overview

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2: 2 Overview The issues Chemistry Pharmacology: how the body handles the drug Pharmacology: mechanisms The desired effects: why people like it The problems: why people hate it Methamphetamine vs other drugs Pregnancy: mother and child

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6: Why do people take drugs?

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9: 9 Chemistry 1: Methamphetamine does not occur in nature. It is like two chemicals found in the body:?? Adrenaline, released in �fight or flight� ?? Dopamine which controls both reward and movement in the brain

10: 10 Chemistry 2: Methamphetamine is very close to Amphetamine (�speed�) in structure

11: 11 Chemistry 3: Compounds from plants that are chemically similar are ephedrine and mescaline Methamphetamine is easy to make from materials that are hard to control; pseudoephedrine, iodine, and red phosphorus from matchbooks Waste by-products from the synthesis are toxic and environmentally harmful

12: 12 Methamphetamine Absorption Fat soluble, so easily and rapidly absorbed. Gets into the brain faster than amphetamine Onset: ?? oral - about 30-60 minutes ?? Snorted - 2-5 minutes ?? injected or smoked � almost instantaneous

13: 13 Methamphetamine Elimination Elimination half life about 12 hours Effects can last 24 hours 55% broken down by the liver remainder excreted as methamphetamine or amphetamine Drug and metabolites detectable 2-4 days Urine or saliva can be used for testing Impurity profiling for medico-legal purposes. There are about 245 possible impurities!

14: 14 The most important action� Meth enters the nerve ending, and causes the transmitter to be released. It displaces the transmitter from the storage site. This means that even if the nerve in the reward pathway has not been stimulated, the transmitter will be released and �reward� experienced.

15: 15 Methamphetamine has several mechanisms: It directly releases dopamine and norepinepherine from the nerve endings in the brain (and also outside the brain) It inhibits the transporter leading to increased material in the synapse (like cocaine) It both CAUSES nerves to fire and AMPLIFIES existing nerve activity.

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17: 17 Desired Effects Energy, less fatigue, wakefulness �enhanced performance May promote impulsive decision making Feelings of joy, power, success, high self-esteem Enhanced sexual desire and interest Later in the addiction process the user may have very little interest in sex.

18: 18 Undesired Effects Delusional, risky, paranoid, violent Itching, welts on the skin Nausea, vomiting, diarrhea Uncontrolled body movements �The crash� Increased blood pressure, heart rate, body temperature. Risk of stroke, seizures Japan � most deaths from meth toxicity USA � most deaths from homicide/suicide

19: 19 Short-Term Effects of Methamphetamine PSYCHOLOGICAL Confidence Alertness Mood Sex drive Energy Talkativeness Boredom Loneliness Timidity PHYSICAL Heart rate Respiration Blood pressure Pupil size Sensory acuity Energy Appetite Sleep Reaction time People like MA Addictive�time varies, from immediate to years Initially get a surge. Accentuate the positive, eliminate the negativePeople like MA Addictive�time varies, from immediate to years Initially get a surge. Accentuate the positive, eliminate the negative

20: 20 Long-term Problems Disturbed sleep Social isolation and withdrawal Lifestyle-related �accident� Amphetamine psychosis Violent and/or paranoid behavior Irritability, nervousness, distractibility, difficulty focusing and remembering Extreme depression, suicidal ideation NOT ALL OF THESE ALWAYS REVERSE WITH ABSTINENCE

21: 21 MethamphetamineChronic Physical Effects Tremor Weakness Dry mouth Weight loss Cough Sinus infection

22: 22 MethamphetamineChronic Psychological Effects Confusion Concentration Hallucinations Fatigue Memory loss Insomnia

23: 23 MethamphetaminePsychiatric Consequences Paranoid reactions Permanent memory loss Depressive reactions Hallucinations Psychotic reactions Panic disorders Rapid addiction

24: 24 What about brain damage? This is often stated as a consequence of methamphetamine use. Usually recovers. There is convincing evidence in humans and animals, both by imaging and behavioral studies, that brain damage occurs

25: 25 What about behavioral consequences? Attention, verbal learning, memory, decision making are all impaired during early abstinence After 8 months abstinence, still slow on some tasks Headaches and depression may not improve, and there may be ongoing cognitive impairment.

26: 26 Flashbacks (recurrence of methamphetamine psychosis) do occur Associated with frightening/stressful experience during use. Mild stress then triggers flashbacks Longer exposure to the situation makes flashbacks more frequent

27: 27 Methamphetamine Users Compared to Other Drug Users Use daily More likely to be Caucasian, male, gay/bi, HIV positive, practice unsafe use (sharing needles etc.), have a psychiatric diagnosis, be on psychiatric meds Develop addiction more rapidly Seek treatment earlier Use more marijuana and/or less alcohol (but use alcohol or sedatives for sleep) Have more serious medical and psychiatric conditions

28: 28 Prenatal Exposure to Methamphetamine Methamphetamine easily crosses the placenta The fetal brain is very sensitive to any level of methamphetamine Metabolism of methamphetamine in the fetus is not the same as in adults We must have a high index of suspicion to adequately test moms and infants exposed to methamphetamine

29: 29 In pregnancy� Very little data. Growth restriction occurs with full-term infants, (constriction of the umbilical artery?) 4% have a recognizable withdrawal syndrome. Evidence of cognitive deficit in children born to mothers who use meth Weak evidence for physical defects in children whose mothers used meth.

30: 30 Who to test? Maternal red flags History of drug use during pregnancy Premature birth Late, sporadic, or no prenatal care Numerous skin lesions Extremely poor dentition Very rapid labor/delivery Infant red flags Maternal history of drug use Maternal refusal for drug screen Excessive irritability Excessive jitteriness Very poor feeding, not responding to intervention Physical features suggestive of alcohol/drug use

31: 31 Maternal Effects of Methamphetamine During Pregnancy Increased maternal blood pressure Increased maternal heart rate Increased risk of premature birth Constricts blood flow in the placenta, thereby impacting oxygen flow to the fetus

32: 32 Effects of Methamphetamine on the Developing fetus/infant Poor fetal growth�small for gestational age Elevated fetal blood pressure (stroke) Birth defects (6 times the normal rate) Cleft palate/lip Heart disease Kidney disease Intestines born outside the body Premature birth Placental hemorrhage

33: 33 Newborn signs of meth exposure Withdrawal Jittery Poor feeding Poor wake /sleep cycle Irritable High pitched cry Tremors Hypertonia These symptoms may last as long as 6 weeks, in contrast to withdrawal from other drugs which may only last the first week of life

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