Treatment of Methamphetamine Abuse

By: Allison Colker, Esq.

December 31, 2004

Introduction

Methamphetamine, a dangerous stimulant similar to cocaine, has a large potential for abuse.  Used in a variety of ways, methamphetamine has devastating short- and long-term effects.  Methamphetamine abuse is a growing problem in the United States, especially in the rural West and Southwest.  Initially, it was prescribed for weight loss or used to ward off sleep and help people stay alert; these uses continue, in addition to widespread abuse.  Law enforcement agencies and the media have focused on the illegal production, trafficking and distribution of methamphetamine.  Methamphetamine laboratories are a highly publicized and very serious problem.  Meth labs pose a threat to the health of all people, especially children who are within close proximity to them.  State legislators need to deal with criminal justice issues surrounding methamphetamine such as production in meth labs, trafficking and distribution.  However, the focus of this issue brief is on the treatment of methamphetamine abuse.  The prevention and treatment of methamphetamine abuse are increasingly important issues that also must be dealt with by researchers, providers, advocates, state agencies and legislators.  The current spectrum of treatment for methamphetamine abuse is similar to treatment for other drug addictions.  State legislators play a significant role in the treatment and prevention of methamphetamine abuse as both a purchaser and a provider.  State legislators must decide whether methamphetamine addiction treatment is eligible for Medicaid reimbursement and at what rate, and whether state-funded clinics will provide this treatment.  Furthermore, state lawmakers must decide whether they will appropriate money for methamphetamine use prevention and at what amount, and how schools and state agencies will provide this prevention.

Overview

Methamphetamine

Methamphetamine is a highly addictive central nervous system stimulant.  It is easily manufactured in clandestine laboratories using inexpensive, over-the-counter ingredients.  Therefore, methamphetamine has a high potential for widespread production, availability and abuse ^(1).

Methamphetamine also is known by such terms as "speed," "meth" and "chalk."  The smoked form is called "ice," "crystal," "crank" and "glass."  It is an odorless, white, bitter-tasting crystalline powder that dissolves easily in water.  Methamphetamine, developed in the early 1900s from amphetamine, was originally used in bronchial inhalers and nasal decongestants.  With a chemical structure similar to that of amphetamine, methamphetamine also causes decreased appetite, increased activity, and a general sense of well-being.  The effects can last six to eight hours.  The initial rush usually is followed by a state of extreme agitation that can lead to violence in some individuals ^(2).

Because it is a Schedule II stimulant, methamphetamine is available only through a non-refillable prescription.  Accepted medical reasons for its use include the treatment of attention deficit disorder, narcolepsy, and obesity (for short-term use) ^(3).

Methamphetamine vs. Cocaine

Methamphetamine is classified as a psychostimulant, as are cocaine and amphetamine.  Although methamphetamine is structurally similar to amphetamine, it differs significantly from cocaine.  Even though these stimulants have similar behavioral and physiological effects, major differences exist in the basic mechanisms of how they work in nerve cells.  Methamphetamine and cocaine both result in an accumulation of dopamine in the brain, which seems to produce the user's stimulation of feelings of euphoria.  Although cocaine is quickly removed and almost completely metabolized in the body, methamphetamine has a longer duration of action and a larger percentage of the drug remains unchanged in the body.  Therefore, methamphetamine is present in the brain longer, which ultimately leads to prolonged stimulant effects ^(4).

Methamphetamine Use

Methamphetamine's various forms can be snorted, smoked, injected or orally ingested.  It alters moods in different ways, depending upon the method of administration ^(5).

Immediately following smoking or intravenous injection, the user experiences an intense rush or "flash" that lasts a few minutes and is extremely pleasurable.  Oral ingestion or snorting produces euphoria (a high but not an intense rush).  Oral ingestion produces effects within 15 to 20 minutes, and snorting produces effects within 3 to 5 minutes ^(6).

Methamphetamine is most often used in a "binge and crash" pattern as with similar stimulants.  Tolerance to methamphetamine occurs within minutes (the pleasurable effects disappear even before the drug concentration in the blood falls significantly), so users binge on the drug to try to maintain the high.  Some abusers forego sleep and food while indulging in a form of bingeing known as a "run," injecting up to a gram of methamphetamine every two to three hours over several days until the user is too disorganized to continue or runs out of the drug ^(7).

