Download Methamphetamine

Methamphetamine
Sally Preston, D.M.D
Assistant Professor
University of Colorado School of Dental Medicine
Director, Emergency Clinic
aka meth, tina, crystal
crank, tweak, glass,
ice
,
Meth (Crank, Ice) Facts
Methamphetamine—meth for short—is a white, bitter
powder. Sometimes it's made into a white pill or a clear or
white shiny rock (called a crystal).
Meth powder can be eaten or snorted up the nose. It can
also be mixed with liquid and injected into your body with
a needle. Crystal meth is smoked in a small glass pipe.
Meth lasts 6-24 hours and at first causes a rush of good
feelings, but then users feel edgy, overly excited, angry, or
afraid. Their thoughts and actions go really fast. They
might feel too hot.
rush of good feelings
Causes release of dopamine, the ‘feel
good’ neurotransmitter
An orgasm releases the equivalent of 250
‘units’ of dopamine
From a dose of methamphetamine, 1250
‘units’ of dopamine are released
There is no natural event that mimics this
level of dopamine release
Dopamine depletion changes brain
chemistry
Experiences no longer give pleasure and
leads to more desire for meth
Dopamine deletion leads to depression
Dopamine production may take years to
recover and in one reason for
difficulty in curbing addiction.
Meth users also exhibit negative behaviors
•Anxiety
•Paranoia
•Mood swings
•Violent behavior
•Depression
•Irritability
•Cognitive impairment
Physical Effects with Meth
•Dry skin/mouth
•Skin lesions
•Weight loss
•Increased heart rate
•Hypertension
•Arryrhymias
•Liver damage
•Convulsions
•Hyperthermia may lead to brain damage
•Lowered resistance to illness
Because meth is like a super
Sudafed, it dries out the
user's skin completely.
Addicts begin to believe they
are suffering from "Crystal
Meth lice". This leads to
frantic scratching of the face
using fingernails or any other
tool such as tweezers.
‘Picking’ can lead to serious
self-inflicted wounds,
especially in the face.
Meth and Sex and Infectious Diseases
• Increased libido, increased stamina and energy lowered sexual
inhibitions
• Sex with multiple partners, people they do not know,
unprotected sex and sex with people who may have sexually
transmitted diseases
• Needles may be used which increases transmission of HIV,
hepatitis C etc.
• Meth users may have ‘rough’ and prolonged sexual
experiences which may cause damage to anal or vaginal tissue
and thus increase likelihood of infection
• Chronic meth users may experience erectile dysfunction as a side
effect. Viagra etc. may be used prolonging erections
• HIV meth users are more likely to develop AIDS
Meth and Erectile Dysfunction Drugs
• Study from the San Francisco Department
of Public Health (reported in Alpert JS, Viagra: The Risks of
.
Recreation Use. Am J Med; 26 May 2005, 569-570 )
indicates
that MSM using Viagra
54% used Viagra in conjunction with other
drugs to enhance sexual experience
23% used meth with Viagra
History
• Post WWII used to decrease fatigue called ‘work
pills’ in Japan
• 1960’s Amphetamine or “speed” became favorite
among truckers, bikers and college students
‘Speed Kills’
• 1974 Drug Control Act curbed medicinal use
• 1980’s a new variation of amphetamine…dmethamphetamine was developed
• Production increased in the 1980’s due to the easy
availability of ephedrine mostly from foreign sources
CA
• 1990’s due to regulations, ephedrine imports
decreased. Pseudoephedrine replaced ephedrine
and retail stores became source
• Various regs, blister packs, behind counter have
reduced availability of pseudoephedrine
• Production moved to Mexico where ephedrine was
still available when that changed…recipes changed
etc.
• Landscape is constantly changing and with it addiction
rates
Oral Manifestations of Chronic Meth Use
Xerostomia
Rampant caries
Periodontal disease
Bruxism/fractures
Muscle Trismus
Mouth Sores or Burns
MY TEETH ARE:
Blackened
Stained
Rotting
Crumbling
Falling apart
Falling out
Pattern of Caries of Meth Mouth
•Buccal Smooth surfaces
•Interproximal surfaces of
anterior teeth
•Cervical areas
Contributing Factors
Xerostomia
Bruxism
Poor Oral Hygiene
Poor Nutrition
Caustic materials/heat
http://www.methproject.org/answers/what-ismeth-mouth.html#.UkHhQxyqwR0.mailto
Xerostomia
Xerostomia
Meds: HIV, anti-HPT, anti-depressants,
anti-histamines, etc. etc.
