Transcript “Crystal Meth” Street methamphetamine aka: • • • • • • "speed," "meth," "chalk." “crank” Pepsi means crank Pepsi one means Crystal Methamphetamine hydrochloride: (smokable clear chunky crystals resembling ice) • "ice,“cristy” “glass” “hanyak” “L.A.” “quartz” "crystal” Quantities: • • • “paper” = ¼

“Crystal Meth”
Street methamphetamine aka:
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"speed,"
"meth,"
"chalk."
“crank”
Pepsi means crank
Pepsi one means Crystal
Methamphetamine hydrochloride:
(smokable clear chunky crystals
resembling ice)
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"ice,“cristy” “glass” “hanyak” “L.A.”
“quartz” "crystal”
Quantities:
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“paper” = ¼ gram
“Teenager” = 1/16 oz.
“Eightball” - (eighth of an ounce) = 3.5
grams
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Tina Or Teena - name derives from the
fact that meth is commonly bought in
sixteenths of an ounce packages (aka
"baggies")
“Tweaking” www.tweaker.org
Someone who uses meth. Often refers only to
those who get paranoid or psychotic.
History of Methamphetamine
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Amphetamines were synthesized by the German pharmacologist L. Edeleano in 1887.
The related compound, methamphetamine, was first synthesized in Japan in 1919.
In 1927 The British chemist Gordon Alles discovered the stimulating effects of meth.
In 1932, an U.S. pharmaceutical company bought the patent to the Alles discovery, and
marketed the drug as a nasal decongestant that could be inhaled, Benzedrine.(Bennies) People
used to take apart those inhalers and suck-out the speed.
During the WWII, amphetamines were sanctioned by a number of governments including Nazi
Germany, the United States and Japan for their energizing troops and antidepressant
properties. A friendly fire incident in Afghanistan last year has turned the spotlight on
amphetamine use by US Air Force pilots. Four Canadians were killed and eight injured when
two US pilots misinterpreted their night-time exercises as an attack and dropped a bomb. This
was despite the Canadian forces informing the US military of the manoeuvres, and in
contravention of orders directing the pilots to hold their fire. The pilots now face court martial,
with much of the attention focused on whether the amphetamines in their system made them
trigger-happy.
It is estimated that millions of Japanese soldiers, defense workers, and civilians used
amphetamines and that by the end of the war, at least 2 percent of the adult Japanese
population were dependent on the drug.
In the United States, post-war studies of American military prisoners revealed abuse of
amphetamine inhalers. In 1959, the first use in the United States of intravenous injection of the
contents of a Benzedrine inhaler for non-medicinal purposes was reported; in 1971, the last
non-prescription inhaler was removed from the U.S. market pursuant to the passage of the
Controlled Substances Act of 1970.
In the United States, there have been three distinct methamphetamine epidemics: one in the
Street Cost of Methamphetamine:
A Cheap Date?
• One ounce of meth equals about 110 meth "hits."
$25 per 1/4 gram
$ 100 per gram
$1700 per ounce
Nationwide, prices ranged from $12,000 to $35,000 per kilogram of
Cocaine.
0.5gm which would cost between $60 and $100. 1 oz cocaine= $2800
Oct. 9, 1999
New York
March 28, 2000
Bay Area of California
1/4 gram - $60
1 gram - $240
1/4 gram - $20
1 gram - $80
Before and After
Methamphetamine Treatment Admissions 1992
Methamphetamine Treatment Admissions 1996
Methamphetamine a “cottage industry”
National Clandestine
Laboratory
Epidemic or Not?
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According to the New York City's largest private clinic for lesbians and
gay men, Callen-Lorde Community Health Center, two-thirds of those
testing positive for H.I.V. since June acknowledged that crystal meth
was a factor in their infection.
Dr. Howard Grossman, one of the city's best-known AIDS specialists,
said more than half the men who test positive in his private practice
blamed methamphetamine. "This drug is destroying our community,"
he said. "It just seems to be getting worse and worse, and no one is
doing anything about it."
Although the city Department of Health does not track crystal meth use
among the newly infected, the city's poison control center received four
dozen reports of crystal meth overdoses in 2002 and 2003. In the
previous two years, there were none, said the city's health commissioner,
Thomas R. Frieden. In another survey, the agency found that H.I.V.positive men were twice as likely as uninfected men to use
methamphetamine; those who use the drug were also less likely than
other men to wear condoms during anal intercourse. "We're seeing a
general increase in risky sexual behavior, and we're concerned," Dr.
