Methamphetamine

Methamphetamine is a powerful amphetamine-like synthetic substance in the STIMULANT family. Other substances in the stimulant family include amphetamines, cocaine and prescription medications such as dextroamphetamine and methylphenidate. The U.S. Drug Enforcement Agency (DEA) classifies methamphetamine as a Schedule II substance under the Controlled Substances Act, making this substance illegal apart from one FDA approved prescription medication, methamphetamine hydrochloride, used to treat attention deficit hyperactivity disorder (ADHD) or for the short-term treatment of obesity that does not respond to other treatments.

Methamphetamine exists in pill, powder, and crystal forms. Most non-prescription methamphetamine is manufactured from over-the-counter medications in illegal laboratories.

How is it methamphetamine typically used?

Typically, methamphetamine is sniffed, smoked, or injected into a vein, but it also can be swallowed or inserted rectally. Injecting and smoking methamphetamine achieve the most rapid onset of effects, within seconds.

Common names for methamphetamine:

Batu, Bikers Coffee, Black Beauties, Chalk, Chicken Feed, Crank, Crystal, Glass, Go-Fast, Hiropon, Ice, Meth, Methlies, Quick, Poor Man’s Cocaine, Shabu, Shards, Speed, Stove Top, Tina, Trash, Tweak, Uppers, Ventana, Vidrio, Yaba, and Yellow Bam

^{(Adapted from DEA methamphetamine drug fact sheet 2020)}
 

What is “Crystal Meth?”

•  “Crystal meth” refers to an illicitly manufactured form of methamphetamine mixed with other chemicals in methamphetamine laboratories. The name “crystal meth” reflects its resemblance to glass crystal shards or shiny, bluish-white rocks. Typically, these crystals or rocks are smoked using glass pipes like those used to smoke crack cocaine. It is thought that this form of methamphetamine may be more potent, therefore, more hazardous for the person using this substance.
   
• Several hazardous chemicals are used to make crystal methamphetamine, including ether, acetone (found in paint thinner and nail polish remover), lithium (from batteries), anhydrous ammonia (fertilizer), iodine crystals, and red phosphorus (found on the striking surface of matchbooks).

Immediately after use

Immediately after use, the effects of methamphetamine are similar to other stimulants like cocaine and include euphoria (”a rush”), increased alertness, increased energy, decreased appetite, and a decreased need for sleep. More intense mental health and physical symptoms, including paranoia and hallucinations, feelings of panic, insomnia, rapid heart rate, tremors, sweating, teeth grinding, and seizures can occur as well. These effects can last from 8 hours to 24 hours, longer than the effects from other stimulants like cocaine. Continuous use of methamphetamine over several days or “binging” may cause more pronounced mental health and physical symptoms, due in part to the effects of severe sleep deprivation.

Chronic Use

With chronic use, tolerance to the effects of methamphetamine may develop, meaning that a larger amount of the substance is required to achieve the same intended effects. Individuals also may change the way the substance is used, the frequency of use, and amount of substance taken. For those individuals using methamphetamine regularly, withdrawal symptoms such as fatigue, depression, anxiety, and strong cravings for methamphetamine can occur after they stop using methamphetamine.

Substances mixed with methamphetamine that make it more dangerous. Unfortunately, it is not possible to identify reliably the presence of these illicit substances, chemicals or fillers by the mixture’s appearance, taste, or smell. Therefore, one should plan and assume that dangerous substances may be present.

• Fentanyl and its analogues (potent illicitly manufactured synthetic opioids) increasingly are mixed into methamphetamine and other stimulants to make the substance more powerful and more likely to cause addiction. Fentanyl and its analogues are linked to the sharp increase in overdose deaths related to the use of methamphetamine and other stimulants, especially in those people lacking tolerance to opioids.
• Chemical additives used to manufacture methamphetamine (Crystal meth).
• Fillers such as talcum powder, corn starch, or crushed over-the-counter medications also are mixed into methamphetamine to add weight. When injected into the body or inhaled, these fillers are known to cause additional harms to the lungs.

Overamping

Overamping refers to a negative reaction to using stimulants; while it is different from overdosing -- it can be life-threatening.

• Symptoms include: Chest pain, breathing difficulties, elevated blood pressure, rapid heart rate, elevated body temperature, seizures, anxiety, paranoia, aggression.
• Tips to prevent overamping: hydration, replenishment of electrolytes (Gatorade™ is a good source for electrolytes), seeking medical attention, a quiet and calm space, protecting the head in case of seizure.

Physical health effects:

Methamphetamine is associated with an increased risk of early death related to its effects on the body. Like other substances in the stimulant family, methamphetamine can have a significant impact on the cardiovascular system, including heart attacks, heart muscle thickening, dangerous heart rhythm disturbances, strokes, and rupture of the large blood vessels in the body. Methamphetamine’s impact on the brain can cause impaired decision-making leading to patterns of sexual behaviors that place the individual at greater risk of transmitting and acquiring HIV and other sexually transmitted infections. Additionally, chronic use of methamphetamine is associated with skin picking and infections, severe dental problems, and permanent problems with memory, concentration, learning, and decision-making among many other health effects. Methamphetamine use during pregnancy may lead to abnormal fetal development, life-threatening placental rupture, and the risk of premature delivery.

Mental health effects:

People who use methamphetamine are more likely to have or develop mental health disorders, including anxiety, depression, compulsive behaviors, psychosis (delusions, hallucinations) and risky sexual behaviors. As with other substances, methamphetamine use is associated with an increased risk of suicide.

