Crystal Meth

When crystal methamphetamine is used, neurotransmitters dopamine, serotonin, and norepinephrine are released into the central nervous system (CNS), having a stimulating effect (Kish, 2008; Richards & Laurin, 2021). This causes the user to experience feelings of heightened alertness, suppression of appetite, increased sexual arousal, and euphoria (Kish, 2008; Schep et al., 2010).

While motivations for using crystal methamphetamine may be to enhance sexual desire, the user will experience a sense of well-being or excitement, often referred to as euphoria (Kish, 2008). Crystal methamphetamine also activates the cardiovascular system causing heart rate and blood pressure to increase. Other effects may include:

• Increased confidence and being talkative.
• Heightened alertness and no desire to sleep.
• Urge to be physically active.
• Suppression of appetite.

The effects of crystal methamphetamine depend on how much is used, the frequency of use, and the administration route. When crystal methamphetamine is smoked or injected, the user experiences an intense ‘rush’ that is followed by a prolonged high. Since the ‘intense’ rush is short-lived, the user may ‘binge’ crystal methamphetamine to achieve more intense effects (Varner et al., 2002). Other factors that can impact the effects of crystal methamphetamine include:

• Individual factors (e.g., age, weight, comorbidities).
• Environmental factors (e.g., the setting/location).
• Drug interactions.

Crystal methamphetamine can lead to acute and/or chronic adverse effects having both short-term and long-term impacts (Sinai, 2019). Acute adverse effects unwanted effects of crystal methamphetamine develop, usually when large amounts of the substance is used. Chronic adverse effects refers to the long-term impacts of regular crystal methamphetamine use.

Acute adverse effects of crystal methamphetamine include:

•  Agitation, violent and/or aggression behaviour.
•  Chest pain, irregular/stopped heartbeat, or heart attack.
•  Difficulty breathing.
•  High body temperature.
•  Paranoia.
•  Severe stomach pain.
•  Coma, unresponsiveness.
•  Seizures.
•  Stroke.

Long-term overdose effects of regular crystal methamphetamine use include:

• Paranoia and delusions.
• Hallucinations.
• Agitation and mood swings.
• Insomnia.
• Missing and rotting teeth.
• Weight loss.
• Skin sores and repeated infections.

Smoking (Inhalation):

Smoking is one of the most common ways to use crystal methamphetamine. Generally, crystal methamphetamine is heated in a glass pipe or aluminum foil creating a smoke which can be inhaled into the lungs (Schifano et al., 2007). The user may experience an intense ‘rush’ seconds after inhalation that lasts for several minutes. While this ‘rush’ is short-lived, a prolonged effect is experienced for 10-12 hours (CAMH, 2012b; Klasser & Epstein, 2005).

Snorting:

Crystal methamphetamine can be crushed into a powder-like substance and inhaled into the nose. Tools including a rolled piece of paper such as a bill, business card, paper straw or other materials may be used to facilitate inhalation (Klasser & Epstein, 2005). Generally, the effect is less intense and can last for several hours (Klasser & Epstein, 2005).

Service provider tip: Remind guys that sharing tools when snorting crystal methamphetamine can increase transmission risk of infectious diseases. To encourage safer use, tool sharing should be avoided or tools should be cleaned/disinfected between users.

Ingestion (Oral):

Crystal methamphetamine can be ingested orally when put into empty gelatin capsules, wrapped in small amounts of tissue paper, or dissolved into drinks. The user may experience effects within 15-20 minutes after ingestion that last for 6-8 hours (CAMH, 2012b; Klasser & Epstein, 2005).

Injection (Intravenous):

Crystal methamphetamine can be dissolved using water and injected intravenously (Schifano et al., 2007). This is another common way that crystal methamphetamine is used due to the intense ‘rush’ that is experienced seconds after injection (Klasser & Epstein, 2005).

Service Provider Tip: Remind guys that sharing needles can increase transmission risk of infectious diseases. To encourage safer use, sharing needles should be avoided. Guys should only use a needle once as the needle can become blunt, reusing the same needle can damage veins and increase risk of infection.

Booty Bumping (Anal Insertion):

Crystal methamphetamine can be dissolved using water or alcohol and inserted into the rectum using a needleless syringe (Schifano et al., 2007). Crystal methamphetamine may also be wrapped in tissue paper and inserted into the rectum without dissolving in water or alcohol first. Booty bumping may be a preferred route of administration because the rectum is efficient at absorbing a high amount of crystal methamphetamine into the bloodstream causing the user to experience a strong effect (Cantrell et al., 2006).

Service Provider Tip: Booty bumping causes damage to the rectum. Encourage guys to alternate between different administration techniques to give the rectum a chance to heal. Remind guys to avoid sharing syringes or to ensure any materials used for booty bumping have been cleaned/disinfected between users to reduce harms.

Prescribed Substances 

Crystal methamphetamine can produce serious and life threatening adverse effects when used with certain HIV medications, antidepressants, antipsychotics, and blood pressure medications (Jenner & Lee, 2008).

HIV Medications:

• Ritonavir and Cobicistat are used to boost other anti-HIV medications in the body by decreasing the breakdown of these substances (Nuh, 2020).
• Ritonavir and Cobicistat interact with crystal methamphetamine by increasing the availability of crystal methamphetamine in the body, leading to adverse effects (Lee et al., 2021).
• Significant interactions with crystal methamphetamine have been observed cobicistat-boosted elvitegravir regimen (Lee et al., 2021).
• There is weak potential for the Atazanavir HIV medication to interact with crystal methamphetamine (Lee et al., 2021).

Antidepressants:

• Monoamine Oxidase Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat depression by blocking the reuptake of the serotonin neurotransmitter in the body.
• Use of crystal methamphetamine with MAOIs or SSRIs may cause dangerously high blood pressure, increased body temperature, and serotonin syndrome/toxicity.

Antipsychotics:

• Antipsychotics are generally used to treat psychotic disorders such as schizophrenia.
• Use of crystal methamphetamine with antipsychotics can decrease effectiveness, causing behaviours associated with psychotic disorders to reappear including seizures.

Blood Pressure Medications:

• Controls or regulates blood pressure.
• Can be ineffective when used with crystal methamphetamine.

Recreational Substances

When crystal methamphetamine is used with other recreational substances, this is known as polysubstance use and can lead to serious or life threatening adverse effects (Jenner & Lee, 2008).

Alcohol: 

• Interacts with crystal methamphetamine to increase blood pressure, placing increased strain on the heart.
• Alcohol makes the user feel less intoxicated by crystal methamphetamine, leading to overuse of crystal methamphetamine to achieve an effect, increasing risk of overdose.
• Crystal methamphetamine can dull the effects of alcohol, leading to overconsumption of alcohol, alcohol poisoning or accidents related to being intoxicated.

Opiates:

•  Crystal methamphetamine can dull the effects of opiates such as heroin, leading to overuse of opiates and possible opiate overdose.

Stimulates: 

• Combining crystal methamphetamine with other stimulant drugs can increase the risk of heart attack, stroke, and psychosis.

Recently, Canada passed the “Good Samaritan Drug Overdose Act.” This means that if police attend a 911 call for an overdose and there are drugs present, anyone in attendance is protected against simple drug possession charges, even if they’re on probation or parole. See this helpful info by the HIV Legal Network. You can download a PDF of it [here].