Methamphetamines

University of Pittsburgh Graduate

 Learning objectives
1. To provide a historical context of
methamphetamine use and abuse
2. To overview medicinal uses of
methamphetamine
3. To discuss mechanisms and outcomes of
methamphetamine abuse
4. To discuss the challenges of
methamphetamine research
 What is methamphetamine?
Formula C10H15 N
Molecular mass: 149.233 g/mol
Half life: 9-15 hours
Excretion: renal
 What is methamphetamine?

Source – NIDA Research Report – 1998

 History of meth
• Amphetamine created in Germany in 1887

• Used widely during WWII by the Nazi

and Japanese armies

• Japanese kamikaze pilots were

documented to be high on meth
• Major challenge in postwar Japan

• Biker gangs in California after WWII

began to distribute meth

Source – Nebraska State Patrol

Methamphetamine: medical uses
• Narcolepsy
• Attention deficit disorder
• Obesity (short term use)
Forms of Distribution
What does meth look like?
• Typically an odorless powder that
dissolves quickly in water

• Another form of meth is clear chunky

crystals referred to as crystal meth or
ice

• May be in the form of small brightly

colored tablets, referred to as YABA
 How is meth used?
• Injected
• Snorted
• Smoked
• Orally
Methamphetamine/Amphetamine Treatment Admissions
by Route of Administration: 1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

 Meth causes…
• Increased alertness
• Decreased appetite
• A distorted sense of well-
being
• Effects that can last 8 to 24
hours
 U.S. Emergency Dept. Mentions of
Meth/amphetamines 1995-2002
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
1995 1996 1997 1998 1999 2000 2001 2002

DAWN, July 2004

 Demographics of MA-related
ED visits in U.S., 2002
58% male and 42% female
Race/ethnicicty
White 65%
Latino 11%
African American 6%
Age
Under 18 11%
18-34 years 56%
Over 34 33%
DAWN, 2004
 Behavior changes Health changes
Psychotic behavior Stroke
Paranoia Brain damage
Aggression Weight loss
Anxiety Death
Fatigue
Depression
Delusions
Mood swings
Confusion
Insomnia
Hallucinations

Source – Congressional Research Sites

 How does methamphetamine
work?
Methamphetamine releases large
amounts of dopamine in the brain,
causing feelings of pleasure and
euphoria.
Source: National Institute on Drug Abuse. April 1998,
Reprinted January 2002. Research Report Series: Methamphetamine
Abuse and Addiction.
www.nida.nih.gov/ResearchReports/methamph/methamph.html
Effects of meth on dopamine

Researchers report that the

dopamine-producing cells in
the brain can be damaged
after prolonged exposure to
relatively low levels of
methamphetamine.
 Natural Rewards Elevate Dopamine
FOOD
Levels SEX

DA Concentration (% Baseline)
200 200
NAc shell
% of Basal DA Output

150 150

Copulation Frequency
100 100
15

Empty 10
50
Box Feeding
5

0 0
0 60 120 180 ScrScr Scr Scr
BasFemale 1 Present Female 2 Present
Time (min) Sample 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Number
Mounts
Intromissions
Ejaculations

Source: Di Chiara et al. Source: Fiorino and Phillips

 Effects of Drugs on Dopamine Levels
1100 Accumbens AMPHETAMINE Accumbens
COCAINE
1000 400
% of Basal Release

% of Basal Release
900
800 DA
DA 300 DOPAC
700 DOPAC
HVA
600 HVA
500 200
400
300
200 100
100
0
0 1 2 3 4 5 hr 0
0 1 2 3 4 5 hr
Time After Amphetamine Time After Cocaine

250
NICOTINE 250 Accumbens MORPHINE
% of Basal Release

% of Basal Release
Dose (mg/kg)
200 Accumbens
200 0.5
Caudate 1.0
150 2.5
150 10

100
100

0
0 1 2 3 hr 0
0 1 2 3 4 5hr
Time After Nicotine Time After Morphine
Source: Di Chiara and Imperato
PET Scan of Long-Term Meth Brain Damage
 Long-term effects: What will happen
in the future