Parotid impairment i.e. trauma, ca, HIV
Radiation/Chemotherapy
Autoimmune diseases
Drug use i.e. cocaine, methamphetamine
Xerostomia
Vasoconstriction in salivary gland vasculature leads
to decrease in flow
Stimulation of inhibitory adrenoreceptors in
salivary nuclei decreases flow
Dehydration due to increased metabolism(heat)
and physical activity
Methamphetamine abuse and oral health: A
pilot study of "meth mouth"
Ravenel, Michele C. / Salinas, Carlos F. /
Marlow, Nicole M. / Slate, Elizabeth H. / Evans,
Zachary P. / Miller, Peter M.
No significant difference in salivary flow rates were noted,
yet results showed significant trends for lower pH and
decreased buffering capacity. These findings suggest that
salivary quality may play a more important role in meth
mouth than previously considered. Salivary analysis may
be useful when managing a dental patient with history of
methamphetamine abuse.
28 subjects, meth users had higher caries rate missing teeth
Periodontal Disease
Reduced blood flow leads to:
• Increased risk of infection
• Slow healing
• Xerostomia and poor nutrition and
hygiene also contribute to poor
periodontal health
Bruxism/Clenching
• Increased energy and neuromuscular activity
• Parafunctional habits
• Temporomandibular disorder symptoms
• Muscle tenderness
• Fractured teeth and wear patterns
Poor Oral Hygiene
An individual who is high on meth can go for
days and days, just running on meth and pretty
much nothing else. These day or even week long
meth binges are called "tweeking" in the drug
community. "Tweekers", as they are so called,
will either ingest by mouth, snort, and smoke or
inject meth repeatedly during these binges, and
will typically forego eating and sleeping during
this time. Once they finally do fall asleep, a
tweeker will sleep for days only to wake up and
do it all over again.
Poor Diet
• High intake of refined carbohydrates
• Highly caloric carbonated beverages
• Regurgitation or vomiting
• Increased acidity of saliva in meth users
Caustic Materials/Heat
Ephedrine
or Pseudoephedrine
Acetone
Alcohol
Battery acid
Benzene
Anhydrous ammonia
Camp stove fuel
Ether
Lithium from batteries
Iodine
Freon
Drain cleaner
Paint thinner
Toluene
Lye
Red phosphorous
Salt
Muriatic acid
ETC.
Chemicals Used in “meth”
Production
• Acetone
• Anhydrous ammonia
• Sodium hypochlorite
(bleach)
• Sulfuric acid (drain
cleaner)
• Heet and Iso-Heet
(gasoline additives)
•
•
•
•
Red phosphorous
Muriatic acid
Ether (starting fluid)
Trichloroethane (gun
cleaning fluid)
• Isopropyl alcohol
• Sulfuric acid (battery
acid)
amphethamines.com/meth lab-terro
Chemicals Used in “meth”
Production
• Coleman fuel
(white gas)
• Sterno (ethanol,
methanol &
amphoteric
acid)
• Red Devil lye
• Hydrogen
peroxide
• Mineral spirits
• Sodium
• Lithium (including
lithium batteries
Meth mouth is one of the
most visible consequences of
methamphetamine use. In
this
study, we identified risk
factors
that influence the severity of
meth
mouth.
We found that an oral route
of use (smoking) is a stronger
predictor of meth mouth
severity than non-oral routes
(intravenous or intranasal)
and duration of use.
