Methamphetamine: Review of The Problem

1. Methamphetamine: Review of The Problem Igor Koutsenok, MD Assistant Professor of Psychiatry University of California San Diego Associate Director, Center for Criminality & Addiction Research, Training & Application www.ccarta.ucsd.edu

2. What Is Methamphetamine? • Powerfully addictive stimulant that • dramatically affects the central nervous system • Made easily in labs with OTC ingredients

3. The active ingredient in making methamphetamine is ephedrine or pseudoephedrine, commonly found in over the counter cold remedies.

4. Methamphetamine

5. Ephedrine and Methamphetamine

6. Forms of Methamphetamine Methamphetamine PowderIDU Description: Beige/yellowy/off-whitepowder Base / Paste MethamphetamineIDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel,moist, waxy Crystalline MethamphetamineIDU Description: White/clearcrystals/rocks; ‘crushed glass’ / ‘rock salt’

7. 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

8. Ice High purity methamphetamine crystals or coarse powder ranging from translucent to white

9. Methamphetamine Lab Seizures • A small percentage of labs 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.

10. Chemical Ingredients • Trichloroethane (Gun Scrubber)Ether(Engine Starter) • Toluene(Brake Cleaner) • Methanol(Gasoline Additive) • Gasoline • Kerosene

12. 1887 1919 1932 Amphetamine developed Methamphetamine developed Amphetamine & methamphetamine used as decongestant MethamphetaminesA Brief History

13. MethamphetaminesA Brief History • WW II Extensive use by: - Fighter pilots - German Panzer troops - Japanese workers - Kamikaze

14. MethamphetaminesA Post-War Epidemic FACTORS • Large quantities • Social disorganization • “Work pills” • 500,000 addicts JAPAN

15. MethamphetaminesEpidemic in Sweden FACTORS • Large supply • 3% are users • Preludin use widespread • Mostly oral use SWEDEN

16. MethamphetaminesFactors Related to Epidemic • Over supply • Opportunity to experience • Widespread knowledge • A reliable market • No need for injections (in most cases) • Many “speed labs”

17. Worldwide Trends of Methamphetamine Use • WHO 2005 data estimates 42 million meth users worldwide; 15M- heroin; 12M- cocaine • Areas of very heavy use: Thailand, Philippines, Indonesia, SE Asia, Eastern Europe, Russia, China • Areas of increasing use; Northern Mexico, USA, Canada, South Africa, Europe

18. The Eastward Spread of Methamphetamine Epidemic

21. Total Number of Primary Methamphetamine Admissions:1998-2002 50% Increase from 1998-2002 SAMHSA, Treatment Episode Data Set: 1992-2002.

22. Methamphetamine: A Growing Problem in Rural America • In 1998, rural areas nationwide reported 949 methamphetamine labs. • In 2003, 9,385 were reported. Source: El Paso Intelligence Center (EPIC), U.S. DEA, 2005

26. Methamphetamine/Amphetamine TreatmentAdmissions, by Route of Administration: 1992-2002

27. A Major Reason People Take Methamphetamines is they Like What It Does to Their Brains

29. striatum hippocampus frontal cortex substantia nigra/VTA nucleus accumbens raphe Dopamine Pathways Serotonin Pathways • Functions • reward (motivation) • pleasure,euphoria • motor function • (fine tuning) • compulsion • perseveration • Functions • mood • memory • processing • sleep • cognition

30. Methamphetamine: Neurochemical Mechanisms • Methamphetamine enters the brain through dopamine transporters • Enters dopamine vesicles • Vesicles deplete themselves of dopamine • Free-floating DA produces “free radicals” (neurotoxins). • The synapse is flooded with dopamine, producing a profound sense of pleasure

31. Natural Rewards Elevate Dopamine Levels FOOD SEX 200 200 150 150 DA Concentration (% Baseline) 100 100 15 % of Basal DA Output 10 Empty Copulation Frequency 50 Box Feeding 5 0 0 0 60 120 180 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

32. 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 2.5 150 % of Basal Release 10 150 % of Basal Release 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, 2004

33. Dopamine Reward Pathway Activation without drugs

34. Methamphetamine Addiction The brains of people addicted to methamphetamine are different than those of non-addicts

36. Axon МАО storage Reuptake Neurotransmitter Synapse Receptors Dendrite G-protein Signal

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

42. Dopamine Transporter Loss After Heavy Methamphetamine Use Comparison Subject METH user

43. Partial Recovery of Brain DopamineTransporters in Methamphetamine Abuser After Protracted Abstinence Meth abuser Meth abuser (1 month detox) (24 month in recovery Normal control Volkow, ND, Journal of Neurscience, 21, 2001

44. Methamphetamine Cognitive and Memory Effects

45. Executive Systems Functioning Deficits on executive tasks associated with: • Poor judgment. • Lack of insight. • Poor strategy formation. • Impulsivity. • Reduced capacity to determine consequences of actions.

46. Reasons for Meth Use • Reasons for using meth were wide-ranging: • To get high (56%) • To get more energy (37%) • To cope with mood (34%) • To lose weight/feel more attractive (29%) • To party (28%) • To escape (27%) • To enhance sexual pleasure (18%) Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87

47. Meth and Women • Typical gender ratio of heroin users in treatment : 3 men to 1 woman • Typical gender ratio of cocaine users in treatment : 2 men to 1 woman • Typical gender ratio of methamphetamine users in treatment : 1 man to 1 woman * *among large clinical research populations

48. Self-Reported Reasons for Starting Methamphetamine Use

49. Methamphetamine and Sex

50. My sexual drive is increased by the use of … (Rawson et al., 2002)