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Methamphetamine Abuse: Fact or Fiction?

Methamphetamine Abuse: Fact or Fiction? . Diana Hu, MD Thanks to Harrison Alter, MD, MS Emergency Department Tuba City Regional Health Care Corp. Why talk about meth?. One of the fastest growing drugs of abuse across America Higher rates of use in rural America

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Methamphetamine Abuse: Fact or Fiction?

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  1. Methamphetamine Abuse:Fact or Fiction? Diana Hu, MD Thanks to Harrison Alter, MD, MS Emergency Department Tuba City Regional Health Care Corp

  2. Why talk about meth? • One of the fastest growing drugs of abuse across America • Higher rates of use in rural America • One of few drugs of abuse where women abuse as frequently as men • Many issues with family safety • A single dose can cause brain damage and/or fatal results

  3. Why talk about meth? • Teenagers are using at “raves”, as a “club drug” • HS students in Tuba all know where to get it • Easily made in a home lab with chemicals you can buy legally in a drugstore or discount store • Endangers family members and community

  4. Why talk about meth? • Locally the hospital has seen increased numbers of patients on meth, with both acute and chronic effects on them and their families. • 14 alleged meth related deaths in our community in the past 2 years

  5. Methamphetamine • What is it? • Stimulant medication that is the methylated form of amphetamine • 2-15x more potent than per weight than amphetamine

  6. How do you feel on meth? • Increased energy • Decreased appetite • Increased wakefulness ( don’t need to sleep) • Initial “rush”- euphoria • Primarily with smoking or injecting

  7. Street names for Methamphetamine ampblue belly , black bear, black beautycrank*crystal* glass (pure meth with no cuts)*ice *meth speedwhite crosswhite crunch

  8. Methamphetamine:Amphetamine Sulfate Precursor • First synthesized 1887 • Initial application 1920s as nasal decongestant • WW II used as stimulant • Schedule II in 1971 • Off-white/pinkish or yellowish powder, 5-20% purity

  9. Methamphetamine:

  10. Methamphetamine:Physiology • Average dose 50 – 200 mg • Onset of action • Oral: 30-60 min • Nasal: 15-20 min • Inhaled or injected: 1-3 min • Elimination half-life and duration of action: 4 – 6 hours • Can have longer effects with chronic use and depends on route of use

  11. Methamphetamine:Physiology • Dopamine receptor stimulation and reuptake inhibition effects • Serotoninreceptor stimulation and reuptake inhibition effects

  12. Long Term physiologic effects • Depletion in the neurons of these neurotransmitters, especially dopamine, can have permanent effects in the brain • Slowness • Parkinson’s like movement disorders- tremor and rigidity • Thinking problems

  13. Methamphetamine uses • Limited medical use • Obesity/diet aids • Narcolepsy • Primarily a drug of abuse • Usually smoked, snorted, or injected • Often used with marijuana • Sometimes in combination with other drugs as well

  14. Methamphetamine: Epidemiology Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002

  15. Methamphetamine:Epidemiology Past Month Alcohol Use among Persons Aged 12 to 20, by Race/Ethnicity: 2002

  16. Methamphetamine: Epidemiology Percentage Reporting Methamphetamine Use, by Age Group, 2002 Substance Abuse and Mental Health Services Administration, Results from the 2002 National Survey on Drug Use and Health: National Findings, September 2003.

  17. Methamphetamine: Epidemiology High School Students Reporting Methamphetamine Use, 2003 National Institute on Drug Abuse and University of Michigan, Monitoring the Future 2003 Data from In-School Surveys of 8th-, 10th-, and 12th- Grade Students, December 2003.

  18. Methamphetamine:Local Epidemiology

  19. Methamphetamine:Synthesis • Manufacture possible with ephedrine/ pseudoephredrine • Found in cold medicines • Found in diet pills • Many pharmacies restrict bulk purchase of these drugs

  20. Methamphetamine:Synthesis Meth Lab

  21. Methamphetamine:Synthesis Propane tank modified for storage of anhydrous ammonia

  22. Methamphetamine:Synthesis • Can be synthesized with common household products • Generates 5-7 pounds of hazardous waste per pound of drug • $70 of ingredients can create drugs with $2000 street value • But you can die trying to make it.