Effects from combining substances:

Often, people who use methamphetamine may use other substances at the same time, including alcohol, benzodiazepines, cannabinoids, and opioids, among others. Combinations of substances may be used intentionally to enhance the intended effects or counteract negative effects of methamphetamine, but often individuals are unaware that these other substances are affecting them as well. Substantially worse health outcomes are observed for those using a combination of methamphetamine with other substances versus the impact from using methamphetamine alone. For example, combining alcohol and cannabis with methamphetamine may increase the risk of developing a severe mental health crisis, like psychosis. Combining substances may intensify already impaired decision-making related to methamphetamine, leading to risky sexual behaviors and increased likelihood of acquiring HIV or other sexually transmitted infections. Most concerning, fatal overdoses have increased dramatically among individuals using methamphetamine, attributed to combinations of methamphetamine with highly potent opioids like illicitly manufactured fentanyl and its analogues.

Additional health effects are related to how the substance is used:

• Smoking may cause burns in the throat and lungs, asthma, and other serious lung conditions caused by direct injury to the lung tissue and to the blood vessels of the lungs.
• Inhaling through the nose (insufflation, sniffing) may cause damage to the lining of the nose and nasal septum, potentially causing perforation (a hole) in the septum.
• Injection may cause skin and blood-borne infections and damage veins. People who inject methamphetamine and share syringes or any other equipment used to prepare or use substances are at risk of acquiring or transmitting HIV, hepatitis B virus, or hepatitis C virus.
• Swallowing, also called “eating meth”, causes a delayed onset of methamphetamine’s effects and may prompt ingestion of larger amounts of the substance leading to an increased risk of medical complications and overdose. Complications to the digestive tract from swallowing methamphetamine include inflammation of the liver (hepatitis) and a dangerous restriction of blood flow and oxygen to the intestines (ischemia).
• Insertion into the rectum, known as “booty bumping” or “plugging”, may cause direct trauma to the anus and rectum, painful rectal infections, and a dangerous restriction of blood flow and oxygen to the rectal area. Individuals using methamphetamine rectally may use larger amounts per episode versus other routes leading to an increased risk of complications and overdose.

Yes, chronic use of methamphetamine may lead to methamphetamine addiction, also known as methamphetamine use disorder. Compared to other stimulants, people who use methamphetamine are more likely to develop an addiction.

Some symptoms that suggest a methamphetamine use disorder include:

• Needing to take more and more methamphetamine to get the desired effect
• Using larger amounts of methamphetamine or over a longer period than you intended
• Persistent desire or unsuccessful efforts to cut down on methamphetamine use
• A lot of time spent doing things to get methamphetamine, use methamphetamine, or recover from its effects
• Craving, or a strong need or desire to use methamphetamine
• Failure to fulfill major role obligations at work, school, or home because of methamphetamine use
• Continued methamphetamine use despite having persistent or recurrent social or interpersonal problems
• Important things in life are given up because of methamphetamine use
• Recurrent methamphetamine use in situations in which it is physically hazardous, such a driving a car or operating a machine
• Continued methamphetamine use despite knowing its negative impacts on your mental or physical health
   

^{(Adapted from the DSM-5 criteria for Substance Use Disorder)}

• Consider testing methamphetamine for fentanyl and its analogues with fentanyl test strips.
• When using methamphetamine, use with a buddy and have naloxone available in case of accidental overdose.
• If using methamphetamine or other substances while alone, consider calling a hotline like Neverusealone.com while using substances.
• Utilize a harm reduction program for supplies, support, education, and linkage to other resources if using any form of methamphetamine. Examples of harm reduction programs include syringe services programs (SSPs), and drug user health hubs (DUHHs).
• If a person prefers not to attend a program in person or doesn’t have access to harm reduction services in their community and lives outside New York City, NEXT Distro (www.nextdistro.org) ,is an online mail-based harm reduction service where a person can order harm reduction supplies and have them delivered confidentially to their home.
• Get tested frequently for sexually transmitted infections like HIV, syphilis, gonorrhea, and chlamydia if at risk.Consider taking a medication called PrEP (pre-exposure prophylaxis) to prevent HIV infection if a person is having unprotected sex or sharing equipment used to prepare or use substances with individuals who might have HIV.
  • HARM  REDUCTION TIP: If a person is using methamphetamine and cannot remember to take their PrEP medications or other medications needed for other health conditions, they should plan ahead and take their medications before using. People who use substances can address their health issues successfully despite the potentially damaging effects of the substance.

Two forms of therapy have evidence as the most effective treatments for stimulant or methamphetamine use disorder: cognitive behavior therapy and contingency management.

• Medical and mental health providers may recommend individual or group counseling or behavioral therapy for methamphetamine use disorder. These therapies exist in both the outpatient and inpatient treatment settings. Different levels of care are available for individuals seeking help, depending on their needs. Sometimes, an individual may choose to enter an inpatient facility (rehabilitation) or residential program to receive intensive treatment for this disorder.
• There are no FDA-approved medications to treat methamphetamine use disorder unlike those approved for opioid use disorder (buprenorphine, methadone, naltrexone), alcohol use disorder (naltrexone, acamprosate, disulfiram) and tobacco use disorder (varenicline, nicotine replacement therapy, bupropion). However, there are some medications already in use for mental or physical health conditions that have shown promise for treating methamphetamine use disorder in some research studies.
• It is important to discuss treatment options with medical or mental health providers to see what may work best.
• Identifying and treating other co-existing substance use disorders and mental and physical health conditions related to methamphetamine use disorder are essential to maximize treatment options, reduce harms, and improve health outcomes.

• For help and hope 24/7, call 1-877-8-HOPENY (467369) or
  text HOPENY (467369). Toll-free and confidential.
• The National Suicide and Crisis Lifeline: call or text 988
• New York State Syringe Service Programs (SSPs): Syringe Access and Disposal (ny.gov)
• New York State Office of Drug User Health (ny.gov)