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| Methamphetamine Methamphetamine is a synthetic stimulant drug used for both medicinal and recreational purposes (the latter use is illegal in most countries — see Legal issues). Like most stimulants, methamphetamine can cause a strong feeling of euphoria, thus creating the potential for addiction. Availability and names Pure methamphetamine in tablet form is prescribed by physicians, and is available under the brand name Desoxyn®. Illicit methamphetamine comes in a variety of forms. Most commonly it is found as a colorless crystalline solid, sold on the street under a variety of names, such as: crystal meth or shards or crystal, glass, P, ice, chimichanga or Tina. It is also sold as a less-pure crystalline powder called crank or speed, or in crystalline rock form called dope, sh**, or tweak. Colorful flavored pills containing methamphetamine and caffeine are known as yaba (Thai for "crazy medicine"). See the list of street names for a more comprehensive list of common street names for methamphetamine. Methamphetamine found on the street may be pure, or adulterated with chemicals that were used to synthesize it. In some instances, it may be diluted or cut with non-psychoactive substances like inositol. In other instances, it may be mixed with other psychoactive drugs. History Methamphetamine was first synthesized in 1919 in Japan by the chemist A. Ogata. The method of synthesis was reduction of ephedrine using red phosphorus and iodine. Methamphetamine is closely related to amphetamine, which was first synthesized in 1887 by Lazar Edeleanu, a Romanian chemist. Over time, the chemical's use, distribution, and place in society has changed from insignificant, to controversially beneficial, to infamous. Methamphetamine was later distributed during World War II by the Allies and the Axis to troops, under the name Pervitin.The Nazis widely distributed methamphetamine to their soldiers for use as a stimulant, particularly to SS personnel and Wehrmacht forces in the Eastern Front. Adolf Hitler received shots of methamphetamine from his personal physician, Theodore Morell. After World War II, a massive supply of methamphetamine, formerly stockpiled by the Japanese military, became available in Japan under the street name shabu[citation needed]. The Japanese banned the drug soon after World War II, which is thought to have added to the growing yakuza activities related to illicit drug production. Today, the Japanese underworld is still associated with the drug, although its use is discouraged by strong social taboos. With the 1950s came a rise in the legal prescription of methamphetamine to the American public. According to the 1951 edition of Pharmacology and Therapeutics (by Arthur Grollman), it was to be prescribed for "narcolepsy, post-encephalitic parkinsonism, alcoholism, ... in certain depressive states...and in the treatment of obesity." The 1960s saw the start of the significant use of clandestine manufacture to supply methamphetamine. Prior to 1983, U.S. laws prohibiting the possession of precursors and equipment for methamphetamine production were not yet in place. The recreational use of methamphetamine sky-rocketed in the 1980s. The December 2, 1989 edition of The Economist described San Diego, California as the "methamphetamine capital of North America." In 1986, the U.S. government passed the Federal Controlled Substance Analogue Enforcement Act in an attempt to combat the growing usage of designer drugs. In spite of this, its use expanded throughout the rural United States, especially in the Midwest and South. Growth of methamphetamine use continues into the 21st century, and many states are considering tougher legislation. On August 8, 2005, an issue of Newsweek devoted a cover story to methamphetamine and its abuse, including criticism of the Bush administration's policies regarding methamphetamine. Newsweek blamed the administration for not devoting enough resources to education about and prevention of the drug's use. The Bush administration has countered with the position that cannabis is a dangerous 'gateway drug', so prevention of cannabis use will prevent potential abusers from trying and becoming hooked on "hard" drugs such as methamphetamine. Meanwhile, the online magazine Slate posted an article in reaction to the Newsweek article , attacking Newsweek for failing to appropriately cite sources and data to back up the claim that this is a "new" problem. The topic remains controversial. The most recent figures released by the Federal government indicate that contrary to public perception, methamphetamine use has actually declined nationally in recent years. Production Methamphetamine is structurally similar to methcathinone, amphetamine, and other stimulants, and it may be produced from ephedrine or pseudoephedrine by chemical reduction. Most of the necessary chemicals are readily available in household products or