Methamphetamine

Methamphetamine

Clinical data
Other names	Deoxyephedrine Pervitin Anadrex Metamfetamine Methylamphetamine
Routes of administration	Medical: Oral Recreational: Oral, I.V., I.M., Insufflation, Inhalation, Suppository
ATC code	N06BA03 (WHO)
Legal status
Legal status	AU: S9 (Prohibited substance) CA: Schedule I US: Schedule II Class A(NZ) Schedule 5(SA) Injectable:Class A, Oral: A(UK)
Pharmacokinetic data
Bioavailability	Depends on route of administration
Metabolism	Hepatic
Elimination half-life	9-15 hours
Excretion	Renal
Identifiers
IUPAC name N-methyl-1-phenyl-propan-2-amine
CAS Number	537-46-2
PubChem CID	1206
CompTox Dashboard (EPA)	DTXSID8037128
ECHA InfoCard	100.007.882
Chemical and physical data
Formula	C10H15N
Molar mass	149.233 g/mol g·mol−1
3D model (JSmol)	Interactive image
SMILES CC(CC1=CC=CC=C1)NC

This article is about the psychostimulant, d-methamphetamine. For the decongestant, l-methamphetamine, see Levomethamphetamine.

Methamphetamine (methylamphetamine or desoxyephedrine), popularly shortened to meth, is a psychostimulant drug. It is prescribed for attention-deficit hyperactivity disorder or narcolepsy under the brand name Desoxyn. It is also used illegally for recreational purposes. "Crystal meth" refers to the crystalline, smokeable form of the drug and is not used for the drug in pill or powdered form.

Methamphetamine acts as a dopaminergic and adrenergic reuptake inhibitor and as a sympathomimetic. Since it stimulates the mesolimbic reward pathway, causing euphoria and excitement, it is prone to abuse and addiction. Methamphetamine rapidly enters the brain and triggers a cascading release of norepinephrine, dopamine and serotonin. Users may become obsessed or perform repetitive tasks such as cleaning, hand-washing, or assembling and disassembling objects. Withdrawal is characterized by excessive sleeping, eating and depression-like symptoms, often accompanied by anxiety and drug-craving. Users of Methamphetamine often take one or more benzodiazepines as a means of "coming down".

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. The acute effects of the drug closely resemble getting high off of low grade beaver tranquliser 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. The methyl group is responsible for the potentiation of effects as compared to the related compound amphetamine, rendering the substance on the one hand more lipid soluble and easing transport across the blood brain barrier, and on the other hand more stable against enzymatic degradation by MAO. Methamphetamine causes the norepinephrine, dopamine and, serotonin(5HT) 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 (releasing monoamines in rats with ratios of about NE:DA = 1:2, NE:5HT= 1:60), 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 (inhibiting monoamine reuptake in rats with ratios of about: NE:DA = 1:2.35, NE:5HT = 1:44.5).

Recent research published in the Journal of Pharmacology And Experimental Therapeutics (2007)[1], indicates that methamphetamine binds to a group of receptors called TAAR. TAAR is a newly discovered receptor system which seems to be affected by a range of amphetamine-like substances called trace amines.

Illicit production

Methamphetamine crystals

Methamphetamine is most structurally similar to methcathinone and amphetamine. When illicitly produced, 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 cold or allergy medicines. Synthesis is relatively simple, but entails risk with flammable and corrosive chemicals, particularly the solvents used in extraction and purification. Clandestine production is therefore often discovered by fires and explosions caused by the improper handling of volatile or flammable solvents.

Most methods of illicit production involve hydrogenation of the hydroxyl group on the ephedrine or pseudoephedrine molecule. The most common method for small-scale methamphetamine labs in the United States is primarily called the "Red, White, and Blue Process", which involves red phosphorus, pseudoephedrine or ephedrine(white), and blue iodine, from which hydroiodic acid is formed.

