Comments on
Is There Such A Thing As Casual Crystal Meth Use?


Methamphetamine is a synthetic compound that stimulates the release of dopamine and norepinephrine, a neurotransmitter closely related to adrenaline. The effects of meth are much more prolonged than the short burst of dopamine and norepinephrine that is released when neurons fire on their own.

Like all amphetamines (“speed” drugs), meth creates feelings of euphoria, intensity, and power, along with the drive to do whatever activity the user wishes to engage in. If going to clubs and dancing is your thing, then while you’re high on meth you’re up all night, feeling energized by every thump of music—at least until you start coming down.

Meth is sold legally (with a prescription) in tablet form as Desoxyn, FDA approved for the treatment of ADHD and exogenous obesity. More often, though, it’s cooked in makeshift labs and sold illegally as a powder or rock. The powder form can be snorted, smoked, eaten, dissolved in a drink, or heated and injected. The rock form is usually smoked, though it can also be heated and injected. Widely available in the 1960s, meth faded in the 1970s as controls were tightened on legal production, and cocaine took its place as the new party drug of choice. Crack cocaine dominated the 1980s, along with designer drugs like MDMA (Ecstasy), but in the early 1990s meth made a comeback, and it seems to be here to stay. According to the World Health Organization, meth is now the second most widely abused illicit drug worldwide, trailing only marijuana.

12 Comments to
Is There Such A Thing As Casual Crystal Meth Use?

The comments below begin with the oldest comments first. (If there's more than one page, click on the last comments page to jump to the most recent comments.) Jump to reply form.

  1. Dr. Sack- I am commenting about your comparison of methamphetamine to adrenaline. I’m sure that you, as a scientist, don’t really believe this. Adrenaline is not a psychoactive substance. Maybe, you could use a different analogy if you are trying to present information about addiction to the lay public.

    • I know this post is super old but I feel like I had to leave a reply. I’m so sick of reading all these propaganda type “facts” about how meth users are dirty, ugly, neglect their hygiene, pick at their skin constantly, are delusional psychotic nut cases, look a decade+ older then they are, smell bad etc. First of all, the majority of meth users do not fall into that category, I know from personal experience. I been smoking meth for 7 and a half years and unfortunately haven’t been able to stay clean yet but I wish to some day and hopefully that day comes soon. The people I use with including my bf all look like normal people and you wouldn’t even be able to tell they are meth addicts. I look completely normal myself which makes it very easy for me to hide my addiction and I’m not trying to sound conceited but I’m def above average in looks. My physical appearance has always been very important to me since I was little so my hair, makeup, and style/fashion are always high on my priority list. I am also a very clean person and hell would freeze over before I would neglect my hygiene. I might go a day without a shower or fall asleep without brushing my teeth once in a blue moon but nothing beyond that. I have all my teeth thank god but I have quite a bit of cavities and one needs a root canal which sucks. I’ve always been blessed with nice skin and I would never ruin it by picking at it. I’ve never really had any psychotic episodes or crazy delusions but I have gotten kinda crazy and out of control a few times in the past when I was coming down or in the beginning stage of withdrawal. I never completely lost touch of reality or anything though. I never really had intense hallucinations like a lot of users get. I’ve seen a few “shadow people” here and there after staying up for days but I always knew they were nothing but my vision getting blurry from sleep deprivation so it never really bothered me much.

  2. Nice post. Now it is time for physicians to realize that many addicts are finding out what is available with some alleged legitimacy at the pharmacy counter.

    People coming in claiming to have ADD and need stimulants, especially asking for Adderall and other amphetamine based meds, make ’em do the work, have the psychological testing done and then get collateral contacts to confirm they had ADD features as children. When the patients hem and haw to be compliant with the appropriate work up, tell ’em to move on.

    You are doing yourself as a doctor a service, and making them rethink if they want to risk exposure for their fraudulent efforts!

  3. Hi David,

    Methamphetamine is a highly rewarding and re-inforcing substance, with a high potential for dependence.

    However the majority of people who use meth are indeed “casual” users, (if by this you mean occasional and non-addicted users).

    If you look at the national survey on drug use and health; ( http://www.samhsa.gov/data/NSDUH.aspx )
    .
    you can see that every year the number of people who have ever taken meth is many times higher than the number of people who have taken it in the last year.

    More significantly, less than half the people who report taking meth in the last 12 months have taken it in the last month. We know that most who report using it in the last month use it less often than once a week. Most of them are not dependent.

    By the way, methamphetamine is not a “synthetic version of adrenaline”. It is a sympathomimetic amine that fits into receptors and re-uptake pumps for (nor)adrenaline, serotonin and dopamine. Increasing adrenalin levels improves energy, alertness and endurance, (but increasing it too much can cause cardiac problems or stroke); increasing serotonin levels improves mood and sociability, (but increasing it too much may causing seizures and hyperthermia); increasing dopamine levels is very rewarding, and improves mental performance, concentration and response time, (but increasing it too much can cause obsessive repetitive behaviours, delusions of persecution, paranoia, and/or psychosis).

