Crystal Meth

(Note: Crystal Meth - properly known as crystal methamphetamine - is a synthetic type of amphetamine. I will refer to it as "meth" in this article).

General

Crystal Meth is not an opiate, or cocaine. It is a psycho-stimulant. It is synthetic, as it does not occur in nature.

Meth is a stimulant drug that is chemically similar to amphetamine (a drug occasionally used to treat ADHD and narcolepsy).

It's colorless (sometimes with a blue hue), opaque, and odorless. It comes in fragments of various sizes that look like crystals. Due to its appearance, it's sometimes called "ice," "blue-ice," "glass," or simply "meth." I will not show a picture of meth here, out of respect for addicts who may find it to be a visual cue (trigger).

Some people prefer crystal meth to other illicit drugs because the sense of euphoria it gives can last for hours. Depending on how it's ingested, the effects of meth can last for 6-24 hours. This is a much longer duration than cocaine, a drug with similar effects. As well, compared with cocaine, meth is cheaper and can be made locally with commonly available ingredients (although government controls are making these ingredients more difficult to obtain).

Meth is used recreationally for its effects as a potent euphoriant, stimulant, and aphrodisiac.

It can be smoked in pipes, snorted, injected, swallowed, or taken rectally or by the urethra (ouch!).

Smoking or injecting methamphetamine causes an immediate, intense "rush" that lasts for a few minutes. Snorting does not produce the intense rush but rather a euphoric high within 3-5 minutes of ingestion. The oral effects can be felt within 20 minutes.

After cannabis, meth is the second most used illicit drug worldwide, but meth dominates the global market for synthetic drugs.

Most of the meth found in the United States is made in "superlabs" in the U.S. or, more often, in Mexico. However, huge amounts of domestic meth is produced in "Mom-and-Pop" cook labs in home kitchens, workshops, recreational vehicles [like "Eisenberg"] and rural cabins.

Some ingredients are found in over-the-counter products, such as pseudoephedrine, a common ingredient in cold medicines. To curb production, the law requires pharmacies and other retail stores to keep a purchase record of products containing pseudoephedrine. A person may only buy a limited amount of those products on a single day.

Illicitly manufactured methamphetamine may include drain cleaner, antifreeze, lantern fuel, battery acid, hydrochloric acid, acetone, fertilizer, red phosphorus (matches or road flares) and lye. Your basic list of healthy natural ingredients.

 

History of meth

Amphetamine was discovered before methamphetamine in Germany in 1887. Methamphetamine was first synthesized from ephedrine in 1893 by a Japanese chemist. 

During World War II, meth was sold in tablet form under the brand name Pervitin by a German pharmaceutical company. It was used extensively by all branches of the German armed forces of the Third Reich, and was particularly popular with Luftwaffe pilots, for its performance-enhancing stimulant effects and to induce extended wakefulness. Pervitin became known among the German troops as "Stuka-Tablets" and "Herman-Göring-Pills" because of their extensive use by the Luftwaffe. However, its side effects were so serious that the army cut back its usage in 1940. Some soldiers turned very violent, committing war crimes or attacking their own officers. Historian Lukasz Kamienski says "A soldier going to battle on Pervitin usually found himself unable to perform effectively for the next day or two. Suffering from a drug hangover and looking more like a zombie than a great warrior, he had to recover from the side effects." 

 Pervitin: pharmaceutical meth

In the 1950s methamphetamine came into use as a legal pharmaceutical (marketed under the brand name Obetrol) for treating obesity. Unsurprisingly, Obetrol became a popular diet pill in America in the 1950s and 1960s, as many people became addicted to its stimulant effects. Eventually, as the addictive and other detrimental properties of the drug became known, governments began to strictly regulate the production and distribution of methamphetamine. Currently, methamphetamine is sold under the trade name Desoxyn in the U.S., as a last-resort way to treat ADHD. Note that Desoxyn is prescribed in doses far lower than the amount used by typical meth addicts. 

