Download Properties of Crystal Methamphetamine

Properties of Crystal Meth
AADAC Youth services, Red Deer, September 13th, 2004
David Cook, 2J3.00 WMC, University of Alberta, Edmonton, Alberta, T6G 2R7
Phone: (780) 492-6848, Fax: (780) 492-5487, e-mail: [email protected]
The big three!
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Addiction liability – very high (although this has sometimes been exaggerated)
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Withdrawal (abstinence syndrome)
o Physiological – relatively minor
o Psychological – profound and protracted
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Tolerance – very high
About the desired effects
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Energy, lack of fatigue, wakefulness –enhances performance
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May promote impulsive decision making?
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Feelings of joy, power, success, high self-esteem
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Enhanced sexual desire and interest (although sometimes this is not accompanied by improved sexual
performance)
What happens in the “social use” phase?
POSITIVE
NEGATIVE
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Relief from depression, anxiety and
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Risk of arrest
loneliness
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Cost
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Energy, Euphoria, High self-esteem
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Hangover
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Increased sexual and social confidence
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Health problems that may cause
absenteeism
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Work and thought processes are enhanced
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Moral concerns
What happens in the “abuse” phase
POSITIVE
NEGATIVE
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Relief from depression
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Disruption of career
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Enhanced confidence
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Relationship concerns
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Relief from boredom
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Financial problems
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Sexual and social enhancement
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Beginning of compulsive use
What happens in the “addiction” phase?
POSITIVE
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Social support from other users
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Some euphoria remains
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Relief from tiredness
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Relief from stress
NEGATIVE
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Physiologic problems – nosebleeds,
infections, skin lesions
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Major relationship issues
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Family problems
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Impending job loss
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Impending serious financial issues
What happens in late addiction?
POSITIVE
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Relief from fatigue
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Diminished stress
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Diminished depression
NEGATIVE
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Weight loss
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Paranoia/Violence
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Social/family support evaporates
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Seizures/tweaking
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Depression/suicidal ideation
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Unemployment
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Bankruptcy
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Effects on sexual activity
of Alcohol, cocaine and meth
Data from Rawson, Washton, Domier and Reiber.
Journal of Substance Abuse Treatment, Volume 22, Issue
2 , March 2002, Pages 103-108
Other effects that are neutral
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Garrulousness
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Lack of interest in food and drink, despite increased physical activity
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Sweating
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Visual and auditory hallucinations
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Typical user uses 20 days/mo, fewer times/day than cocaine (duh!)
About the acute problems
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Delusional, risky, paranoid, violent behaviour
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Itching, welts on the skin
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Nausea, vomiting, diarrhoea
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Uncontrolled body movements
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“The crash”
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Increased blood pressure and heart rate, increased body temperature. Risk of stroke
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Seizures
Long-term behaviour problems
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Disturbed sleep
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Social isolation and withdrawal
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Lifestyle-related “accident”
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Amphetamine psychosis
o Violent and/or paranoid behaviour
o Irritability, nervousness, distractibility, difficulty focussing and remembering
o Extreme depression, suicidal ideation
o NOT ALL OF THESE REVERSE WITH ABSTINENCE
Physiological damage
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Remember the drug increases heart rate and constricts blood vessels
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Cardiovascular problems arising from increased noradrenaline release include
o Changes in heart rhythm
o Increase heart rate
o Increased blood pressure
o Chronic heart failure
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In one study, meth users had a more than 10x increase in coronary artery disease
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Intracranial hemorrhage which is unusual in young people. Arises from blood pressure increase
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Immune system dysfunction (makes AIDS worse)
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Long term damage to lungs (from smoking)
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Liver and kidney damage from constricted blood vessels
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Significant dental problems
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The more prolonged the use, the more likely the user is to report a ongoing health problem
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In pregnancy…
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Very little data.
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Growth restriction occurs with full-term infants, constriction of the umbilical artery?
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4% have a recognizable withdrawal syndrome.
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At this point, there is no convincing evidence that the agent is teratogenic
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Meth users make bad parents!