    The epidemiology of meth use that national surveys reveal does not support the article’s statement that only “the very very lucky” can use methamphetamine without becoming dependent.

    And while regular methamphetamine use is definitely bad for your physical and mental health, the “Faces of Meth” campaign might be more accurately titled “The Faces of Poverty and Disadvantage”.

    There are very real problems caused by methamphetamine use.
    However alarmist “worst drug ever” “instantly addicting” style journalism doesn’t help anyone to avoid or treat these problems.

    Regards,
    Paul.

  4. Paul, your reply is perfect.
    In no way am i promoting meth use because it is a highly addictive an dangerous drug.
    However, one sided articles such as this will only cause people to believe that everything you’re saying/ other similar articles are saying is a lie due to the obvious falsity of what you have written.
    I personally know people who have let meth destroy their lives and now live in psych wards or prison. However i also know people who smoke meth regularly and have done so for 10+ years and function as a normal member of society (even some who excel).
    It all depends on the person and their common sense/ willpower.
    In my opinion people who allow themselves to become addicted to meth are “very very” stupid.
    Cheers
    Zirkle

  5. I am a meth user of 20+years. I have tried various recovery methods with no success.
    I have tried rehabs, CMA ( Crystal Meth Anonymous ), Nacotics Anonymous. Etc, etc.

    Currently I have given up on the idea that these methods will be able to help me.
    The success rate of the 12 step programs is less than ten percent. (For meth users)

    I have been working on my own method of getting off of crystal that seems to be working (for me)

    I agree that addiction to methamphetamines (initially) is mostly psychological, unfortunately at 10 plus years of daily use it begins to become as physical as it is psychological. I know this from my own experience. My withdrawl symptoms include profuse sweating, high fevers, dizziness, nausea, extreme physical exhaustion, and extreme restlessness after day three of sleep I don’t have the energy to get out of bed but I am incapable of getting back to sleep. The worst part of my withdrawl is a feeling I have heard many users describe in different ways but most commonly they will describe the feeling as ” jumping out of your skin “.

    What I assume this is describing is (I have nothing to back this up) my central nervous system experiencing the lack of something it has become accustomed to having so regularly for such a long period of time.

    It is an extremely uncomfortable feeling! Imagine an electrical current not quite strong enough to do any real harm, but strong enough to give you the same effect a hiccup or sneeze could induce.

    One thing you mentioned about people that use meth is that ” methmouth” is caused by bad hygiene. I am especially offended by that . I do not have bad hygiene, I do not indiscriminately pick my face in an attempt to remove anything that may or may not exist there. I never have even once thought I was being followed by anyone, law enforcement or otherwise.

    To set the record straight and get rid of the misinformation you have here on your website about hygiene and methmouth.

    1. “Methmouth” is not caused by bad hygiene, it is caused by dehydration resulting in a lack of saliva in someones mouth. The lack of saliva allows bacteria to attack the enamel on your teeth.

    I Myself have for most of my life brushed my teeth two to three times a day and flossed on a regular basis and as a result of snoring when I sleep and lack of information I have still had to have all of my teeth removed because I thought good hygiene would protect me from that kind of thing .

    Thank you for your time, I appreciate the good things I think you are doing.

    Navarre

  6. Navarre is quite correct.

    Media stories often claim meth damages teeth because it is acidic, despite the fact that methamphetamine is actually an alkaline substance.

    Methamphetamine and other amphetamine type stimulants such as MDMA do cause tension in the jaw muscles and this can result in tooth grinding, however the main reason for damage to teeth is as Navarre mentioned chronic dry mouth (xerostomia).

    Paul.

  7. As a young man, I used high purity crystalline methamphetamine intravenously and very regularly for nearly 15 years, and like Navarre never developed delusions of persecution or suffered a psychotic episode.

    I have spent the subsequent 14 years working for a harm reduction agency and in mental health, and roughly 60% of the people referred to my projects identify methamphetamine as their principle drug-of-concern.
    Many of these people have developed delusions or experienced an acute episode of psychosis, however this is not the most common mental health problem amongst methamphetamine users.
    Far, far more prevalent are chronic problems with depression, mood regulation, and energy, due to physiological dependence on the substance.

    re Methamphetamine addiction being “psychological”.
    To say that “meth addiction is all in your head” is true, (in the sense that all human experience actually takes place inside your head) but rather misleading. The idea that there is a qualitative difference between physiological addiction and psychological addiction is based on the old Cartesian dichotomy between mind and body. In fact there is no such division- brain chemistry affects state of mind, and vice-versa. Psychoactive substance use affects both state of mind and brain chemistry. There is a complex set of feedback loops nested within these two simple sentences.

    Regular meth use (more often than once per week?) depletes monoamine stores. The dysthemia, anhedonia, depression, lack of energy, and problems with memory, concentration, sexual function and mood which many regular users experience on abrupt abstinence are caused by this, and by the fact that your nervous systemn responds to chronic use of any psychoactive substance by down-regulating the neurotransmitters the particular drug releases.

