Methamphetamines University of Pittsburgh Graduate Learning objectives 1. To provide a historical context of methamphetamine use and abuse 2.
Download ReportTranscript Methamphetamines University of Pittsburgh Graduate Learning objectives 1. To provide a historical context of methamphetamine use and abuse 2.
Methamphetamines University of Pittsburgh Graduate Learning objectives 1. To provide a historical context of methamphetamine use and abuse 2. To overview medicinal uses of methamphetamine 3. To discuss mechanisms and outcomes of methamphetamine abuse 4. To discuss the challenges of methamphetamine research What is methamphetamine? Formula C10H15 N Molecular mass: 149.233 g/mol Half life: 9-15 hours Excretion: renal What is methamphetamine? Source – NIDA Research Report – 1998 History of meth • Amphetamine created in Germany in 1887 • Used widely during WWII by the Nazi and Japanese armies • Japanese kamikaze pilots were documented to be high on meth • Major challenge in postwar Japan • Biker gangs in California after WWII began to distribute meth Source – Nebraska State Patrol Methamphetamine: medical uses • Narcolepsy • Attention deficit disorder • Obesity (short term use) Forms of Distribution What does meth look like? • Typically an odorless powder that dissolves quickly in water • Another form of meth is clear chunky crystals referred to as crystal meth or ice • May be in the form of small brightly colored tablets, referred to as YABA How is meth used? • Injected • Snorted • Smoked • Orally Methamphetamine/Amphetamine Treatment Admissions by Route of Administration: 1992-2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS). Meth causes… • Increased alertness • Decreased appetite • A distorted sense of wellbeing • Effects that can last 8 to 24 hours U.S. Emergency Dept. Mentions of Meth/amphetamines 1995-2002 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 1995 DAWN, July 2004 1996 1997 1998 1999 2000 2001 2002 Demographics of MA-related ED visits in U.S., 2002 58% male and 42% female Race/ethnicicty White Latino African American Age Under 18 18-34 years Over 34 DAWN, 2004 11% 56% 33% 65% 11% 6% Behavior changes Psychotic behavior Paranoia Aggression Anxiety Fatigue Depression Delusions Mood swings Confusion Insomnia Hallucinations Health changes Stroke Brain damage Weight loss Death Source – Congressional Research Sites How does methamphetamine work? Methamphetamine releases large amounts of dopamine in the brain, causing feelings of pleasure and euphoria. Source: National Institute on Drug Abuse. April 1998, Reprinted January 2002. Research Report Series: Methamphetamine Abuse and Addiction. www.nida.nih.gov/ResearchReports/methamph/methamph.html Effects of meth on dopamine Researchers report that the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. 200 % of Basal DA Output NAc shell 150 100 Empty 50 Box Feeding 200 150 100 15 10 5 0 0 0 60 120 Time (min) 180 ScrScr BasFemale 1 Present Sample 1 2 3 4 5 6 7 8 Number Scr Scr Female 2 Present 9 10 11 12 13 14 15 16 17 Mounts Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Copulation Frequency DA Concentration (% Baseline) Natural Rewards Elevate Dopamine Levels FOOD SEX Accumbens 1100 1000 900 800 700 600 500 400 300 200 100 0 AMPHETAMINE Accumbens % of Basal Release 400 DA DOPAC HVA 0 1 2 3 4 250 200 100 0 5 hr 0 NICOTINE Accumbens Caudate 150 100 0 0 1 2 3 hr Time After Nicotine 1 Accumbens 250 % of Basal Release 200 COCAINE DA DOPAC HVA 300 Time After Amphetamine % of Basal Release % of Basal Release Effects of Drugs on Dopamine Levels 2 3 4 Time After Cocaine 5 hr MORPHINE Dose (mg/kg) 0.5 1.0 2.5 10 200 150 100 0 0 Source: Di Chiara and Imperato 1 2 3 4 Time After Morphine 5hr PET Scan of Long-Term Meth Brain Damage Long-term effects: What will happen in the future Methamphetamine destroys the endings of dopamine containing nerve cells (NIDA 2) Partial Recovery of Brain from Methamphetamine After Abstinence 3 0 ml/gm Normal Control METH Abuser (1 month abstinent) METH Abuser (14 months abstinent) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001. Dopamine improvements after 1 year, but not