Methamphetamine, commonly known as “meth”, is a highly addictive stimulant drug that affects the central nervous system. While it is available as a prescription drug under the brand name Desoxyn® indicated for the treatment of attention deficit hyperactivity disorder and obesity, it is more commonly encountered as an illegal and dangerous street drug. Also known as blue, ice, crystal and speed, meth takes the appearance of a white, odorless, bitter-tasting crystalline powder that can be smoked, insufflated (snorted) or injected. When smoked or injected, the high from methamphetamine is felt instantly, peaks within 15 minutes and typically lasts 4-8 hours.
According to a 2017 survey by the National Survey on Drug Use and Health, approximately 1.6 million Americans had reported using methamphetamine in the past year, with the average age of a first-time user being 23.3 years old. While methamphetamine is accessible anywhere in the country, its use is significantly more prevalent in the western and midwestern United States.
The Drug Enforcement Agency (DEA) has identified the primary source of large-scale methamphetamine production originating from Mexican drug cartels, which smuggle the drug across the United States-Mexico border.5 Meth is also produced in the United States as well, where users and/or distributors synthesize meth in clandestine “meth labs.” Far from pristine, meth labs use crude household products to manufacture meth in filthy conditions. Below are some of the ingredients used:
Acetone – an extremely flammable compound; primary ingredient in nail polish remover
Anhydrous ammonia – colorless, pungent gas used as agricultural fertilizer
Pseudoephedrine – the active ingredient found in the nasal decongestant Sudafed®; it is a key chemical precursor to methamphetamine
Lithium – corrosive chemical found in battery acid
Red phosphorus – highly flammable substance used for match tips
Toluene – a solvent used in the production of paint thinner
Possession of these ingredients should serve as a red flag to the possibility of meth production and/or use, particularly excessive purchasing of pseudoephedrine. In 2005, the Combat Methamphetamine Epidemic Act was passed to curb meth production. The Act mandates that retailers require photo identification upon purchase, track purchase history and limit the sale of pseudoephedrine-containing products.
Meth works by flooding the brain with dopamine, our body’s natural “feel-good” chemical, as well as norepinephrine, a chemical associated with arousal and alertness. As a result, users often experience intense euphoria, hyper-confidence and a feeling of never-ending energy.
Psychological symptoms of methamphetamine intoxication include:
Physical symptoms of methamphetamine intoxication include:
increased and/or irregular heart rate
increase in blood pressure
increase in body temperature
While under the influence, users may feel capable of anything and often engage in high-risk behavior such as gambling, criminal activity and unprotected sex.
Due to its long-lasting stimulant properties, meth users may go several days without sleep. During this period of no sleep, known as “tweaking,” the user becomes increasingly paranoid, aggressive and prone to mood swings as the lack of sleep wreaks havoc on their mental health.
The stages of methamphetamine abuse often follow a predictable “binge and crash” pattern outlined below:
The Rush – After administration, the user feels an intense “rush” of euphoria within seconds as dopamine and norepinephrine flood their brain.
The High – Once the initial rush subsides, the effects of the drug linger, lasting up to 14 hours. During this time the user may act aggressive and engage in high-risk behavior.
The Binge – In an effort to stay high, the user continues to use the drug for several days, often forgoing sleep and food completely.
The Crash – After binging for days without sleep, the user will inevitably suffer a crash when they either run out of meth or cannot stay awake any longer. The crash is associated with extreme exhaustion as they recover from days of sleep deprivation.
Meth addicts often exhibit a characteristic appearance.
Malnourished – Due to meth’s appetite suppressant properties, addicts are often underweight and have thin hair due to a lack of proper nutrient intake.
Tired – Many addicts have shallow, sunken eyes due to the extreme insomnia experienced during drug binges
Trace marks – Users who inject the drug may have bruised or bloodied “trace marks” on their arms at the site of injection.
Meth sores – During the binge portion of the abuse cycle, many users experience hallucinations of bugs crawling under their skin. As a result, users are often riddled with sores along their body from trying to pick off the imaginary bugs.
Long term effects of meth abuse can result in profound mental changes such as paranoia, psychosis and depression. Because meth addicts will often go days without eating and neglecting person hygiene, many addicts develop “meth mouth,” characterized by severe tooth decay. A 2015 study found that out of 571 meth users, 96% had cavities, 58% had untreated tooth decay and 31% had at least six missing teeth.
Many meth users choose to inject the drug intravenously, causing the effects to be felt instantly. This is perhaps the most dangerous method of taking meth, as research has shown that injecting a drug leads to addiction the fastest. In addition, the use of dirty needles can result in skin and soft tissue infections as well as heart valve infections such as endocarditis. Many users also share needles, drastically increasing the risk of contracting blood-borne diseases such as HIV and hepatitis C. The CDC estimates that intravenous drug users accounted for approximately 9% of HIV cases in 2016.
Acute Phase – The acute phase of withdrawal, lasting 2-3 days, is characterized by extreme exhaustion and increased appetite, as the user has likely not slept or eaten during the binge portion of the drug cycle.
Post-Acute Phase – The next phase, lasting 7-10 days, is characterized by continued sleep difficulty and loss of appetite.8 Significant depression can occur during this stage as the drug has depleted the body’s “feel good” chemicals. Lingering
Symptoms – Withdrawal symptoms can persist for up to three weeks following the last dose, where sleep difficulties continue and the body’s heart rate remains low.
While these are general timelines, the length of each withdrawal phase varies for each individual. Users who have been abusing meth for a longer period can expect withdrawal to last longer, sometimes up to months until complete recovery.
Addiction treatment for meth is notoriously difficult, as there are no FDA-approved treatments. Unlike drugs such as opioids and benzodiazepines, withdrawal from meth is not likely to be physically dangerous, though that does not mean it is any easier to detox from.
The immediate goal of meth detoxification is complete cessation of meth and control of withdrawal symptoms. Some health care practitioners may choose to use benzodiazepines such as Xanax to control the anxiety and aggression associated with withdrawal as the body acclimates to functioning without meth. Treatment will primarily focus on behavioral therapies to reverse the psychological damage done by meth. These therapies may include counseling sessions and group therapy as part of the rehabilitation process.
Research has been conducted on the use of naltrexone, a drug commonly used to treat opioid and alcohol addiction, in the management of meth addiction. A 2015 study9 found that naltrexone significantly reduced meth craving following detoxification. It was also found to dull the pleasurable feelings associated with meth.
With drug craving being a core symptom of meth addiction that persists long after withdrawal symptoms subside, naltrexone may have utility in preventing relapse following successful detoxification from meth.Treatment of meth addiction is a difficult process that requires the support of a qualified healthcare professional. While some attempt to quit meth on their own without help, it is significantly more effective to enroll in a treatment program that can help manage withdrawal symptoms and build strategies to prevent future use.