HIV medications, which could cause serious side effects. Also, many users of methamphetamine suffer from psychiatric problems, including depression. Methamphetamine increases the blood levels of a class of commonly used antidepressants known as tricyclic antidepressants, which, when taken at high levels, can cause respiratory depression and even death.
TREATMENT AND REHABILITATION
Many addiction specialists believe that methamphetamine addiction is one of the hardest, if not the hardest, illegal drug addictions to treat. Methamphetamines affect the brain of addicts in many ways, and actually causes marked brain changes and damage. Because of its powerful effects, methamphetamine is one of the most addictive illegal substances on the streets today. It may take months to years for people to get over long-term withdrawal symptoms such as anxiety, depression, and craving for the drug.
Currently, the most effective form of treatment for methamphetamine addiction appears to be cognitive behavioral interventions in a controlled treatment center. Cognitive behavioral interventions are designed to help modify and change a person's thinking processes, along with their expectations, behaviors, and skills in coping with the various stresses of life. Methamphetamine support groups have also been useful in keeping people off drugs for long periods of time.
There are currently no medications that can be given to methamphetamine addicts to help them quit their habit. The National Institute of Drug Abuse (NIDA) is currently testing several medications and substances in hopes that they will provide some help in treating methamphetamine addiction, including selegiline, which is a medication that increases dopamine levels in the brain and is currently used in treating patients with Parkinson's disease. Another substance is hydergine, which increases blood flow to the brain and is used to help patients with Alzheimer's dementia and those recovering from strokes. Other, more experimental substances include DADLE (D-Ala2,D-Leu5), which is a synthetic brain chemical that has been shown to block and reverse methamphetamine-induced brain damage in mice; glial-derived neuro-trophic factor, which has been shown to decrease methamphetamine's neurotoxic effects in monkeys; and natural and/or synthetic antioxidants, which have been shown to decrease or prevent methamphetamine's neurotoxic effects in mice.
PERSONAL AND SOCIAL CONSEQUENCES
The personal and social consequences of drug abuse are wide-reaching. Consequences of drug abuse affect all ethnic groups and all ages. The impact of drug abuse is a complete societal problem that leaves no person in this country, either directly or indirectly, untouched.
Methamphetamine addiction is quickly reaching epidemic proportions in some areas of the country. The drug lends itself to addiction in many ways. First, it is cheap to manufacture and therefore is inexpensive on the street, especially when compared to other powerful drugs such as cocaine or heroin. Second, smoking or injecting methamphetamine brings on an almost instantaneous high that lasts much longer than an equivalent amount of cocaine. However, because tolerance to methamphetamine occurs quite rapidly, users typically indulge in what is referred to as a "binge and crash" pattern of use, that is, using methamphetamine over and over to try and recreate their original high.
The personal consequences of methamphetamine abuse can be staggering. People addicted to methamphetamine generally have a variety of psychiatric and medical problems. As compared to persons their own age, people who abuse methamphetamine have a significantly higher incidence of anxiety, depression, schizophrenic-like symptoms, paranoia, drastic mood swings, and other serious psychiatric disorders. Long-term users of methamphetamine often display very violent behaviors. Methamphetamine abusers also suffer from multiple medical problems. Due to their intravenous use, methamphetamine addicts have a very high rate of hepatitis B, hepatitis C, and HIV. People who abuse methamphetamines are also at higher risk of high blood pressure and irregular heart rates.
The effects of having a family member who is addicted to methamphetamine can be terrible for the user's spouse and children. Addicts often find that maintaining meaningful employment is almost impossible. Likewise, maintaining stable relationships or marriage and making and keeping friends are nearly impossible tasks for addicts. Most methamphetamine addicts have to steal in order to maintain their habit, so they are at very high risk of being jailed.
The children of methamphetamine addicts also suffer from the their parent's addiction. The risk of danger to them begins even before birth. Methamphetamine use during pregnancy decreases the life-sustaining blood flow to the unborn child, along with having a direct toxic effect on the developing baby's brain. After birth, infants born to mothers who are methamphetamine addicts may show classical withdrawal signs, including uncontrollable trembling, trouble making eye contact, trouble feeding, and sleeping excessively.
