Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-27T12:46:28.258Z Has data issue: false hasContentIssue false

The methamphetamine problem

Commentary on … Psychiatric morbidity and socio-occupational dysfunction in residents of a drug rehabilitation centre

Published online by Cambridge University Press:  02 January 2018

Niall Galbraith*
Affiliation:
University of Wolverhampton, UK
Rights & Permissions [Opens in a new window]

Summary

This paper introduces the reader to the characteristics of methamphetamine. Explored within are the drug's effects on those who consume it as well as the history and prevalence of its use. The highly addictive nature of methamphetamine is compounded by its affordability and the ease with which it is produced, with North America and East Asia having become established as heartlands for both consumption and manufacture. The paper discusses recent cultural depictions of the drug and also the role that mental health professionals may take in designing and delivering interventions to treat methamphetamine addiction.

Type
Original Papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2015

The nature of methamphetamine

Methamphetamine (‘meth’) is a stimulant which increases levels of monoamines (particularly dopamine, but also noradrenaline and serotonin) in the central nervous system. Its pharmacological effects occur via a number of neurochemical processes, including disruption of vesicular Reference Brown, Hanson and Fleckenstein1 and transporter Reference Fleckenstein, Metzger, Gibb and Hanson2 functioning, through the inhibition of monoamine oxidase Reference Mantle, Tipton and Garrett3 and the facilitation of tyrosine hydroxylase. Reference Sulzer, Sonders, Poulsen and Galli4 Like other stimulants, such as cocaine and amphetamine, it produces feelings of euphoria, alertness and increased energy. Unlike cocaine though, a single dose of methamphetamine sustains these effects for many hours. Methamphetamine can be smoked, snorted, injected or swallowed. The psychological effects of long-term use include hallucinations and delusions, depression, suicidality and aggression. Reference Darke, Kaye, McKetin and Duflou5 Withdrawal may exacerbate these symptoms, while also leading to fatigue and intense craving. Reference McGregor, Srisurapanont, Jittiwutikarn, Laobhripatr, Wongtan and White6 Long-term health effects are considerable, and include neural damage and associated cognitive impairment, Reference Barr, Panenka, MacEwan, Thornton, Lang and Honer7 cardiovascular damage, Reference Kaye, McKetin, Duflou and Darke8 dental disease Reference Shetty, Mooney, Zigler, Belin, Murphy and Rawson9 and stroke. Reference Rothrock, Rubenstein and Lyden10 The drug is also associated with risky sexual behaviour, resulting in a high prevalence of sexually transmitted disease. Reference Halkitis, Parsons and Stirratt11 Methamphetamine is also noted for its addictiveness. Evidence shows that addiction occurs more rapidly than with cocaine Reference Castro, Barrington, Walton and Rawson12 and that unlike with amphetamine, methamphetamine-seeking behaviour may persist even when tolerance is reached. Reference Shoblock, Maisonneuve and Glick13 The trajectory of methamphetamine use over a 10-year period has been found to resemble that of heroin more so than that of cocaine. Reference Hser, Huang, Brecht, Li and Evans14 Methamphetamine is also associated with criminality Reference Cartier, Farabee and Prendergast15 and social decline. Reference Sommers, Baskin and Baskin-Sommers16 It therefore represents a major public health, social and political dilemma.

Who uses methamphetamine and where?

Across the world, methamphetamine use as a recreational drug has increased significantly since the 1990s, and it is reported as the second most widely misused substance, exceeded only by cannabis. 17 In the USA during the 1960s and 1970s, methamphetamine was produced and trafficked mainly by motorcycle gangs, mostly in California. Reference Miller and Klee18 Patrons were typically White, male, blue-collar workers, but the drug has since become popular among white-collar workers, students, ethnic minorities and women, Reference Potter and Kolbye19 and manufacturing has spread to Midwestern states. 20 One of the principal factors in its rise is the ease with which it can be manufactured. The chemicals necessary for its production (e.g. methylamine, ephedrine or pseudoephedrine) are relatively easy to obtain, as is the equipment required for the ‘cooking’ process. This has led to a cottage industry in methamphetamine production, with home-based laboratories being commonly uncovered by law enforcement agencies in the USA 21 and in other parts of the world, particularly in Asia. Reference Kozel, Lund, Douglas and McKetin22 In addition to the home lab phenomenon, there exist industrial producers of methamphetamine, who manufacture and transport large quantities of the drug. Reference Anglin, Burke, Perrochet, Stamper and Dawud-Noursi23 In North America, large-scale production occurs in both Mexico and Canada and the product is then brought across the border for sale within the USA. In the USA itself, 4.7% of respondents to a national survey admit to lifetime use of methamphetamine. 24

