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 Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine University of California at Los Angeles

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. 1887 1919 1932 Amphetamine developed Methamphetamine developed Amphetamine & methamphetamine used as decongestant MethamphetamineA Brief History

6. MethamphetaminesA Brief History • WW II Extensive use by: - RAF fighter pilots - German Panzer troops - Japanese workers - Led to Kamikaze fever

7. According to surveys and estimates by WHO and UNDCP, methamphetamine is the most widely used illicit drug in the world except for cannabis. World wide it is estimated there are over 42 million regular users of methamphetamine, as compared to approximately 15 million heroin users and 10 million cocaine users Scope of the Methamphetamine Problem Worldwide

8. IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar Year

9. The Eastward Spread of Methamphetamine

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. Meth Lab Seizures • A small percentage of labs seized are labeled “Super Labs” and are capable of producing over 10 lbs per batch. • Super Labs are operated by Mexican National Drug Trafficking Organizations (MNDTO’s), and supply the majority of meth to the market.

14. Stove Top Labs • The active ingredient in making methamphetamine is ephedrine or pseudoephedrine, commonly found in over the counter cold remedies.

15. Toxic Effects of Methamphetamine Manufacturing • Fires • Explosions • Toxic gases • Toxic wastes

16. Toxic Effects of Methamphetamine Manufacturing • Manufacturers • Law enforcement officers • Bystanders

17. Children • Children who live in and around the area of the meth lab become exposed to the drug and its toxic precursors and byproducts. • 80-90% of children found in homes where there are meth labs test positive for exposure to meth. Some are as young as 19 months old.

18. Children • Children can test positive for methamphetamine by: • Having inhaled fumes during the manufacturing process • Coming into direct contact with the drug • Through second-hand smoke.

19. Cardiovascular problems • ↑ heart rate • Palpitations • Arrhythmia • ↑ blood pressure • Chest Pain • Acute Coronary Syndrome • Valve thickening

20. Neurological problems • Seizures • Stroke • Cerebral hemorrhage • Cerebral vasculitis • Mydriasis

21. Respiratory problems • Dyspnea • Pulmonary hypertension • Pleuritic chest pain

22. Other problems • Eye ulcers • Over-heating • Rhabdomyolysis • Obstetric complications • Anorexia / weight loss • Tooth wear, cavities • “Speed bumps”

23. Interpersonal trauma Assault Gunshot Knife Motor Vehicles Suicide attempts Trauma

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

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

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

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

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

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

33. Methamphetamine abusers have abnormal brain activity.

34. 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

35. Effects of Drugs on Dopamine Levels COCAINE AMPHETAMINE Accumbens 1100 Accumbens 400 1000 900 DA 800 DA 300 DOPAC 700 DOPAC % of Basal Release HVA HVA 600 % of Basal Release 500 200 400 300 100 200 100 0 0 0 1 2 3 4 5 hr Time After Amphetamine Time After Cocaine MORPHINE NICOTINE 250 Accumbens 250 Dose (mg/kg) 200 Accumbens 0.5 200 Caudate 1.0 2.5 % of Basal Release 150 % of Basal Release 10 150 100 0 1 2 3 hr 100 0 1 2 3 4 5 hr 0 0 0 1 2 3 4 5hr Time After Nicotine Time After Morphine Source: Di Chiara and Imperato

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

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

47. Voluntary Drug Use Compulsive Drug Use (Addiction)

48. Control > MA 4 3 2 1 0

49. 5 4 3 2 1 0 MA > Control

50. Treatment Length by Route P<.05