Current Research on Methamphetamine: Epidemiology, Medical and Psychiatric Effects, Treatment, and Harm Reduction Efforts
Methamphetamine (MA) is widely used and has a high prevalence of use and abuse. Based on this research paper, MA is the second most abused drug globally after cannabis and increases activation of the dopamine, norepinephrine, and serotonin systems.
Dopamine is the feel-good hormone and plays a role in the pleasure and reward system. Serotonin regulates mood, body temperature, and the majority of serotonin is stored in the gut. Norepinephrine is associated with fight or flight response, mobilizes the brain and body for action, and increases heart rate and blood pumping from the heart.
MA inhibits dopamine transport, which creates an abnormally high concentration of dopamine, which contributes to the neurotoxicity of MA. Over the long term, heavy use and high MA dose results in neurobiological deficiency and take months to resolve. MA also produces norepinephrine effects of an increase in blood pressure and pulse. Higher doses of MA will cause an increase in alertness and repetitive behaviors. Other side effects of MA noted in this research include “dizziness, tremor, hyperreflexia, pyrexia, mydriasis, diaphoresis, tachypnea, tachycardia, and hypertension.” These side effects can last for up to 12 hours. Additionally, a high level of dopamine in the central nervous system “reinforces the highly addictive properties of MA.”
There are many routes of MA administration. These include intranasal, oral, smoked, and injected. Smoking and injecting MA leads to easier addiction plus future medical and psychiatric issues. The rapid onset of MA euphoria by smoking (6-8 seconds), injection (10-15 seconds), intranasal (3-5 mins), and oral (180 minutes). The effect of euphoria from MA creates a need for reuptake of the drug for ongoing euphoria.
The research explores implications for psychiatric care, which is varied and complex. The impact on care is dependent on frequency of use and route of administration. There are also medical considerations of MA use on neurological, dental, cardiovascular health plus infectious diseases and sexually transmitted blood borne infections.
The demographic most affected by MA use are women and men who have sex with men (MSM). Women use MA for weight loss, depression and often have a history of physical and sexual abuse. MSM tends to use MA to promote sexual desire, sexual behaviors that directly correlate with an increase in STIs and dealing with isolation and manage fatigue for some HIV-positive MSM.
In conclusion, there is no efficacious pharmacotherapy treatment for MA dependency. There are discussions of various medications used in clinical settings with limited success. Additional reviews of behavior therapies include Cognitive Behavior Therapy (CBT) and contingency management therapy with principles of reinforcement for desired behaviors. Both therapies have had some success. Another model of care is to offer client-centered harm reduction services. Harm reduction services reduce the shame and stigma of drug use, addiction, provision of sexual health education, and access to safer sex materials. More research is required to develop holistic care and treatment for MA users.