Methamphetamine destroys the endings of dopamine

containing nerve cells
(NIDA 2)
 Partial Recovery of Brain from
Methamphetamine After Abstinence

ml/gm

Normal Control METH Abuser METH Abuser

(1 month abstinent) (14 months abstinent)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Dopamine improvements after 1 year, but not cognitive and motor functioning
 Methamphetamine
Acute Physical Effects
Increases Decreases
Heart rate – Appetite
Blood pressure – Sleep
Pupil size – Reaction time
Respiration
Sensory acuity
Energy
 Methamphetamine
Acute Psychological Effects
Increases Decreases
Confidence Boredom
Alertness Loneliness
Mood Timidity
Sex drive
Energy
Talkativeness
 Highly Toxic Substances
Drain cleaner
Battery acid
Antifreeze
Over-the-counter asthma medicine
containing ephedrine or pseudoephedrine
Match-box striker (Red phosphorous)
Hydrochloric acid
Lye
Lantern fuel
(KCI)
 Methamphetamine use and
pregnancy
Possible effects found in the few human
studies that exist include increased rates of
premature delivery, placental abruption
(early separation of a normal placenta from
the wall of the uterus), retarded fetal growth,
and cardiac and brain abnormalities.
Source: Volkow, Nora, M.D., Director, NIDA. April 21, 2005. Testimony Before the Subcommittee on Labor, Health,
and Human Services; Education; and Related Agencies. Committee on Appropriations, U.S. Senate.
www.hhs.gov/asl/testify/t050425b.html
Meth Mouth: Myth and Reality
 How many Americans use
methamphetamines?
Lifetime use: 4.9 percent of those aged 12 and
over (12 million people)
Past-year use: 0.6 percent of those aged 12
and over (1.4 million people)
Past-month use: 0.2 percent of those aged 12
and over (600,000 people)
Source: The Substance Abuse and Mental Health Services Administration/Office of Applied Studies. September 16,
2005. The NSDUH Report: Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004, In Brief.
http://oas.samhsa.gov/2k5/meth/meth.htm
 Environmental effects of meth
• Meth production leaves behind 5 to 6 pounds
of toxic waste per pound of meth produced.

• Toxic by-products contaminate sites where

meth is produced, posing serious health and
environmental hazards to those nearby.

• The cost to clean up one meth lab often

exceeds $4,000.

Source – Koch Crime Institute

 Impacts on families
• Danger of children being exposed
to toxic fumes
• Children are more at risk than
adults to environmental hazards,
as their bodies are immature
• Risk of explosion, fire, and
chemical burns
• Exposure to weapons, finished
drugs, and unsanitary conditions
More impacts on families
• Increase in child abuse and neglect
cases
• Increased risk for substance abuse
among children in later life
• A rise in domestic disputes
 Is there an effective treatment for
methamphetamine abuse?
At this time the most effective treatments for
methamphetamine addiction are cognitive
behavioral interventions. These approaches are
designed to help modify the patient's thinking,
expectancies, and behaviors and to increase skills in
coping with various life stressors.
Methamphetamine recovery support groups also
appear to be effective adjuncts to behavioral
interventions that can lead to long-term drug-free
recovery.
 U.S. admissions for
MA drug treatment

SAMSHA, 2004
 Epidemiology
High prevalence of HIV in patients who use crystal
MA
• Shoptaw, et al, J Addict Dis 2002 showed in a CA study that
61% of men seeking tx for MA had HIV infection
– 77% of men were white, 17% were Latino
– All were in their mid 30’s and had some college education
– Reported a mean of 66 different partners in 6 months
– Persons with HIV were more likely to have injected MA,
contracted an STD and had more UAI
• Klitzman, et al Am J Psychiatry 2000 reported strong
association between MDMA use and high-risk sexual behavior
• 2001 report in MMWR found that in an outbreak of 130 cases
of syphilis in CA, 51% were MSM and 18% reported use of
MA
 Epidemiology
Study of 25 HIV+ gay men using MA
(Semple et al., J Subst Abuse Treat 2002)
– “provided temporary escape from being HIV+”
– “helps manage negative self-perception and
social rejection associated with being HIV+
– “method of coping with the specter of death”
 Key points on methamphetamine
Methamphetamine is a drug that can be effectively used for several
medical conditions
When used illegally, Meth is a powerful, highly addictive stimulant
that can be made easily from legally available products.
Twelve million Americans ages 12 and over have used meth at least
once; use is most common between ages 19 and 40.
Meth labs use and produce toxic, explosive chemicals; meth labs
are dangerous and expensive to clean up.
Exposure to chemicals used to make meth may cause cancer,
damage the brain and other organs, and result in birth defects.