These children grow up and show higher levels of aggressive behavior, have greater difficulty adjusting to different social environments, and have a higher rate of difficulties at school when compared to children whose mothers were not methamphetamine users.
Methamphetamine users also pose a danger to the communities in which they reside. Many users of methamphetamine also manufacture the drug, since the precursor chemicals needed are cheap and easily available. However, these chemicals are highly toxic, and thus introduce the risk to the community of toxic gases, fires, and explosions.
Chemical residues and waste generated in the manufacturing of methamphetamine pose a serious danger to the environment. This waste is often poured down the drain, into storm sewers, or into crudely dug pits in the ground. These chemicals can leach into the soil and groundwater and cause contamination for many years.
The federal penalties for methamphetamine use and trafficking are quite severe. The basic, mandatory minimum sentences under federal law are five years in prison for 10 grams of methamphetamine, and 10 years in prison for 100 grams of the drug. State penalties vary considerably. A methamphetamine user in Minnesota caught with 10 grams of the drug would face a $500,000 fine and 25 years in prison. However, the same offender in Virginia would face fines of only $1,000 and six months in prison.
Methamphetamine was discovered and first produced in Japan in 1919. It was quickly introduced to the United States and was marketed initially as an over-the-counter remedy for congestion and asthma. In World War II, it was widely produced by the government and used by military personnel in the war effort. After World War II, it became a prescription drug and was used for weight loss and for its stimulating effects. In 1970, methamphetamine and amphetamine came under strict control of the U.S. government through the Comprehensive Drug Abuse Prevention and Control Act.
Federal guidelines, regulations, and penalties
Methamphetamine use is under strict governmental controls and laws. The Comprehensive Drug Abuse Prevention and Control Act of 1970 established five schedules, or lists, of controlled medications and substances, with substances in Schedule I having the highest abuse potential and substances in Schedule V having the lowest abuse potential. Methamphetamines are classified as a Schedule II drug. According to the government, all Schedule II drugs have a high potential for abuse, have the potential to lead to severe mental or physiological dependence, and have currently accepted medical uses.
Due to the destructive nature of methamphetamine on both its users and the community at large, the federal government has continued to play an increasing role in its control. The Comprehensive Methamphetamine Control Act of 1996 increased penalties for the manufacture, distribution, and possession of methamphetamine, as well as the reagents and chemicals needed to make it. The act also required that any products containing pseudoephedrine, a key ingredient in the manufacturing of methamphetamine, must be sold only in blister packs, with the intent of making it harder for methamphetamine makers to purchase large amounts. Stores that sell pseudoephedrine were also required to report any large-volume sales of the chemical.
Two more laws were passed in 1998 to control methamphetamine. While the Speed Trafficking Life in Prison Act increased penalties for the production, distribution, and use of methamphetamine, the Drug Free Communities Act offered federal money to communities to help educate citizens on the dangers on methamphetamine use and production.
In 1999, the DEFEAT Methamphetamine Bill authorized $30 million for the Drug Enforcement Administration (DEA) to develop a comprehensive, nationwide plan to target and control methamphetamine. It also added $25 million for methamphetamine prevention efforts, especially in rural and urban areas hard hit by methamphetamine use. This bill also added to the list of chemicals considered precursors to methamphetamine production that could result in criminal penalties. In the same year, the Comprehensive Methamphetamine Abuse Reduction Bill authorized more federal money for methamphetamine treatment and prevention programs, as well as targeting federal resources to high-use methamphetamine areas.
The federal Office of National Drug Trafficking Areas has identified multiple areas in the United States that have particularly high rates of methamphetamine use and manufacturing. These areas are known as High Intensity Drug Trafficking Areas (HIDTA), including Iowa, Kansas, Missouri, Nebraska, and South Dakota. Through the designation of these HIDTA areas, federal law enforcement agencies hope to promote a comprehensive, cooperative strategy with local and state law enforcement agencies to significantly reduce metamphetamine trafficking and use.
See also Amphetamines
Bray, R., and Mary Ellen Marsden. Drug Use in Metropolitan America. Thousand Oaks, CA: Sage Publications, 1997.