over-the counter medicines. This makes methamphetamine appear unusually easy to make. There are a lot of different syntheses for conversion which can be found on the internet, although these sources are usually not trustworthy, and most experienced 'cooks' learned from either chemistry classes or other individuals involved in methamphetamine manufacture. Almost every method of synthesis involves highly dangerous chemicals and processes. Most production methods involve hydrogenation of the hydroxyl group on the ephedrine/pseudoephedrine molecule. The most common method in the United States involves red phosphorus and iodine which forms hydroiodic acid. An increasingly common method utilizes a Birch reduction process, where metallic lithium is substituted for metallic sodium (due to the difficulty in obtaining metallic sodium). The Birch reduction is extremely dangerous since the alkali metal and liquid anhydrous ammonia are both extremely reactive, and because the temperature of liquid ammonia makes it susceptible to explosive boiling when reactants are added. Other less-common methods use other means of hydrogenation, such as hydrogen gas in the presence of a catalyst. A completely different synthesis procedure involves creating methamphetamine using phenylacetone and methylamine, both of which are currently DEA list I chemicals (as are pseudoephedrine and ephedrine). This was once the preferred method of production by motorcycle gangs in California, but DEA restrictions on the chemicals have made this an uncommon way to produce the drug today. The chemicals used in methamphetamine manufacture are commonly used by people without laboratory training. These chemicals are safely used in and around the household for a variety of different purposes, but despite this, their use in the production of methamphetamine is generally quite dangerous. When a law enforcement officer finds a methamphetamine lab, specially trained and certified professionals wearing full hazardous materials protection suits must be called in to dismantle and dispose of the lab equipment and materials. It is estimated that, for every pound of methamphetamine produced, 5 pounds of hazardous waste are also produced. The highly toxic by-products of methamphetamine synthesis are often dumped in unsafe places. Some of the more obvious signs of a production lab of metamphetamine in operation is the smell of a cat-urine-like odor and witnessing brass fittings on pipes, such as propane bottles, turn a blue colour. This is caused by hydrochloric acid vapours and in some cases from anhydrous HCl gas. It also makes stainless steel go a blackish colour and become rusted; anything made of regular steel ends up quickly coated in rust.[citation needed] When performed by individuals who are not trained chemists, methamphetamine manufacture can lead to extremely dangerous situations. For example, in certain syntheses, if a particular reaction is allowed to overheat, phosphine gas can be produced. When produced in large quantities, it usually explodes, due to autoignition from diphosphine formation caused by overheating phosphorus, injuring or killing any individuals who are present. Since the late 1990s, the number of burn victims in the United States whose injuries were sustained from meth labs has skyrocketed[citation needed]. Until the early 1990s, methamphetamine was made mostly in clandestine labs run by drug traffickers in Mexico and California. These areas are still the largest producers for the U.S. market. Since then, however, authorities have discovered increasing numbers of small-scale methamphetamine labs all over the United States, mostly located in rural, suburban, or low-income areas. The Indiana state police found 1,260 labs in 2003, compared to just 6 in 1995, although this may only be a result of increased police activity. Recently, mobile and motel-based methamphetamine labs have caught the attention of both the news media and law enforcement agencies. The labs can cause explosions and fires, as well as expose the public to hazardous chemicals. In addition to these issues, individuals who manufacture methamphetamine are often armed and dangerous. Many police forces have responded by creating a specialized task force educated in responding to persons involved in methamphetamine production. The amount of methamphetamine actually contributed to the market by small-scale labs is, however, disputed. Large-scale labs maintained by criminal organizations continue to exist, and rely more on diverted or stolen shipments of laboratory-grade precursors than over-the-counter prescriptions. Drug policy critics suggest that restriction of over-the-counter medication is more politically than socially motivated, and may in fact shift the balance of supply more in favor of large criminal organizations. Distribution A wide variety of groups are involved in the distribution of methamphetamine, from the aforementioned prison gangs and