In Canada we have a similar product called dextroamphetamine (Dexedrine). I have been involved in the care of hundreds of patients with ADHD, and I have never started any of them on it because many more acceptable options are available. Unfortunately, I have learned that Desoxyn seems to be more heavily prescribed in the U.S. than is Dexedrine here in Canada.

Immediate effects of meth

In low doses, methamphetamine can elevate mood, increase alertness, concentration and energy in fatigued individuals, reduce appetite, and promote weight loss. It brings on increased activity and talkativeness, decreased appetite and a sense of well-being or euphoria. It removes tiredness and brings a feeling of power and self-control. Sounds great... but the price is high.

Few people are able to use meth "responsibly." Meth is highly addictive, and tolerance develops especially rapidly with it. Meth is known to possess a high addiction liability (i.e., a high likelihood of compulsive drug use) and high dependence liability (i.e. a high likelihood that withdrawal symptoms will occur when use ceases).

Because the "high" from meth starts and fades quickly, users most often end up taking repeated doses in a "binge and crash" pattern. Many users end up in a form of binging known as a "run," giving up food and sleep while continuing to take the drug every few hours for up to several days. Users try to maintain the high by taking more of the drug before the first dose wears off. Some abusers binge for several days, withholding food and sleep while continually using until they finally run out of the drug.

As with other addictive drugs, in time the need for the "high" becomes more important than other factors in the user's life. As well, tolerance builds and use of the drug produces less and less of a high. Continued use ends up being about stopping withdrawal symptoms, and chasing the elusive high.

The immediate physical effects of meth can include loss of appetite, hyperactivity, dilated pupils, flushed skin, excessive sweating, dry mouth and teeth grinding (leading to "meth mouth"), headache, abnormal heartbeat, rapid breathing, high or low blood pressure, high body temperature, constipation, blurred vision, dizziness, twitching, numbness, shaking, dry skin, acne, and pale appearance.

Excoriation disorder - scratched-away skin replaced by rashes and infections - caused by obsessive scratching and skin picking is common and makes meth addicts easy to spot.

Unfortunately, at higher doses, it can also induce psychosis, muscle breakdown, seizures, and bleeding in the brain.

Violent behaviors are common among methamphetamine users. The other day I was at a gas station and I saw a guy I know to be a meth user yelling and waving his arms in the air. He was running around aimlessly and ranting at who-knows-what. People were frightened.

   

Long-term effects

Meth is particularly hard on the body in a visible way. The weight loss from the hyperactivity and loss of appetite, the lack of sleep, the skin damage from excoriation disorder, the malnutrition, the "meth mouth," the shaking, and the hyperactive and aggressive behavior all make these unfortunate people stand out. This is the reason for the famous "before and after" photos that abound online.

 The "meth make-over."

Long-term methamphetamine use has many other negative consequences, including:

• extreme weight loss
• severe dental problems ("meth mouth" - see next section)
• intense itching, leading to skin sores from scratching
• anxiety
• confusion
• sleeping problems
• violent behavior
• psychosis

In addition, continued methamphetamine use causes changes in the brain's dopamine system that are associated with reduced coordination and impaired verbal learning. In studies of people who used methamphetamine over the long term, severe changes also affected areas of the brain involved with emotion and memory. This may explain many of the emotional and cognitive (higher brain functions - planning, reasoning, communicating, etc.) problems observed in those who use methamphetamine.

Addictive substances all - via various mechanisms - cause very high levels of dopamine in the brain. Dopamine is the "feel-good" brain chemical (neurotransmitter) that causes the high and the cravings. However, with most substances the levels of dopamine return to normal after a short period once the person is in recovery. Meth is unique in that recovery of dopamine is partial and incomplete in most cases. Because of this, meth addicts are often faced with especially severe long-term consequences of their drug use, most often some level of psychosis and shaking or inability to use hands or walk properly.

