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Methamphetamine

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Methamphetamine
Clinical data
Routes of
administration		Medical: Oral
Recreational: Oral, I.V., I.M., Insufflation, Inhalation, Suppository
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityDepends on route of administration
MetabolismHepatic
Elimination half-life9-15 hours[1]
ExcretionRenal
Identifiers
  • (S)-N-methyl-1-phenyl-propan-2-amine
CAS Number
PubChem CID
CompTox Dashboard (EPA)
ECHA InfoCard100.007.882 Edit this at Wikidata
Chemical and physical data
FormulaC10H15N
Molar mass149.2 g/mol g·mol−1

Methamphetamine (sometimes referred to as methylamphetamine or desoxyephedrine) is a psychostimulant drug used primarily for recreational purposes (under the street-name crystal meth), but is sometimes prescribed for Attention-deficit hyperactivity disorder and narcolepsy under the brand name Desoxyn.[2]

It causes euphoria and excitement by acting directly on the brain's reward mechanisms, thus making it highly addictive. Methamphetamine rapidly enters the brain and causes a cascading release of norepinephrine and dopamine (and to a lesser extent, serotonin). Users may become obsessed or perform repetitive tasks such as cleaning, hand-washing or assembling and disassembling objects.[3] Withdrawal is characterized by increased sleeping and eating, and depression-like symptoms, often accompanied by anxiety and drug-craving.[4]

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.[5] 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".[6] 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 former is presumably more common due to its low price relative to other common drugs.

History

Methamphetamine was first synthesized from ephedrine in Japan in 1893 by chemist Nagayoshi Nagai. [7] In 1919, crystallized methamphetamine was synthesized 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 earliest uses of amphetamine occurred during World War II when the German military dispensed the stimulant under the trade name Pervitin to troops.[8] The drug was widely distributed across rank and division, from elite forces to tank crews and aircraft personnel. Chocolates dosed with methamphetamine were known as Fliegerschokolade ("flyer's chocolate") when given to pilots, or Panzerschokolade ("tanker's chocolate") when distributed to tank crews. From 1942 until his death in 1945, Adolf Hitler was given daily intravenous injections of methamphetamine by his personal physician, Theodor Morell,[9] as a treatment for depression and fatigue. It is possible that the Parkinsons-like symptoms which Hitler increasingly developed from 1940 onwards were related to his use of this drug.[10]

After World War II, a massive supply of amphetamine, formerly stockpiled by the Japanese military, became available in Japan under the street name shabu (also Philopon (pronounced ヒロポン, or Hiropon), its tradename there.[11]) 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.[12] 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 methamphetamine 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. Methamphetamine use continues into the 21st century, and many states are considering harsher legislation.

Since 1989, five federal laws and dozens of state laws have been implemented to combat the production and thus availability of methamphetamine. Methamphetamine is easily “cooked up” in home laboratories using pseudoephedrine and/or ephedrine, the active ingredients in over-the-counter drugs such as Sudafed and Contac. Thus, preventive legal strategies over the past 17 years have steadily strengthened restrictions on the distribution of pseudoephedrine/ephedrine-containing products. The current federal standard, as of January 2006, restricts the amount of pseudoephedrine and ephedrine an individual may purchase in a designated time period, and it requires that such products are stored in such a way as to prevent theft.[13]

On August 8, 2005, an issue of Newsweek devoted a cover story to methamphetamine and its abuse,[14] 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.

Meanwhile, the online magazine Slate posted an article in reaction to the Newsweek article,[15] 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.[16]

Production

Methamphetamine Crystals

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 or pseudoephedrine molecule. The most common method of production in the United States involves red phosphorus and iodine which forms hydroiodic acid. This is a fairly dangerous process. The red phosphorus production method can create phosphine gas, which is extremely toxic when inhaled. 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 (AKA the "Nazi method") 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.

Industrial scale methamphetamine/MDMA factory in Cikande, Indonesia

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). The reaction requires a catalyst that acts as a reducing agent, such as mercury-aluminum amalgam or platinum dioxide, also known as Adams' catalyst. 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.

Other less-common methods use other means of hydrogenation, such as hydrogen gas in the presence of a catalyst.

