Methamphetamine is one of the powerful stimulants of the central nervous system (CNS). It is sometimes used as a second-line treatment for attention deficit hyperactivity disorder and obesity; however, methamphetamine is better known as a recreational drug.
Methamphetamine was first discovered in 1893 from two chemical subgroups: dextromethamphetamine and levomethamphetamine. After 2 decades, in 1919 methamphetamine originated from amphetamine in Japan. Later in the 1930s, the drug was introduced to the United States as a bronchial inhaler and a nasal decongestant. Later, it was used to treat obesity. Overall, the use of the term methamphetamine refers to an equal mixture of dextromethamphetamine and levomethamphetamine in their pure amine forms. Prescribing this medication is limited due to its neurotoxic potential and risk of recreational use as a euphoriant. Today, there are safer medications of choice with the same treatment efficacy, and hence, the use of methamphetamines in the United States is very limited.
Due to illicit trafficking and recreational use of racemic methamphetamine, levomethamphetamine, and dextromethamphetamine, the agent is classified as a schedule II, controlled substance in the United States and the United Nations Convention on Psychotropic Substances.
Because of the easy chemical process of synthesis of methamphetamine, it can be easily produced illicitly in meth-labs nationwide. Illegal laboratories and larger super-labs across the United States, particularly in California (Central Valley), Arizona, Utah, and Texas have been discovered over the past 3 decades. The growth of Mexico-based traffickers and the expansion of independent illegal labs, methamphetamine is mass manufactured in many places today in the Pacific Northwest, Midwest, and some parts of the southeast and the northeast United States.
Use of methamphetamine triggers elevated mood, alertness, increase concentration, energy, decreased appetite and causes weight loss, and increased sexual libido (recreational methamphetamine).
The use of methamphetamine in higher doses can induce psychosis, bleeding in the brain, skeletal muscle breakdown, and seizures. Moreover, when it is used chronically, it can cause violent behavior, mood swings, and psychosis such as paranoia, delirium, auditory and visual hallucination, and delusions.
Chronic long-term methamphetamine use can be highly addictive, and if it discontinued abruptly, may lead to withdrawal symptoms that can be persistent for months after use.
Street Terms for Methamphetamine
Meth, Crystal Meth, Crystal, Speed, Scootie, Yellow Powder, Crank, Ice, Spoosh, Glass, Chalk, Redneck Cocaine, Yellow Barn, Tina, Tick-Tick
Street Terms for Smokable Methamphetamine
Hot Ice, L.A. Glass, Hiropon, Super Ice, L.A. Ice, Batu, Quartz, Hanyak
Methamphetamine affects the central nervous system (CNS) by enhancing the release of monoamine neurotransmitters such as serotonin, dopamine, and norepinephrine.  Use of methamphetamine can lead to many pharmacological effects because of its ability to use various molecular processes. Methamphetamine causes the levels of monoamines to be increased by:
Methamphetamine is highly lipid soluble that helps to be transferred relatively fast across the blood-brain barrier and has an immediate effect on CNS.
Methamphetamine can be ingested orally, through intravenous injection, smoked, and snorted.
People who use methamphetamine feel an acute, powerful short rush for about 5 to 30 minutes which varies based on different routes of use. The drug also causes the enhance energy level, decreases appetite, and creates euphoria for a range of 6 to 12 hours.
The last stage of methamphetamine abuse happens when the person who abuse methamphetamine become paranoid and irritable because of lack of sleep for about 3 to 15 days. This behavior is called "tweaking," and the person with this behavior is known as the "tweaker." Usually, tweakers continue to require more methamphetamine to get to the original high. This is difficult to achieve, which causes frustration and irritability and unsteady behavior in the tweaker. Because tweakers are unpredictable, they can behave violently, can get involved in domestic arguments, spur-of-the-moment offenses, and become a danger to others or themselves.
A tweaker can behave normally and have clear eyes, concise speech, and brisk movements; however, careful observation will indicate that the person's eye movement is much faster than normal (up to 10 times), and they have a minor quiver voice and jerky movements. Some tweakers minimize or cover these physical symptoms by using a depressant like alcohol or opioids; however, use of a depressant by the tweaker increases his or her negative feelings of paranoia, irritability, and frustration significantly. Other people around these users should use extreme caution because of their unpredictable behaviors.
Methamphetamine users have different symptoms that can be recognized, for example, lack of sleep (insomnia), acute anxiety, agitation, and psychotic or violent behavior. If these types of behavior develop after using the methamphetamine, the meth use may have developed dependency. Chronic meth users also usually show poor personal hygiene, and sores on their bodies from picking at "crank bugs," unhealthy complexion, a pale, and tactile hallucination that often seen in tweakers. Methamphetamine users may develop cracked teeth because of extreme clenching of their jaw during the time being high on methamphetamine.
Use of methamphetamine can cause physical and psychological dependence and increased tolerance. Because of the rapid development of tolerance, methamphetamine users frequently need to increase the dose to get to the satisfying "high" which can be very dangerous because administration of too much methamphetamine also increases the risk of an overdose. Based on the reports from 2011, more than 102,000 emergency department visits in the United States were related to methamphetamine use, with over 50% of users also using a combination of other drugs such as alcohol and marijuana, thus producing a synergistic effect. Knowing the physical and behavioral symptoms of the methamphetamine overdose, and diagnosis of the toxicity is important for saving the patient’s life.
Signs and symptoms of methamphetamine toxicity:
Patients who experience methamphetamine toxicity usually presenting with an altered mental status that can show as psychotic episodes, irritability, suicidal ideation, and rarely coma or seizures.
Some patients present with psychotic symptoms, including tactile hallucinations and severe paranoia.
Chronic long-term methamphetamine use can also cause dental complications, significant weight loss, and skin problems such as sores and abscesses.
Due to the unpredictable behaviors, irritability, and the possibility of psychotic behavior of methamphetamine users especially during the hospital visit due to the overdose, or complication, the safety of medical and security staff are important. Hence, it is always advised to use precautions when dealing with these patients. Another healthcare worker or security personnel should always accompany these patients. The triage nurse should be fully aware of the adverse effects of amphetamine and ensure that the emergency department is fully aware of the individual admitted.
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