Transcript Chronic Physical Effects

The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
What is Methamphetamine and
what are its effects?
Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
August 1, 2007
Sioux Falls, South Dakota
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Overview
• The issues
• Chemistry
• Pharmacology: how the body handles
the drug
• Pharmacology: mechanisms
• The desired effects: why people like it
• The problems: why people hate it
• Methamphetamine vs other drugs
• Pregnancy: mother and child
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Views of the Most Important Problems
Facing Teenagers Today
67%
Drugs/drug abuse
15%
Violence/crime/guns
Alcohol
13%
Peer pressure
13%
Sexual activity
13%
10%
Breakdown of homelife/related issues
Sexually transmitted disease/HIV/AIDS
9%
Education
9%
Lack of good character/morality
9%
Teen pregnancy
Smoking
8%
6%
Mental health
3%
Medical problems
3%
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Harvard School of Public Health/Robert Wood Johnson Foundation/ICR, July 2000
National Drug Intelligence Center
National Drug Threat Assessment 2005 - February 2005
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A Major Reason People
Take a Drug is they Like
What It Does to Their Brains
The first use is usually voluntary
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Why do people take drugs?
To feel good
To have novel:
Feelings
Sensations
Experiences
AND
To share them
To feel
better
To lessen:
Anxiety
Worries
Fears
Depression
Hopelessness
Withdrawal
Effects of Drugs on Dopamine
Accumbens
AMPHETAMINE
% of Basal Release
1100
1000
900
800
700
600
500
400
300
200
100
0
% of Basal Release
Dopamine
Pathways
Principal
“Pleasure”
System of the
Brain
DA
0
1
2
3
4
5 hr
Time After Amphetamine
400
COCAINE
Accumbens
DA
300
200
100
0
0
1
2
3
4
Time After Cocaine
5 hr
Source: Di Chiara and Imperato
200
NAc shell
150
100
Empty
50 BoxFeeding
0
0
60
120
180
Time (min)
Di Chiara et al.
150
100
SEX
Copulation Frequency
nucleus
accumbens
FOOD
200
DA Concentration (% Baseline)
substantia
nigra/VTA
Natural Rewards Elevate Dopamine
% of Basal DA Output
frontal
cortex
striatum
hippocampus
15
10
5
0
ScrScr
Scr Scr
BasFemale 1 Present
Female 2 Present
1 2 3 4 5 6 7 8
9 101112131415 1617
Sample
Mounts
Number
Intromissions
Ejaculations
7 Phillips
Fiorino and
Forms of Methamphetamine
Methamphetamine Powder
Beige/yellowy/off-white powder
Base / Paste Methamphetamine
‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy
Crystalline Methamphetamine
White/clear crystals/rocks; ‘crushed
8
glass’ / ‘rock salt’
Chemistry 1:
• Methamphetamine does not occur in nature.
• It is like two chemicals found in the body:
􀂓 Adrenaline, released in “fight or flight”
􀂓 Dopamine which controls both reward
and movement in the brain
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Chemistry 2:
Methamphetamine is very close to
Amphetamine (“speed”) in structure
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Chemistry 3:
• Compounds from plants that are chemically
similar are ephedrine and mescaline
• Methamphetamine is easy to make from
materials that are hard to control;
pseudoephedrine, iodine, and red phosphorus
from matchbooks
• Waste by-products from the synthesis are toxic
and environmentally harmful
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Methamphetamine Absorption
• Fat soluble, so easily and rapidly
absorbed.
• Gets into the brain faster than
amphetamine
• Onset:
􀂓 oral - about 30-60 minutes
􀂓 Snorted - 2-5 minutes
􀂓 injected or smoked – almost
instantaneous
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Methamphetamine Elimination
•
•
•
•
Elimination half life about 12 hours
Effects can last 24 hours
55% broken down by the liver
remainder excreted as methamphetamine
or amphetamine
• Drug and metabolites detectable 2-4 days
• Urine or saliva can be used for testing
• Impurity profiling for medico-legal
purposes. There are about 245 possible
impurities!
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The most important action…
Meth enters the nerve ending, and
causes the transmitter to be
released. It displaces the transmitter
from the storage site. This means
that even if the nerve in the reward
pathway has not been stimulated,
the transmitter will be
released and “reward” experienced.
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Methamphetamine has several
mechanisms:
• It directly releases dopamine and
norepinepherine from the nerve endings in
the brain (and also outside the brain)
• It inhibits the transporter leading to
increased material in the synapse (like
cocaine)
• It both CAUSES nerves to fire and
AMPLIFIES existing nerve activity.
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Desired Effects
• Energy, less fatigue, wakefulness –
enhanced performance
• May promote impulsive decision making
• Feelings of joy, power, success, high selfesteem
• Enhanced sexual desire and interest
• Later in the addiction process the user
may have very little interest in sex.
