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Methamphetamine: How it Influences the Brain and Behavior of Users . Richard A. Rawson, Ph.D Adjunct Associate Professor Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University of California at Los Angeles www.uclaisap.org [email protected]

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methamphetamine how it influences the brain and behavior of users

Methamphetamine: How it Influences the Brain and Behavior of Users

Richard A. Rawson, Ph.D

Adjunct Associate Professor

Semel Institute for Neuroscience and Human Behavior

David Geffen School of Medicine

University of California at Los Angeles

www.uclaisap.org

[email protected]

Supported by:

National Institute on Drug Abuse (NIDA)

Pacific Southwest Technology Transfer Center (SAMHSA)

methamphetamine
Methamphetamine
  • Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater.
methamphetamine speed
Methamphetamine: Speed
  • Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown.
  • Color variations are due to differences in chemicals used to produce it and the expertise of the cooker.
  • Other names: shabu, crystal, crystal meth, crank, tina, yaba
methamphetamine ice
Methamphetamine: Ice

High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

primary amphetamine methamphetamine teds admission rates 1992 per 100 000 aged 12 and over

> 58

35 - 58

12 - 35

< 12

No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992(per 100,000 aged 12 and over)
primary amphetamine methamphetamine teds admission rates 1997 per 100 000 aged 12 and over

> 58

35 - 58

12 - 35

< 12

No data

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997(per 100,000 aged 12 and over)

< 12

primary amphetamine methamphetamine admission rates by state 2002

3-27

28 - 54

200 or more

150 or more

100 or more

55 or more

Primary Amphetamine/Methamphetamine Admission Rates by State: 2002

Admissions per 100,000 population aged 12 and over

slide9

Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older: 1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

meth epidemic less drama more long term risk danger
Meth Epidemic; less drama, more long term risk/danger
  • Cocaine/Crack epidemic hit fast (in NYC 1986-87, as well as other major east coast cities); overnight emergency, tremendous media attention.
  • Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug.
  • Dramatic decreases in indicators by early 1990s, except in inner cites of east coast.
  • Crack epidemic: Rapid onset; Rapid decrease
  • Meth epidemic: Slow west to east spread. No decrease in western cities. Use becomes endemic?
methamphetamine a growing menace in rural america
Methamphetamine: A Growing Menace in Rural America
  • In 1998, rural areas nationwide reported 949 methamphetamine labs.
  • Last year, 9,385 were reported.
  • This year, 4,589 rural labs had been reported as of July 26.
  • Source: El Paso Intelligence Center (EPIC), U.S. DEA
anhydrous ammonia tank tips officers to possible meth lab
Anhydrous Ammonia Tank Tips Officers to Possible Meth Lab

5/4/04 Omaha, Neb. – A large

anhydrous ammonia tank

helped Sarpy County

Sheriff’s deputies bust

a suspected

methamphetamine

lab Tuesday.

SOURCE: TheOmahaChannel.com

methamphetamine acute physical effects
MethamphetamineAcute Physical Effects

Increases -Decreases

Heart rate Appetite

Blood pressure Sleep

Pupil size Reaction time

Respiration

Sensory acuity

Energy

methamphetamine acute psychological effects
Increases

Confidence

Alertness

Mood

Sex drive

Energy

Talkativeness

Decreases

Boredom

Loneliness

Timidity

MethamphetamineAcute Psychological Effects
methamphetamine chronic physical effects
MethamphetamineChronic Physical Effects

- Tremor - Sweating

- Weakness - Burned lips; sore nose

- Dry mouth - Oily skin/complexion

- Weight loss - Headaches

- Cough - Dental Problems

- Sinus infection - Anorexia

slide19

METH Use Leads to Severe Tooth Decay

“METH Mouth”

Source: The New York Times, June 11, 2005.

meth use in hawaii
Meth Use in Hawaii
  • As of the middle of May, not even halfway through the year, the city medical examiner\'s office already recorded 38 deaths connected to crystal methamphetamine. So, we\'re well on the way to exceeding last year\'s total of 68.
  • Deaths:
  • 2005 (mid-May) - 38 deaths
  • 2004 - 68 deaths
  • 2003 - 56 deaths
  • 2002 - 62 deaths
  • 2001 - 54 deaths
  • 2000 - 34 deaths
methamphetamine chronic psychological effects
MethamphetamineChronic Psychological Effects

- Confusion - Irritability

- Concentration - Paranoia

- Hallucinations - Panic reactions

- Fatigue - Depression

- Memory loss - Anger

- Insomnia - Psychosis

methamphetamine psychiatric consequences
MethamphetaminePsychiatric Consequences
  • Paranoid reactions
  • Permanent memory loss
  • Depressive reactions
  • Hallucinations
  • Psychotic reactions
  • Panic disorders
  • Rapid addiction
slide23

A Major Reason People

Take a Drug is they Like

What It Does to Their Brains

slide26

FOOD

SEX

200

200

NAc shell

150

150

DA Concentration (% Baseline)

100

100

15

% of Basal DA Output

10

Empty

Copulation Frequency

50

Box

Feeding

5

0

0

Scr

Scr

Scr

Scr

0

60

120

180

Bas

Female 1 Present

Female 2 Present

Mounts

Time (min)

Sample

Number

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Intromissions

Ejaculations

Source: Di Chiara et al.

