Methamphetamine (crystal meth, meth, crank, glass, ice, etc.) is a man-made form of the central nervous system stimulant drug d-methamphetamine. The synthetic form of the drug often appears as if it is simply shards of broken glass or as white or bluish white rocks (hence, some of the above street names for the drug). Abusers of the drug will most often smoke or snort it.
The drug is manufactured overseas, in Mexico, or in the United States in private home laboratories using the drugs pseudoephedrine or ephedrine that have been extracted from over-the-counter medications like cough syrup and other additives. The National Institute on Drug Abuse (NIDA), the United States Drug Enforcement Administration (DEA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and numerous other sources report that meth is extremely addictive, and use of meth is associated with significant risks, even for occasional users. Chronic abuse of methamphetamine can lead to the development of numerous physical and psychological disorders and significant dysfunction.
The DEA recognizes that methamphetamine continues to have some medicinal purposes and classifies methamphetamine as a Schedule II controlled substance. This is the strictest classification offered by the DEA for drugs that are available with a prescription from a physician. Drugs in the next highest class, Schedule I, cannot be legally obtained by private individuals and are not considered to be safe to use even if they are used under the supervision of a prescribing physician.
The mechanism of action associated with stimulant drugs like methamphetamine is the release of massive amounts of neurotransmitters in the brain and spinal cord, particularly the neurotransmitters norepinephrine and dopamine. The massive release of these neurotransmitters produces significant feelings of euphoria, feelings of invulnerability, increased energy, and other psychoactive effects, including potential psychosis (hallucinations and/or delusions). In addition, massive releases of dopamine lead to significant reinforcing effects of the drug.
The intense effects of methamphetamine typically wear off very quickly, and people who use the drug find themselves bingeing on it to maintain the intense euphoria and a rush of energy that the drug gives them. This leads to a rapid development of tolerance and physical dependence as well as other detrimental side effects.
How Is Street Meth Made?
Methamphetamine is manufactured by professional drug companies for limited medicinal uses, but the majority the of the meth that is abused on the street is manufactured in private laboratories. The DEA reports that the ease of manufacture associated with making large amounts of meth has led to numerous private manufacturers producing the drug. The ingredients include:
- Some over-the-counter medication that contains either ephedrine or pseudoephedrine since methamphetamine can be extracted from these products
- Highly combustible components, such as acetone (often taken from paint thinner or nail polish remover), or ammonia (often taken from household cleaners), acid (either sulfuric or hydrochloric acid that can be extracted from over-the-counter drain cleaners)
- Lithium that is extracted from car batteries
- Phosphorus extracted from flares or matches
- Ether taken from chloroform
- Benzene and/or gasoline
- Freon from air-conditioning units
The traditional method is to use a four-step process where the pseudoephedrine or ephedrine is combined with iodine and phosphorus or with lithium and ammonia and mixed in water. The next step is to add a solvent, such as gasoline or alcohol, to extract meth from the over-the-counter drugs. The concoction is heated with acid to crystallize it, and the methamphetamine can be separated from waste products. Often, this involves the use of phosphorus, making the heating procedure quite dangerous.
The “shake and bake” method requires that the ingredients be combined in a large container, such as a glass or plastic bottle, shaken vigorously, and then the methamphetamine is removed. This is also a dangerous process because shaking highly combustible and volatile substances can result in an explosion.
The process of making meth is not supervised unless it is produced by a professional laboratory. This means that numerous cutting agents, other drugs, etc., can be added to the concoction without any fear of reprisal on the manufacturer. The use of caffeine, other over-the-counter drugs, cocaine, etc., is not uncommon in the manufacture of methamphetamine by private individuals, according to the DEA and the NIDA. In addition, even though manufacturers attempt to separate the methamphetamine from waste products, such as phosphorus and other toxic products, they cannot totally separate these potential toxic waste products, and individuals who use methamphetamine are subject to the effects of these products.
When the drug is manufactured out of the country, there is even less attention paid to the removal of these waste products, and there is no consideration for the health of the user by any private manufacturer. The drug is simply made to be sold, get people high, and keep them coming back for more.
The Consequences of Meth Abuse and Addiction
Abuse of methamphetamine results in a very intense rush of euphoria, particularly in the early stages of abuse. Symptoms of meth include extreme feelings of wellbeing, increased energy, boosted sociability, and extreme talkativeness. People who repeatedly use the drug attempt to replicate their early experiences on methamphetamine; however, over time, the actual intensity of the euphoria and positive effects diminishes, and many of the negative effects, such as hyperactivity, confusion, psychosis, etc., begin to dominate the individual’s subjective experience.
Abuse of stimulant drugs has been used as an example to support a theory that has attempted to explain why individuals continue to abuse drugs. This theory is known as incentive sensitization, where over time chronic abusers of drugs actually enjoy their experience less and less, but they continue to abuse the drug in an attempt to chase their initial experiences, which have diminished substantially, and to ward off negative feelings, such as withdrawal, depression, etc.
