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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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Methamphetamine: The Great American Tragedy
I am at the midpoint of my month as the hospitalist Los Angeles County-USC Medical Center. I have worked as a physician through the Aids epidemic, worked to fight multi-drug resistant Tuberculosis, alcoholic liver disease, and increasing rates of stomach and lung cancer in our young folks. This month, however, my heart is breaking over how Meth is taking over. Methamphetamine use is becoming one of our biggest American tragedies and though this blog has been in my mind for a year I've finally sat down to write it out. Here is my tough love blog.
Most of us on Dailystrength know someone who has struggled with Meth and I hope you know our hospitals and emergency rooms are packed with meth users.
Some background: In the United States medical use of amphetamines began in 1932, when amphetamines (marketed as Benzedrine) was used as a treatment for asthma, narcolepsy, ADHD, appetite suppression and schizophrenia among other things.
Why it caught on? The widespread use of meth stems largely from its potential to produce euphoria, reduce fatigue, enhance performance, suppress appetite, and induce weight loss among other things. Unlike cocaine and heroin, which are plant derived, methamphetamine is easily prepared from simple chemical precursors. The more recently available "ice" is created from ephedrine and pseudoephedrine by reduction to its beta-hydroxyl group to form methamphetamine hydrochloride. Domestic and Mexican "superlabs" can produce 10 lbs plus of high purity meth within a 24 hour period.
How many folks are using? Instead of bombarding you with numbers I've selected the most statistics most striking to me. In 2004, 12 million Americans reported having used methamphetamine at least once. Emergency rooms, jails and treatment centers are packed with meth users. In 2003, the percentage of male arrestees testing positive for meth was 40% in Honolulu, 33% in San Diego and 28% in Los Angeles. The number of new users of meth increased 250% between 1996 and 2002. In Hawaii 80 to 90% of child abuse cases involve meth use in one or both parents.
Who uses meth? Unlike other drugs, methamphetamine appeals equally to both genders. Although traditionally used by white, working class males 18 to 34 years of age on the West Coast and College students the demographics are now much broader. Native Americans and Hispanics are using meth in growing numbers however relatively few African Americans are regular users of methamphetamines.
What are the "risk factors" for meth abuse and dependence? Early onset of stimulant use, multiple-substance abuse, daily cigarette smoking between 13 and 17 years of age, depression, ADHD, the manic phase of bipolar disorder, obesity and a desire to enhance sexual pleasure and known risk factors for methamphetamine abuse and dependence.
What is a stimulant and how does meth work? Stimulants are powerful modulators of Dopamine activity. Stimulants are grouped into two distinct classes based on mechanism of action. 1) The first group consists of the "uptake blockers" and includes cocaine and Ritalin. 2) The second group is the "releasers" which include the amphetamine analogs like methamphetamine, dextroamphetamine, and MDMA or Ecstasy.
Is Meth more addictive than other stimulants? Yes. Compared to other stimulants, the progression to meth addiction is accelerated. Meth use is characterized by frequent ingestion (8-10 times a day) and users who initially snorted or smoked meth often find they need to administer the drug intravenously to achieve the desired effects. There are differences in neurotoxicity between meth and other stimulants. Methamphetamine use damages neurons that inhibit dopamine and serotonin pathways while cocaine is not toxic to these neurons. Because of this, the lack of mental energy, dysphoria and depression experienced during withdrawal is more severe and protracted in meth than with other stimulants. What is STARTLING is that many of the effects of meth withdrawal (impairment in thinking and performance for example) are present up to three years AFTER quitting meth.
Treatment, does anything work? In addition to the standard 90 day inpatient rehab facilities that have proven effective, psychosocial therapy (cognitive behavioral therapy) as an outpatient can help and there are some pharmacological therapies that show promise. Interestingly when the SSRI antidepressants (Zoloft and Paxil) were studied treatment during meth withdrawal there wasn't much benefit. Three medications, however, were effective when studied: Mirtazapine (Remeron), Buproprion and Ritalin with several additional therapies currently being studied.
What are we seeing in the hospital? Just this month I have seen patients with dilated cardiomyopathy (heart failure) from meth with one awaiting heart transplant his only option for life. I see patients with psychosis and the effects of violence every day in our ER. Chronic users complain of dizziness, nausea, fatigue, hair loss and sores where the addict has scratched down to the bone. "Meth mouth" is often seen in our addicts and I've seen every variation of dead and decayed teeth, and smelly exposed jawbones in 20 year old women who look nothing like their drivers license pictures from 2 years prior.
If meth has wreaked havoc on you or someone you know please share your story. Spread the word.
Dr O.
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