Data from Asia also indicate high levels of use. Japan has a long history of misuse, dating back to the 1940s, Reference Anglin, Burke, Perrochet, Stamper and Dawud-Noursi23 when military stocks of methamphetamine flooded the market, giving rise to high incidence of misuse among young people. A second epidemic occurred in the 1970s, when use soared among blue-collar workers. This crisis has now stabilised and Japan's methamphetamine users now represent an aging population. Since the 1990s, the popularity of methamphetamine has spread to other East Asian countries. By 2007, 63% of worldwide methamphetamine seizures occurred within the Southeast Asian region, and it is estimated that half of the world's methamphetamine users are found there. 25 The Mekong region of Myanmar, close to the border of Thailand and China, is identified as Asia's most prolific production centre for methamphetamine. From there the drug is transported across the borders for sale in neighbouring countries. 25 In Myanmar, it is usually pressed into pill form, known colloquially as yaba (‘crazy medicine’). Thailand has suffered its own epidemic, with methamphetamine treatment admissions rising dramatically in the late 1990s, Reference Devaney, Reid and Baldwin26 but evidence of increasing methamphetamine use is also found in Brunei, Laos, the Philippines Reference Kozel, Lund, Douglas and McKetin22 and Cambodia. 27

In Europe, the meth epidemic has not yet arrived, perhaps because there is already a congested market for stimulant drugs, although the Czech Republic and to a lesser extent Slovakia have a history of high methamphetamine use. Reference Griffiths, Mravcik, Lopez and Klempova28 In Australia, use has increased in recent years but not dramatically. Reference Degenhardt, Roxburgh, Black, Bruno, Campbell and Kinner29 In South Africa, the past decade has seen a significant increase in treatment admissions for methamphetamine. Reference Plüddemann, Myers and Parry30 This increase in methamphetamine use is positively associated with risk-taking sexual behaviour, Reference Pluddemann, Flisher, Mathews, Carney and Lombard31 which if unchecked may in turn exacerbate an already urgent HIV epidemic.

Cultural depictions of methamphetamine

The emergence of methamphetamine as one of the most widely used recreational drugs is associated with its rise in the media. Methamphetamine has become a cultural phenomenon, in much the same way that heroin, MDMA (contracted from 3,4-methylenedioxy-methamphetamine; ecstasy) and cannabis had become popularised already. The most obvious cultural reference to methamphetamine is in the hugely successful American drama series Breaking Bad. This drama describes the exploits of a terminally ill chemistry teacher who chooses to become a manufacturer and then seller of methamphetamine, initially to guarantee financial security for his family after his death. The series focuses on the corruption of the main character and the erosion of his relationships with those close to him. What is notable about the series though is that the problem of devastating effects of methamphetamine on individuals and communities occupies only a minor part in the story. The series has done much to publicise the existence of methamphetamine to households across the world, but in not fully exploring its sinister effects (other than the moral degeneration of those who manufacture it), the series runs the risk of sanitising or normalising this destructive drug to the wider society.

At the other extreme, also in the USA, there has been a widely publicised campaign to highlight the unpleasant physical effects of methamphetamine addiction. The ‘Faces of Meth’ project Reference Linnemann and Wall32 exposes police custody photographs of users, showing images of the same individual at different points in time, so as to longitudinally chronicle the ravages of the drug on physical appearance. These before and after photos – which reveal apparently common features of long-term methamphetamine use: skin damage (caused by obsessive picking) and dental ill health (or ‘meth mouth’ as it is colloquially known) Reference Hendrickson, Cloutier and John McConnell33 – are designed to shock and appal observers. The effectiveness of the scheme is difficult to assess due to the absence of trials, however, the use of fear and shock is not always an effective deterrent in health campaigns and is generally regarded as inferior to positive reinforcement approaches. Reference Soames Job34

The Faces of Meth-type approach has come under criticism from Naomi Murakawa, Reference Murakawa35 who argues that its focus on the visual effects of methamphetamine, mostly in White methamphetamine users, represents a type of social panic. Murakawa argues that historically, drug panics in the USA have been constructed in line with racial prejudices (e.g. Chinese-focused opium scares, Mexican-focused cannabis scares and Black-focused crack scares). Methamphetamine addiction is often described along racial lines as a ‘White trash’ phenomenon. Murakawa claims that decayed or missing teeth mark prevailing fears over the decline in White social status, as traditional representations of American so-called ‘White trash’ typically depict poor dental health as a visual indicator of lower class.

