Methamphetamines University of Pittsburgh Graduate.
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Transcript of Methamphetamines University of Pittsburgh Graduate.
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 well-
being•Effects that can last 8 to 24
hours
U.S. Emergency Dept. Mentions of Meth/amphetamines 1995-2002
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
1995 1996 1997 1998 1999 2000 2001 2002
DAWN, July 2004
Demographics of MA-related ED visits in U.S., 2002
58% male and 42% femaleRace/ethnicicty
White 65%Latino 11%African American 6%
AgeUnder 18 11%18-34 years 56%Over 34 33%
DAWN, 2004
Behavior changes Health changes
Psychotic behaviorParanoiaAggressionAnxietyFatigueDepressionDelusionsMood swingsConfusionInsomniaHallucinations
StrokeBrain damageWeight lossDeath
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
Researchers report that the dopamine-producing cells in the brain can be damaged
after prolonged exposure to relatively low levels of
methamphetamine.
Effects of meth on dopamine
00
5050
100100
150150
200200
00 6060 120120 180180
Time (min)Time (min)
% o
f B
asal
DA
Ou
tpu
t%
of
Bas
al D
A O
utp
ut
NAc shellNAc shell
EmptyEmpty
BoxBox FeedingFeeding
Source: Di Chiara et al.Source: Di Chiara et al.
FOODFOOD
100100
150150
200200
DA
Co
nce
ntr
ati
on
(%
Bas
elin
e)D
A C
on
cen
tra
tio
n (
% B
asel
ine)
MountsMountsIntromissionsIntromissionsEjaculationsEjaculations
1515
00
55
1010
Co
pu
latio
n F
req
ue
nc
yC
op
ula
tion
Fre
qu
en
cy
SampleNumberSampleNumber
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717
ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present
ScrScrFemale 2 PresentFemale 2 Present
ScrScr
Source: Fiorino and PhillipsSource: Fiorino and Phillips
SEXSEX
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels
00100100200200300300400400500500600600700700800800900900
1000100011001100
00 11 22 33 44 5 hr5 hr
Time After AmphetamineTime After Amphetamine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbens AMPHETAMINEAMPHETAMINE
00
100100
200200
300300
400400
00 11 22 33 44 5 hr5 hrTime After CocaineTime After Cocaine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
DADADOPACDOPACHVAHVA
AccumbensAccumbensCOCAINECOCAINE
00
100100
150150
200200
250250
00 11 22 33 44 5hr5hrTime After MorphineTime After Morphine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbens
0.50.51.01.02.52.51010
Dose (mg/kg)Dose (mg/kg)
MORPHINEMORPHINE
00
100100
150150
200200
250250
00 11 22 3 hr3 hrTime After NicotineTime After Nicotine
% o
f B
as
al
Re
lea
se
% o
f B
as
al
Re
lea
se
AccumbensAccumbensCaudateCaudate
NICOTINENICOTINE
Source: Di Chiara and ImperatoSource: Di Chiara and Imperato
Effects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine LevelsEffects of Drugs on Dopamine Levels
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
Normal Control METH Abuser(1 month abstinent)
METH Abuser(14 months abstinent)
0
3
ml/gm
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
Dopamine improvements after 1 year, but not cognitive and motor functioning
MethamphetamineAcute Physical Effects
Increases
Heart rateBlood pressurePupil size RespirationSensory acuityEnergy
Decreases – Appetite– Sleep– Reaction
time
MethamphetamineAcute Psychological Effects
Increases
Confidence Alertness MoodSex driveEnergyTalkativeness
Decreases BoredomLonelinessTimidity
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.