  23. Meth production • Three categories of chemicals for production • Solvents • Corrosives • Metals/Salts

  24. Methamphetamine:Synthesis • Toluene: paint thinner • Methanol: gas tank anti-freeze ("Heet“) • Ethyl Ether: starting fluid • Anhydrous ammonia: farmer’s co-ops • Hydrochloric acid: hardware stores • Sodium hydroxide: "Drano" or Red Devil Lye • Sulfuric acid: battery acid or drain cleaners • Iodine crystals: iodine crystals or tincture of iodine • Red phosphorous: striker plates, road flares • Lithium: camera batteries

  25. Methamphetamine:Synthesis • “Pour and run” • Ephedrine reduction method • Boil pills in red phosphorous and iodine • Convert ephedrine to MAP with lye, HCl, or hydrogen sulfide • Add hydrocarbon solvent • Filter precipitate • Pour byproduct down the drain • “Dry cook” with anhydrous ammonia

  26. Meth labs • Meth labs use so many toxic solvents/ create toxic waste, HAZMAT trained specialists are needed to decontaminate/dismantle • In 40% of meth lab seizures, children were present in the home at the time of the raid.

  27. Meth related deaths in Tuba City in the past year • 4 murders • 4 deaths in motor vehicle accidents • 2 suicides • 2 overdose related deaths • 2 meth lab explosion/fire deaths

  28. Meth related violence in Tuba City • 13 assaults with 23 victims • At least 4 families with children placed in foster care because of parental meth use

  29. What can we do to stop this problem? • DON”T START • Even one dose can lead to death, brain damage, and/or addiction • REMEMBER- some people use this drug at parties or sprinkled on marijuana- you could get some and you wouldn’t even know it at first

  30. What can we do to stop the problem? • Recognition of friends/family members/community members who are using • Get medical help for those people • Report people who have a meth lab/are dealing in the community

  31. Methamphetamine:Clinical Presentation • Rush (5-30 min) – • Adrenal gland release of epinephrine • Explosive release of dopamine • Intensely euphoric • BP spike, heart rhythm abnormalities

  32. Methamphetamine:Clinical Presentation • High (4-16 hrs) • “The shoulder” • Feelings of aggression and heightened intellect • Binge (3-15 days) • Continuation of the high • Larger doses required to achieve same intensity • Little or no rush or high felt • Physical and mental hyperactivity

  33. Methamphetamine:Clinical Presentation • “Tweaking” • Follows a binge • Feelings of emptiness and dysphoria • Often alcohol and heroin used to self-medicate • Most dangerous state of cycle for law enforcement and medical personnel

  34. Methamphetamine:Clinical Presentation • “Crash” or “Washout” (1-3 days) • Total excitatory neurotransmitter depletion • No threat posed, lifeless and sleepy • Withdrawal (30-90 days) – • Slow progression to depression, lethargy, cravings, suicidal thoughts • MAP use during this period can alleviate dysphoria

  35. These people NEED HELP • There is both a physical and psychological addiction to methamphetamine • Users can be a risk to themselves and others during the withdrawal periods • Intensive therapy is the best hope, but the relapse rate is very high

  36. PREVENTION vs.TREATMENT • Methamphetamine is highly addictive, even after a single use. • How can we prevent our loved ones from even trying this dangerous drug?

  37. How can you tell if a friend is using meth? • It may not be easy to tell. But there are signs you can look for.

  38. Symptoms of methamphetamine use may include: • Inability to sleep • Increased sensitivity to noise • Nervous physical activity, like scratching • Irritability, dizziness, or confusion • Extreme anorexia (won’t eat)/ sudden weight loss • Tremors or even convulsions • Increased heart rate, blood pressure, and risk of stroke • Presence of inhaling paraphernalia, such as razor blades, mirrors, and straws • Presence of injecting paraphernalia, such as syringes, heated spoons, or surgical tubing

  39. Methamphetamine Side effects • Increased energy and decreased fatigue • Increased activity • Decreased appetite and weight loss • Euphoria and rush • Increased respiration

  40. Methamphetamine Side Effects • Hyperthermia – up to 108F. • Stroke • Seizures • Headache • Increased blood pressure • Heart failure/heart attack • Liver, kidney, and lung damage

  41. Methamphetamine side effects • Nausea, vomiting, bad taste in mouth, diarrhea, constipation • Difficulty voiding • Muscle destruction/kidney failure • Hives, sores on skin, painful rash • Hypersexual • Increases risk of Hep B, HepC, HIV, other STD

  42. Methamphetamine Side effects • Dependence and addiction psychosis, including paranoia, hallucinations, mood disturbances, anxiety, and repetitive motor activity • Repetitive actions ( like picking at skin) • Depression, suicidal thoughts/homicidal thoughts

  43. It is up to us…. • Community watch/support law enforcement • Community forums • Political pressure • Talk to your families

  44. “You have to be honest with people. You have to have great respect for yourself . If you see something that is not right you must do something about it.” Annie Dodge Wauneka

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