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Undesired Effects
•
•
•
•
•
•
Delusional, risky, paranoid, violent
Itching, welts on the skin
Nausea, vomiting, diarrhea
Uncontrolled body movements
“The crash”
Increased blood pressure, heart rate,
body temperature. Risk of stroke, seizures
• Japan – most deaths from meth toxicity
• USA – most deaths from homicide/suicide
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Short-Term Effects of Methamphetamine
PHYSICAL
PSYCHOLOGICAL
Heart rate
Respiration
Blood pressure
Pupil size
Sensory acuity
Energy
Confidence
Alertness
Mood
Sex drive
Energy
Talkativeness
Appetite
Sleep
Reaction time
Boredom
Loneliness
Timidity
Source: Judith Cohen, Ph.D., Presentation to NASADAD, June 2005
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Long-term Problems
•
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•
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Disturbed sleep
Social isolation and withdrawal
Lifestyle-related “accident”
Amphetamine psychosis
Violent and/or paranoid behavior
Irritability, nervousness, distractibility,
difficulty focusing and remembering
• Extreme depression, suicidal ideation
• NOT ALL OF THESE ALWAYS REVERSE
WITH ABSTINENCE
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Methamphetamine
Chronic Physical Effects
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Tremor
Weakness
Dry mouth
Weight loss
Cough
Sinus infection
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Sweating
Burned lips; sore nose
Oily skin/complexion
Headaches
Diarrhea
Anorexia
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Methamphetamine
Chronic Psychological Effects
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Confusion
Concentration
Hallucinations
Fatigue
Memory loss
Insomnia
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Irritability
Paranoia
Panic reactions
Depression
Anger
Psychosis
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Methamphetamine
Psychiatric Consequences
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Paranoid reactions
Permanent memory loss
Depressive reactions
Hallucinations
Psychotic reactions
Panic disorders
Rapid addiction
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What about brain damage?
• This is often stated as a consequence of
methamphetamine use. Usually recovers.
• There is convincing evidence in humans
and animals, both by imaging and
behavioral studies, that brain damage
occurs
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What about behavioral
consequences?
• Attention, verbal learning, memory, decision
making are all impaired during early
abstinence
• After 8 months abstinence, still slow on some
tasks
• Headaches and depression may not
improve,
and there may be ongoing cognitive
impairment.
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Flashbacks (recurrence of
methamphetamine psychosis) do occur
• Associated with frightening/stressful
experience during use. Mild stress then
triggers flashbacks
• Longer exposure to the situation makes
flashbacks more frequent
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Methamphetamine Users
Compared to Other Drug Users
• Use daily
• More likely to be Caucasian, male, gay/bi, HIV
positive, practice unsafe use (sharing needles etc.),
have a psychiatric diagnosis, be on psychiatric meds
• Develop addiction more rapidly
• Seek treatment earlier
• Use more marijuana and/or less alcohol (but use
alcohol or sedatives for sleep)
• Have more serious medical and psychiatric conditions
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Prenatal Exposure to
Methamphetamine
• Methamphetamine easily crosses the placenta
• The fetal brain is very sensitive to any level of
methamphetamine
• Metabolism of methamphetamine in the fetus is
not the same as in adults
• We must have a high index of suspicion to
adequately test moms and infants exposed to
methamphetamine
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In pregnancy…
• Very little data.
• Growth restriction occurs with full-term
infants, (constriction of the umbilical artery?)
• 4% have a recognizable withdrawal syndrome.
• Evidence of cognitive deficit in children born
to mothers who use meth
• Weak evidence for physical defects in children
whose mothers used meth.
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Who to test?
• Maternal red flags
– History of drug use
during pregnancy
– Premature birth
– Late, sporadic, or no
prenatal care
– Numerous skin
lesions
– Extremely poor
dentition
– Very rapid
labor/delivery
• Infant red flags
– Maternal history of drug
use
– Maternal refusal for
drug screen
– Excessive irritability
– Excessive jitteriness
– Very poor feeding, not
responding to
intervention
– Physical features
suggestive of
alcohol/drug use 30
Maternal Effects of
Methamphetamine During
Pregnancy
•
•
•
•
Increased maternal blood pressure
Increased maternal heart rate
Increased risk of premature birth
Constricts blood flow in the placenta, thereby
impacting oxygen flow to the fetus
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Effects of Methamphetamine on
the Developing fetus/infant
• Poor fetal growth—small for gestational age
• Elevated fetal blood pressure (stroke)
• Birth defects (6 times the normal rate)
– Cleft palate/lip
– Heart disease
– Kidney disease
– Intestines born outside the body
– Premature birth
• Placental hemorrhage
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Newborn signs of meth exposure
• Withdrawal
– Jittery
– Poor feeding
– Poor wake /sleep
cycle
– Irritable
– High pitched cry
– Tremors
– Hypertonia
• These symptoms
may last as long as
6 weeks, in contrast
to withdrawal from
other drugs which
may only last the
first week of life
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ADDICTION INVOLVES MULTIPLE FACTORS
Biology/Genes
Environment
DRUG
Brain Mechanisms
Addiction
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Research Tells Us That
STRESS
Can Be A Major Factor In the
Initiation of Drug Use…
And One of the Most Powerful
Triggers for Relapse
In Recovering Addicts
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org
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