Source: Fiorino and Phillips

Natural Rewards Elevate Dopamine Levels

slide27

Effects of Drugs on Dopamine Release

1500

1000

500

0

COCAINE

METHAMPHETAMINE

Accumbens

400

Accumbens

DA

300

DOPAC

HVA

% of Basal Release

% Basal Release

200

100

0

0

1

2

3hr

Time After Cocaine

Time After Methamphetamine

250

NICOTINE

ETHANOL

250

Accumbens

Dose (g/kg ip)

200

Accumbens

200

Caudate

0.25

0.5

150

% of Basal Release

1

2.5

% of Basal Release

150

100

0

1

2

3 hr

100

0

0

0

1

2

3

4hr

Time After Nicotine

Time After Ethanol

Source: Shoblock and Sullivan; Di Chiara and Imperato

slide28

Prolonged Drug Use Changes

the Brain In Fundamental

and Long-Lasting Ways

decreased dopamine transporter binding in meth users resembles that in parkinson s disease patients
Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients

%ID/cc

Control Methamphetamine PD

Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

.

slide30

Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH)

Abuser After Protracted Abstinence

3

0

ml/gm

METH Abuser

(1 month detox)

Normal Control

METH Abuser

(24 months detox)

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

methamphetamine neurochemical mechanisms
Methamphetamine: Neurochemical Mechanisms
  • Methamphetamine enters the brain and is removed from the synapse by dopamine transporters
methamphetamine neurochemical mechanisms38
Methamphetamine: Neurochemical Mechanisms
  • Enters dopamine vesicles
  • Vesicles deplete themselves of dopamine
methamphetamine neurochemical mechanisms40
Methamphetamine: Neurochemical Mechanisms
  • Free-floating DA produces “free radicals” (neurotoxins), so it is forced out of the neuron.
  • The synapse is flooded with dopamine, producing a profound sense of pleasure.
slide42

Their Brains

have been

Re-Wired

by Drug Use

Because…

slide45

5

4

3

2

1

0

MA >

Control

is treatment for methamphetamine effective
Is Treatment for Methamphetamine Effective?

A major demand that competes for scarce community resources are for the treatment needs of those who have become addicted to methamphetamine (MA).

meth treatment effectiveness
Meth Treatment Effectiveness?

A pervasive rumor has surfaced in many geographic areas with elevated MA problems:

  • MA users are virtually untreatable with negligible recovery rates.
  • Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences.

**The resulting conclusion is that spending money on treating MA users is futile and wasteful, BUT no data exists that supports these statistics**

meth treatment statistics
Meth Treatment Statistics

During the 2002-2003 fiscal year:

  • 35,947 individuals were admitted to treatment in California under the Substance Abuse and Crime Prevention Act funding.
  • Of this group, 53% reported MA as their primary drug problem
statistics
Statistics

Analysis of:

  • Drop out rates
  • Retention in treatment rates
  • Re-incarceration rates
  • Other measures of outcome

All these measures indicate that MA users respond in an equivalent manner as individuals admitted for other drug abuse problems.

urinalysis results
Urinalysis Results
  • Results of Ua Tests at Discharge, 6 months and 12 Months post admission **
      • Matrix GroupTAU Group

D/C: 66% MA-free 65% MA-free

6 Ms: 69% MA-free 67% MA-free

12 Ms: 59% MA-free 55% MA-free

**Over 80% follow up rate in both groups at all points

clinical challenges of ma users
Clinical Challenges of MA Users
  • Poor treatment engagement rates
  • High drop out rates
  • Severe paranoia
  • High relapse rates
  • Ongoing episodes of psychosis
  • Severe craving
  • Protracted dysphoria
  • Anhedonia
steps to address treatment needs of ma users
Steps to Address Treatment Needs of MA Users
  • Psychiatric/Professional Mental Health Staffing
  • Add Treatment Programming for Women Exposed to Violence and Their Kids
  • Training, Training, Training
medications
Medications
  • Currently, there are no medications that can quickly and safely reverse life threatening MA overdose.
  • There are no medications that can reliably reduce paranoia and psychotic symptoms, that contribute to episodes of dangerous and violent behavior associated with MA use.
special treatment consideration should be made for the following groups of individuals
Special treatment consideration should be made for the following groups of individuals:
  • Female MA users (higher rates of depression; very high rates of previous and present sexual and physical abuse; responsibilities for children).
  • Injection MA users (very high rates of psychiatric symptoms; severe withdrawal syndromes; high rates of hepatitis).
  • MA users who take MA daily or in very high doses.
  • Homeless, chronically mentally ill and/or individuals with high levels of psychiatric symptoms at admission.
  • Individuals under the age of 21.
  • Gay men (at very high risk for HIV and hepatitis).
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