This is a fairly dangerous process for amateur chemists, because phosphine gas, a side-product from phosphorus production, is extremely toxic to inhale. An increasingly common method uses the process of Birch reduction, in which metallic lithium (commonly extracted from rechargeable batteries) is substituted for metallic sodium, to circumvent the difficulty of procuring metallic sodium.

The Birch reduction, however, is dangerous because the alkali metal and liquid anhydrous ammonia are both extremely reactive, and the temperature of liquid ammonia makes it susceptible to explosive boiling when reactants are added. Anhydrous ammonia and lithium or sodium (Birch reduction) may be surpassing hydroiodic acid (catalytic hydrogenation) as the most common method of manufacturing methamphetamine in the US and possibly in Mexico. Hydroiodic acid "super lab busts" receive more media attention because the equipment employed is much more complex and visible than the glass jars or coffee carafes commonly used to produce methamphetamine with Birch reduction.

Industrial scale methamphetamine/MDMA factory in Cikande, Indonesia

A completely different procedure of synthesis uses 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, until DEA restrictions on the chemicals have made this difficult. Other less common methods use other means of hydrogenation, such as hydrogen gas in the presence of a catalyst.

Methamphetamine labs can give off noxious fumes, such as phosphine gas, 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. If performed by amateurs, manufacturing methamphetamine can be extremely dangerous. If the red phosphorus overheats, because of a lack of ventilation, phosphine gas can be produced. This gas, if present in large quantities, is likely to explode upon autoignition from diphosphine, which is formed 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, authorities have discovered increasing numbers of small-scale methamphetamine labs all over the United States, mostly in rural, suburban, or low-income areas.Indiana state police found 1,260 labs in 2003, compared to just 6 in 1995, although this may be a result of increased police activity. Recently, mobile and motel-based methamphetamine labs have caught the attention of both the US news media and the police.

These labs can cause explosions and fires, and expose the public to hazardous chemicals. Those who manufacture methamphetamine are often harmed by toxic gases. Many police departments have specialized task forces with training to respond to cases of methamphetamine production. The National Drug Threat Assessment 2006, produced by the Department of Justice, found "decreased domestic methamphetamine production in both small and large-scale laboratories", but also that "decreases in domestic methamphetamine production have been offset by increased production in Mexico." They concluded that "methamphetamine availability is not likely to decline in the near term."

Black Market distribution

A rocket used by smugglers to quickly discard meth.

Methamphetamine is distributed by prison gangs, motorcycle gangs, street gangs, traditional organized crime operations, and impromptu small

Medical use

d-Methamphetamine

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

• Attention deficit hyperactivity disorder;
• Extreme obesity;
• Narcolepsy

10 mg Desoxyn

Because of its social stigma, Desoxyn is not generally prescribed for ADHD unless other stimulants, such as methylphenidate (Ritalin®), dextroamphetamine (Dexedrine®) or mixed amphetamines (Adderall®) have failed.

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 person it is highly dependent 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. To compensate, larger quantities of the drug are needed in order to achieve the same level of effects.

Effects

Range of Effects

Common immediate side effects.:

• Euphoria
• Increased energy and attentiveness
• Diarrhea, nausea
• Loss of appetite, insomnia, tremor, jaw-clenching (Bruxism)
• Agitation, compulsive fascination with repetitive tasks (Punding)
• Talkativeness, irritability, panic attacks
• Increased libido
• Dilated pupils

Side effects associated with chronic use:

• Drug craving
• Weight loss
• Withdrawal-related depression and anhedonia
• Rapid tooth decay ("meth mouth")
• Amphetamine psychosis, mainly due to sleep deprivation

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
• Rhabdomyolysis (Muscle breakdown) which leads to Kidney failure

Death from overdose is 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 any corrosive effects of the drug itself, 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." 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.

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.

Sexual Behaviour

Main article: Methamphetamine and sex

Users may exhibit sexually compulsive behaviour while under the influence. This disregard for the potential dangers of unprotected sex or other reckless sexual behavior may contribute to the spread of sexually transmitted infections (STIs).