 Only 1.5 years difference between these two shots!

Chronic high-dose use can precipitate unpredictable and rapid mood swings, stimulant psychosis, and violent behavior. Heavy use of methamphetamine may lead to a post-acute-withdrawal syndrome, which can persist for months beyond the typical withdrawal period.



 

Meth mouth

Regular users of meth usually lose their teeth through severe decay. This is known as meth mouth.

 A mild case of "meth mouth."

One reason is that meth contains ingredients that are bad for the teeth: drain cleaner, battery acid, and hydrochloric acid, for example.

There are other reasons for meth mouth:

• Meth causes teeth grinding and forceful jaw clenching (bruxism).
• Meth causes dry mouth, reducing levels of protective saliva (xerostomia).
• Users crave sugary drinks.
• Users neglect oral hygiene, especially while binging and crashing.

Meth mouth occurs regardless of the route of administration, so injecting doesn't prevent meth mouth. In fact, the condition is generally most severe in users who inject the drug, rather than swallow, smoke, or inhale it.

Meth and pregnancy

Meth in a pregnant user passes through the placental barrier to the fetus, and is also secreted in the breast milk.

Meth exposure causes withdrawal symptoms in the newborn, consisting of agitation, vomiting and fast breathing. This withdrawal syndrome is relatively mild and only requires medical intervention in approximately 4% of cases. However, it causes intense suffering for the newborn, who is welcomed into the world only to endure "cold-turkey" cessation after being born addicted.

There appears to be an alarming trend among meth-addicted mothers, who fear being exposed and having their child (or drugs) taken away from them. They do not reveal their drug use to the doctor and try to wean the baby off meth by giving them meth mixed in with their formula. We are starting to see deaths among babies from this scary practice. In the addicted mind, however, this makes sense. When we are caught up in addiction our thinking is not sane.

Meth and the brain

Crystal meth, like other addictive drugs, changes the user's brain chemistry (see The Brain in Addiction / Alcoholism Click Here).

Meth is neurotoxic, damaging dopamine and serotonin neurons in the brain.

Dopamine changes can result in a stimulant psychosis which may present with a variety of symptoms (e.g., paranoia, hallucinations, delusions, and weird behaviors). A Cochrane Collaboration review on meth-induced psychosis states that about 5–15% of users fail to recover completely (see reference list below).

Antipsychotic medications effectively resolve the symptoms of acute amphetamine psychosis, but these medications are themselves fraught with troubling side-effects.

Studies in chronic methamphetamine users have shown structural and functional changes in the brain associated with emotion and memory, some of which may be irreversible.

Although some of these brain changes may reverse after being off the drug for a year or more, other changes may not recover even after a long period of abstinence. A recent study even suggests that people who used meth have an increased the risk of developing Parkinson's disease, a disorder of the nerves that affects movement.

Studies of meth users have also found evidence of neurodegeneration and brain shrinkage, and adverse neuroplastic changes in brain structure and function. Neuroplastic changes involve learning and adapting.

Dependence and withdrawal

Tolerance develops especially rapidly with meth use. Withdrawal symptom severity depends on the level of drug tolerance.

Withdrawal symptoms in chronic users are frequent, occurring in up to 87.6% of cases [I believe that number, provided by the Cochrane review, is low], and persist for three to four weeks with a marked "crash" phase occurring during the first week.

There is currently no approved drug that can help a person recover from crystal meth addiction.

Withdrawal symptoms occur within 24 hours of the last dose. Symptoms can last for days or weeks, depending on how long the addiction has lasted.

Withdrawal symptoms can include:

• severe overall feeling of being physically sick
• agitation and anxiety
• drug craving
• severe depression. Depression from meth withdrawal lasts longer and is more severe than that of cocaine withdrawal.
• fatigue and insomnia
• psychosis
• emotional turmoil
• lack of motivation
• vivid or lucid dreams.