Given the prevalence of methamphetamine use across the globe, considerable effort has been put into designing effective treatment programmes for its users. Broadly speaking, these interventions are pharmacological, psychosocial or community-based prevention approaches. The evidence in favour of pharmacological treatments is mixed, although some promising findings with modafinil, bupropion and naltrexone have been reported. Reference Karila, Weinstein, Aubin, Benyamina, Reynaud and Batki36 Psychosocial interventions have proved effective in the short term, but more evidence is needed to demonstrate long-term benefits. Reference Lee and Rawson37 Community-based prevention schemes have also shown evidence of benefit. Reference Guyll, Spoth and Crowley38 The promise shown by such interventions is encouraging, given the addictiveness of methamphetamine, the intensity and duration of cravings experienced by those who go through withdrawal Reference McGregor, Srisurapanont, Jittiwutikarn, Laobhripatr, Wongtan and White6 and also the psychological comorbidity. Interestingly for mental health professionals, there is evidence that the cost-effectiveness of treatment Reference Ettner, Huang, Evans, Rose Ash, Hardy and Jourabchi39 and prevention Reference Guyll, Spoth and Crowley38 approaches may compare favourably with alternatives, such as, for example, interventions by law enforcement to disrupt the supply of the precursor chemicals needed for methamphetamine production. Reference Dobkin and Nicosia40 Furthermore, given the advance of this drug across Asia and North America and its potential for expansion across thus far untapped markets (e.g. Europe and Africa), the further development of robust treatment programmes for the future is urgently needed.

Footnotes

See original paper, pp. 213–217, this issue.

Declaration of interest

None.

