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Methamphetamine: How it Influences the Brain and Behavior of Users . Richard A. Rawson, Ph.D Adjunct Associate Professor Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine University of California at Los Angeles. Methamphetamine.

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Methamphetamine: How it Influences the Brain and Behavior of Users

Richard A. Rawson, Ph.D

Adjunct Associate Professor

Department of Psychiatry and Biobehavioral Sciences

David Geffen School of Medicine

University of California at Los Angeles


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 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

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


1887

1919

1932

Amphetamine developed

Methamphetamine developed

Amphetamine & methamphetamine used as decongestant

MethamphetamineA Brief History


MethamphetaminesA Brief History

  • WW II Extensive use by:

    - RAF fighter pilots

    - German Panzer troops

    - Japanese workers

    - Led to Kamikaze fever


According to surveys and estimates by WHO and UNDCP, methamphetamine is the most widely used illicit drug in the world except for cannabis.

World wide it is estimated there are over 42 million regular users of methamphetamine, as compared to approximately 15 million heroin users and 10 million cocaine users

Scope of the Methamphetamine Problem Worldwide


IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar Year


The Eastward Spread of Methamphetamine


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


Meth Lab Seizures

  • A small percentage of labs seized are labeled “Super Labs” and are capable of producing over 10 lbs per batch.

  • Super Labs are operated by Mexican National Drug Trafficking Organizations (MNDTO’s), and supply the majority of meth to the market.


Stove Top Labs

  • The active ingredient in making methamphetamine is ephedrine or pseudoephedrine, commonly found in over the counter cold remedies.


Toxic Effects of Methamphetamine Manufacturing

  • Fires

  • Explosions

  • Toxic gases

  • Toxic wastes


Toxic Effects of Methamphetamine Manufacturing

  • Manufacturers

  • Law enforcement officers

  • Bystanders


Children

  • Children who live in and around the area of the meth lab become exposed to the drug and its toxic precursors and byproducts.

  • 80-90% of children found in homes where there are meth labs test positive for exposure to meth. Some are as young as 19 months old.


Children

  • Children can test positive for methamphetamine by:

    • Having inhaled fumes during the manufacturing process

    • Coming into direct contact with the drug

    • Through second-hand smoke.


Cardiovascular problems

  • ↑ heart rate

  • Palpitations

  • Arrhythmia

  • ↑ blood pressure

  • Chest Pain

    • Acute Coronary Syndrome

  • Valve thickening


Neurological problems

  • Seizures

  • Stroke

  • Cerebral hemorrhage

  • Cerebral vasculitis

  • Mydriasis


Respiratory problems

  • Dyspnea

  • Pulmonary hypertension

  • Pleuritic chest pain


Other problems

  • Eye ulcers

  • Over-heating

  • Rhabdomyolysis

  • Obstetric complications

  • Anorexia / weight loss

  • Tooth wear, cavities

  • “Speed bumps”


Interpersonal trauma

Assault

Gunshot

Knife

Motor Vehicles

Suicide attempts

Trauma


MethamphetamineAcute Physical Effects

- Increases -Decreases

Heart rate Appetite

Blood pressure Sleep

Pupil size Reaction time

Respiration

Sensory acuity

Energy


Increases

Confidence

Alertness

Mood

Sex drive

Energy

Talkativeness

Decreases

Boredom

Loneliness

Timidity

MethamphetamineAcute Psychological Effects


MethamphetamineChronic Physical Effects

-Tremor - Sweating

- Weakness - Burned lips; sore nose

- Dry mouth - Oily skin/complexion

- Weight loss - Headaches

- Cough - Diarrhea

- Sinus infection - Anorexia


MethamphetamineChronic Psychological Effects

- Confusion - Irritability

- Concentration - Paranoia

- Hallucinations - Panic reactions

- Fatigue - Depression

- Memory loss - Anger

- Insomnia - Psychosis


MethamphetaminePsychiatric Consequences

  • Paranoid reactions

  • Permanent memory loss

  • Depressive reactions

  • Hallucinations

  • Psychotic reactions

  • Panic disorders

  • Rapid addiction


A Major Reason People

Take a Drug is they Like

What It Does to Their Brains


Methamphetamine abusers have abnormal brain activity.