One of the more obvious signs of a production lab of metamphetamine in operation is the smell of a cat-urine-like odor. Meth labs can also give off noxious fumes, such as: phosphine gas, mercury vapors, lead, methylamine gas, solvent fumes; such as acetone or chloroform, iodine vapors, white phosphorus, anhydrous ammonia, hydrogen chloride/muriatic acid, hydrogen iodide, lithium/sodium metal, ether, or methamphetamine vapors.

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.

Until the early 1990s, methamphetamine for the US market was made mostly in labs run by drug traffickers in Mexico and California. 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. Simultaneously, clandestine labs throughout Mexico have dwindled. Producing around 88 percent of methamphetamine being used in America circa 1993, these labs have dropped production to around 12 percent. 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.[17] Recently, mobile and motel-based methamphetamine labs have caught the attention of both the US 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 US market by small-scale labs is disputed. Large-scale labs maintained by American criminal organizations continue to exist. In the United States, 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. This may actually be considered beneficial in terms of decreasing lab accidents and environmental contamination.

Distribution

A rocket used by smugglers to quickly discard meth.

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. Because of the ease of synthesis from OTC medicines, clandestine manufacture is very common. The government of North Korea has supposedly been linked to the manufacture and distribution of crystal meth, and allegedly plays a role in distribution networks throughout Asia as well as those in Australia and even in North America.[18] Meth trafficking is not exclusively dominated by cartels along the lines of Colombian cocaine cartels or Pakistani heroin cartels.

Medical use

d-Methamphetamine

Main article: Desoxyn

d-Methamphetamine is used medically under the brand name Desoxyn for the following conditions:

10mg Desoxyn

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.

l-Methamphetamine

Main article: Levmetamfetamine

l-Methamphetamine is available over the counter as Vicks inhaler as a nasal decongestant. l-Methamphetamine alone can raise blood pressure and cause the heart to beat rapidly due to its effects mimicking the sympathetic nervous system, but is not thought to be nearly as addictive or centrally active as the d- isomer of methamphetamine. Its common side effects include muscle tremors and stomach cramps.

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 and dopamine transporters 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).[19] It is neurotoxic in overdose.[20][21]

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 not completely 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.[22] To compensate, larger quantities of the drug are needed in order to achieve the same level of effects.

Side effects

Suspected case of meth mouth

Immediate and Chronic Effects

Common immediate side effects:[23]

Side effects associated with chronic use:

Side effects associated with overdose:

  • Brain damage (Neurotoxicity)
  • Formication (sensation of flesh crawling with bugs, with possible associated compulsive picking and infecting sores)
  • Paranoia, delusions, hallucinations
  • Kidney damage (from Hyperkalemia)

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

Meth Mouth

Main article: Meth mouth

Methamphetamine addicts may lose their teeth abnormally quickly, a condition known as "meth mouth". This effect is not caused by "corrosive" effects that meth itself has on teeth as per commonly repeated myth. According to the American Dental Association, meth mouth "is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high calorie, carbonated beverages and tooth grinding and clenching."[24] 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.[25] 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.[26]

Sexual Behavior

Main article: Crystal methamphetamine and sex

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.

Among the effects reported by crystal users (known as "tweakers") is an increase in the need and urgency for sex, the ability to have sex for extended periods (hours or even days), and an inability to ejaculate or reach orgasm or physical release.

In addition to increasing the need for sex and enabling the user to engage in marathon sex sessions, crystal lowers inhibitions and causes users to behave recklessly or to become forgetful. According to a recent San Diego study, crystal users often engage in unsafe sexual activities, and forget or choose not to use condoms. The study found that crystal users were a sixth as likely to use condoms[27].

The urgency for sex combined with the inability to achieve release can result in tearing, chafing and trauma (such as rawness and friction sores) to the sex organs and the rectum and mouth, dramatically increasing the risk of transmission of HIV and other sexually transmitted diseases. Crystal also causes erectile dysfunction (this is known as "crystal dick", though the term has more rarely been used to describe the extreme urge for sex experienced by many crystal users) which often leads people to decide to engage in receptive anal sex or fisting.

