Methamphetamine Abuse: Fact or Fiction

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Methamphetamine AbuseFact or Fiction?

• Diana Hu, MD
• Thanks to Harrison Alter, MD, MS
• Emergency Department
• Tuba City Regional Health Care Corp

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Why talk about meth?

• One of the fastest growing drugs of abuse across
  America
• Higher rates of use in rural America
• One of few drugs of abuse where women abuse as
  frequently as men
• Many issues with family safety
• A single dose can cause brain damage and/or fatal
  results

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Why talk about meth?

• Teenagers are using at raves, as a club drug
• HS students in Tuba all know where to get it
• Easily made in a home lab with chemicals you can
  buy legally in a drugstore or discount store
• Endangers family members and community

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Why talk about meth?

• Locally the hospital has seen increased numbers
  of patients on meth, with both acute and chronic
  effects on them and their families.
• 14 alleged meth related deaths in our community
  in the past 2 years

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Methamphetamine

• What is it?
• Stimulant medication that is the methylated form
  of amphetamine
• 2-15x more potent than per weight than amphetamine

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How do you feel on meth?

• Increased energy
• Decreased appetite
• Increased wakefulness ( dont need to sleep)
• Initial rush- euphoria
• Primarily with smoking or injecting

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Street names for Methamphetamine

• ampblue belly , black bear, black
  beautycrankcrystal glass (pure meth with no
  cuts)ice
• meth
• speedwhite crosswhite crunch

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MethamphetamineAmphetamine Sulfate Precursor

• First synthesized 1887
• Initial application 1920s as nasal decongestant
• WW II used as stimulant
• Schedule II in 1971
• Off-white/pinkish or yellowish powder, 5-20
  purity

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Methamphetamine
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MethamphetaminePhysiology

• Average dose 50 200 mg
• Onset of action
• Oral 30-60 min
• Nasal 15-20 min
• Inhaled or injected 1-3 min
• Elimination half-life and duration of action 4
  6 hours
• Can have longer effects with chronic use and
  depends on route of use

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MethamphetaminePhysiology

• Dopamine receptor stimulation and reuptake
  inhibition effects
• Serotonin receptor stimulation and reuptake
  inhibition effects

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Long Term physiologic effects

• Depletion in the neurons of these
  neurotransmitters, especially dopamine, can have
  permanent effects in the brain
• Slowness
• Parkinsons like movement disorders- tremor and
  rigidity
• Thinking problems

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Methamphetamine uses

• Limited medical use
• Obesity/diet aids
• Narcolepsy
• Primarily a drug of abuse
• Usually smoked, snorted, or injected
• Often used with marijuana
• Sometimes in combination with other drugs as well

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Methamphetamine Epidemiology
Past Month Illicit Drug Use among Youths Aged 12
to 17, by Race/Ethnicity 2002
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MethamphetamineEpidemiology
Past Month Alcohol Use among Persons Aged 12 to
20, by Race/Ethnicity 2002
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Methamphetamine Epidemiology
Percentage Reporting Methamphetamine Use, by Age
Group, 2002
Substance Abuse and Mental Health Services
Administration, Results from the 2002 National
Survey on Drug Use and Health National Findings,
September 2003.
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Methamphetamine Epidemiology

• High School Students Reporting Methamphetamine
  Use, 2003

National Institute on Drug Abuse and University
of Michigan, Monitoring the Future 2003 Data from
In-School Surveys of 8th-, 10th-, and 12th- Grade
Students, December 2003.
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MethamphetamineLocal Epidemiology
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MethamphetamineSynthesis

• Manufacture possible with ephedrine/
  pseudoephredrine
• Found in cold medicines
• Found in diet pills
• Many pharmacies restrict bulk purchase of these
  drugs

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MethamphetamineSynthesis

Meth Lab
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MethamphetamineSynthesis
Propane tank modified for storage of anhydrous
ammonia
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MethamphetamineSynthesis

• Can be synthesized with common household products
• Generates 5-7 pounds of hazardous waste per pound
  of drug
• 70 of ingredients can create drugs with 2000
  street value
• But you can die trying to make it.