motorcycle gangs to street gangs, traditional organized crime operations, and impromptu small networks made up of users. The government of North Korea is said to promote the manufacture of crystal meth, and allegedly plays a role in distribution networks throughout Asia as well as those in Australia and even in North America. Regardless, meth trafficking is not exclusively dominated by cartels along the lines of Colombia's cocaine cartels or Pakistan's heroin cartels. [edit] Medical use Methamphetamine is used medically to treat the following conditions: * attention deficit hyperactivity disorder * narcolepsy * obesity Physical and chemical properties Methamphetamine is a synthetic compound similar in structure to amphetamine and MDMA (Ecstasy), which both belong to the phenethylamine class of stimulants. Compared to most illegal drugs, methamphetamine is a simple molecule with a low molecular weight. Methamphetamine is the trivial name given to two different stereoisomers. As in amphetamines, the two optical isomers, dextro-methamphetamine and levo-methamphetamine, have different activity on both the peripheral nervous system and central nervous system. The effects of the drug on the peripheral nervous system contributes to the “fight-or-flight” like actions of the drug. The increased activity of the peripheral nervous system is the main contributor to the side effects of the drug, ranging from increased cardiovascular activity to gastrointestinal pains. The action of the drug on the central nervous system is thought to be the main cause of its euphoric properties, expanded on in “Pharmacology”. The dextro isomer has been cited as having 3-4 times greater effect on the central nervous system than the levo isomer, making dextrometamphetamine product far more desired among users. Levomethamphetamine is not generally used recreationally, due to the greater risk of its side effects at the high doses needed for CNS stimulation. Because of its action on the endocrine and cardiovascular systems, levomethamphetamine was once a common ingredient in OTC medications, such as Vic's Inhalers. Brand name Desoxyn® is the S enantiomer of methamphetamine, corresponding with dextromethamphetamine. However, street grade methamphetamine varies in optical purity, depending on the method of production and precursor chemicals used. Unlike freebase cocaine; which is a waxy, smokeable form of cocaine, or the less refined crack, freebase methamphetamine is an oily liquid that has no use except in the production of street methamphetamine. Before the manufacturer (or "cook") can sell his drug, he must convert the oil to methamphetamine hydrochloride. Usually this is done via an acid/base extraction into dilute hydrochloric acid solution, out of a solvent such as naphtha or toluene. Methamphetamine hydrochloride is a precipitate of methamphetamine, and this is the form commonly available in the illegal marketplace. On the street, this hydrochloride salt is called "crystal meth," "speed", "crank," "crystal," "ice," and many other names. The HCl salt of meth can be vapourised in a glass pipe or smoked with cannabis or other materials because it dissociates into HCl gas and gaseous methamphetamine freebase at approximately 190 °C. The HCl salt is somewhat hygroscopic but generally speaking if it is pure it does not absorb water from the air very quickly, if at all. Pharmacology Methamphetamine is a potent central nervous system stimulant that affects the brain by acting on the mechanisms responsible for regulating a class of neurotransmitters known as the biogenic amines or monoamine neurotransmitters. This broad class of neurotransmitters is generally responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions. Although the exact mechanism of action is unknown, it is generally believed that methamphetamine causes the monoamine transporter to reverse its direction of flow. This releases monamines from the vesicles to the cytoplasm and from the cytoplasm to the synapse and blocks the re-uptake of these neurotransmitters, causing them to remain in the synaptic cleft longer. As in most neurotransmitter chemistry, the affected neuron decreases its production of neurotransmitters, leading to tolerance and withdrawal effects. In medicine it is used as an appetite suppressant in treating obesity, anesthetic overdose, and narcolepsy. The acute effects of the drug closely resemble the physiological and psychological effects of the fight-or-flight response, including increased heart rate and blood pressure, vasoconstriction (constriction of the arterial walls), pupil dilation, bronchodilation, and hyperglycemia (increased blood sugar). The person who ingests meth will experience an increased focus and mental alertness and the elimination of the subjective effects of fatigue, as well as a decrease in appetite. Many of these effects are broadly interpreted as euphoria or a sense of well-being, intelligence, and power. The 