A smokable form of methamphetamine, "ice," came into use in the 1980's.  Ice is a large, usually clear crystal of high purity that is smoked in a glass pipe (like crack cocaine).  The smoke is odorless, leaves a resmokable residue, and produces effects that may continue for 12 or more hours ^(8).

Consequences of Methamphetamine Use

Short-Term Effects of Methamphetamine Abuse

Even in small doses, methamphetamine can increase wakefulness and physical activity and decrease appetite.  Users who smoke or inject methamphetamine report a brief, intense sensation, or rush.  Those who ingest methamphetamine orally or snort it report a long-lasting high--instead of a rush--that can continue for as long as half a day.  Researchers believe that both the rush and the high result from the release of very high levels of dopamine into areas of the brain that regulate feelings of pleasure ^(9).

Methamphetamine has toxic effects.  A single high dose can damage nerve terminals in the dopamine-containing regions of animals' brains.  Researchers believe that the large dopamine release produced by methamphetamine contributes to its toxic effects on nerve terminals in the brain.  High doses can cause convulsions and can raise body temperature to dangerous, sometimes lethal, levels ^(10).

Long-Term Effects of Methamphetamine Abuse

There are many damaging effects of long-term methamphetamine abuse, including addiction.  According to the National Institute of Drug Abuse (NIDA), "Addiction is a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use, which is accompanied by functional and molecular changes in the brain."  Other effects of chronic methamphetamine use include anxiety, violent behavior, insomnia and confusion.  Chronic abusers also display a number of psychotic features, including auditory hallucinations, paranoia, delusions and mood disturbances.  The paranoia can result in suicidal as well as homicidal thoughts ^(11).

Tolerance for methamphetamine can develop with chronic use.  To intensify the desired effects, users make take the drug more frequently, change their method of drug intake, or take higher doses.  Chronic abuse can result in psychotic behavior, characterized by visual and auditory hallucinations, intense paranoia, and out-of-control rages that can lead to extremely violent behavior ^(12).

There are no physical manifestations of a withdrawal syndrome when a chronic methamphetamine user stops taking the drug, but several psychological symptoms occur when use is stopped.  These include anxiety, depression, paranoia, fatigue, an intense craving for the drug and aggression ^(13).

Scientific studies of the consequences of long-term methamphetamine exposure in animals have led to concern about its toxic effects on the brain.  Research has found that up to 50 percent of the dopamine-producing brain cells can be damaged after prolonged exposure to relatively low levels of methamphetamine.  Another finding is that serotonin-containing nerve cells may be damaged even more extensively.  It is still an open question whether this toxicity is related to the psychosis displayed by some long-term methamphetamine abusers ^(14).

Medical Complications of Methamphetamine Abuse

Another significant problem in the United States is fetal exposure to methamphetamine.  Current research indicates that methamphetamine abuse during pregnancy can result in increased rates of premature delivery, prenatal complications and altered neonatal behavioral patterns, such as extreme irritability and abnormal reflexes.  Prenatal methamphetamine abuse also may be linked to congenital deformities ^(15).

HIV/AIDS and Hepatitis B and C Risk for Methamphetamine Abusers

Like other needle injecting drugs, there is the potential for HIV and hepatitis B and C transmission.  Research also shows that methamphetamine and related psychomotor stimulants can increase users' libidos (in contrast to opiates, which decrease the libido).  However, long-term methamphetamine abuse may be associated with decreased sexual functioning, at least in men.  Furthermore, methamphetamine appears to be associated with rougher sex, which may cause vaginal abrasions and bleeding.  The combination of injection and sexual risks could mean that HIV will become a greater problem among methamphetamine abusers than among opiate and other drug abusers; and there already is evidence of this in California ^(16).

Research funded by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) has found that, through prevention, community-based outreach programs, and drug abuse treatment, drug abusers can change their HIV risk behaviors.  Drug use can be eliminated and drug-related risk behaviors, such as unsafe sexual practices and needle sharing, can be significantly reduced, thus decreasing the risk of exposure.  Therefore, drug abuse treatment also can be highly effective in preventing the spread of hepatitis B, hepatitis C, and HIV ^(17).

