# Presentation: 246321

## Methamphetamine Abuse:Fact or Fiction? 

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

## 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

## 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

## 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

## Methamphetamine

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

## How do you feel on meth?

- Increased energy
- Decreased appetite
- Increased wakefulness ( don’t need to sleep)
- Initial “rush”- euphoria
- Primarily with smoking or injecting

## Slide 7

## Street names for Methamphetamine

**    ****amp****blue belly , black bear, black beauty****crank*****crystal***** glass (pure meth with no cuts)*****ice**
**	*****meth**
**    ****speed****white cross****white crunch**

## Methamphetamine:Amphetamine 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

**Notes:**
Speed; bennies, black beauties, truckers, etc.

## Methamphetamine:

## Slide 11

## Methamphetamine:Physiology

- 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

**Notes:**
Half – life is dose-dependent, and also lasts longer with alkalinization of the urine

## Methamphetamine:Physiology

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

| Movement
Emotion
 | Motivation 
Pleasure 
 |
| --- | --- |

| Mood
Personality
Affect
Appetite | Motor function
Temperature regulation
Sexual activity 
Sleep induction |
| --- | --- |
|  |  |

## Long Term physiologic effects

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

## 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

## Methamphetamine: Epidemiology

- Methamphetamine: Epidemiology

**Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002**

**Notes:**
Lifetime nonmedical use of stimulants increased steadily from 1990 to 2002 for youths aged 12 to 17 (0.7 to 4.3 percent). For young adults aged 18 to 25, rates declined from 1981 to 1994 (from 10.9 to 5.9 percent), then increased to 10.8 percent in 2002. Rates increased between 2001 and 2002 for both youths (3.8 to 4.3 percent) and young adults (10.2 to 10.8 percent). 

## Methamphetamine:Epidemiology

**Past Month Alcohol Use among Persons Aged 12 to 20, by Race/Ethnicity: 2002**

## Methamphetamine: Epidemiology

| Age Group | Lifetime | Annual | Last 30 days |
| --- | --- | --- | --- |
| 12–17 | 1.5% | 0.9% | 0.3% |
| 18–25  | 5.7  | 1.7 | 0.5 |
| 26–34  | 6.7 | 1.0 | 0.5 |
| > 35 | 5.5 | 0.3  | 0.1 |
| > 12 (Total)  | 5.3 | 0.7 | 0.3 |

**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](http://www.samhsa.gov/oas/nhsda/2k2nsduh/Results/2k2Results.htm#highlights)__, September 2003._

## Methamphetamine: Epidemiology

**High School Students Reporting Methamphetamine Use, 2003**

| Grade | Lifetime | Annual | Last 30 days |
| --- | --- | --- | --- |
| 8th | 3.9% | 2.5% | 1.2% |
| 10th | 5.2 | 3.3 | 1.4 |
| 12th | 6.2 | 3.2 | 1.7 |

- 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,](http://monitoringthefuture.org/data/03data.html#2003data-drugs)__ December 2003._

## Methamphetamine:Local Epidemiology

## Methamphetamine:Synthesis

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

**Notes:**
Other street names include:  CR, tina, speed, blade, crypto and fast. bikers coffee, chalk, chicken feed, methlies quick, poor man's cocaine, shabu, stove top, trash and yellow bam. In contrast to amphetamine, inhalational exposure is equipotent to intravenous injection.

Also available in tablet form from Thailand as Yaba

## Methamphetamine:Synthesis

- Meth Lab

## Methamphetamine:Synthesis

- Propane tank modified for storage of anhydrous ammonia

## Methamphetamine:Synthesis

- 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.

**Notes:**
Solvents:  Acetone, ether, freon, hexane, methanol, toluene, trichloroethene, white gas, xylene
Corrosives: Anhydrous ammonia, hydrochloric acid, phosphine, sodium hydroxide, sodium thiosulfate, sulfuric acid
Metals/Salts: iodine, lithium metal, red phosphorous, yellow phsophorous, sodium metal
In a California study of 2400 children exposed to clandestine labs, about 35% tested positive for heavy metal exposure.

## Meth production 

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

## Methamphetamine:Synthesis

- Toluene: paint thinner
- Methanol: gas tank anti-freeze ("Heet“)
- Ethyl Ether: starting fluid
- Anhydrous ammonia: farmer’s 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

## Methamphetamine:Synthesis

- “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

**Notes:**
Pour and run involves the use of chloroform and evolves more sulphur dioxide and hydrogen sulfide – which acts like cyanide gas, arresting mitochondrial respiration
Ephedrine now controlled, but can be obtained from psedoephedrine

Dry cook also called “cold cook” or “Nazi method” – case reports of ocular burns from anhydrous

## 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.

## Slide 29

## Slide 30

## 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

## 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

## What can we do to stop this problem?

- DON”T 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 wouldn’t even know it at first

## 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

## Methamphetamine:Clinical Presentation

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

## Methamphetamine:Clinical 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

## Methamphetamine:Clinical 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

## Methamphetamine:Clinical Presentation

- “**Crash**” or “**Washou**t” (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

## 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

## 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?

## 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.

##  Symptoms of methamphetamine use may include:

- Inability to sleep
- Increased sensitivity to noise
- Nervous physical activity, like scratching
- Irritability, dizziness, or confusion
- Extreme anorexia (won’t 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

## Methamphetamine Side effects

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

## Methamphetamine Side Effects 

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

## 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

## 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

## It is up to us....

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

## “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