Frieden said.
Nearly two dozen 12-step meetings are held each week around the city
for those trying to shake the drug. In 2002, there were four Crystal
Meth Anonymous meetings each week. In 1999, there were none.
Geographical method of usage varies
A recent study by the Center for
H.I.V./AIDS Educational
Studies and Training found that
more than half of gay men in
New York who admitted using
alcohol or drugs had tried
crystal meth in the previous
year. By comparison, a 1998
survey conducted at bars and
clubs by the center found that
10 percent of gay men said they
had tried it.
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According to the 2000 National Household
Survey on Drug Abuse, an estimated 8.8
million people(4.0 percent of the
population) have tried methamphetamine
at some time in their lives.
Data from the 2000 Drug Abuse Warning
Network (DAWN), which collects
information on drug-related episodes from
hospital emergency departments in 21
metropolitan areas, reported that
methamphetamine related episodes
increased from approximately 10,400 in
1999 to 13,500 in 2000, a 30 percent
increase. However, there was a significant
decrease in methamphetamine-related
episodes reported between 1997 (17,200)
and 1998 (11,500).
$25 will keep a user high for a day on a
mere quarter gram of methamphetamine.
Decreased Striatal Dopamine D1 Receptor-Stimulated Adenylyl Cyclase Activity in Human Methamphetamine Users
Junchao Tong, Ph.D. Brian M. Ross, Ph.D. Gregory A. Schmunk, M.D. Frank J. Peretti, M.D. Kathryn S. Kalasinsky, Ph.D.
Yoshiaki Furukawa, M.D. Lee Cyn Ang, M.D. Sally S. Aiken, M.D. Dennis J. Wickham, M.D. Stephen J. Kish, Ph.D.
(Am J Psychiatry 2003; 160:896–903)
Emotional & Social Consequences
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Delinquency
School Problems
School Absenteeism
Criminal Behavior
Homelessness
Shame
Attachment Disorders
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Isolation
Poor Peer Relations
Unemployment
Poverty
Addictions
Poor Anger Mgmt.
Chaotic Lifestyle
Symptoms of Methamphetamine
Use/Abuse
• Increased alertness &
activity, with a feeling
of euphoria & selfconfidence
• Mood disturbances &
delusional sensory
experiences, such as
bugs crawling on the
skin
• Elevated heart rate,
respiration & body
temperature
• Blurred vision
• Dizziness
• Welts on the skin
• Rotten teeth
• Severe weight loss
• Dilated pupils
Meth “Binge & Crash”
• Binge: can last up to 3 days characterized by redosing in effort to obtain original rush, close with
period of confusion, “tweaking”
• Crash has 4 phases:
– 1. Insomnia, exhaustion, fatigue, paranoia, auditory
hallucinations, violence, irritability, aggression
– 2. Intense sleep: up to 3 days, body can starve & begin
to catabolize muscle: danger of coma & seizures
– 3. Intense hunger, eating, disorientation, depression
– 4. Depression: lasting up to 5 months
Dopamine Transporter binding in chronic
Methamphetamine Abusers
Methamphetamine-Related Psychiatric Symptoms and Reduced Brain Dopamine Transporters Studied With PET
(Am J Psychiatry 2001; 158:1206–1214) Yoshimoto Sekine, M.D., Ph.D. Masaomi Iyo, M.D., Ph.D. Yasuomi Ouchi, M.D., Ph.D. Tsutomu Matsunaga,
M.D., Ph.D. Hideo Tsukada, Ph.D. Hiroyuki Okada, B.A. Etsuji Yoshikawa, B.A. Masami Futatsubashi, B.A. Nori Takei, M.D., Ph.D., M.Sc. Norio Mori,
M.D., Ph.D.
Limbic System
Dopamine Transporter binding in chronic
Methamphetamine Abusers
• We found no significant correlation between the
duration of abstinence, which lasted in our subjects
from 1 week to 1.5 years, and dopamine transporter
density in either the caudate/putamen or the nucleus
accumbens.
• The previous PET study (15) showed a significant
reduction in the caudate/putamen dopamine
transporter density in chronic methamphetamine
users, some of whom had been abstinent for more
than 3 years.