Among the effects reported by methamphetamine users is an increase in the need and urgency for sex, the ability to have sex for extended periods of time, 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, methamphetamine lowers inhibitions and may cause users to behave recklessly or to become forgetful.

According to a recent San Diego study, methamphetamine users often engage in unsafe sexual activities, and forget or choose not to use condoms. The study found that methamphetamine users were six times less likely to use condoms. The urgency for sex combined with the inability to achieve release (ejaculation) can result in tearing, chafing, and trauma (such as rawness and friction sores) to the sex organs, the rectum and mouth, dramatically increasing the risk of transmission of HIV and other sexually transmitted diseases. Methamphetamine also causes erectile dysfunction due to vasoconstriction.

Addiction

Methamphetamine is potentially addictive, particularly when injected or smoked. 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 he said to his son that you need to quit being such a stupid stoner, 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.

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. It is possible that daily administration of the amino acids L-Tyrosine and L-5HTP/Tryptophan can aid in the recovery process by making it easier for the body to reverse the depletion of Dopamine, Norepinephrine, and Serotonin. Although studies involving the use of these amino acids have shown some success, this method of recovery has not been shown to be consistently effective.

It is shown that taking ascorbic acid prior to using methamphetamine may help reduce acute toxicity to the brain, as rats given the human equivalent of 5-10 grams of ascorbic acid 30 minutes prior to methamphetamine dosage had toxicity mediated, yet this will likely be of little avail in solving the serious behavioral problems associated with methamphetamine use that create many of the problems the users experience.

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.

To combat addiction, doctors are beginning to use other, less volatile forms of amphetamine such as dextroamphetamine to break the addiction cycle in a method similar to methadone for heroin addicts. There are no known drugs comparable to naloxone that blocks opiate receptors, and is sometimes used in treating opiate dependence, for use with methamphetamine problems. Since the phenethylamine Phenteremine is a constitutional isomer of methamphetamine, it has been speculated that it may be effective in treating methamphetamine addiction. Although Phenteremine is a central nervous stimulant that acts on dopamine and norepinephrine, it has not been reported to cause the same degree of euphoria that is associated with other amphetamines.

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 shafting), or into the urethra. 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.

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 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, 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 methamphetamine 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. The rectum is where the majority of the drug would likely be taken up, through the mucous membranes lining its walls. (See Methamphetamine and sex for further information on other risk factors.)

Legality

Australia

The medical use of methamphetamine is not recognized in Australia. It is also known as "ICE" and has become the focus of a government wide crackdown and as of 2007 an election agenda of both major political parties.

Canada

Methamphetamine is not approved for medical use in Canada. 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 purposes. The substance can be be given by pharmacists under a prescription. Anyone who supplies the substance without prescription 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 (short for "pure methamphetamine").

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

United Kingdom

As of 18 January 2007, 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. 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. 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. 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.

Legality of similar chemicals

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

Famous People User: Edo Saputra

See also

• Methamphetamine in popular culture
• Montana Meth Project
• Meth song
• Party and Play
• Phenethylamines
• Clandestine chemistry
• Amphetamine
• Illegal drug trade

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.

External links

• EMCDDA drugs profiles: Methamphetamine (2007)
• A Key to Methamphetamine-Related Literature - A comprehensive thematic index of methamphetamine research published in academic and scientific journals with links from citations to the PubMed abstracts.
• Asia & Pacific Amphetamine-Type Stimulants Information Centre - an extensive information source on Amphetamine-Type Stimulants in Asia managed by the United Nations Office on Drugs and Crime
• Erowid Methamphetamine Vault
  • Meth FAQ - More detailed synthesis and synthesis from other sources.
• NLM Hazardous Substances Data Bank - Entry for d-methamphetamine

Documentaries

• The Ice Age - ABC Australia - 4 Corners - Australian methamphetamine use.
• Frontline - The Meth Epidemic - PBS United States - Frontline - The Meth Epidemic