Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 16
Abuse of crystal meth (CM), a form of methamphetamine, is a growing problem in many different regions of the country, and those who use it come from a variety of different backgrounds. CM is a powerful stimulant which can be injected, snorted, smoked or swallowed. In addition to creating a ‘high,’ CM artificially stimulates the body’s adrenalin system, raising body temperature, heart rate and blood pressure. Immediate dangers of intoxication with CM may include heart attack, stroke, seizures and even death. However, more commonly, psychosis and long-term changes within the brain associated with its use plague the user and place a huge burden on health and addiction resources, which are often ill-equipped to deal with the problem.
Worldwide, amphetamine and methamphetamine are the most widely abused drugs after cannabis (marijuana). According to the World Health Organization, there are 29 million regular users in the world, which is more than for heroin and cocaine combined.1 In Vancouver, 68% of street youth report having used CM at some point in their lives; 46% report using the drug within the last month; and the prevalence of CM use is most pronounced among the Aboriginal and lesbian/ gay/bisexual/transgendered (LGBT) communities.2 Some people use CM to enhance sexual pleasure. Gay or bisexual men who use CM (via any route) have a much higher risk of HIV than heterosexual intravenous drug users due to unsafe, prolonged, rough sex practices.3 Because small amounts of the drug can be used to suppress appetite, suppress sleep and enhance concentration, it is used by students and professionals to lose weight and meet deadlines.
Amphetamine psychosis was first described in 1944, by Dr. Clifton Himmelsbach of Kentucky and his team, who provided varying amounts of amphetamine to opiate-addicted prisoners.4 Today, the drug has changed, but the symptoms are similar. In terms of its chemical makeup, methamphetamine is the basic amphetamine molecule with an extra methyl group, or carbon atom, on its molecular structure. The extra atom allows the drug to impact the dopamine reward centre of the brain (the limbic system). This creates a more intense high than amphetamine and makes it more addictive and toxic to the brain. The term ‘crystal’ refers to the drug’s appearance (see photo on opposite page) which usually looks like clear shards of glass that are then crushed. The form of methamphetamine used today can be crushed up, heated and still have a potent effect on the brain, meaning it can be smoked.
CM users usually experience some degree of psychological problems due to the drug. CM-related psychosis – indistinguishable from the psychotic symptoms of paranoid schizophrenia – is often the most troubling. A single dose of the drug can keep the user awake for 24 hours or more, and psychosis most commonly develops with more sustained binges of use which often last three to eight days at a time. Symptoms of psychosis seen with CM use include paranoia, hearing voices, disorganized thinking, and formication (a sensation as though small insects are crawling under the skin). The latter of these may cause the user to seek medical attention for what they believe to be scabies or lice, and which may appear to be severe acne but is due to the individual picking at his or her skin. An additional psychotic symptom often seen is stereotypy, which is meaningless, repetitive activity such as assembling and disassembling bicycles or making intricate drawings for hours at a time. As with many of these symptoms of psychosis, users are aware that the activity is meaningless, but are unable to stop.5 However, with sustained use, insight into their actions is lost and the CM user becomes increasingly psychotic.
After bingeing, the user will sleep for prolonged periods and often awake with symptoms of confusion and psychosis, along with profound depression leading to suicidal behaviour and potential violence. These users are unable to take medication as prescribed – such as HIV medication, methadone or antibiotics – and are certainly unable to deal with their addiction. After being clean of the drug for several months, about 5-15% of users developing psychosis will fail to recover completely.
It is often quite difficult to determine what came first, the drug or the mental illness, and a lot has yet to be learned about helping people with CM-related psychosis. Often, inpatient detoxification from the drug is unavailable, and detoxification centres are not able to cope with people who are dangerously psychotic. In addition, a seven-day stay in a detox centre, or a 28day treatment centre – designed for those with cocaine and heroin addiction – is inadequate to deal with the long-term side-effects of CM dependency. Once the user has been medically assessed, there is some evidence that treatment with an antipsychotic is of benefit in decreasing agitation, confusion, paranoia, and can help keep the user safe, assuming they are not in need of hospitalization.
Research shows that by treating patients early, there may be some benefit in preventing the development of long-term psychosis and schizophrenia.7 We have had good experiences using the atypical antipsychotics (e.g., olanzapine) in managing some patients as outpatients regardless of whether they are clean of the drug.8 The hope is to decrease the rate of hospitalization, keep patients safe, ensure they are able to keep scheduled appointments, ensure they are able to comply with treatment for other diseases like HIV, and put the user in a position where they can deal with their addiction. However, these are not harmless medications and more research is required to look at the management aspects of methamphetamine addiction and the mental health issues associated with it.
About the Author
Ian is a Vancouver family physician working at Three Bridge Community Health Centre where he attends to the health care needs of those who suffer from mental illness and addiction issues, those who identify with the lesbian/gay/bisexual transgendered (LGBT) community, and street youth. He has developed a specific interest in the management of crystal meth dependency, and is actively involved in trying to help develop better ways to help those affected by this drug
UN Office for Drug Control and Prevention (2000). World drug report
Martin, I & McGhee, D. (2003). The methamphetamine study of youth (MASY) Preliminary unpublished data presented at the Canadian Society of Addiction Medicine Conference, October.
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