 

The link between meth and HIV and hepatitis

People who inject meth are at increased risk of contracting infectious diseases such as HIV and hepatitis B and C, especially those who share needles. These diseases are transmitted through contact with blood or other bodily fluids.

Meth use can also alter judgment and decision-making leading to risky behaviors, such as unprotected sex with other users, which also increases risk for infection. Meth often causes "hyper-sexuality" which further raises the risk.

Meth use may worsen the progression of HIV/AIDS and its consequences. Studies indicate that HIV causes more injury to nerve cells and more cognitive problems in people who have HIV and use meth than it does in people who have HIV and don't use the drug. Cognitive problems are those involved with thinking, understanding, learning, and remembering.

How can a methamphetamine overdose be treated?

Meth overdose can lead to stroke, heart attack, or organ problems—such as kidney failure—caused by overheating. These conditions can result in death.

An extremely large overdose may produce symptoms such as adrenergic storm (potentially fatal adrenalin rush), methamphetamine psychosis, substantially reduced or no urine output, cardiogenic shock and circulatory collapse, bleeding in the brain, hyperpyrexia (dangerously high body temperature), pulmonary hypertension, kidney failure, toxic muscle breakdown, serotonin syndrome, and a form of stereotypy (self-mutilation, feeling trapped). A methamphetamine overdose will likely also result in mild brain damage due to severe, acute neurotoxicity. Death from methamphetamine poisoning is typically preceded by convulsions and coma.

Unlike opiates, where people can be saved from overdose by administering naloxone (see Fentanyl / Opiate Overdose - Click Here), there is no antidote for meth.

Because methamphetamine overdose often leads to a stroke, heart attack, or organ problems, first responders and emergency room doctors try to treat the overdose by treating these conditions, with the intent of:

• restoring blood flow to the affected part of the brain (stroke)
• restoring blood flow to the heart (heart attack)
• treating the organ problems
• lowering body-temperature
• sedation for the agitation and psychosis
• treating seizures and brain toxicity
• surgery if there is a brain bleed
• life support of there is a coma

Recovering from meth addiction

There is no one alive who is not capable of recovery from any substance addiction, including meth. However, it ain't easy! I always recommend that someone motivated to get off the drugs check into a 7-day detox facility, so that medical supervision, professional expertise, and a warm and supportive environment are part of that first week. While there, the addict usually learns about options for recovery, such as rehab, sober-living housing, out-patient rehab, and recovery programs. Best of all, toughing out that first week with other people going through the same thing is very helpful.

There are many articles on this website that provide information about finding recovery and staying in it. I especially recommend Barriers to Recovery Click Here, and I'm Overwhelmed! Click Here for those seeking recovery or those who wish to help them.

Because of the very high overlap between meth addiction and mental health symptoms I suggest the article Mental Health and Addiction Click Here for those who have such concerns.

This website has many other articles for those who are in recovery and wish to learn more. Feel free to explore and to contact us with your own thoughts and experiences. Recovery is so much easier when we do it together.

The U.S. National Institute for Drug Abuse (NIDA) has information about what to do for anyone concerned about themselves or a loved one who may have an addiction Click Here. The website provides information for adults as well as teens/young adults.



To learn more about the science and psychology of addiction and recovery, and to understand why alcoholics and addicts behave the way they do, see the author's book The Alcoholic / Addict Within.

Available in print and e-book editions from amazon.com (Click Here).

  References:
Nordqvist, Christian. (2017, Jul 7). Crystal meth: Facts, effects, and addiction. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/23207.php

Minozzi, S; Saulle, R; De Crescenzo, F; & Amato, L. (2016). Psychosocial interventions for psychostimulant misuse. Cochrane Database of Systematic Reviews. 9:CD011866. DOI: 10.1002/14651858.CD011866.pub2.

United States National Institute on Drug Abuse (NIDA). (2017, February 8). Methamphetamine. Retrieved from https://www.drugabuse.gov/publications/drugfacts/methamphetamine