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


Effects of Drugs on Dopamine Levels

COCAINE

AMPHETAMINE

Accumbens

1100

Accumbens

400

1000

900

DA

800

DA

300

DOPAC

700

DOPAC

% of Basal Release

HVA

HVA

600

% of Basal Release

500

200

400

300

100

200

100

0

0

0

1

2

3

4

5 hr

Time After Amphetamine

Time After Cocaine

MORPHINE

NICOTINE

250

Accumbens

250

Dose (mg/kg)

200

Accumbens

0.5

200

Caudate

1.0

2.5

% of Basal Release

150

% of Basal Release

10

150

100

0

1

2

3 hr

100

0

1

2

3

4

5 hr

0

0

0

1

2

3

4

5hr

Time After Nicotine

Time After Morphine

Source: Di Chiara and Imperato


Prolonged Drug Use Changes

the Brain In Fundamental

and Long-Lasting Ways


Prolonged Drug Use Changes

the Brain In Fundamental

and Long-Lasting Ways


Voluntary

Drug Use

Compulsive

Drug Use

(Addiction)


Control > MA

4

3

2

1

0


5

4

3

2

1

0

MA >

Control


Treatment Length by Route

P<.05


Treatment Completion by Route

P<.05


MA-Free Samples by Route

P<.05


BSI Psychiatric Symptoms by Route

P<.05

Positive Symptom Total (PST)


Depression Symptoms by Route

P<.05


Psychopathology and Route

  • IDUs > likely to have a psychiatric disability.

  • IDUs > likely to have prior hospitalizations for psychiatric problems


Hepatitis C by Route

P<.05


Women and Meth


Meth and Women:

Typical gender ratio of heroin users in treatment : 3 men to 1 woman

Typical gender ratio of cocaine users in treatment : 2 men to 1 woman

Typical gender ratio of methamphetamine users in treatment : 1 man to 1 woman *

*among large clinical research populations


Drug Use by Gender


Self-Reported Reasons for Starting Methamphetamine Use


Self-Reported Reasons for Starting Methamphetamine Use


My sexual drive is increased by the use of …

(Rawson et al., 2002)


My sexual pleasure is enhanced by the use of …

(Rawson et al., 2002)


My sexual performance is improved by the use of …

(Rawson et al., 2002)


CSAT Methamphetamine Treatment Project: Cross-Site Sample Description

  • 1,016 clients

  • Average age was 32.8 years

  • 55% female

  • 60% Caucasian

  • 12.2 years of education on average

  • 16% currently married

  • 31% awaiting charges, trial, or sentencing


Methamphetamine Use History

Avg. years of lifetime use:7.54

Avg. days used in past 30:11.53

Percent that usually smoked:65%


Violence Issues in Lifetime

  • 78% experienced violence

  • 39% experienced sexual abuse

  • 81% experienced one or the other

  • 36% experienced both


Psychological Issues in Lifetime

  • 60% depressed

  • 56% anxiety

  • 45% memory problems

  • 43% violence control problems

  • 34% suicidal thoughts

  • 32% received medication

  • 9% memory problems


Gender Differences in Violence History


Gender Differences in Partner Violence


Gender Differences in Sexual Abuse History


Analyses reveal that a history of physical or sexual violence (controlling for gender) is significantly related to a number of negative outcomes.

These results suggest the importance of understanding client background factors before they enter treatment.


Behavior Symptom Inventory (BSI) Scores at Baseline


Beck Depression Inventory (BDI) Scores at Baseline


Implications

  • Physical and sexual violence is related to psychological problems and drug use pattern differences

  • Different types of traumas may have different outcomes and may affect people in different ways

  • A history of trauma may be related to treatment engagement and outcome


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