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Meth production

• Three categories of chemicals for production
• Solvents
• Corrosives
• Metals/Salts

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MethamphetamineSynthesis

• Toluene paint thinner
• Methanol gas tank anti-freeze ("Heet)
• Ethyl Ether starting fluid
• Anhydrous ammonia farmers co-ops
• Hydrochloric acid hardware stores
• Sodium hydroxide "Drano" or Red Devil Lye
• Sulfuric acid battery acid or drain cleaners
• Iodine crystals iodine crystals or tincture of
  iodine
• Red phosphorous striker plates, road flares
• Lithium camera batteries

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MethamphetamineSynthesis

• Pour and run
• Ephedrine reduction method
• Boil pills in red phosphorous and iodine
• Convert ephedrine to MAP with lye, HCl, or
  hydrogen sulfide
• Add hydrocarbon solvent
• Filter precipitate
• Pour byproduct down the drain
• Dry cook with anhydrous ammonia

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Meth labs

• Meth labs use so many toxic solvents/ create
  toxic waste, HAZMAT trained specialists are
  needed to decontaminate/dismantle
• In 40 of meth lab seizures, children were
  present in the home at the time of the raid.

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Meth related deaths in Tuba City in the past year

• 4 murders
• 4 deaths in motor vehicle accidents
• 2 suicides
• 2 overdose related deaths
• 2 meth lab explosion/fire deaths

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Meth related violence in Tuba City

• 13 assaults with 23 victims
• At least 4 families with children placed in
  foster care because of parental meth use

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What can we do to stop this problem?

• DONT START
• Even one dose can lead to death, brain damage,
  and/or addiction
• REMEMBER- some people use this drug at parties or
  sprinkled on marijuana- you could get some and
  you wouldnt even know it at first

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What can we do to stop the problem?

• Recognition of friends/family members/community
  members who are using
• Get medical help for those people
• Report people who have a meth lab/are dealing
  in the community

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MethamphetamineClinical Presentation

• Rush (5-30 min)
• Adrenal gland release of epinephrine
• Explosive release of dopamine
• Intensely euphoric
• BP spike, heart rhythm abnormalities

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MethamphetamineClinical Presentation

• High (4-16 hrs)
• The shoulder
• Feelings of aggression and heightened intellect
• Binge (3-15 days)
• Continuation of the high
• Larger doses required to achieve same intensity
• Little or no rush or high felt
• Physical and mental hyperactivity

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MethamphetamineClinical Presentation

• Tweaking
• Follows a binge
• Feelings of emptiness and dysphoria
• Often alcohol and heroin used to self-medicate
• Most dangerous state of cycle for law enforcement
  and medical personnel

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MethamphetamineClinical Presentation

• Crash or Washout (1-3 days)
• Total excitatory neurotransmitter depletion
• No threat posed, lifeless and sleepy
• Withdrawal (30-90 days)
• Slow progression to depression, lethargy,
  cravings, suicidal thoughts
• MAP use during this period can alleviate dysphoria

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These people NEED HELP

• There is both a physical and psychological
  addiction to methamphetamine
• Users can be a risk to themselves and others
  during the withdrawal periods
• Intensive therapy is the best hope, but the
  relapse rate is very high

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PREVENTION vs.TREATMENT

• Methamphetamine is highly addictive, even after a
  single use.
• How can we prevent our loved ones from even
  trying this dangerous drug?

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How can you tell if a friend is using meth?

• It may not be easy to tell. But there are signs
  you can look for.

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Symptoms of methamphetamine use may include

• Inability to sleep
• Increased sensitivity to noise
• Nervous physical activity, like scratching
• Irritability, dizziness, or confusion
• Extreme anorexia (wont eat)/ sudden weight loss
• Tremors or even convulsions
• Increased heart rate, blood pressure, and risk of
  stroke
• Presence of inhaling paraphernalia, such as razor
  blades, mirrors, and straws
• Presence of injecting paraphernalia, such as
  syringes, heated spoons, or surgical tubing

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Methamphetamine Side effects

• Increased energy and decreased fatigue
• Increased activity
• Decreased appetite and weight loss
• Euphoria and rush
• Increased respiration

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Methamphetamine Side Effects

• Hyperthermia up to 108F.
• Stroke
• Seizures
• Headache
• Increased blood pressure
• Heart failure/heart attack
• Liver, kidney, and lung damage

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Methamphetamine side effects

• Nausea, vomiting, bad taste in mouth, diarrhea,
  constipation
• Difficulty voiding
• Muscle destruction/kidney failure
• Hives, sores on skin, painful rash
• Hypersexual
• Increases risk of Hep B, HepC, HIV, other STD

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Methamphetamine Side effects

• Dependence and addiction psychosis, including
  paranoia, hallucinations, mood disturbances,
  anxiety, and repetitive motor activity
• Repetitive actions ( like picking at skin)
• Depression, suicidal thoughts/homicidal thoughts

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It is up to us.

• Community watch/support law enforcement
• Community forums
• Political pressure
• Talk to your families

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You have to be honest with people. You have to
have great respect for yourself . If you see
something that is not right you must do something
about it.

• Annie Dodge Wauneka