1. Methamphetamine: How it Influences the Brain and Behavior of Users
Richard A. Rawson, Ph.D
Adjunct Associate Professor
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine
University of California at Los Angeles
Supported by:
National Institute on Drug Abuse (NIDA)
Pacific Southwest Technology Transfer Center (SAMHSA)

2. Methamphetamine
Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple systems in the brain. Methamphetamine is closely related chemically to amphetamine, but the central nervous system effects of methamphetamine are greater.

3. Methamphetamine: Speed
Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown.
Color variations are due to differences in chemicals used to produce it and the expertise of the cooker.
Other names: shabu, crystal, crystal meth, crank, tina, yaba

4. Methamphetamine: Ice
High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

5. The Eastward Spread of Methamphetamine

6. Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992 (per 100,000 aged 12 and over)
< 12
No data
> 58

7. Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000 aged 12 and over)
< 12
No data
> 58
< 12

8. Primary Amphetamine/Methamphetamine Admission Rates by State: 2002
Admissions per 100,000 population aged 12 and over
3-27
55 or more
200 or more
150 or more
100 or more

9. Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older:
Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

10. IHS-Wide RPMS PCC Outpatient Encounters for Amphetamine Related Visit by Calendar Year

11. Meth Epidemic; less drama, more long term risk/danger
Cocaine/Crack epidemic hit fast (in NYC , as well as other major east coast cities); overnight emergency, tremendous media attention.
Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug.
Dramatic decreases in indicators by early 1990s, except in inner cites of east coast.
Crack epidemic: Rapid onset; Rapid decrease
Meth epidemic: Slow west to east spread. No decrease in western cities. Use becomes endemic?

12. Methamphetamine: A Growing Menace in Rural America
In 1998, rural areas nationwide reported 949 methamphetamine labs.
Last year, 9,385 were reported.
This year, 4,589 rural labs had been reported as of July 26.
Source: El Paso Intelligence Center (EPIC), U.S. DEA

13. Anhydrous Ammonia Tank Tips Officers to Possible Meth Lab
5/4/04 Omaha, Neb. – A large
anhydrous ammonia tank
helped Sarpy County
Sheriff’s deputies bust
a suspected
methamphetamine
lab Tuesday.
By large, they mean 9,600 gallons…The owners had run a hose from the tank inside the house. “This was a semi trailer parked in a residential neighborhood. Nobody called.”
SOURCE: TheOmahaChannel.com

14. Methamphetamine Acute Physical Effects
Increases Decreases
Heart rate Appetite
Blood pressure Sleep
Pupil size Reaction time
Respiration
Sensory acuity
Energy

15. Methamphetamine Acute Psychological Effects
Increases
Confidence
Alertness
Mood
Sex drive
Energy
Talkativeness
Decreases
Boredom
Loneliness
Timidity

16. Methamphetamine Chronic Physical Effects
- Tremor Sweating
- Weakness Burned lips; sore nose
- Dry mouth Oily skin/complexion
- Weight loss Headaches
- Cough Dental Problems
- Sinus infection - Anorexia

19. METH Use Leads to Severe Tooth Decay
“METH Mouth”
Source: The New York Times, June 11, 2005.

20. Meth Use in Hawaii 2005 (mid-May) - 38 deaths 2004 - 68 deaths
As of the middle of May, not even halfway through the year, the city medical examiner's office already recorded 38 deaths connected to crystal methamphetamine. So, we're well on the way to exceeding last year's total of 68.
Deaths:
2005 (mid-May) - 38 deaths
deaths
deaths
deaths
deaths
deaths

21. Methamphetamine Chronic Psychological Effects
- Confusion Irritability
- Concentration Paranoia
- Hallucinations Panic reactions
- Fatigue Depression
- Memory loss Anger
- Insomnia Psychosis

22. Methamphetamine Psychiatric Consequences
Paranoid reactions
Permanent memory loss
Depressive reactions
Hallucinations
Psychotic reactions
Panic disorders
Rapid addiction

23. What It Does to Their Brains
A Major Reason People
Take a Drug is they Like
What It Does to Their Brains

26. Natural Rewards Elevate Dopamine Levels50
100
150
200 60
120
180
Time (min)
% of Basal DA Output
NAc shell
Empty
Box
Feeding
Source: Di Chiara et al.
FOOD
100
150
200
DA Concentration (% Baseline)
Mounts
Intromissions
Ejaculations 15 5 10
Copulation Frequency
Sample
Number 1 2 3 4 6 7 8 9 11 12 13 14 16 17
Scr
Bas
Female 1 Present
Female 2 Present
Source: Fiorino and Phillips
SEX

