Joan Ellen Zweben PhD J Thomas Payte MD

METHAMPHETAMINE Methampheta-mine (also called METHEDRINE) is a potent PSYCHOMOTOR STIMULANT with a chemical structure similar to AMPHETAMINE. Methamphetamine's stimulant effects on the central nervous system are more pronounced than those of amphetamine, while its peripheral effects (e.g., cardiovascular and gastrointestinal) are less marked. Like amphetamine, it causes increased activity, increased talkativeness, more energy and less fatigue, decreased food intake, and a general sense of well-being. Injecting the drug intravenously results in the production of a ''rush,'' described by some as the best part of the drug effect. Methamphetamine is more soluble than Dextroamphetamine, and, when available, of this group is generally the illicit user's drug of choice for intravenous injection—although dextroamphetamine dissolves sufficiently to permit intravenous use.

Japan was the first nation to experience a major epidemic of methamphetamine use. Immediately following World War II, large quantities of meth-amphetamine, which had been produced to keep combat troops alert, were released for sale to the Japanese public. Within a short time there was widespread use and abuse of the drug, much of it

Figure 1

Methamphetamine

Figure 1

Methamphetamine intravenously. At the peak of the epidemic, more than a million users were involved. Despite the experience of the Japanese, the belief persisted in the United States that amphetamines did not lead to serious compulsive use, and these drugs were not subject to any special regulatory controls like the ones governing the availability of the opioid drugs until 1964.

The first methamphetamine (''speed'') epidemic in the United States began in the 1960s in the San Francisco area. A number of physicians there were prescribing the drug to HEROIN abusers for self-injection—to treat their heroin dependence by substituting methamphetamine. The drug achieved widespread popularity, with increasing numbers of people claiming heroin abuse and requesting prescriptions for methamphetamine. When the sale of intravenous methamphetamine to retail pharmacies was curtailed in the mid-1960s, illicitly synthesized methamphetamine began to appear. By the late 1960s a substantial number of users throughout the United States were injecting high doses of this illicit methamphetamine in cyclical use patterns—resulting in toxic syndromes that included the development of a paranoid psychosis (i.e., amphetamine psychosis).

Although illicit methamphetamine never completely disappeared from street use, its availability was considerably reduced by the 1970s. This trend began to reverse during the 1980s, with pockets of methamphetamine abuse occurring in the United States. Hawaii was the first area of the United States to experience the most recent methampheta-mine outbreak, mostly in the form of smokable methamphetamine. Initial reports of smoking methamphetamine occurred in late 1986, with increases occurring about a year later, and a more sustained increase occurring in 1988 and 1989. Called ''ice'' or ''crystal,'' this is the same sub stance as "speed," which was abused several decades earlier.

Methamphetamine, sold as "ice," is a large, usually clear crystal of high purity (greater than 90%) that is generally smoked using a glass pipe with two openings, much like a CRACK-cocaine pipe. Because it is a large crystal, it is difficult to adulterate with inert substances, a property that makes it extremely desirable to purchasers of illicit products. The smoke is odorless and, unlike crack, the residue of the drug stays in the pipe and can be resmoked. The effect is long-lasting, reported by users to be as long as twelve hours, although it is likely that this prolonged effect is due to the use of several doses.

Like COCAINE, methamphetamine abuse occurs in binges, with users taking the drug repeatedly for several hours to several days. During this time the user generally neither eats nor sleeps. Ending a methamphetamine binge is accompanied by fatigue, depression, and other "crash"-related effects. One of the most profound of the toxic effects of repeated methamphetamine use is the development of a paranoid psychosis, often indistinguishable from schizophrenia. With time off the drug, this psychosis generally resolves, although it can reappear if the user returns to methamphetamine abuse. Some Japanese psychiatrists have reported that methamphetamine psychosis may persist for many months.

(SEE ALSO: Amphetamine Epidemics; Designer Drugs; Epidemics of Drug Abuse)

BIBLIOGRAPHY

KALANT, O.J. (1973). The amphetamines: Toxicity and addiction, 2nd ed. Springfield, IL: Charles C. Thomas.

Miller, M. A., & KOZEL, N.J. (1991). Methamphetamine abuse: Epidemiologic issues and implications. NIDA Research Monograph Series, no. 115. Washington, DC: U.S. Government Printing Office. Smith, D. E., & Wesson, D. R. (Eds.). (1972). The politics of uppers and downers. Journal of Psychedelic Drugs, 5, 101-182.

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