Methamphetamine

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METHAMPHETAMINE

OFFICIAL NAMES: Methampethamine

STREET NAMES: Meth, speed, crank, zip, chalk, ice, crystal

DRUG CLASSIFICATIONS: Schedule II, stimulant

OVERVIEW

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.

CHEMICAL/ORGANIC COMPOSITION

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."

INGESTION METHODS

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.

THERAPEUTIC USE

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.

USAGE TRENDS

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.

MENTAL EFFECTS

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.

PHYSIOLOGICAL EFFECTS

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.

LEGAL CONSEQUENCES

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.

Legal history

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

RESOURCES

Books

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.

Periodicals

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.