17th edition of "The Merck Manual" (1999) describes the effects of heavy methamphetamine use in these terms: "Continued high doses of methamphetamine produce anxiety reactions during which the person is fearful, tremulous, and concerned about his physical well-being; an amphetamine psychosis in which the person misinterprets others' actions, hallucinates, and becomes unrealistically suspicious; an exhaustion syndrome, involving intense fatigue and need for sleep, after the stimulation phase; and a prolonged depression, during which suicide is possible" (p. 1593 - ch. 195). Depending on delivery method and dosage, a dose of methamphetamine will potentially keep the user awake with a feeling of euphoria for periods lasting 2–24 hours. The acute effects decline as the brain chemistry starts to adapt to the chemical conditions and as the body metabolizes the chemical, leading to a rapid loss of the initial effect and a significant rebound effect as the previously-saturated synaptic cleft becomes depleted of the same neurotransmitters that had previously been elevated. Many users then compensate by administering more of the drug to maintain their current state of euphoria and alertness. This process can be repeated many times, often leading to the user remaining awake for days, after which secondary sleep deprivation effects manifest in the user. Classic sleep deprivation effects include irritability, blurred vision, memory lapses, confusion, paranoia, hallucinations, nausea, and (in extreme cases) death. After prolonged use, the meth user will begin to become irritable, most likely due to lack of sleep. Methamphetamine is reported to attack the immune system, resulting in increased susceptibility to a variety of opportunistic infections (including MRSA, streptococcus, pseudomonads, and other bacterias and yeasts). This, too, may simply be a result of long-term sleep deprivation and/or chronic malnutrition. It is a common belief that methamphetamine gives people super-human strength. This is not really true, although methamphetamine inhibits pain and increases metabolism, which allows a person to push muscles to points of failure that would otherwise be harder or impossible to reach. (See the article entitled Exercise and Stimulants for a better description of the factors involved.) Other side effects include twitching, "jitteriness", repetitive behavior (known as "tweaking"), and jaw clenching or teeth grinding. It has been noted anecdotally that methamphetamine addicts lose their teeth abnormally fast, a condition known as "methmouth"; this may be due to the jaw clenching, although heavy meth users also tend to neglect personal hygiene, such as brushing teeth. It is often claimed that smoking methamphetamine speeds this process by leaving a crystalline residue on the teeth, but no studies have been done to support that claim. In fact, it is largely believed by most dentists that the cause of tooth rot in methamphetamine users is dry mouth. Methamphetamine causes the user to have a loss of saliva and increased thirst, which is quenched usually by soda[citation needed]. The combination of high sugar content and loss of acid fighting saliva create an increased risk for tooth decay. Some users exhibit sexually compulsive behavior and may engage in extended sexual encounters with one or more individuals, often strangers. As it is symptomatic to continue taking the drug to combat fatigue, an encounter or series of encounters can last for several days. This compulsive behavior has created a link between meth use and sexually transmitted disease (STD) transmission, especially HIV and syphilis. This caused great concern among larger gay communities, particularly those in Atlanta, Miami, Chicago, New York City, and San Francisco, leading to outreach programs and rapid growth in 12-step organizations such as Crystal Meth Anonymous. Effects Methamphetamine is used both medically and recreationally for one or more of the following effects: * Increased alertness, motivation, and brain activity (short-term) * Euphoria in high doses * Weight loss (may also be an adverse effect, depending upon circumstances) * Heightened sexual stimulation The undesirable effects of methamphetamine use include: * Compulsive fascination with useless repetitive tasks (see Punding) * Severe psychological addiction * Acne * Depression * Formication (false sensation of flesh crawling with bugs, with possible associated compulsive picking and infected sores) * Amphetamine psychosis * Erectile dysfunction ("Crystal cock") * Long-term cognitive impairment due to neurotoxicity * Tooth decay ("meth mouth") * Damage to immune system * Persistent anhedonia with chronic use * Death * Staph infection Side effects Common side effects of methamphetamine include: * Cardiovascular - Hypertension * Endocrinal - Elevated body temperature * Eye - Dilated pupils * Gastrointestinal - Diarrhea, nausea, vomiting * Neuro-psychological - Paranoia, especially when mixed with cannabis. * Neuro-psychological - Euphoria followed by depression * Skin - Rash * Miscellaneous - Anorexia, insomnia, restlessness, weight loss Severe side effects (with chronic use) include: * Amphetamine psychosis * Clinical depression * Kidney damage * Liver damage Contraindications The use of methamphetamine should be avoided in persons with the following: * Glaucoma * Hypertension * Cardiovascular disease * Methamphetamine should not be taken within 14 days of taking a non-reversible MAOI. (If in good health, it can be safely combined with reversible MAOI's such as moclobemide.) Addiction Methamphetamine is a highly psychologically addictive drug. The mental and social consequences of quitting can be severe and extremely difficult for the addict. As with all addictions, relapse is common. To combat relapse, many recovering addicts attend 12 Step meetings, such as Crystal Meth Anonymous. In an article about his son's addiction to methamphetamine, a California writer who has also experimented with the drug put it this way: [T]his drug has a unique, horrific quality. In an interview, Stephan Jenkins, the singer in the band Third Eye Blind, said that methamphetamine makes you feel 'bright and shiny.' It also makes you paranoid, incoherent and both destructive and pathetically and relentlessly self-destructive. Then you will do unconscionable things in order to feel bright and shiny again (David Sheff, "My Addicted Son," New York Times Magazine, February 6, 2005, p. 44). Former users have noted that they feel stupid or dull when they quit using methamphetamine. This is because the brain is adapting a need for methamphetamine to think faster, or at what seems to be a higher level. Individuals with ADHD are often at especially higher risk for addiction to methamphetamine, because the drug often increases the user's ability to focus and reduces impulsivity, creating a mechanism by which one is better able to cope. For this reason, drugs like this should be used only under the supervision of a physician. The individual with ADHD is susceptible to meth's adverse effects (see below), so prescription stimulants such as methylphenidate (Ritalin®), dextroamphetamine (Dexadrine®) and amphetamine salt (Adderall®) are overwhelmingly indicated. With long-term methamphetamine use, enough dopamine will have flooded the brain to cause chemical cell damage. This often leads to slow thinking (which in turn requires that the addict use meth to 'fix' it), and depression. This is known colloquially as "The Vampire Life." In one particular case, researchers were able to reverse many of the addict's symptoms by treatment with fish oil Very serious long-term meth abuse correlates highly with poor hygiene and general self-care, and many of the health risks inherent in administering the drug are often severely exacerbated by this. Poor hydration and infrequent dental hygiene strongly increase the risks of damage to teeth from smoking or snorting, while infrequent bathing increases the chance that minor skin rashes or irritations on the arm from needle use will progress to infection and complications. Generally poor maintenance of living conditions can increase the general risk of exposure to illness through a wide variety of malaise-causing agents, such as bacteria that may grow in poorly cleaned living spaces. Finally, if methamphetamine does in fact attack the immune system, it follows that the ability of the individual to resist any illness is compromised, and that heavy meth users, over time, become more susceptible to poor health and illness in general. Severe cases of addiction are often marked by many of these symptoms and hallmarks, which can work in combination to almost completely destroy the user's health. Routes of administration Methamphetamine can be swallowed, snorted, smoked, dissolved in water and injected, inserted anally (with or without dissolution in water), or into the urethra. [citation needed] As with all addictive drugs, the potential for addiction is greater when it is delivered by methods that cause the concentration in the blood to rise quickly, principally because the effects desired by the user are felt more quickly and with a higher intensity than through a moderated delivery mechanism. In fact, studies have shown that the subjective pleasure of drug use (the reinforcing component of addiction) is proportional to the rate that the blood level of the drug increases. In general, smoking is the "fastest" mechanism (i.e., it causes the blood concentration to rise the most quickly in the shortest period of time as it allows the substance to travel to brain through a more direct route than intravenous injection), followed by injecting, then snorting, then swallowing. It is not entirely certain where anal insertion would fall on this list, but some scant anecdotal evidence puts the effects somewhere between those of smoking and snorting. Methamphetamine