• These findings suggest that lasting reduction of brain
dopamine transporter density could occur after
habitual methamphetamine use.
Methamphetamine and D2 Receptor Availability
(Am J Psychiatry 158:12, December 2001 VOLKOW, CHANG, WANG, ET AL.)
Pathways of Addiction
•The first PET study to document lower levels
of dopamine D2 receptors in methamphetamine
abusers. PET measures of dopamine D2
receptors mostly reflect the level of postsynaptic
receptors
•Lower levels of D2 receptor availability in
methamphetamine abusers could reflect
receptor down-regulation from exposure to a
higher extracellular dopamine concentration
secondary to methamphetamine’s acute
pharmacological effects.
•Alternatively, the low levels of D2 receptors
could have preceded methamphetamine use and
may have predisposed these subjects to drug
use.
•Subjects with low D2 receptor levels
experienced a “pleasurable” response, whereas
subjects with high receptor levels experienced
an “unpleasant” response. These findings led us
to speculate that D2 receptors, by modulating
pleasant versus unpleasant drug responses, may
be a variable that contributes to drug abuse and
addiction.
Dopamine Neuron destruction
• Chronic administration of
morphine in rats shrinks
dopamine neurons in the
reward circuit. The
receiving branches, called
dendrites, wither and the
filaments that transport
important substances
down the neuron's axon
are reduced. Nerve growth
factors appear to reverse
the damage.
Illustration by Lydia Kibiuk, Copyright © 1997 Lydia Kibiuk.
Orbitofrontal Cortex
Dopamine modulation of the orbitofrontal cortex could underlie
addictive behaviors in several ways. First, the orbitofrontal cortex is
involved in the regulation of “drive” , and thus enhanced activation
secondary to drug-induced dopamine stimulation could result in an
intense motivation to self-administer methamphetamine in the
addicted subjects. Moreover, because the orbitofrontal cortex
processes information about the rewarding properties of stimuli, its
disruption could account for the enhanced salience of drug-related
stimuli. Second, the orbitofrontal cortex has been implicated in the
occurrence of compulsive behaviors, and thus one could postulate
that its inappropriate activation could induce compulsive drug
administration in methamphetamine abusers.
In laboratory animals, damage to the orbitofrontal cortex results in
perseveration and resistance to extinction of reward-associated
behaviors . These findings are reminiscent of the reports of drug
addicts who claim that once they start taking a drug of abuse they
cannot stop even when the drug is no longer pleasurable. Third, the
orbitofrontal cortex is involved with learning stimulus-reinforcement
associations and with conditioned responses and could therefore
participate in cues or drug-induced craving. Laboratory animals
exposed to an environment where they had received a drug of
abuse show orbitofrontal activation (49), and lesions of the
orbitofrontal cortex interfere with drug-induced conditioned place
preference (50). These findings are relevant because drug-induced
conditioned responses have been implicated in the craving elicited
in humans by drug-related stimuli (51), which is one of the factors
that contributes to relapse in drug abusers (52). Moreover,
activation of the orbitofrontal cortex has been shown in drug
abusers during craving elicited by a drug (53), by viewing a video of
drug paraphernalia (54), and by recalling previous drug
experiences (55). Limitations for this study are those inherent in
clinical research in drug abuse populations,
Human Genome
• The results showed that the gene whose
expression was stimulated to the greatest
degree by the methamphetamine was a G
protein receptor kinase, called GRK3.
GRK3 in the rat genome is analogous to the
region 22q11 on the human genome, the
area where several laboratories, including
ours, have identified an association with
both bipolar illness and schizophrenia. This
close proximity of a susceptibility gene for
bipolar disorder/schizophrenia with a gene
that is activated by methamphetamine in rat
brain strengthens the claim that this
preparation is a model for manic psychosis.
ALEXANDER B. NICULESCU III, M.D., PH.D.
JOHN R. KELSOE, M.D. San Diego, Calif.
Reward/Punishment activation of the Orbital Frontal
Cortex
Reward Activation
Punishment Activation
Reward/Punishment activation of the
Orbital Frontal Cortex
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University of Oxford study using fMRI.
Choice of the correct stimulus led to a probabilistically determined
‘monetary’ reward and choice of the incorrect stimulus led to a monetary
loss.
