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?

• 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, 5 20% 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 –Motivation –Emotion –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

1.5% 5.7 6.7

5.5

5.3

Annual

0.9% 1.7

1.0

0.3 0.7

Last 30 days

0.3% 0.5

0.5

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

Grade

8 th 10 th 12 th

Lifetime Annual 3.9% 2.5%

Last 30 days

1.2% 5.2

6.2

3.3

3.2

1.4

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 Nov

Month

Sept July 0 4.8

6.6

2 3 8 5 8 5 6 6 5 7 24 24 23 29.5

33 34 39 20 40

Number of screens

Total screens THC Meth/amp 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 • 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 • 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) – – 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) – 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

” – 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 “

Washou

t” (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: • 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 • Increased energy and decreased fatigue • Increased activity • Decreased appetite and weight loss • Euphoria and rush • Increased respiration

Methamphetamine Side Effects • 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….

• 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