Spread of Methamphetamine Across the United States

Methamphetamine abuse has a history of abuse in the San Diego, California, area, and is now a major problem in other areas of the West and Southwest.  It also is spreading to rural and urban areas of the South and Midwest.  Initially, methamphetamine use was associated with white, male, blue-collar workers, but now is used by diverse population groups that have changed over time and geographic area ^(18).

The 2000 National Household Survey on Drug Abuse reports that approximately 8.8 million people (4 percent of the population) have tried methamphetamine at least once ^(19).

The Drug Abuse Warning Network (DAWN) reported a 30 percent increase in methamphetamine-related episodes between 1999 and 2000, from approximately 10,400 in 1999 to 13,500 in 2000.  However, a 33 percent decrease in methamphetamine-related episodes was reported between 1997 and 1998, from approximately 17,200 in 1997 to 11,500 in 1998 ^(20).

The National Institute on Drug Abuse's Community Epidemiology Work Group (CEWG) reported in June 2001 that methamphetamine is a continuing problem in Hawaii; San Francisco and Los Angeles, California; and Denver, Colorado.  Methamphetamine is available and produced in more diverse areas of the country, particularly rural areas, which could lead to its widespread illegal use ^(21).

CEWG's June 2001 report of drug abuse treatment admissions revealed that methamphetamine remained the leading drug of abuse in San Diego, California, and Hawaii.  Stimulants, including methamphetamine, were the primary drug of abuse for a smaller percentage of treatment admissions in other metropolitan areas and Western states.  Furthermore, stimulants accounted an even smaller percentage of treatment admissions in most Eastern and Midwestern metropolitan areas ^(22).

Methamphetamine Use Trends

Unlike many of the other known illicit drugs, methamphetamine is not usually bought and sold on the streets.  Users report that they obtain methamphetamine from friends and acquaintances.  It is typically a more closed or hidden sale, prearranged by "networking" with producers.  Often, it is sold "by invitation only" at all-night "raves" or warehouse parties ^(23).

Great variation exists in the processes and chemicals used, since methamphetamine can be made with readily available, inexpensive materials.  Therefore, the final product sold may not be methamphetamine at all, but rather a highly altered chemical mixture with some stimulant-like effects.  Uncertainty about the drug's sources and the pharmacological agents used to produce it make it extremely difficult to determine its toxicity and resulting symptoms and consequences ⁽²⁴⁾.  Methamphetamine often is used in dangerous combination with other substances, including marijuana, cocaine/crack, alcohol and heroin ^(25).

Methamphetamine Users

Methamphetamine use is increasing among men who have sex with men and use other drugs, making this population more vulnerable to contracting and spreading sexually transmitted diseases, particularly HIV/AIDS.  There has been a notable increase in its use among young adults who attend "raves" or private clubs and among homeless and runaway youth.  Male and female commercial sex workers who also trade sex for drugs, and members of motorcycle gangs, have been using this drug at increased rates.  Increasing use of methamphetamine has been reported for people in occupations--such as long-haul truckers--that demand mental alertness, physical endurance and long hours ^(26).

Workers Use Methamphetamine to Stay Awake

A recent study by the Center for Substance Abuse Prevention (CSAP), A Look at Methamphetamine Use Among Three Populations, demonstrates that although some people use methamphetamine to get high, there also is a connection to the American work ethic:  people use the drug to stay awake on the job ^(27).

Students Use Methamphetamine to Study and to Lose Weight

Some students use methamphetamine to enhance alertness  The drug appeals to youth who want a short, intense "rush" or to study all night.  Because methamphetamine suppresses appetite, teenage girls take it to lose weight.  According to the 2000 Monitoring the Future survey, approximately 7.9 percent of high school seniors polled had taken methamphetamine at least once--4.3 percent in the past year (approximately twice the rate of 1990) ^(28).

