The methamphetamine resource

Methamphetamine (pharmaceutically referred to as methylamphetamine or desoxyephedrine) is a psychostimulant drug used primarily for recreational purposes, but is sometimes prescribed for ADHD and narcolepsy under the brand name Desoxyn. Methamphetamine is highly psychologically addictive. It rapidly enters the brain and causes a cascading release of norepinephrine and dopamine (and to a lesser extent, serotonin) resulting in euphoria and the availability of undirected energy. Users may become obsessed or perform repetitive tasks such as cleaning, hand-washing or assembling and disassembling objects.^[2] Withdrawal is characterized by increased sleeping and eating, and depression-like symptoms, often accompanied by anxiety and drug-craving.^[3]

Availability and names

In the U.S., illicit methamphetamine comes in a variety of forms, with an average price of $150 per gram of pure substance.^[4] Most commonly it is found as a colorless crystalline solid, sold on the street under the name crystal meth and a variety of other names. It is also sold as a less-pure crystalline powder called crank, or in crystalline rock form. Colourful flavored pills containing methamphetamine and caffeine are known as yaba (Thai for "crazy medicine"). At its most impure, it is sold as a crumbly brown or off-white rock commonly referred to as "peanut butter crank"^[5]. Methamphetamine found on the street is rarely pure, but adulterated with chemicals that were used to synthesize it. It may be diluted or "cut" with non-psychoactive substances like inositol. It may also be cut with other psychoactive substances, but the reverse is presumably more common due to its low price relative to other common drugs.

History

Methamphetamine was first synthesized in Japan in 1919 by Akira Ogata via reduction of ephedrine using red phosphorus and iodine. The related compound Amphetamine was first synthesized in Germany in 1887 by Lazar Edeleanu.

One of the early uses of amphetamine occurred during World War II where the German Wehrmacht dispensed the stimulant known under the trade name Pervitin to troops.^[6] The drug was widely distributed not at least to elite forces like tank crews and aircraft personnel. For pilots the drug was embedded into chocolate bars, the infamous Fliegerschokolade.

Adolf Hitler received three daily IV injections of methamphetamine and steroids from his personal physician, Theodore Morell.^{citation needed]} After World War II, a massive supply of amphetamine, formerly stockpiled by the Japanese military, became available in Japan under the street name shabu^{citation needed]} (also Philopon, its tradename there.^[7]) The Japanese Ministry of Health banned it in 1951, which is thought to have added to the growing yakuza activities related to illicit drug production.^[8] 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 Levoamphetamine 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 use 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,^[9] including criticism of the Bush administration's policies regarding meth. 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 should prevent potential abusers from trying and becoming hooked on "hard" drugs such as methamphetamine. This is known as the "stepping stone theory."

Meanwhile, the online magazine Slate posted an article in reaction to the Newsweek article,^[10] 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.^[11]

Production

Methamphetamine is most structurally similar to methcathinone and amphetamine. In illicit production, it is commonly made by the reduction of ephedrine or pseudoephedrine. Most of the necessary chemicals are readily available in household products or over-the counter medicines. Synthesis is relatively simple, but most methods involve flammable and corrosive chemicals. As a result, clandestine production is often discovered due to fires caused by amateur chemists working with makeshift laboratory equipment.

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. This is a fairly dangerous process; in fact, on the Darwin Awards site, there is a story of a man who burned himself trying to conceal these chemicals.^[12] The red phosphorus production method can create phosphine gas, which is extremely toxic when breathed in. 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 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 by the reductive amination of phenylacetone with 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.

One of the more obvious signs of a production lab of metamphetamine in operation is the smell of a cat-urine-like odor.

When performed by individuals who are not trained chemists, methamphetamine manufacture can lead to extremely dangerous situations. For example, if the red phosphorus 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 after they blow up. 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.^[13]

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 harmed by toxic gases. 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 disputed. Large-scale labs maintained by criminal organizations continue to exist. 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 ^{citation needed]}. Regardless, meth trafficking is not exclusively dominated by cartels along the lines of Colombian cocaine cartels or Pakistani heroin cartels.