When individuals use stimulant drugs like methamphetamine, the initial rush of energy and elation is very quickly followed by feelings of apathy, depression, hopelessness, etc., as levels of the neurotransmitters in the central nervous system drop or become depleted. Meth users often continue to binge on the drug to avoid the negative effects of the drug. Thus, at least according to this theory, it is not the positive effects of drug use that drive abuse and addiction, but the negative reinforcing effects (removal of negative feelings) that drive addiction. Eventually, even the negative effects cannot be controlled by drug abuse, and they begin to dominate the substance abuser’s life. The depletion of neurotransmitters in the brain actually results in a diminished capacity for the person to experience positive feelings like satisfaction, pleasure, and contentment. Moreover, tolerance to the drug is a result of the person’s system producing neurotransmitters and hormones that foster feelings opposite to those that the drug produces (e.g., pleasure) in an effort for the person’s system to maintain balance. This situation can result in a diminished capacity for the person to have positive emotional experiences.
There are some specific physical signs that signify a person may have a problem with meth. Some of these physical signs include:
- Significant loss of weight without attempts to diet
- An emaciated and unhealthy appearance
- Dry, cracked skin, particularly around the fingertips or lips
- Sudden development of acne around the lips
- Burns around the mouth or fingertips
- Abscesses or red marks on the skin
- Rapid deterioration of dental health (meth mouth)
- Chronic issues with halitosis
- Runny nose or frequent nosebleeds, particularly due to snorting
- Sudden development of twitches or ticks
In addition, the person may:
- Becomes very fidgety and excessively talkative
- Appear overheated or perspire excessively while using the drug
- Go through significant periods where they do not sleep
- Repeat meaningless behaviors
- Display significant mood swings that vacillate between irritability and extreme happiness
- Seem suspiciousness or paranoid
- Experience visual or auditory hallucinations
Long-term signs can include issues with memory, chronic depression, and even psychosis. Some individuals may begin to slur their speech when not under the influence of the drug, display significant problems with judgment or rational thinking that were not noticeable previously, and even appear to have regressed to an earlier state in their development, such as an adolescent type of thinking.
Other behavioral symptoms may also be present. These could include:
- Lack of attention to the individual’s hygiene
- Financial issues
- Isolation from others
- Associating with other individuals who use meth
- A significant decline in important areas, such as an individual’s occupation, personal relationships, parenting duties, etc.
- Beginning to engage in criminal activity, such as stealing
Physical Dependence on Meth
Because the majority of individuals who begin to abuse methamphetamine binge on the drug, tolerance to methamphetamine develops extremely rapidly. Individuals begin to use very high amounts of the drug, for significant periods of time in order to chase the wanted psychoactive effects of the drug. As tolerance develops, the person’s system also begins to adjust itself to account for the presence of the drug. Normal regulatory functions of the system are altered, such that when there is not a certain amount of the drug present, the system is thrown out of balance. This is the beginning of the withdrawal syndrome.
The withdrawal syndrome from stimulant drugs like methamphetamine is associated with the massive depletion of neurotransmitters in the brain and spinal cord that produces severe issues with judgment, awareness, and emotional functioning. Most of the time, individuals do not experience some of the more common withdrawal symptoms associated with other drugs, such as nausea and vomiting. However, stimulant drug withdrawal often produces imbalances in the autonomic nervous system, part of the nervous system outside of the brain and spinal cord that speeds up and slows down various bodily functions.
Individuals may experience heartbeat irregularities, sweating, nervousness, irritability, increased appetite, extreme tiredness and lethargy, etc., during withdrawal from methamphetamine.
Withdrawal from methamphetamine will often result in the following presentation:
- A rapid appearance of symptoms due to the very short half-life of the drug (very often, within 24 hours of stopping it)
- Fatigue, sleepiness, lethargy, dry mouth, and significantly increased appetite
- Issues with mood, such as the onset of depression, hopelessness, and apathy
- Very powerful cravings to use meth
- Psychosis (e.g., hallucinations, delusions, extreme paranoia, etc.).
Once the symptoms appear, they will often peak within the first week to 10 days after the person has stopped using the drug and then their intensity will begin to decrease. Overall, withdrawal from methamphetamine may last for 2-3 weeks, and most studies suggest that a period of two weeks is most common.
It is not uncommon for individuals to become desperate, emotionally distraught, and even suicidal during the withdrawal period. Cravings can become very intense. Severe problems with depression, cravings, and psychosis should be addressed medically. Additionally, chronic methamphetamine abusers often display long-term issues with cognition, including problems with attention and concentration, memory, speech, and judgment.
Treating Methamphetamine Abuse
According to the American Society of Addiction Medicine (ASAM), the initial step in the treatment of an individual who has developed a stimulant use disorder as a result of methamphetamine abuse is to enroll in a physician-assisted program of withdrawal management. Medications to deal with lethargy (typically mild stimulants like Provigil [modafinil]) and medications to address cravings and other symptoms, such as the use of baclofen or Neurontin (gabapentin), may be used.
Behavioral interventions are commonly used in treatment. Individuals who are displaying issues with psychosis would be given antipsychotic medications. Depression is often initially addressed behaviorally as use of antidepressants for the treatment of depression will often take several weeks for their effects to take hold; however, some antidepressant medications can also address other symptoms, and these may be prescribed. Other interventions for co-occurring disorders should also be implemented. Attention to any effects produced by the abuse of meth, such as issues with dentition or skin, should also be given.
In addition to addressing withdrawal symptoms, a person who is recovering from the abuse of methamphetamine should become involved in a formal substance use disorder therapy program and peer support groups. These interventions should be ongoing even after the person has remained abstinent from meth during the withdrawal process. Being involved in a long-term aftercare program is crucial to continued recovery.
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