Definition

Addiction is defined as a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use and by neurochemical and molecular changes in the brain.

Amphetamines are substances taken to boost energy, mood, confidence and to suppress appetite (Morrison, 1995). Amphetamine is a collective term given to amphetamines, dextroamphetamines and methamphetamines, all of which act similarly in the body.

Out of these, methamphetamines are the strongest (according to NIDA). In the 1930s, it was used in nasal decongestants, and was used to treat narcolepsy, ADHD and Minimal brain dysfunction (MBD). Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.

Methamphetamine is commonly known as “speed,” “meth,” and “chalk.” In its smoked form, it is often referred to as “ice,” “crystal,” “crank,” and “glass.” It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. The drug was developed early in this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine’s chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours. After the initial “rush,” there is typically a state of high agitation that in some individuals can lead to violent behavior.

Methamphetamine is classified as a psychostimulant, as are other drugs of abuse such as amphetamine and cocaine. We know that methamphetamine is structurally similar to amphetamine and the neurotransmitter dopamine, but it is quite different from cocaine. Although these stimulants have similar behavioral and physiological effects, there are some major differences in the basic mechanisms of how they work at the level of the nerve cell. However, the bottom line is that methamphetamine, like cocaine, results in an accumulation of the neurotransmitter dopamine, and this excessive dopamine concentration appears to produce the stimulation and feelings of euphoria experienced by the user. In contrast to cocaine, which is quickly removed and almost completely metabolized in the body, methamphetamine has a much longer duration of action and a larger percentage of the drug remains unchanged in the body. This results in methamphetamine being present in the brain longer, which ultimately leads to prolonged stimulant effects.

Methamphetamine comes in many forms and can be smoked, snorted, orally ingested, or injected. The drug alters moods in different ways, depending on how it is taken. People often ingest amphetamines by snorting them through the nostril initially. However, the level of absorption through this form of intake is not as predictable and rapid as injection or smoking (Morrison, 1995).

Immediately after smoking the drug or injecting it intravenously, the user experiences an intense rush or “flash” that lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria - a high but not an intense rush. Snorting produces effects within 3 to 5 minutes, and oral ingestion produces effects within 15 to 20 minutes.

As with similar stimulants, methamphetamine most often is used in a “binge and crash” pattern. Because tolerance for methamphetamine occurs within minutes - meaning that the pleasurable effects disappear even before the drug concentration in the blood falls significantly - users try to maintain the high by binging on the drug.

In the 1980s, “ice,” a smokable form of methamphetamine, came into use. Ice is a large, usually clear crystal of high purity that is smoked in a glass pipe like crack cocaine. The smoke is odorless, leaves a residue that can be resmoked, and produces effects that may continue for 12 hours or more.

Symptoms
Using amphetamines once is sufficient to induce some of these symptoms:

Short Term Effects:

 
• Enhances mood and body movement  
• Increased wakefulness, physical activity  
• Increased respiration  
• Euphoria  
• Insomnia  
• Increased heart rate  
• Increased blood pressure  
• Reduced appetite  
• Cardiovascular collapse ? death  
• Dilated pupils

Long Term Effects:

 
• Damages brain cells containing serotonin  
• Over time, it reduces the level of dopamine resulting in Parkinson’s-like symptoms  
• Weight loss  
• Confusion  
• Tremors  
• Convulsion  
• Paranoia  
• Hallucinations  
• Damage to nerve cells - causing strokes  
• Cardiovascular collapse - death

Effects from Withdrawal:

 
• Irritability  
• Anxiety  
• Paranoia  
• Aggressiveness  
• Fatigue and long periods of sleep  
• Depression

Behaviors resulting from amphetamine intoxication such as withdrawal from others, experiencing hallucinations, paranoia, delirium perhaps occurring with violence and stereotyped behaviors such as repeatedly assembling and dissembling electronic equipment may resemble symptoms of schizophrenia (Morrison, 1995). But a skilled clinician should be able to make the proper diagnosis.

Complications

 
• According to the National Institute on Drug Abuse website, a study in Seattle showed that methamphetamine use was widespread in the homosexual and bisexual community and they reported using the drug when engaging in unsafe-sex and unsafe needle-use behaviors, leaving them at risk for contracting and transmitting HIV and AIDS  
• Meth can be injected with a needle, increasing the chance of contracting HIV/AIDS, hepatitis and other infectious diseases  
• Often pure amphetamines are mixed with other substances such as sugar, glucose, bi-carb soda and ephedrine that can be poisonous, causing collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver and brain  
• Incessant use might result in addictions to other drugs such as benzodiazepines (a kind of anti-anxiety agent) taken to calm down so the individual can sleep

Causes

While this class of drugs was initially unregulated, today legal uses are limited to prescription to treat attentional disorders, obesity, narcolepsy and depressive disorders (Morrison, 1995). Causes of amphetamine addiction are largely related to features of the drugs. While the effects are almost immediate, tolerance is built up quickly thus increasing the amount needed to produce the desired effect (Morrison, 1995). During periods of nonuse, the user will recall the feeling of euphoria produced by the drug and desire to intake it again. According to the DEA, abuse of amphetamines began when they were used as a “cure-all” to keep people awake, train longer, treat depression and for weight control.

A 1997 study showed 4.4% of high school seniors had used the drug. Its use is increasing in the homosexual and bisexual communities. Its use during raves is also increasing. Increasingly used in the homeless youth community as well as among members in the sex trade.

Treatment
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.

There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs such as methamphetamine. The current pharmacological approach is borrowed from experience with treatment of cocaine dependence. Unfortunately, this approach has not met with much success since no single agent has proven efficacious in controlled clinical studies. Antidepressant medications are helpful in combating the depressive symptoms frequently seen in methamphetamine users who recently have become abstinent.

There are some established protocols that emergency room physicians use to treat individuals who have had a methamphetamine overdose. Because hyperthermia and convulsions are common and often fatal complications of such overdoses, emergency room treatment focuses on the immediate physical symptoms. Overdose patients are cooled off in ice baths, and anticonvulsant drugs may be administered also.

Acute methamphetamine intoxication can often be handled by observation in a safe, quiet environment. In cases of extreme excitement or panic, treatment with antianxiety agents such as benzodiazepines has been helpful, and in cases of methamphetamine-induced psychoses, short-term use of neuroleptics has proven successful.

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