Journal of the California Dental Association
(June 2013) “Meth Mouth Severity in Response
to Drug-Use Patterns & Dental Access in
Methamphetamine Users” Vol 41, No. 6, pp
421-428, R Brown et al. Retrieved from
http://www.cda.org/Portals/0/journal/journal
_062013.pdf
99 patients controlled for
alcohol use users vs non users
How mouth sores are formed by meth use
may include the following possible culprits:
Chemical burn
Cottonmouth
Tissue damage
Skinned raw
Caustic and Hot
Stimulants, including methamphetamine,
deplete salivary secretions and raise body
temperature to a much higher level than
normal.
Constriction of blood vessels in the mouth
harms tissues initially, but after recurrent
episodes, can cause tissues to die.
Continuous friction between the tongue and
the inside of the mouth
Rampant Caries is not
always meth mouth
TAKING A THOROUGH
MEDICAL HISTORY AND
ORAL AND PHYSICAL
EXAMINATION IS
IMPERATIVE
•Poverty
•Medications
•Poor dental IQ
•Systemic Illness
•Neglect
•Abuse
•Psychiatric Issues
Xerostomia related caries
“meth mouth” or not?
Caries in the HIV patient
Treatment Objectives
•Improve nutrition
•Reduce consumption of highly caloric beverages
and refined carbohydrates
•Improve oral hygiene
•Decrease xerostomia and high acidity of saliva
•Decrease bruxism
STOP
USING
METH
• Meth abusers who become abstinent experience
a reduction in dopamine
• Lowest point may be after several months
• Dopamine levels may take a
year or longer to fully return to baseline levels
•
Most substance abuse tx involves immediate
intervention, but support services are important
months/years after abstinence from meth use.
Meth Mouth
Emergency /Urgent Care Situations
Patients ‘high’ on meth should not receive dental
treatment for at least 6 hours after last
administration of drug (Goodchild and Donaldson
2007)
• Seek immediate medical attention
• Monitor vital signs
• Administer oxygen
• Be prepared to administer CPR
• Pt may be experiencing paranoia and the potential
for violent behavior
Local Anesthetics with vasoconstrictor
Use with Care
Hypertensive crisis
Cardiac dysrhythmias
Myocardial Infarction
Strokes
Pain Control
Important to know other drugs being used
When meth was used last
Evaluate for drug seeking behavior
NSAIDS can be used
Opioids are not contraindicated unless other
CNS depressants are being used or if actively
using meth
Assess and Treat
• Comprehensive oral exam
• Thorough medical history
• Concern for oral health and dental findings
• Preventive Measures
• Address xerostomia
• Occlusal Guards
• Nutrition counseling
(Adapted from ADA)
Xerostomia Therapies
Adequate water intake
Sugarless candy or gum
Artificial saliva substitutes
Avoid caffeine and alcohol
Topical fluoride: varnish, gels,
toothpaste
Pilocarpine
Pilocarpine (Salagen)
•Cholinergic agonist
•Increases endocrine secretions
•Has been approved by FDA for use in Sjogren’s
Syndrome
•Dosage is 5mg tid
•Side effects include chills, nausea, diaphoresis
•Caution in patients with cardiac dysrhythmias,
hypertension, renal disease
Fluoride Toothpastes/gels
Fluoride applications such as cavity varnish/trays
Xylitol gums/mints
Sealants
MI paste calcium/phosphates
Saliva substitutes
Occlusal guards
Dual purpose:
• Administering Fluoride Treatments
• Minimizing deleterious effects of
bruxism
Educate
Encourage drinking water instead of sugary
drinks
Risks of meth use
Be aware of drug interactions
Risk reduction strategies i.e. clean works, drug
tx
Risk of co infection with HIV hep B, C
(adapted from ADA)
Consult and Refer
• Know medical referral and
consultative resources
• Be familiar with treatment facilities
and what pt can expect
• Encourage testing and refer for
potential infections such as HIV,
Hepatitis and STD’s
(adapted from ADA)
Meth Project
www.Methproject.org
Methamphetamine and the mouth(ADA)
www.ada.org
Meth Awareness Prevention Project
www.mappsd.org
Methresources.gov
www.methresouces.gov
Office of National Drug Control Policy
www.whitehousedrugpolicy.gov
Methamphetamine Treatment Project
www.methamphetamine.org
Hazelden Foundation
www.hazelden.org/meth
Crystal Meth Anonymous
www.crystalmeth.org