Addiction

Methamphetamine is highly addictive, particularly when injected or smoked.[28] 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:

This drug has a unique, horrific quality. In an interview, Stephan Jenkins, the singer in the band Third Eye Blind, said that methamphetamine makes you feel 'bright and shiny.' It also makes you paranoid, incoherent and both destructive and pathetically and relentlessly self-destructive. Then you will do unconscionable things in order to feel bright and shiny again.[29]

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 without water, in what is called a dry shot), inserted anally (with or without dissolution in water; also known as a booty bump), or into the urethra.[30] 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 the brain through a more direct route than intravenous injection), followed by injecting, anal insertion, insufflation 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 heroin 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", "keistering", or "plugging" and is anecdotally reported to increase sexual pleasure while the effects of the drug last.[31] 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

Australia

The medical use of methamphetamine is not recognised in Australia.

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.

Hong Kong

Methamphetamine is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It can only be used legally by health professionals and for university research purporses. The substance can be be given by pharmacists under a prescription. Anyone who supply the substance without presciption can be fined $10000(HKD). The penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and life imprisonment. Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.

The Netherlands

Methamphetamine is not approved for medical use in The Netherlands. It falls under Schedule I of the Opium Act. Although production and distribution of this drug are prohibited, few people who were caught with a small amount for personal use have been prosecuted.

New Zealand

Methamphetamine is a Class A controlled drug under the New Zealand Misuse of Drugs Act 1975. The maximum penalty for production and distribution is imprisonment for life. While in theory a doctor could prescribe it for an appropriate indication, this would require case-by-case approval by the director-general of public health. In New Zealand, Methamphetamine is most commonly referred to by the street name P [32].

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).[33] Commonly called Tik, it is mostly abused by youths under the age of 20 in the Cape Flats areas.

United Kingdom

As of 2006, methamphetamine is classified as a Class A drug under the Misuse of Drugs Act 1971 following a recommendation made by the Advisory Council on the Misuse of Drugs in June 2006.[34] It had previously been classified as a Class B drug, except when prepared for injection.

United States

Methamphetamine is classified as a Schedule II substance by the Drug Enforcement Administration under the Convention on Psychotropic Substances.[35] It is available by prescription under the trade name Desoxyn, manufactured by Ovation Pharma. 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 notoriety.

Illicit methamphetamine has become a major focus of the 'war on drugs' in the United States in recent years. In addition to federal laws, somes states have placed additional restrictions on the sale of precursor chemicals commonly used to synthesize methamphetamine, particularly pseudoephedrine, a common over-the-counter decongestant. In 2005, the DEA seized 2,148.6kg of methamphetamine.[36]


In 2005, the Combat Methamphetamine Epidemic Act of 2005 was passed as part of the USA PATRIOT Act, putting restrictions on the sale of methamphetamine precursors.

On November 7, 2006, the US Department of Justice declared that November 30, 2006 be Methamphetamine Awareness Day.[37]

Legality of similar chemicals

See pseudoephedrine and ephedrine for legal restrictions in place as a result of their use as a precursors in the clandestine manufacture of methamphetamine.

See also

References

  • Poison Information Monograph (PIM 334: Methamphetamine)
  • Chronic Amphetamine Use and Abuse A very thorough review on the effects of chronic use (American College of Neuropsychopharmacology)
  • Methamphetamine Use: Clinical and Forensic Aspects, by Errol Yudko, Harold V. Hall, and Sandra B. McPherson. CRC Press, Boca Raton, Fl, 2003.

