Methamphetamine

Aka: Methamphetamine, Methamphetamine Hydrochloride

1. See Also
   1. Amphetamine
   2. MDMA
   3. Cocaine
2. Background: Street Names
   1. Methamphetamine
      1. Speed
      2. Meth
      3. Chalk
   2. Methamphetamine Hydrochloride (Crystalline)
      1. Crystal Meth
      2. Glass
      3. Ice
3. Definition
   1. Stimulant drug of abuse similar to Cocaine
   2. Manufactured from Pseudoephedrine
4. Epidemiology
   1. Prevalence: 2.8% of U.S. adults 18 to 26 years of age
      1. More common in those living in Western United States
      2. Iritani (2007) Addiction 102:1102-13
   2. Ethnicity
      1. Most Methamphetamine users are white (0.7% of white population)
      2. Pacific islanders (e.g. Hawaii) and Native Americans (2.2 to 1.7% of these populations)
   3. Other populations with higher use percentages of Methamphetamine abuse
      1. Homosexual men
5. Effects
   1. Stimulant agent similar to Cocaine
   2. Used orally, intranasally, intravenously, smoked or inserted rectally
   3. Effect: Initial
      1. Immediate rush-sensation that lasts for minutes (limited to smoked or IV forms)
      2. Euphoria
      3. Hightened alertness
      4. Increased energy
      5. Increased libido (and associated high risk sexual behavior)
      6. Diminshed appetite
   4. Effect: Later as drug wears off
      1. Prolonged sleep or Sedation
      2. Dysphoria
6. Pharmacokinetics
   1. Half-life: 12 hours
   2. Metabolized by liver via Cytochrome P2D6 system
7. Pathophysiology
   1. High potential for abuse and dependence
   2. Enhances mood via stimulation of Dopamine release
   3. Nerve terminals recede in response to Methamphetamine
      1. Affects Dopamine and Serotonin nerve endings
      2. Effects may be permanent
8. Adverse Effects: Acute
   1. Most related deaths occur from homicides, Suicides and accidents following use
   2. Similar to other adrenergic agents (e.g. Amphetamine)
      1. See Sympathomimetic Toxicity
   3. Vascular effects
      1. Sympathomimetic effects (Tachycardia, Hypertension, hyperthermia)
      2. Cerebrovascular Accident
      3. Myocardial Infarction
9. Adverse Effects: Chronic
   1. Addiction
   2. Irreversible neuronal destruction
      1. Memory loss
      2. Learning Impairment
      3. Motor slowing
   3. Psychiatric Changes
      1. Worsening Mood Disorders
         1. Anxiety Disorder
         2. Depression with increased Suicidal Ideation
      2. Psychosis (esp. paranoia)
   4. Premature aging effect
   5. Chronic malnutrition and associated anorexia
   6. Severe Tooth Decay ("meth mouth")
   7. Skin Abscesses (related to skin-picking behaviors)
10. Adverse Effects: Pregnancy
    1. Placental Abruption
    2. Fetus
       1. Intrauterine Growth Retardation
       2. Prematurity
       3. Cleft Lip and Palate
       4. Heart defects
    3. Newborn withdrawal
       1. Abnormal sleep or food intake
       2. Tremors
    4. Infant
       1. Methamphetamine is secreted in Breast Milk
11. Labs: Drug Screening
    1. Urine Drug Screen positive for 48 hours after use
    2. Hair analysis detects Methamphetamines
    3. Meconium testing is preferred for Newborn Screening
       1. Positive for Methamphetamine use in the second half of pregnancy
12. Management: Acute Toxicity
    1. See Sympathomimetic Toxicity
    2. Consider Gastric Lavage with Activated Charcoal if Methamphetamine was ingested
13. Management: Chemical Dependency Treatment
    1. Chemical Dependency Program (e.g. Matrix Model)
    2. Contingency management program with rewards for patients with negative Urine Drug Screens
    3. Medications which may offer benefit
       1. Fluoxetine and Bupropion may reduce short-term cravings
       2. Imipramine improves compliance with therapy
    4. References
       1. Cretzmeyer (2003) J Subst Abuse Treat 24: 267-77
14. Associated Conditions (related to demographics of Methamphetamine use)
    1. Human Immunodeficiency Virus (HIV Infection)
    2. Hepatitis C Infection
    3. Criminality
    4. Hazardous environment
       1. Methamphetamine produces 6 pounds of toxic waste for every 1 pound of drug
       2. Methamphetamine lab explosions are not uncommon
15. References
    1. Winslow (2007) Am Fam Physician 76(8):1169-76
    2. (2004) Med Lett Drugs Ther 46:62-3
16. Resources
    1. National Institute on Drug Abuse: Methamphetamine
       1. http://www.drugabuse.gov/drugpages/methamphetamine.html