Transcript Methamphetamine: A Cinical Primer

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?
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Increased energy
Decreased appetite
Increased wakefulness ( don’t need to sleep)
Initial “rush”- euphoria
– Primarily with smoking or injecting
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, 520% purity
Methamphetamine:
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
Methamphetamine:
Physiology
• Dopamine receptor stimulation and
reuptake inhibition effects
–Movement
–Emotion
–Motivation
–Pleasure
• Serotonin receptor stimulation and reuptake
inhibition effects
–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
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
Methamphetamine:
Epidemiology
Past Month Alcohol Use among Persons Aged 12 to 20, by Race/Ethnicity: 2002
Methamphetamine:
Epidemiology
Percentage Reporting Methamphetamine Use, by
Age Group, 2002
Age Group
12–17
18–25
26–34
> 35
> 12 (Total)
Lifetime
Annual
Last 30 days
1.5%
5.7
6.7
0.9%
0.3%
1.7
1.0
0.3
0.7
0.5
0.5
5.5
5.3
0.1
0.3
Substance Abuse and Mental Health Services Administration, Results from the 2002
National Survey on Drug Use and Health: National Findings, September 2003.
Methamphetamine:
Epidemiology
High School Students Reporting
Methamphetamine Use, 2003
Last 30
days
Grade
Lifetime Annual
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, December 2003.
Methamphetamine:
Local Epidemiology
TCRHCC drug screens, 2003
Avg
29.5
4.8 6.6
7
7
Nov
33
8
3
Month
39
Sept
2
July
24
24
6
23
57
0
Total screens
THC
Meth/amp
34
5 8
5 6
20
40
Number of screens
60
Methamphetamine:
Synthesis
• Manufacture possible with ephedrine/
pseudoephredrine
– Found in cold medicines
– Found in diet pills
– Many pharmacies restrict bulk purchase of
these drugs
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.
Meth production
• Three categories of chemicals for
production
– Solvents
– Corrosives
– Metals/Salts
Methamphetamine:
Synthesis
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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
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.
Meth related deaths in Tuba City in
the past year
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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) –
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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)
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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”
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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 “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
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:
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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
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Increased energy and decreased fatigue
Increased activity
Decreased appetite and weight loss
Euphoria and rush
Increased respiration
Methamphetamine Side Effects
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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….
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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