Footnotes

  1. ^ Methamphetamine and amphetamine pharmacokinetics in oral fluid and plasma after controlled oral methamphetamine administration to human volunteers.
  2. ^ "Crystal meth" refers specifically to the crystaline, smokeable form of the drug and is not used for the drug in pill or powdered form.
  3. ^ MacKenzie R, Heischober B (1997). "Methamphetamine". Pediatr Rev. 18 (9): 305–9. PMID 9286149.
  4. ^ McGregor C, Srisurapanont M, Jittiwutikarn J, Laobhripatr S, Wongtan T, White J (2005). "The nature, time course and severity of methamphetamine withdrawal". Addiction. 100 (9): 1320–9. PMID 16128721.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ The Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003
  6. ^ http://www.oehha.ca.gov/public_info/pdf/TSD%20Methamphetamine%20Meth%20Labs%2010'8'03.pdf#search=%22%22peanut%20butter%20crank%22%22
  7. ^ Nagai N. (1893). "Kanyaku maou seibun kenkyuu seiseki (zoku)". Yakugaku Zashi. 13: 901. {{cite journal}}: line feed character in |journal= at position 9 (help)
  8. ^ SID 271075 PubChem Substance Page on Methamphetamine
  9. ^ "Methamphetamine". Drugscope. Retrieved 2006-12-28.
  10. ^ Doyle, D (2005). "Hitler's Medical Care" (PDF). Journal of the Royal College of Physicians of Edinburgh. 35: 75–82. Retrieved 2006-12-28.
  11. ^ Digital Creators Studio Yama-Arashi (2006-04-16). "抗うつ薬いろいろ (Various Antidepressants)". 医療情報提供サービス (in Japanese). Retrieved 2006-07-14.
  12. ^ M. Tamura (1989-01-01). "Japan: stimulant epidemics past and present". Bulletin on Narcotics. United Nations Office on Drugs and Crime. pp. 83–93. {{cite web}}: Unknown parameter |accessmonthday= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  13. ^ Cunningham JK, Liu LM. (2003) Impacts of federal ephedrine and pseudoephedrine regulations on methamphetamine-related hospital admissions. Addiction, 98, 1229-1237.
  14. ^ Jefferson, David J. (2005-08-08). "The Meth Epidemic: Inside America's New Drug Crisis". Newsweek. Retrieved 2006-07-14.
  15. ^ Shafer, Jack (2005-08-03). "Meth Madness at Newsweek: This is your magazine on drugs". Slate. Retrieved 2006-07-14.
  16. ^ http://www.in.gov/cji/methfreeindiana/enforce.html
  17. ^ http://www.state.gov/p/inl/rls/rm/21044.htm
  18. ^ R.B. Rothman, M.H. Baumann (2002): Pharmacology and Therapeutics 95, 73-85 (page 76)
  19. ^ Itzhak Y, Martin J, Ali S (2002). "Methamphetamine-induced dopaminergic neurotoxicity in mice: long-lasting sensitization to the locomotor stimulation and desensitization to the rewarding effects of methamphetamine". Prog Neuropsychopharmacol Biol Psychiatry. 26 (6): 1177–83. PMID 12452543.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ C. Davidson, A. J. Gow, T. H. Lee, E. H. Ellinwood (2001). "Methamphetamine neurotoxicity: necrotic and apoptotic mechanisms and relevance to human abuse and treatment". Brain Research Reviews. 36 (1): 1–22. doi:10.1016/S0165-0173(01)00054-6.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ Bennett B, Hollingsworth C, Martin R, Harp J (1998). "Methamphetamine-induced alterations in dopamine transporter function". Brain Res. 782 (1–2): 219–27. PMID 9519266.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. ^ http://www.inchem.org/documents/pims/pharm/pim334.htm#SectionTitle:2.2%20%20Summary%20of%20clinical%20effects
  23. ^ "Methamphetamine Use (Meth Mouth)". American Dental Association. Retrieved 2006-12-16.
  24. ^ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15460293&query_hl=5&itool=pubmed_docsum
  25. ^ Shaner JW, Caries associated with methamphetamine abuse
  26. ^ "Life Or Meth home page". Life Or Meth.
  27. ^ Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration
  28. ^ David Sheff, "My Addicted Son," New York Times Magazine, February 6, 2005, p. 44
  29. ^ Ellison, J.M.; Dobies, D.F. Ann. Emerg. Med., Vol 13, No 3, pp. 198-200
  30. ^ http://www.citypages.com/databank/24/1171/article11254.asp
  31. ^ http://www.fade.org.nz/alcohol-and-drug-info/methamphetamine/
  32. ^ http://www.saps.gov.za/drugs/ats.htm
  33. ^ Crystal meth to be class A drug, BBC News, 14 June 2006
  34. ^ http://www.incb.org/pdf/e/list/green.pdf
  35. ^ http://www.dea.gov/statistics.html#seizures
  36. ^ DEA (01-01-07). "Meth Awareness News Releases". {{cite web}}: Check date values in: |date= (help)

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