What about brain damage?
There is convincing evidence in humans and animals, both by imaging and behavioural studies, that brain
damage occurs. Specifically
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There is long-term depletion of dopamine and serotonin
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This arises from damage to the transporter protein that takes these compounds back into the nerve
terminal
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There is also direct damage to serotoninergic and dopaminergic nerves
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There is desensitization of the D1 receptor, although this is probably reversible
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Increased problems the longer the person uses (ongoing loss of transporter)
How does meth cause death of brain cells?
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All cells have mechanisms for self-destruction. The process is called “apoptosis”, and meth seems to
affect the genes that code for apoptotic proteins.
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Also, release of DA overloads the normal inactivation mechanisms, and the resulting oxidation products
are toxic.
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The toxicity also arises from same process that is involved in cell death during stroke.
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Many animal studies use a single large dose. This may overestimate the problem
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Dopamine transporters may recover, but there is cognitive impairment later on (17mo after abstinence)
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There is evidence for long-term neuronal damage
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It is not clear whether full recovery is possible (consider stroke, for example!)
What about behavioural consequences?
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Attention, verbal learning, memory, decision making are all impaired during early abstinence
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After 8 months abstinence, still slower on some tasks; this may underestimate the real situation
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While social functioning is much improved after abstinence, headaches and depression do not appear
to improve.
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Flashbacks (recurrence of meth psychosis) do occur
o Associated with frightening or stressful experience while stoned. Mild stress triggers flashbacks
o Longer exposure to the situation makes flashbacks more frequent
How do meth users compare to other drug users?
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Use daily rather than binge
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More likely to be Caucasian, male, gay/bi, HIV positive, practice unsafe use (sharing needles etc.), have
a psychiatric diagnosis, be on psychiatric meds
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Develop addiction more rapidly
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Seek treatment earlier
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Use more marijuana and/or less alcohol
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Have more serious medical and psychiatric conditions
Treatment
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No drugs that help recovery in humans (some nerve growth stimulants may help, based on animal data)
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No convincing evidence for benefit from antidepressants
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Recovery patterns are similar to cocaine use, and just as difficult
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Key features:
o Relationship with the counsellor
o Disassociation from those with a drug-based lifestyle (avoiding triggers)
o Support groups
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1. Withdrawal (0-15 days)
Problems
Suggested Actions
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Craving
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Sleep
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Fatigue
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Exercise
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Depression
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Explicit direction
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Anxiety/irritability
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Address triggers
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Fear/paranoia
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Medical examination
2. The honeymoon period (16-45 days)
Problems
Suggested Actions
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Energy but little stability
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Education
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Reduced craving
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Scheduled time
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Unrealistic sense of confidence
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Address triggers
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Resistance to behavioral change
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Exercise
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Return to previous lifestyle
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Support Group
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Other drug use
3. The “Wall” (46-120 days)
Problems
Suggested actions
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Euphoric recall
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Identify justifications for relapse
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Craving
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Group involvement
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Devaluation of progress
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Exercise
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Secondary use
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Address secondary use
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Depression
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Group involvement
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Anxiety
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Boredom
4. Adjustment (121-180 days)
Suggested actions
Problems
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Reduced Craving
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Goal consolidation
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Questioning of addiction
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Group involvement
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Return to high-risk behaviours
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Relapse prevention
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Use of other drugs
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Relationship counselling
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Emergence of long-term relationship
problems
5. Resolution (181-?)
Problems
Suggested actions
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Questioning need for support
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Recovery support group
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Emergence of other excessive activities
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Group counseling
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Relationship problems
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Psychological/psychiatric issues
Perspective
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Crystal meth is potentially a very damaging drug physically, and its use is on the increase
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Despite the potential for harm, most users will probably NOT experience problems that are obvious to
them or their drug-using friends until use has become established, by which time abstention may be very
difficult.
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The real issues are:
o Dependence
o Behavior on the drug
o Later on, behavior when not on the drug
o Problems arising from lifestyle – violence, crime etc.
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