Lowinson, J., et al. Substance Abuse: A Comprehensive Textbook. Baltimore: Williams & Wilkins, 2001.
McDowell, D., and Henry Spitz. Substance Abuse: From Principles to Practice. Philadelphia: Taylor & Francis, 1999.
Pennell, S., et al. Meth Matters: Report on Methamphetamine Users in Five Western Cities. Washington, DC: U.S. Department of Justice, 1999.
Smith, D., and Richard Seymour. Clinician's Guide to Substance Abuse. New York: McGraw Hill, 2000.
Volkow, N., L. Chang, G. Wang, et al. "Association of Dopamine Transporter Reduction with Psychomotor Impairment in Methamphetamine Abusers." The American Journal of Psychiatry 3 (March 2001): 377-382.
Volkow, N., L. Chang, G. Wang, et al. "Higher Cortical and Lower Subcortical Metabolism in Detoxified Methamphetamine Abusers." The American Journal of Psychiatry 3 (March 2001): 383-389.
Koch Crime Institute. <http://www.kci.org/meth>.
National Institute on Drug Abuse. <http://www.drugabuse.gov>.
Edward R. Rosick, D.O., M.P.H.
Methamphetamine is a central nervous system (CNS) stimulant with recognized medical value. The U.S. Drug Enforcement Administration (DEA) lists methamphetamine as a Schedule II drug, which means it has high abuse potential and must be prescribed by a prescription that cannot be refilled.
Methamphetamine is produced illegally in many countries, including the United States, and can be synthesized with readily available materials. The drug’s misuse is deemed to be a major societal problem. Methamphetamine is highly addictive and goes by the street names of ice, crystal, crystal meth, speed, crank, and glass.
Description and doses
Methamphetamine is similar to other CNS stimulants, such as amphetamine (its parent drug),
methylphenidate , and cocaine , in that it stimulates dopamine reward pathways in the brain . Consistent with its stimulant profile, methamphetamine causes increased activity and talkativeness, decreased appetite and fatigue , and a general sense of well-being. Compared to amphetamine, methamphetamine is more potent and longer lasting, and it has more harmful effects on the brain. In animals, a single high dose of methampetamine has been shown to damage nerve terminals in the dopamine-containing regions of the brain.
Approved medical indications for the drug are the sleep disorder narcolepsy , attention deficit hyperac-tivity disorder, and extreme obesity , but in each case methamphetamine is a second-line drug at best.
The prescription drug (brand name Desoxyn) comes in the form of a small white tablet, which is orally ingested. Dosing begins at 5 mg once or twice a day and is increased weekly until the lowest effective dose is attained. Desoxyn should not be taken with other stimulants (including caffeine and decongestants) or antidepressant drugs (especially monoamine oxidase inhibitors, but also tricyclic antidepressants ). Desoxyn should not be taken by patients with glaucoma, cardiovascular disease (including hypertension and artiosclerosis), or hyperthyroidism.
Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. Misuse occurs in many forms, as methamphetamine can be smoked, snorted, injected, or taken orally. When smoked or injected, methamphetamine enters the brain very rapidly and immediately produces an intense but short-lived rush that many abusers find extremely pleasurable. Snorting or oral ingestion produces euphoria—a feeling of being high—within minutes. As with other abused stimulants, methamphetamine is most often used in a binge-and-crash pattern. A “run” of repeated doses may be continued over the course of days (binge) before stopping (crash). Exhaustion occurs with repeated use of methamphetamine, involving intense fatigue and need for sleep after the stimulation phase.
National surveys have found that more than 10 million people have tried methamphetamine at least once and more than a million reported use in the last year. Teenagers are a target group for prevention strategies as adolescence and young adulthood are associated with exposure to and an inclination to experiment with drugs. Indeed, 4.5% of high school seniors said that they had tried methamphetamine.
Evidence suggests that methamphetamine abuse is a growing problem in the United States. Emergency room visits related to the drug increased 50% between 1995 and 2002, and treatment program admissions for methamphetamine addiction increased from 1% of all drug abuse admissions in 1992 to 8% in 2004.
