Methamphetamine: How it Influences the Brain and Behavior of Users

1. Methamphetamine: How it Influences the Brain and Behavior of Users Richard A. Rawson, Ph.D Adjunct Associate Professor Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University of California at Los Angeles www.uclaisap.org rrawson@mednet.ucla.edu Supported by: National Institute on Drug Abuse (NIDA) Pacific Southwest Technology Transfer Center (SAMHSA)

2. Methamphetamine • Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater.

3. Methamphetamine: Speed • Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown. • Color variations are due to differences in chemicals used to produce it and the expertise of the cooker. • Other names: shabu, crystal, crystal meth, crank, tina, yaba

4. Methamphetamine: Ice High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

5. The Eastward Spread of Methamphetamine

6. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over)

7. > 58 35 - 58 12 - 35 < 12 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over) < 12

8. 3-27 28 - 54 200 or more 150 or more 100 or more 55 or more Primary Amphetamine/Methamphetamine Admission Rates by State: 2002 Admissions per 100,000 population aged 12 and over

9. Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older: 1992-2002 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

10. IHS-Wide RPMS PCC Outpatient Encounters for Amphetamine Related Visit by Calendar Year

11. Meth Epidemic; less drama, more long term risk/danger • Cocaine/Crack epidemic hit fast (in NYC 1986-87, as well as other major east coast cities); overnight emergency, tremendous media attention. • Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug. • Dramatic decreases in indicators by early 1990s, except in inner cites of east coast. • Crack epidemic: Rapid onset; Rapid decrease • Meth epidemic: Slow west to east spread. No decrease in western cities. Use becomes endemic?

12. Methamphetamine: A Growing Menace in Rural America • In 1998, rural areas nationwide reported 949 methamphetamine labs. • Last year, 9,385 were reported. • This year, 4,589 rural labs had been reported as of July 26. • Source: El Paso Intelligence Center (EPIC), U.S. DEA

13. Anhydrous Ammonia Tank Tips Officers to Possible Meth Lab 5/4/04 Omaha, Neb. – A large anhydrous ammonia tank helped Sarpy County Sheriff’s deputies bust a suspected methamphetamine lab Tuesday. SOURCE: TheOmahaChannel.com

14. MethamphetamineAcute Physical Effects Increases -Decreases Heart rate Appetite Blood pressure Sleep Pupil size Reaction time Respiration Sensory acuity Energy

15. Increases Confidence Alertness Mood Sex drive Energy Talkativeness Decreases Boredom Loneliness Timidity MethamphetamineAcute Psychological Effects

16. MethamphetamineChronic Physical Effects - Tremor - Sweating - Weakness - Burned lips; sore nose - Dry mouth - Oily skin/complexion - Weight loss - Headaches - Cough - Dental Problems - Sinus infection - Anorexia

19. METH Use Leads to Severe Tooth Decay “METH Mouth” Source: The New York Times, June 11, 2005.

20. Meth Use in Hawaii • As of the middle of May, not even halfway through the year, the city medical examiner's office already recorded 38 deaths connected to crystal methamphetamine. So, we're well on the way to exceeding last year's total of 68. • Deaths: • 2005 (mid-May) - 38 deaths • 2004 - 68 deaths • 2003 - 56 deaths • 2002 - 62 deaths • 2001 - 54 deaths • 2000 - 34 deaths

21. MethamphetamineChronic Psychological Effects - Confusion - Irritability - Concentration - Paranoia - Hallucinations - Panic reactions - Fatigue - Depression - Memory loss - Anger - Insomnia - Psychosis

22. MethamphetaminePsychiatric Consequences • Paranoid reactions • Permanent memory loss • Depressive reactions • Hallucinations • Psychotic reactions • Panic disorders • Rapid addiction

23. A Major Reason People Take a Drug is they Like What It Does to Their Brains

26. FOOD SEX 200 200 NAc shell 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 Scr Scr Scr Scr 0 60 120 180 Bas Female 1 Present Female 2 Present Mounts Time (min) Sample Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Intromissions Ejaculations Source: Di Chiara et al. Source: Fiorino and Phillips Natural Rewards Elevate Dopamine Levels

27. Effects of Drugs on Dopamine Release 1500 1000 500 0 COCAINE METHAMPHETAMINE Accumbens 400 Accumbens DA 300 DOPAC HVA % of Basal Release % Basal Release 200 100 0 0 1 2 3hr Time After Cocaine Time After Methamphetamine 250 NICOTINE ETHANOL 250 Accumbens Dose (g/kg ip) 200 Accumbens 200 Caudate 0.25 0.5 150 % of Basal Release 1 2.5 % of Basal Release 150 100 0 1 2 3 hr 100 0 0 0 1 2 3 4hr Time After Nicotine Time After Ethanol Source: Shoblock and Sullivan; Di Chiara and Imperato

28. Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways

29. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients %ID/cc Control Methamphetamine PD Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998. .

30. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 ml/gm METH Abuser (1 month detox) Normal Control METH Abuser (24 months detox) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

36. Methamphetamine: Neurochemical Mechanisms • Methamphetamine enters the brain and is removed from the synapse by dopamine transporters

38. Methamphetamine: Neurochemical Mechanisms • Enters dopamine vesicles • Vesicles deplete themselves of dopamine

40. Methamphetamine: Neurochemical Mechanisms • Free-floating DA produces “free radicals” (neurotoxins), so it is forced out of the neuron. • The synapse is flooded with dopamine, producing a profound sense of pleasure.

42. Their Brains have been Re-Wired by Drug Use Because…

44. Control > MA 4 3 2 1 0

45. 5 4 3 2 1 0 MA > Control

46. Is Treatment for Methamphetamine Effective? A major demand that competes for scarce community resources are for the treatment needs of those who have become addicted to methamphetamine (MA).

47. Meth Treatment Effectiveness? A pervasive rumor has surfaced in many geographic areas with elevated MA problems: • MA users are virtually untreatable with negligible recovery rates. • Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences. **The resulting conclusion is that spending money on treating MA users is futile and wasteful, BUT no data exists that supports these statistics**

48. Meth Treatment Statistics During the 2002-2003 fiscal year: • 35,947 individuals were admitted to treatment in California under the Substance Abuse and Crime Prevention Act funding. • Of this group, 53% reported MA as their primary drug problem

49. Statistics Analysis of: • Drop out rates • Retention in treatment rates • Re-incarceration rates • Other measures of outcome All these measures indicate that MA users respond in an equivalent manner as individuals admitted for other drug abuse problems.

50. Urinalysis Results • Results of Ua Tests at Discharge, 6 months and 12 Months post admission ** • Matrix GroupTAU Group D/C: 66% MA-free 65% MA-free 6 Ms: 69% MA-free 67% MA-free 12 Ms: 59% MA-free 55% MA-free **Over 80% follow up rate in both groups at all points