Amphetamines

Amphetamines provide a boost in energy and mood, and suppress appetite. Methamphetamine in particular has enormous potential for abuse, and addiction can cause long-lasting brain damage along with other problems.

Definition

Addiction is defined as a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use and by neurochemical and molecular changes in the brain. It is considered a brain disease because drugs change the brain's structure and functioning. These brain changes can be long-lasting and can lead to the harmful behaviors seen in people who abuse drugs.

Amphetamine is a collective term given to amphetamines, dextroamphetamines and methamphetamines. They are substances taken to boost energy, mood, and confidence, as well as to suppress appetite. Methamphetamines are the most powerfully addictive and can cause long-lasting damage to the brain and central-nervous system.

The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.

Methamphetamine is commonly known as "speed," "meth," and "chalk." In its smoked form, it is often referred to as "ice," "crystal," "crank," and "glass." It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. It was developed early in the 20th century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine causes increased activity, decreased appetite, and a general sense of well-being. Its effects can last six-to-eight hours. After the initial rush, there is typically a state of high agitation that in some individuals can lead to violent behavior.

Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is legally available only through a prescription. It is indicated for the treatment of narcolepsy (a sleep disorder) and attention-deficit/hyperactivity disorder; these medical uses are limited, and the doses are much lower than those typical among methamphetamine abusers.

We know that methamphetamine is structurally similar to the neurotransmitter dopamine, but it is quite different from cocaine. Although these stimulants have similar behavioral and physiological effects, there are some major differences in the basic mechanisms of how they work at the level of the nerve cell. However, the bottom line is that methamphetamine, like cocaine, results in an accumulation of the neurotransmitter dopamine, which appears to produce the stimulation and feelings of euphoria experienced by the user. In contrast to cocaine, which is quickly removed and almost completely metabolized in the body, methamphetamine has a much longer duration of action and a larger percentage of the drug remains unchanged in the body. This results in methamphetamine being present in the brain longer, which ultimately leads to prolonged stimulant effects. The actions of methamphetamine increase dopamine release while blocking its reuptake, leading to higher concentrations of dopamine, which can be deadly to the nerve terminals.

Methamphetamine comes in many forms and can be smoked, snorted, orally ingested, or injected. The drug alters moods in different ways, depending on how it is taken. People often ingest amphetamines by snorting them through the nostril initially. However, the level of absorption through this form of intake is not as predictable and rapid as injection or smoking.

Immediately after smoking the drug or injecting it, the user experiences an intense rush or flash that lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria—a high, but not an intense rush. Snorting produces effects within five minutes, and oral ingestion produces effects within 20 minutes. Smoking methamphetamine produces effects that can last for 12 hours or more.

As with similar stimulants, methamphetamine most often is used in a "binge and crash" pattern. Because tolerance for methamphetamine occurs within minutes—meaning that the pleasurable effects disappear even before the drug concentration in the blood falls significantly—users try to maintain the high by bingeing on the drug. In some cases, abusers indulge in a form of binging known as a "run," forgoing food and sleep while continuing abuse for up to several days.

Symptoms

Using amphetamines once is sufficient to induce some of these symptoms:

Short-Term Effects:

  • Enhanced mood and body movement
  • Increased wakefulness, physical activity
  • Increased respiration
  • Euphoria
  • Insomnia
  • Increased heart rate
  • Increased blood pressure
  • Reduced appetite
  • Cardiovascular collapse, death
  • Dilated pupils
  • Rapid/irregular heartbeat
  • Hyperthermia

Long-Term Effects:

  • Changes in brain structure and function, including damage to brain cells containing serotonin
  • Weight loss
  • Memory loss
  • Confusion
  • Tremors
  • Convulsion
  • Psychosis: Paranoia, Hallucinations
  • Repetitive motor activity, Parkinson's-like symptoms
  • Damage to nerve cells, causing strokes
  • Cardiovascular collapse, death

Note that psychotic symptoms can sometimes last for months or years after methamphetamine abuse has ceased, and stress has been shown to precipitate spontaneous recurrence of methamphetamine psychosis in formerly psychotic methamphetamine abusers.

Complications

  • Increased HIV and hepatitis B and C transmission are consequences of increased methamphetamine abuse, not only in individuals who inject the drug, but also in noninjecting methamphetamine abusers. Among injection drug users, infection with HIV and other infectious diseases is spread primarily through the reuse of contaminated syringes, needles, or other paraphernalia by more than one person. However, regardless of how it is taken, the intoxicating effects of methamphetamine can alter judgment and inhibition and lead people to engage in unsafe behaviors.
  • Often pure amphetamines are mixed with other substances, such as sugar, glucose, bi-carb soda, and ephedrine, that can be poisonous, causing collapsed veins, tetanus, abscesses and damage to the heart, lungs, liver, and brain.
  • Incessant use might result in addictions to other drugs such as benzodiazepines (an anti-anxiety agent) so the individual can sleep.
  • Methamphetamine abuse may also worsen the progression of HIV and its consequences. In animal studies, methamphetamine increased viral replication; in human methamphetamine abusers, HIV caused greater neuronal injury and cognitive impairment compared with nondrug abusers.

Causes

While the effects of amphetamines are almost immediate, tolerance is built up quickly, thus increasing the amount needed to produce the desired effect. During periods of nonuse, the user will recall the feeling of euphoria produced by the drug and desire to take it again.

According to the 2005 National Survey on Drug Use and Health (NSDUH), an estimated 10.4 million people age 12 or older (4.3 percent of the population) have tried methamphetamine at some time in their lives. A 2005 Monitoring the Future (MTF) survey of student drug use and attitudes study revealed that 4.5 percent of high school seniors reported using methamphetamines at some point in their life, along with 4.1 percent of tenth graders and 3.1 percent of eighth graders. Among high school seniors, 3.2 percent reported methamphetamine use in the past year. Both surveys showed recent declines in methamphetamine abuse among the nation's youth.

In contrast, evidence from emergency departments and treatment programs attest to the growing impact of methamphetamine abuse in the country. The Drug Abuse Warning Network (DAWN), which collects information on drug-related episodes from hospital emergency departments (EDs) throughout the nation, has reported a greater than 50 percent increase in the number of ED visits related to methamphetamine abuse between 1995 and 2002, reaching approximately 73,000 ED visits, or 4 percent of all drug-related visits in 2004.

Treatments

The most effective treatments for methamphetamine addiction are cognitive behavioral intervention and contingency management models. For example, the Matrix Model, a comprehensive behavioral treatment approach that combines behavioral therapy, family education, individual counseling, 12-step support, drug testing, and encouragement for nondrug-related activities, has been shown to be effective in reducing methamphetamine abuse. Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective.

There are no specific medications that counteract the effects of methamphetamine or that prolong abstinence from and reduce the abuse of methamphetamine by an individual addicted to the drug. However, there are a number of medications that are FDA-approved for other illnesses that might also be useful in treating methamphetamine addiction. Recent study findings reveal that bupropion, the anti-depressant marketed as Wellbutrin, reduced the methamphetamine-induced high as well as drug cravings elicited by drug-related cues. This medication and others are currently in clinical trials, while new compounds are being developed and studied in preclinical models.

Find a Treatment Program here.

Sources

  • NIDA Research Report
  • DSM Made Easy: The Clinician's Guide to Diagnosis.
  • Substance Abuse and Mental Health Services Administration (SAMHSA). Office of Applied Studies
Last reviewed 11/24/2014