Rural Unemployed Individuals Manufacture Methamphetamine for Income

Methamphetamine is easy but dangerous to make, and it is manufactured in everything from home labs to barns.  An early 1990s upsurge of production in California's San Joaquin Valley quickly spread to the Midwest, where manufacturers steal a key ingredient, anhydrous ammonia fertilizer, from farmers.  The typical Midwestern methamphetamine "cooker" is a white male between the ages of 15 and 30 who is living in poverty, has little education and often is unemployed ^(29).

Truck Drivers Use Methamphetamine to Stay Awake

Truck drivers are always looking for ways to stay awake longer, drive farther and make more money, despite federal regulations that limit the hours they can drive in a single day.  According to the CSAP study, 17 of 20 truck drivers interviewed said it is easy to obtain methamphetamine at truck stops ^(30).

Migrant Workers Use Methamphetamine to Work Longer Hours

Some Mexican-American and Mexican migrant workers in the food service, agriculture and construction industries rely on methamphetamine to work longer hours and boost their earnings.  According to the CSAP study, all the participating Mexican migrant workers in Arizona said that use of the drug is increasing.  Field workers typically buy methamphetamine from dealers who sell drugs in the fields for $5 to $10 for a single dose ^(31).

Homosexual Men Use Methamphetamine to Boost Sexual Performance

There is a history of methamphetamine use among the homosexual population on the West Coast to boost sexual performance or alleviate depression, and, according to the CSAP study, methamphetamine is spreading to eastern and southern dance clubs and private homes ^(32).

Methamphetamine Use Prevalence

According to the 2001 National Household Survey on Drug Abuse, 4.3 percent of the U.S. population (9.6 million people) reported trying methamphetamine at least once in their lifetime.  The 18 to 25 age group had the highest rate of methamphetamine use, with 5.1 percent reporting lifetime methamphetamine use.  Of those between the ages of 12 and 17, 1.4 percent reported lifetime use, and of those age 26 or older, 4.5 percent reported lifetime use of methamphetamine ^(33).

According to the 2001 Monitoring the Future Study, 6.9 percent of high school seniors surveyed had tried methamphetamine in their lifetime.  Lifetime use was 4.4 percent among eighth graders and 6.4 percent among 10th graders.  Among high school seniors, 3.9 percent had used methamphetamine in the last year and 1.5 percent had used it in the last month.  More than one-quarter (28.3 percent) of high school seniors reported that it was "fairly easy" or "very easy" to obtain "crystal meth" if they wanted some ^(34).

According to the Treatment Episode Data Set (TEDS) 1994-1999:  National Admissions to Substance Abuse Treatment Services, there were 57,834 methamphetamine treatment admissions throughout the nation during 1999, accounting for nearly 3.6 percent of all treatment admissions.  The number of methamphetamine treatment admissions in the United States increased from 14,496 in 1992 to 53,560 in 1997 and to 57,834 in 1999 ^(35).

According to the June 2001 Community Epidemiology Working Group, Epidemiological Trends in Drug Abuse, Advanced Report, methamphetamine use remains concentrated in rural and Western areas.  Although a decline in methamphetamine use occurred during the past two years in the West, indicators now are demonstrating stable or increasing trends ^(36).

Methamphetamine Prevention and Education

Needs and Recommendations

The Comprehensive Methamphetamine Control Act established the Methamphetamine Interagency Task Force in 1996.  The legislation directed the attorney general to convene a group of federal and non-federal experts from the fields of prevention, law enforcement, treatment and education to review existing efforts to confront the problems caused by methamphetamine and to make recommendations about what more should be done.  In its Methamphetamine Interagency Task Force:  Final Report:  Federal Advisory Committee, the Methamphetamine Interagency Task Force set out the following needs and recommendations related to prevention and education programs, based on its guiding principles ^(37).

Address methamphetamine through broad-based drug prevention and education efforts that target all forms of drug use and that are based on research and established prevention principles.

Develop science-based prevention program planning and intervention guidelines in communities where methamphetamine is already a problem.

Involve the entire community in prevention efforts, including educators, youths, parents, vendors of the materials used in the manufacture of methamphetamine, law enforcement officials, business leaders, members of the faith community, social services providers, and representatives of other government agencies and organizations.

Identify the changing population characteristics of users, their motivations, risk factors and demographics.