27. Effects of Drugs on Dopamine Release
Time After Methamphetamine
% Basal Release
METHAMPHETAMINE 1 2
3hr
1500
1000
500
Accumbens
100
200
300
400
Time After Cocaine
% of Basal Release DA
DOPAC
HVA
Accumbens
COCAINE
100
150
200
250 1 2
3 hr
Time After Nicotine
% of Basal Release
Accumbens
Caudate
NICOTINE
100
150
200
250 1 2 3
4hr
Time After Ethanol
% of Basal Release
0.25
0.5
2.5
Accumbens
Dose (g/kg ip)
ETHANOL
Source: Shoblock and Sullivan; Di Chiara and Imperato

28. Prolonged Drug Use Changes the Brain In Fundamental
and Long-Lasting Ways

29. Decreased dopamine transporter binding in METH users resembles that in Parkinson’s Disease patients
%ID/cc
If DAT is decreased in young METH users (almost to that observed in Parkinson’s Disease), and DAT decreases with age, may we see an increase in the number of Parkinsonian patients over time?
Control Methamphetamine PD
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp , October 15, 1998. .

30. Abuser After Protracted Abstinence
Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH)
Abuser After Protracted Abstinence 3
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, , 2001.

36. Methamphetamine: Neurochemical Mechanisms
Methamphetamine enters the brain and is removed from the synapse by dopamine transporters

38. Methamphetamine: Neurochemical Mechanisms
Enters dopamine vesicles
Vesicles deplete themselves of dopamine

40. Methamphetamine: Neurochemical Mechanisms
Free-floating DA produces “free radicals” (neurotoxins), so it is forced out of the neuron.
The synapse is flooded with dopamine, producing a profound sense of pleasure.

42. Their Brains
have been
Re-Wired
by Drug Use
Because…

44. Control > MA 4 3 2 1

45. MA >
Control 5 4 2 1 3

46. Is Treatment for Methamphetamine Effective?
A major demand that competes for scarce community resources are for the treatment needs of those who have become addicted to methamphetamine (MA).

47. Meth Treatment Effectiveness?
A pervasive rumor has surfaced in many geographic areas with elevated MA problems:
MA users are virtually untreatable with negligible recovery rates.
Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences.
**The resulting conclusion is that spending money on treating MA users is futile and wasteful, BUT no data exists that supports these statistics**

48. Meth Treatment Statistics
During the fiscal year:
35,947 individuals were admitted to treatment in California under the Substance Abuse and Crime Prevention Act funding.
Of this group, 53% reported MA as their primary drug problem

49. Statistics Analysis of: Drop out rates Retention in treatment rates
Re-incarceration rates
Other measures of outcome
All these measures indicate that MA users respond in an equivalent manner as individuals admitted for other drug abuse problems.

50. Urinalysis Results
Results of Ua Tests at Discharge, 6 months and 12 Months post admission **
Matrix Group TAU Group
D/C: % MA-free % MA-free
6 Ms: 69% MA-free % MA-free
12 Ms: 59% MA-free % MA-free
**Over 80% follow up rate in both groups at all points

51. Clinical Challenges of MA Users
Poor treatment engagement rates
High drop out rates
Severe paranoia
High relapse rates
Ongoing episodes of psychosis
Severe craving
Protracted dysphoria
Anhedonia

52. Steps to Address Treatment Needs of MA Users
Psychiatric/Professional Mental Health Staffing
Add Treatment Programming for Women Exposed to Violence and Their Kids
Training, Training, Training

53. Medications
Currently, there are no medications that can quickly and safely reverse life threatening MA overdose.
There are no medications that can reliably reduce paranoia and psychotic symptoms, that contribute to episodes of dangerous and violent behavior associated with MA use.

54. Special treatment consideration should be made for the following groups of individuals:
Female MA users (higher rates of depression; very high rates of previous and present sexual and physical abuse; responsibilities for children).
Injection MA users (very high rates of psychiatric symptoms; severe withdrawal syndromes; high rates of hepatitis).
MA users who take MA daily or in very high doses.
Homeless, chronically mentally ill and/or individuals with high levels of psychiatric symptoms at admission.
Individuals under the age of 21.
Gay men (at very high risk for HIV and hepatitis).