Medical use

Pharmacology

Methamphetamine is a potent central nervous system stimulant which affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions. Methamphetamine causes the norepinephrine transporter, dopamine transporter to reverse their direction of flow. This inversion leads to a release of these transmitters from the vesicles to the cytoplasm and from the cytoplasm to the synapse, causing increased stimulation of post-synaptic receptors. Methamphetamine also indirectly prevents the reuptake of these neurotransmitters, causing them to remain in the synaptic cleft for a prolonged period. Serotonin levels are only weakly affected (ratio NE: DA = 2:1, NE:5HT = 60:1).^[14] It is neurotoxic in overdose.^[15]

The acute effects of the drug closely resemble the physiological and psychological effects of an epinephrine-provoked fight-or-flight response, including increased heart rate and blood pressure, vasoconstriction (constriction of the arterial walls), bronchodilation, and hyperglycemia (increased blood sugar). Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.

Tolerance

As with other amphetamines, tolerance to methamphetamine is incompletely understood, but known to be sufficiently complex that it cannot be explained by any single mechanism. The extent of tolerance and the rate at which it develops varies widely between individuals, and even within one individual it is highly dependant on dosage, duration of use and frequency of administration. Many cases of narcolepsy are treated with methamphetamine for years without escalating doses or any apparent loss of effect.

Short term tolerance can be caused by depleted levels of neurotransmitters within the vesicles available for release into the synaptic cleft following subsequent reuse (tachyphylaxis). Short term tolerance typically lasts 2-3 days, until neurotransmitter levels are fully replenished. Prolonged overstimulation of dopamine receptors caused by methamphetamine may eventually cause the receptors to downregulate in order to compensate for increased levels of dopamine within the synaptic cleft.^[16] To compensate, larger quantites of the drug are needed in order to achieve the same level of effects.

Side effects

The most commmon side effects include twitching, "jitteriness", repetitive behavior (known as "tweaking"), and jaw clenching or teeth grinding.

Methamphetamine addicts may lose their teeth abnormally fast, a condition known as "meth mouth". Similar, though far less severe symptoms have been reported in clinical use of other amphetamines, where effects are not exacerbated by a lack of oral hygiene for extended periods.^[17] Like other substances which stimulate the sympathetic nervous system, methamphetamine causes decreased production of acid-fighting saliva and increased thirst, resulting in increased risk for tooth decay, especially when thirst is quenched by high-sugar drinks.^[18]

Users may exhibit sexually compulsive behavior and may engage in sexual acts with one or more individuals. This sexual behavior is believed to have 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.

Overdose fatalities are usually due to stroke or heart failure, but can also be caused by hyperthermia or kidney failure.

Addiction

Methamphetamine is highly addictive, particularly when injected or smoked.^[20] While not life-threatening, withdrawal is often intense and, 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:

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 may be at higher risk for addiction to methamphetamine, because the drug increases the user's ability to focus and reduces impulsivity. Because of its abuse potential, meth is not generally prescribed for ADHD unless other stimulants, such as methylphenidate (Ritalin®), dextroamphetamine (Dexedrine®) or mixed amphetamines (Adderall®) have failed.

With long-term use, abstinence often leads to slow thinking and depression, which in turn requires that the addict use more meth to 'fix' it. A chronic pattern of such behavior is known colloquially as "The Vampire Life."

Serious drug addiction correlates with poor hygiene and general self-care, and even minor health problems can lead to serious complications when left untreated. Striking health problems popularly associated with methamphetamine addiction, such as severe tooth decay or massive skin infections, are caused by unsterilized needles and a lack of hygiene. Even long-term use does not generally result in outward symptoms, but may lead to hypertension, damage to heart valves, and increased risk of strokes.

Routes of administration

The usual route for medical use is oral administration. In recreational use it can be swallowed, snorted, smoked, dissolved in water and injected (or even with out water as what is called a dry shot), inserted anally (with or without dissolution in water), or into the urethra. ^[22] 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, snorting, anal insertion, and swallowing.