Involve parents and other adults in prevention and education programs for youth, particularly in the areas of monitoring for latchkey status children, enhancing parent-child communication skills, and providing consistent family/home rules for youths' behavior and leisure time activities.

Ensure that media campaigns proceed with caution, focusing on raising awareness of methamphetamine by using messages designed to minimize unintended effects, such as arousing curiosity about methamphetamine.

Develop or augment programs aimed at educating those communities in which methamphetamine is an emerging or chronic problem.

Law Enforcement Response to Methamphetamine

In July 2000, Congress passed the Methamphetamine Anti-Proliferation Act.  In addition to strengthening sentencing guidelines, the act provides training for state and federal law enforcement officers on methamphetamine investigations and the handling of the chemicals used in clandestine meth labs.  Furthermore, it controls the distribution of the chemical ingredients used to produce methamphetamine and expands substance abuse prevention efforts ^(38).

Needs and Recommendations

The Methamphetamine Interagency Task Force outlined the following needs and recommendations for methamphetamine-related law enforcement efforts, based on its guiding principles ^(39).

Improve information sharing across jurisdictions (e.g., develop existing intelligence systems that encompass federal, state and local partners; fix responsibility for data collection; standardize definitions; enhance dissemination efforts).

Increase information sharing among agencies (e.g., involve treatment providers, educators and law enforcement officers).

Expand collaboration with social services agencies and public health officials, particularly in situations involving clandestine laboratories.

Facilitate law enforcement and other research-based interventions by promoting early detection and warning systems that identify emerging methamphetamine and other synthetic drug problems.

Establish ongoing drug monitoring systems at the local, regional and national levels.

Link law enforcement activities to other criminal justice efforts, especially the judicial system. Use sanctions to combat existing and pervasive methamphetamine use through such mechanisms as comprehensive drug testing, the diversion into treatment of arrestees who test positive for methamphetamine use, the implementation of drug courts, and the use of graduated sanctions and enforced abstinence to complement treatment efforts.

Invest resources in law enforcement training, such as expanding existing police training on how to seize methamphetamine laboratories and further developing laboratory cleanup hazard education programs for both law enforcement agencies and entire communities.

Increase outreach efforts (e.g., training vendors of products used to produce methamphetamine, neighborhood residents and landlords; developing problem-solving and community policing activities; and collaborating with community- and school-based prevention and education activities).

Treatment of Methamphetamine Abuse

Cognitive behavioral interventions currently are the most effective treatments for methamphetamine addiction.  These approaches are designed to help change the patient's expectancies, behaviors and thinking and to increase skills to cope with various life stressors.  Methamphetamine recovery support groups also seem to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery ^(40).

No unique pharmacological treatments currently exist for dependence on amphetamine or amphetamine-like drugs such as methamphetamine.  The current pharmacological approach is borrowed from experience with cocaine dependence.  Unfortunately, this approach has not been totally successful because no single agent has proven effective in controlled clinical studies.  Antidepressant medications are helpful in fighting the depressive symptoms frequently displayed by methamphetamine users who have recently become abstinent ^(41).

Emergency room physicians use some established protocols to treat individuals who have had a methamphetamine overdose.  Emergency room treatment focuses on the immediate physical symptoms, since convulsions and hyperthermia are common and often fatal complications of these overdoses.  Overdose patients are cooled off in ice baths and also may be given aniconvulsant drugs ^(42).

Acute methamphetamine intoxication often can be handled by observation in a quiet, safe environment.  Short-term use of neuroleptics has proven successful in cases of methamphetamine-induced psychoses, and treatment with antianxiety agents such as benzodiazepines has been helpful in cases of extreme excitement or panic ^(43).

Needs and Recommendations

The Methamphetamine Interagency Task Force outlined the following needs and recommendations for action, based on its guiding principles ^(44).

Increase the methamphetamine treatment capacity in the community and in correctional facilities.

Increase treatment access by providing health insurance parity for substance abuse treatment.

Increase treatment resources to address sufficiently the protracted recovery period of methamphetamine abusers in treatment. (Research suggests that methamphetamine treatment must be of a sufficient duration to adequately address the extended timetable of methamphetamine recovery.)