Short-term effects of methamphetamine relate to its stimulation of the brain and the cardiovascular system. Euphoria and rush, alertness, increased physical activity, and decreased sleep and appetite occur, and any or all of these effects can lead to compulsive use of the drug that characterizes addiction. In addition, methamphetamine causes rapid heart beat, increased respiration, and increased blood pressure, and with very high doses, hyperthermia and convulsions can occur.
Chronic use of methamphetamine can result in two hallmark features of addiction: tolerance and dependence. Tolerance to the euphoric effects in particular can prompt abusers to take higher or more frequent doses of the drug. Withdrawal symptoms in chronic users include depression , anxiety , fatigue, and an intense craving for the drug. Users who inject methamphetamine risk contracting life-threatening viruses such as HIV and hepatitis through the use of dirty needles.
With repeated use, methamphetamine can cause anxiety, insomnia , mood disturbances, confusion, and violent behavior. Psychotic features sometimes emerge, such as paranoia , hallucinations , and delusions , and can last well after methamphetamine use
Addiction —A chronic condition characterized by compulsive drug-seeking and drug-using behavior.
Amphetamine —A central nervous system stimulant.
Antidepressant —A medication taken to alleviate clinical depression.
Antipsychotic —A medication taken to alleviate psychotic symptoms, including delusions and hallucinations.
Attention deficit hyperactivity disorder —A mental disorder in which patients have trouble paying attention, sitting still, and controlling impulses; usually emerges in childhood.
Central nervous system (CNS) —The brain and spinal cord.
Cocaine —A central nervous system stimulant that is highly addictive and widely abused.
Craving —A powerful and sometime uncontrollable urge to take drugs.
Dependence —An altered psychological or physiological state produced by repeated administration of a drug such that continued presence of the drug is required to prevent withdrawal.
Dopamine —A chemical messenger in the brain that regulates reward and movement.
Methylphenidate —A central nervous system stimulant that alleviates the symptoms of attention deficit hyperactivity disorder.
Tolerance —The physical state produced when, with repeated dosing, a drug produces a smaller effect or a higher dose is required to achieve the same effect.
Withdrawal —A syndrome of ill effects that occurs when administration of a dependence producing drug ceases.
has stopped. Changes in brain and mental function have been demonstrated with chronic use. While some effects are reversible, others are very long-lasting, perhaps representing permanent neurotoxicity. Stroke and weight loss are other long-term effects.
For acute intoxication accompanied by psychosis , patients may be calmed by reassurance and a quiet setting, but sometimes antipsychotic drugs are warranted.
The most effective treatment for methamphet-amine addiction is cognitive-behavioral intervention such as counseling but may also include family education , drug testing, and group support in a twelve-step program. The goal of these modalities is to modify the patient’s thinking, expectancies, and behaviors to increase coping skills in the face of life’s stressors. Contingent management is a promising behavioral intervention, where incentives are provided in exchange for staying clean and for participating in treatment.
Antidepressant drugs such as buproprion can be a useful treatment aid, but at this time there are no FDA-approved medications to treat stimulant addiction.
“Amphetamines.” The Merck Manual of Diagnosis and Therapy, Professional Edition. 18th ed. Mark H. Beers, ed. Whitehouse Station, NJ: Merck & Co., 2005.
“Methamphetamine.” AHFS Drug Information. Gerald K. McEvoy, Pharm.D, ed. Bethesda: American Society of Health-System Pharmacists, 2006.
“Methamphetamine: Abuse and Addiction.” The National Institute on Drug Abuse Research Report Series. NIH Publication Number 06–4210, Sept. 2006.
“Drug Scheduling.” U.S. Drug Enforcement Administration.http://www.usdoj.gov/dea/pubs/scheduling.pdf
Jill U. Adams
meth·am·phet·a·mine / ˌme[unvoicedth]əmˈfetəˌmēn; -min/ • n. a synthetic drug, C6H5CH2CH(CH3)NH(CH3), with more rapid and lasting effects than amphetamine, used illegally as a stimulant and as a prescription drug to treat narcolepsy and maintain blood pressure.