"Smoking" methamphetamine actually refers to vaporizing it to produce fumes, rather than burning and inhaling the resulting smoke, as with tobacco. It 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 opium known as "chasing the dragon"). There is little evidence that methamphetamine inhalation results in greater toxicity than any other route of administration. Lung damage has been reported with long-term use, but manifests in forms independent of route (pulmonary hypertension and associated complications), or limited to injection users (pulmonary emboli).

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 125 mg to over a gram in one I.V. dose using a small needle. This dosage range may be fatal to non-addicts; addicts rapidly develop tolerance to the drug. Injection users often experience skin rashes (sometimes called "speed bumps") and infections at the site of injection. As with any injected drug, if a group of users shares a common needle or any type of injecting equipment 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.^[23] The rectum is where the majority of the drug would likely be taken up, through the mucous membranes lining its walls. (See Crystal and sex for further information on other risk factors.)

Legality

See pseudoephedrine, for legal restrictions placed on that drug as a result of its use as a precursor in the clandestine manufacture of methamphetamine.

Australia

Methamphetamine is a Schedule 8 (controlled) drug permitting some medical use, but is otherwise outlawed.

Canada

Methamphetamine is not approved for medical use in Canada. As of 2005, it falls under Schedule I of the Controlled Drugs and Substances Act. The maximum penalty for the production and distribution is imprisonment for life.

South Africa

In South Africa methamphetamine is classified as a Schedule 5 drug, and is listed as Undesirable Dependence-Producing Substances in Part III of Schedule 2 of the Drugs and Drug Trafficking Act, 1992 (Act No 140 of 1992).^[24] In this country the drug is commonly called "tik" and is mostly abused by children under the age of 20 in the Cape Flats areas. It is a growing problem, with drug related crimes in this area growing by leaps and bounds.

United Kingdom

In the UK, methamphetamine is classified as a Class B drug under the Misuse of Drugs Act 1971. The maximum penalty for possession is five years imprisonment, and the maximum penalty for supplying is 14 years. If methamphetamine (or any other Class B drug) is prepared for injection, then it is re-classified as a Class A drug. The maximum penalty for such possession is seven years imprisonment, and the maximum penalty for supplying is life imprisonment.

On 14 June 2006 Under-secretary of State for policing, security and community safety in the Home Office, Vernon Coaker, announced that methamphetamine is to be reclassified as a Class A drug, following a recommendation made by the Advisory Council on the Misuse of Drugs earlier in the month.^[25] The reasons for the ACMD's recommendation ^[26] were that there is now evidence that the drug is becoming more widely used within the United Kingdom, that the police have become aware of several illicit laboratories synthesising the drug, and also that media interest in it has grown.

This replaced the Council's previous advice, which was contained in a November 2005 review, that there was little evidence of use of the drug in the United Kingdom at that time, and that reclassifying it would create unnecessary interest in it from potential recreational users.^[27]

United States

Methamphetamine is classified as a Schedule II substance by the Drug Enforcement Agency under the Convention on Psychotropic Substances.^[28] 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.

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. Methamphetamine has become a major focus of the 'war on drugs' in the US in recent years. In some localities (e.g., Pierce County in Washington state, in 2000), special task forces were formed by police to attack the problem of rampant methamphetamine production.

In some areas of the United States, manufacturing methamphetamine is punishable by a mandatory ten-year prison sentence. In some cases, however, judges have ruled for life in prison without the possibility of parole, especially in cases where victims were killed by overdoses or impure substances.

In Michigan (USA) as of 2005, some county prosecutors have begun to charge methamphetamine producers with environmental crimes for reckless and illegal disposal of hazardous wastes in addition to drug violations as well as child abuse if children live in or near the site. Such sentences can extend prison terms for an offender by several years should sentencing be consecutive.

Crackdowns on the theft of anhydrous ammonia, a substance used in the manufacture of the drug, have resulted in additional prison time. Persons who steal anhydrous ammonia while exposing livestock or pets to it, resulting in the deaths of such creatures, may also be subjected to charges of cruelty to animals.

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