is a powerful decongestant, so methamphetamine users who snort it will often have very clear nasal cavities. However, there have been rare cases of people snorting so much meth that their nose cartilage deteriorates, though snorting cocaine is far more likely to cause nasal degeneration, due to its vasoconstrictive properties. Snorting methamphetamine may also cause tooth decay, since the nasal passages are directly connected to the mouth region, and it is theorized that damaging crystalline particles can still attach to the teeth. Another theory is that the drug directly affects calcium balance in the body. Crystal Meth has also been shown to decrease the production of saliva, the lack of which causes tooth decay. Methamphetamine is commonly smoked in glass pipes, or in aluminum foil heated by a flame underneath. This method is also known as "chasing the white dragon". (as derived from the method of smoking heroin known as "chasing the dragon"), Methamphetamine must be heated (not burned) to cause the desired smoke. Smoking methamphetamine is probably the most impure form of ingestion. In addition to the possible effects on teeth, it is very damaging to the lungs. Methamphetamine users who smoke it sometimes experience mild asthma, which can be countered by inhaling salbutamol aerosol spray, or epinephrine aerosol. Another problem with smoking meth is the potential presence of oxidation byproducts created when the heated drug comes in contact with air. Even if the initial drug is pure methamphetamine, the act of smoking it produces other chemicals, some of which may be toxic. Injection is a popular method for use, but potentially carries quite serious risks. The hydrochloride salt of methamphetamine is soluble in water; injection users may use any dose from 200 mg to over a gram in one I.V. dose using a small needle. In methamphetamine research, injection users often do not experience severe tooth decay, presumably because there is no residue left as there is through smoking it. But injection users experience greater jaw-clenching than users who snort or smoke it, since injecting methamphetamine has a much more powerful effect. This can cause loose teeth, so injection users still do lose their teeth. Also, this method of ingestion brings the risk of infection; injection users often experience skin rashes (sometimes called "speed bumps") and all kinds of infections due to the methamphetamine damage to the skin. As with any injected drug, if a group of users shares a common needle without sterilization procedures, blood-borne diseases such as HIV or hepatitis can be transmitted as well. Very little research has focused on anal insertion as a method, and anecdotal evidence of its effects is infrequently discussed, possibly due to social taboos in many cultures regarding the anus. This is often known within communities that use meth for sexual stimulation as a "booty bump" or "Keistering," and is anecdotally reported to increase sexual pleasure while the effects of the drug last. The rectum is where the majority of the drug would likely be taken up, through the mucous membranes lining its walls. Lack of direct exposure to teeth probably insulates users from the majority of damaging dental effects, but damage to sensitive anal and rectal tissues is a risk. Weakness in these tissues may increase the risk of transmission of sexually-transmitted infections during sex. If enough methamphetamine is taken so that not all of it is completely dissolved, abrasion of any prophylactic devices (such as condoms) used during sex can occur due to friction with undissolved meth crystals. This can contribute to breakage of the prophylactic, and increased risk of disease transmission. (See Crystal and sex for further information on other risk factors.) The least-detrimental method of taking methamphetamine may be oral administration. The effects are moderated over time to a greater degree, and neither teeth, skin, nor nasal passages are directly exposed to potentially harmful chemicals (assuming the user is careful not to allow pure crystal meth to come in contact with these parts of the body during ingestion). The less-intense "hit" may make this a less popular current choice for administration. Legal issues Methamphetamine is classified as a Schedule II substance by the DEA in the United States. Internationally, methamphetamine is a Schedule II drug under the Convention on Psychotropic Substances . While there is technically no difference between the laws regarding methamphetamine and other controlled stimulants, most medical professionals are averse to prescribing it due to its status in society. Further, there is some anecdotal evidence that the DEA audits such prescriptions far more often than prescriptions for similar drugs. Methamphetamine is legally marketed in the United States under the trade name Desoxyn, manufactured by Ovation Pharma. Generic formulations of the drug are also available. |