These results are consistent with the hypothesis that the deficits in
emotion-related learning tasks following OFC lesions are due to an
impairment in using information from rewarding and punishing outcomes
to guide behavioral choice. The finding that the magnitude of the
activations depended on the size of the reward or punishment received is
consistent with neurophysiological evidence from primates that rewarding
and punishing stimuli are represented in the OFC, but this finding does
not exclude a possible representation in other brain areas of rewards and
punishments. Our evidence that there is a representation for rewards and
punishments in these regions is also consistent with the hypothesis that the
changed emotional and social behavior demonstrated by humans with this
damage is due to a fundamental impairment in the processing of rewards
and punishments.
Reward and punishment representations in the human orbito-frontal cortex
J. O’Doherty1,2, M. L. Kringelbach1,2, E. T. Rolls1, J. Hornak1 and C. Andrews2 nature neuroscience • volume 4 no 1 • january 2001
CNS
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Even small amounts of methamphetamine can produce euphoria, increased
alertness, paranoia, decreased appetite and increased physical activity. Other
central nervous system effects include athetosis (writhing jerky, or flailing
movements), irritability, extreme nervousness, insomnia, confusion, tremors,
anxiety, aggression, incessant talking, hyperthermia, and convulsions.
Hyperthermia (extreme rise in body temperature as high as 108 degrees) and
convulsions sometimes can result in death.
Physical
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Use can produce chest pain and hypertension which can result in
cardiovascular collapse and death. In addition, methamphetamine causes
accelerated heartbeat, elevated blood pressure and can cause irreversible
damage to blood vessels in the brain. Pupil dilation, respiratory disorders,
dizziness, tooth grinding, impaired speech, dry or itchy skin, loss of appetite,
acne, sores, numbness, and sweating.
Overdose
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A toxic reaction (or overdose) can occur at relatively low levels, 50 milligrams
of pure drug for a non-tolerant user.
Withdrawal
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drug craving, extreme irritability, loss of energy, depression, fearfulness,
excessive drowsiness or difficulty in sleeping, shaking, nausea, palpitations,
sweating, hyperventilation, and increased appetite.
Treatment
• Acute Restorative Treatment (im Ativan for rapid
tranquilization, intravenous hydration for electrolytes,
vitamin, diet)
• Infectious Disease Evaluation (HIV, Hepatitis profile,
Heterophile, Gonococcal etc.)
• CMA (Crystal Meth Anonymous), AA, SAA
• Antidepressants (Wellbutrin), refrain from Major
Tranquilizers when possible, AED preferable for agitated
mood symptomatology
• Individual Therapy > 1year
• Small Group Therapy with daily internet message group
interaction
People, Places and Things
The idea of encoding drug-induced behavioral changes in a memory-like fashion permits the
incorporation of a commonly observed clinical characteristic of addiction, namely that
drug-associated environmental stimuli have inordinate power to direct behavior (3).
Indeed, drug-seeking by addicts is often described as an almost unconscious behavior
that is seemingly immune from conscious control. As such, these behaviors can be
viewed as a form of procedural memory that is triggered by environmental stimuli
indicative of the drug experience. Procedural memories are encoded in a distributed
circuit that integrates the association cortex with the basal ganglia, thalamus, and limbic
nuclei.
However, even as this synthesis of information regarding the acute effects of drugs was
pointing researchers toward the importance of dopamine in reward and reinforcement, it
was becoming ever more apparent that addiction produced by chronic drug use was
associated with long-term changes in brain circuitry distal to dopamine transmission.
Moreover, it appeared possible that these nondopaminergic neuroadaptations were
encoding the behavioral changes that define addiction
Homosexual Issues
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Bathhouse behaviors
HIV/HepC/Syphilis
Viagra
“Meth eventually turns everyone into a bottom”
Obsessive/Compulsive sexual urges
As long as it took to get into the forest, as long as
to get out:patience above ALL ELSE
Future Treatments
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Researchers are testing unique
methods that may help abusers stay
off drugs and treat an overdose. One
technique (a) works like a traditional
vaccine. It attempts to prompt the
immune system to send out a slew of
antibodies that trap and inactivate
target drugs. Another strategy (b)
involves lab-manufacturing a
selection of the most aggressive
antibodies. A dose of the medicine
also is thought to trap and inactivate
target drugs. In a different technique
under investigation (c) specially
created antibodies attack and then
chew up the drug.
ILLUSTRATION BY LYDIA KIBIUK. Copyright © 2001.
Meth Effects