cognitive and motor functioning Methamphetamine Acute Physical Effects Increases Heart rate Blood pressure Pupil size Respiration Sensory acuity Energy Decreases – Appetite – Sleep – Reaction time Methamphetamine Acute Psychological Effects Increases Confidence Alertness Mood Sex drive Energy Talkativeness Decreases Boredom Loneliness Timidity Highly Toxic Substances Drain cleaner Battery acid Antifreeze Over-the-counter asthma medicine containing ephedrine or pseudoephedrine Match-box striker (Red phosphorous) Hydrochloric acid Lye Lantern fuel (KCI) Methamphetamine use and pregnancy Possible effects found in the few human studies that exist include increased rates of premature delivery, placental abruption (early separation of a normal placenta from the wall of the uterus), retarded fetal growth, and cardiac and brain abnormalities. Source: Volkow, Nora, M.D., Director, NIDA. April 21, 2005. Testimony Before the Subcommittee on Labor, Health, and Human Services; Education; and Related Agencies. Committee on Appropriations, U.S. Senate. www.hhs.gov/asl/testify/t050425b.html Meth Mouth: Myth and Reality How many Americans use methamphetamines? Lifetime use: 4.9 percent of those aged 12 and over (12 million people) Past-year use: 0.6 percent of those aged 12 and over (1.4 million people) Past-month use: 0.2 percent of those aged 12 and over (600,000 people) Source: The Substance Abuse and Mental Health Services Administration/Office of Applied Studies. September 16, 2005. The NSDUH Report: Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004, In Brief. http://oas.samhsa.gov/2k5/meth/meth.htm Environmental effects of meth • Meth production leaves behind 5 to 6 pounds of toxic waste per pound of meth produced. • Toxic by-products contaminate sites where meth is produced, posing serious health and environmental hazards to those nearby. • The cost to clean up one meth lab often exceeds $4,000. Source – Koch Crime Institute Impacts on families • Danger of children being exposed to toxic fumes • Children are more at risk than adults to environmental hazards, as their bodies are immature • Risk of explosion, fire, and chemical burns • Exposure to weapons, finished drugs, and unsanitary conditions More impacts on families • Increase in child abuse and neglect cases • Increased risk for substance abuse among children in later life • A rise in domestic disputes Is there an effective treatment for methamphetamine abuse? At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Methamphetamine recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery. U.S. admissions for MA drug treatment SAMSHA, 2004 Epidemiology High prevalence of HIV in patients who use crystal MA • Shoptaw, et al, J Addict Dis 2002 showed in a CA study that 61% of men seeking tx for MA had HIV infection – – – – 77% of men were white, 17% were Latino All were in their mid 30’s and had some college education Reported a mean of 66 different partners in 6 months Persons with HIV were more likely to have injected MA, contracted an STD and had more UAI • Klitzman, et al Am J Psychiatry 2000 reported strong association between MDMA use and high-risk sexual behavior • 2001 report in MMWR found that in an outbreak of 130 cases of syphilis in CA, 51% were MSM and 18% reported use of MA Epidemiology Study of 25 HIV+ gay men using MA (Semple et al., J Subst Abuse Treat 2002) – “provided temporary escape from being HIV+” – “helps manage negative self-perception and social rejection associated with being HIV+ – “method of coping with the specter of death” Key points on methamphetamine Methamphetamine is a drug that can be effectively used for several medical conditions When used illegally, Meth is a powerful, highly addictive stimulant that can be made easily from legally available products. Twelve million Americans ages 12 and over have used meth at least once; use is most common between ages 19 and 40. Meth labs use and produce toxic, explosive chemicals; meth labs are dangerous and expensive to clean up. Exposure to chemicals used to make meth may cause cancer, damage the brain and other organs, and result in birth defects.