Provide effective outreach services to individuals in need of treatment.

Train and encourage mental health and medical professionals to identify and refer methamphetamine abusers to appropriate treatment settings.

Ensure that the service delivery system includes a comprehensive continuum of care that meets the specific needs of methamphetamine abusers.

Increase the ability of publicly funded treatment systems to respond rapidly to emerging drug problems, particularly in underserved rural areas.

Develop methamphetamine treatment guidelines.

Facilitate the adoption of effective research-based approaches to the treatment of methamphetamine abuse through such methods as disseminating existing research findings and training clinicians and supervisors.

Fund and evaluate models of methamphetamine treatment that employ empirically supported treatment strategies adapted for specific high-priority target populations.

Ensure followup services for abusers who are released from prisons and jails.

Increase resources for drug court participation by methamphetamine abusers.

Notes

1. "National Institute on Drug Abuse Research Report Series:  Methamphetamine Abuse and Addiction."  National Institute on Drug Abuse, National Institutes of Health, (Jan. 2002).  (Sept. 26, 2002), http://www.drugabuse.gov/ResearchReports/methamph/methamph.html.
2. Ibid.
3. Ibid.
4. Ibid.
5. Ibid.
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. Ibid.
11. Ibid.
12. Ibid.
13. Ibid.
14. Ibid.
15. Ibid.
16. Ibid.
17. Ibid.
18. Ibid.
19. Ibid.
20. Ibid.
21. Ibid.
22. Ibid.
23. "Methamphetamine:  Community Drug Alert Bulletin."  National Institute on Drug Abuse, National Institutes of Health, (Oct. 1999).  (Sept. 26, 2002), http://www.drugabuse.gov/MethAlert/MethAlert.html.
24. Ibid.
25. Ibid.
26. Ibid.
27. "Prevention Alert:  METH:  What's Cooking In Your Neighborhood?"  The National Clearinghouse for Alcohol and Drug Information, Substance Abuse and Mental Health Services Administration, (Mar. 9, 2001).  (Sept. 26, 2002), http://www.health.org/govpubs/prevalert/v4/5.htm.
28. Ibid.
29. Ibid.
30. Ibid.
31. Ibid.
32. Ibid.
33. Substance Abuse and Mental Health Services Administration, Results from the 2001 National Household Survey on Drug Abuse:  Volume II.  Technical Appendices and Selected Data Tables (Rockville, Md.:  SAMHSA, 2001).
34. National Institute on Drug Abuse, National Institutes of Health, 2001 Monitoring the Future Study (Bethesda, Md.:  NIH, 2001).
35. Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) 1994-1999:  National Admissions to Substance Abuse Treatment Services (Rockville, Md.:  SAMHSA, 2001).
36. National Institute on Drug Abuse, National Institutes of Health, Community Epidemiology Working Group, Epidemiological Trends in Drug Abuse, Advanced Report (Bethesda, Md.:  NIH, 2001).
37. "Methamphetamine Interagency Task Force:  Final Report:  Federal Advisory Committee."  National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.  (Sept. 26, 2002), http://www.ojp.usdoj.gov/nij/methintf/index.html.
38. "Methamphetamine Anti-Proliferation Act of 1999 H.R.2987."  Congressman Chris Cannon.  (Sept. 26, 2002), http://www.house.gov/cannon/meth_text.html.
39. "Methamphetamine Interagency Task Force:  Final Report:  Federal Advisory Committee."  National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.  (Sept. 26, 2002), http://www.ojp.usdoj.gov/nij/methintf/index.html.
40. "National Institute on Drug Abuse Research Report Series:  Methamphetamine Abuse and Addiction."  National Institute on Drug Abuse, National Institutes of Health, (Jan. 2002).  (Sept. 26, 2002), http://www.drugabuse.gov/ResearchReports/methamph/methamph.html.
41. Ibid.
42. Ibid.
43. Ibid.
44. "Methamphetamine Interagency Task Force:  Final Report:  Federal Advisory Committee."  National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.  (Sept. 26, 2002), http://www.ojp.usdoj.gov/nij/methintf/index.html.

---

 Back to Main Site

NCSL Home Page