References

1 Brown, JM, Hanson, GR, Fleckenstein, AE. Regulation of the vesicular monoamine transporter-2: a novel mechanism for cocaine and other psychostimulants. J Pharmacol Exp Ther 2001; 296: 762–7.Google Scholar
2 Fleckenstein, AE, Metzger, RR, Gibb, JW, Hanson, GR. A rapid and reversible change in dopamine transporters induced by methamphetamine. Eur J Pharmacology 1997; 323: R910.Google Scholar
3 Mantle, TJ, Tipton, KF, Garrett, NJ. Inhibition of monoamine oxidase by amphetamine and related compounds. Biochem Pharmacol 1976; 25: 2073–7.Google Scholar
4 Sulzer, D, Sonders, MS, Poulsen, NW, Galli, A. Mechanisms of neurotransmitter release by amphetamines: a review. Prog Neurobiol 2005; 75: 406–33.Google Scholar
5 Darke, S, Kaye, S, McKetin, R, Duflou, J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27: 253.Google Scholar
6 McGregor, C, Srisurapanont, M, Jittiwutikarn, J, Laobhripatr, S, Wongtan, T, White, JM. The nature, time course and severity of methamphetamine withdrawal. Addiction 2005; 100: 1320–9.Google Scholar
7 Barr, AM, Panenka, WJ, MacEwan, GW, Thornton, AE, Lang, DJ, Honer, WG, et al. The need for speed: an update on methamphetamine addiction. J Psychiatr Neuroscience 2006; 31: 301.Google Scholar
8 Kaye, S, McKetin, R, Duflou, J, Darke, S. Methamphetamine and cardiovascular pathology: a review of the evidence. Addiction 2007; 102: 1204–11.Google Scholar
9 Shetty, V, Mooney, LJ, Zigler, CM, Belin, TR, Murphy, D, Rawson, R. The relationship between methamphetamine use and increased dental disease. J Am Dent Assoc 2010; 141: 307–18.Google Scholar
10 Rothrock, JF, Rubenstein, R, Lyden, PD. Ischemic stroke associated with methamphetamine inhalation. Neurology 1988; 38: 589–92.CrossRefGoogle ScholarPubMed
11 Halkitis, PN, Parsons, JT, Stirratt, MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission. J Homosex 2001; 41: 1735.CrossRefGoogle ScholarPubMed
12 Castro, FG, Barrington, EH, Walton, MA, Rawson, RA. Cocaine and methamphetamine: differential addiction rates. Psychology Addict Behav 2000; 14: 390.Google Scholar
13 Shoblock, JR, Maisonneuve, IM, Glick, SD. Differences between d-methamphetamine and d-amphetamine in rats: working memory, tolerance, and extinction. Psychopharmacol 2003; 170: 150–6.CrossRefGoogle ScholarPubMed
14 Hser, YI, Huang, D, Brecht, ML, Li, L, Evans, E. Contrasting trajectories of heroin, cocaine, and methamphetamine use. J Addict Dis 2008; 27: 1321.CrossRefGoogle ScholarPubMed
15 Cartier, J, Farabee, D, Prendergast, ML. Methamphetamine use, self-reported violent crime, and recidivism among offenders in California who abuse substances. J Interpers Violence 2006; 21: 435–45.Google Scholar
16 Sommers, I, Baskin, D, Baskin-Sommers, A. Methamphetamine use among young adults: health and social consequences. Addict Behav 2006; 31: 1469–76.Google Scholar
17 World Health Organization. Amphetamine-like Stimulants: A Report from the WHO Meeting on Amphetamines, MDMA and Other Psychostimulants, Geneva, 12–15 November 1996. WHO, 1997.Google Scholar
18 Miller, MA. History and epidemiology of amphetamine abuse in the United States. In Amphetamine Misuse: International Perspectives on Current Trends (ed. Klee, H): 113–34. Harwood Academic Publishers, 1997.Google Scholar
19 Potter, MJ, Kolbye, KE. Effects of D-Methamphetamine. National Drug Intelligence Center, 1996.Google Scholar
20 Office of National Drug Control Policy. Pulse Check: National Trends in Drug Abuse. ONDCP, 1997.Google Scholar
21 Centers for Disease Control and Prevention. Public health consequences among first responders to emergency events associated with illicit methamphetamine laboratories – selected states, 1996–1999. MMWR 2000; 49: 1021–4.Google Scholar
22 Kozel, N, Lund, J, Douglas, J, McKetin, R. Patterns and Trends in Amphetamine-Type Stimulants in East Asia and the Pacific 2006. United Nations Office on Drugs and Crime Regional Centre for East Asia and the Pacific, 2007.Google Scholar
23 Anglin, MD, Burke, C, Perrochet, B, Stamper, E, Dawud-Noursi, S. History of the methamphetamine problem. J Psychoact Drugs 2000; 32: 137–41.Google Scholar
24 Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: National Findings. Office of Applied Statistics, NSDUH Series H-34, DHHS Publication No. SMA 08-4343. SAMHSA, 2013.Google Scholar
25 United Nations Office on Drugs and Crime. 2007 World Drug Report. Volume 1: Analysis. United Nations Office on Drugs and Crime, 2007.Google Scholar
26 Devaney, M, Reid, G, Baldwin, S. Situational Analysis of Illicit Drug Issues and Responses in the Asia-Pacific Region. Australian National Council on Drugs, 2006.Google Scholar
27 United Nations Office on Drugs and Crime. Drug Abuse among Youth in Vientiane, School Survey. United Nations Office on Drugs and Crime Regional Centre for East Asia and the Pacific, 2002.Google Scholar
28 Griffiths, P, Mravcik, V, Lopez, D, Klempova, D. Quite a lot of smoke but very limited fire – the use of methamphetamine in Europe. Drug Alcohol Rev 2008; 27: 236–42.CrossRefGoogle ScholarPubMed
29 Degenhardt, L, Roxburgh, A, Black, E, Bruno, RB, Campbell, G, Kinner, S, et al. The epidemiology of methamphetamine risk and harm in Australia. Drug Alcohol Rev 2008; 27: 243–52.Google Scholar
30 Plüddemann, A, Myers, BJ, Parry, CD. Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public health. Drug Alcohol Rev 2008; 27: 185–9.Google Scholar
31 Pluddemann, A, Flisher, AJ, Mathews, C, Carney, T, Lombard, C. Adolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa. Drug Alcohol Rev 2008; 7: 687–92.Google Scholar
32 Linnemann, T, Wall, T. ‘This is your face on meth’: the punitive spectacle of ‘white trash’ in the rural war on drugs. Theor Criminol 2013; 17: 315–34.Google Scholar
33 Hendrickson, RG, Cloutier, R, John McConnell, K. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med 2008; 15: 2331.Google Scholar
34 Soames Job, RF. Effective and ineffective use of fear in health promotion campaigns. Am J Publ Health 1988; 78: 163–7.Google Scholar
35 Murakawa, N. Toothless. Du Bois Review: Soc Sci Res Race 2011; 8: 219–28.Google Scholar
36 Karila, L, Weinstein, A, Aubin, HJ, Benyamina, A, Reynaud, M, Batki, SL. Pharmacological approaches to methamphetamine dependence: a focused review. Br J Clin Pharmacol 2010; 69: 578–92.Google Scholar
37 Lee, NK, Rawson, RA. A systematic review of cognitive and behavioural therapies for methamphetamine dependence. Drug Alcohol Rev 2008; 27: 309–17.Google Scholar
38 Guyll, M, Spoth, R, Crowley, DM. Economic analysis of methamphetamine prevention effects and employer costs. J Studies Alcohol Drugs 2011; 72: 577.Google Scholar
39 Ettner, SL, Huang, D, Evans, E, Rose Ash, D, Hardy, M, Jourabchi, M, et al. Benefit-cost in the California Treatment Outcome Project: does substance abuse treatment ‘pay for itself’? Health Serv Res 2006; 41: 192213.Google Scholar
40 Dobkin, C, Nicosia, N. The war on drugs: methamphetamine, public health, and crime. Am Econ Rev 2009; 99: 324.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.