    The brain is a responsive and adaptive organ. It is designed to respond to changes in the environment or in the body’s internal chemistry in order to maintain homeostasis. Your nervous system does not know what methamphetamine is. Regular meth use is “interpreted” by the brain as dysregulation of, or excess release of, noradrenalin, serotonin and dopamine- the response of your brain is to release less of these chemicals naturally, and to make receptors for these neurotransmitters less responsive to them, in an attempt to normalise it’s internal chemistry.
    These changes in brain chemistry are the neurochemical basis to physical dependence.

    If you use meth regularly enough to neuroadapt to the drug’s presence, then you will not function normally without some of the drug in your systemn. Abrupt withdrawal will make you feel pretty crappy for a period of weeks – in some cases 2 or 3 months – while your brain gets its act together and works out how to regulate those chemicals again and while your body rebuilds stores of the precursors for these chemicals. In terms of causation, these symptoms have little to do with psychology- it is a physiological dependence.

    Very heavy use (daily dosing, toxic doses, sustained long term regular use) can significantly modify (or damage) brain structure as well as brain chemistry. This is because dopamine is neurotoxic. It is normally stored away safely in vesicles in the neuron, and released in tiny measured spurts, then rapidly cleaned up by re-uptake pumps and stored away again. Meth occupies the dopamine re-uptake pump and reverses its flow, spewing huge amounts of this neurotransmitter into the synapse. Dopamine is not toxic to neurons (it doesn’t kill brain cells) but excess dopamine does cause axonal pruning (it breaks the connections between brain cells).
    These damaged axons do grow back, in a process called re-arborisation. However animal studies demonstrate that toxic dosing regimes can cause damage that takes up to 12 months of abstinence to repair itself. These studies reinforce anecdotal evidence that heavy meth users can experience serious withdrawal symptoms for 3 to 9 months after abrupt withdrawal.

    When you learn anything, new pathways are physically burned in your brain, connecting neurons that were not connected before.
    (If this is the first time you have encountered this information, then reading this paragraph has subtly changed the structure of your brain, just now).

    When someone uses a dependence forming drug like meth regularly, the person’s nervous system will also form associations between places, people, or events that are associated with drug use. If they always use when in certain situations, with certain people, or to deal with certain social situations or stresses, then these “cues to relapse” are physically hard-wired into their brain. This form of conditioning is the basis of any drug addiction.

    As your brain is just seeking homeostasis, (and as this level of your nervous system is just concerned with immediate, short term results), when someone habituated to a serious dependence abstains abruptly they experience strong urges to relapse; quite simply this is the quickest and easiest way for your nervous system to revert to “normal” function.

    Substantial anecdotal evidence and some small controlled trials suggest that a tapered withdrawal of reducing doses makes the incidence and severity of withdrawal symptoms much less severe. Without supervision, most people dependent on street amphetamines are not able to consistently stick to a reduction regime.

    Agonist replacement pharmacotherapy would be possible in cases of serious methamphetamine dependence. Prescribing and supervising oral dosing of methamphetamine, (or, alternatively, sustained release dexamphetamine) would allow heavily dependent people to reduce to abstinence with much less severe symptoms and much less disruption to their quality of life and day-to-day functioning, in a similar fashion to methadone or heroin prescription for opiate dependent people.

    Regards,
    Paul.

  8. Dr. Hassman, replacement therapy is commonly practiced in treating or managing opiate addiction, and in nicotine addiction as well. There is a significant degree of consensus among medical professionals, recognizing replacement therapy’s potential for favorable outcomes. There is also significant criticism of this approach and it’s not without merit. Rather than treating addiction, addiction maintenance therapy generally only manages addiction, by placating it with just enough of the stimuli to dampen cravings and drug-seeking, while ultimately perpetuating the addiction itself.

    Given the medical credential your username claims, it’s disturbing to note your prejudiced disdain and the unprofessional discrimination inherent in your suggestion physicians adopt a dismissive refusal to treat patients clearly presenting symptoms of a serious medical condition.

    Critics of replacement maintenance therapies for nicotine and opiate addiction raise valid concerns that significant patient risk isn’t adequately mitigated by the minimal potential harm reduction. This is especially true in opiate replacement therapies, as the common narcotic replacements -methadone, buprenorphine and buprenorphine/naloxone -are often more dangerous than the opiate they’re replacing.

    However, a patient presenting the stimulant drug-seeking behavior you describe-indistinguishable, btw, from a patient surreptitiously seeking replacement stimulant therapy as a harm reduction approach to managing their stimulant addiction -does *not rely on a more dangerous substitute. Methamphetamine is neurotoxic, while other amphetamine-class stimulants like Adderall are not. Further, methadone withdrawal is more severe with greater fatality risk than the opiates it typically replaces. Methamphetamine withdrawal, though, is no more or less severe than any other amphetamine-class stimulant withdrawal.

    A qualified physician, who remembers his Oath, appropriately diagnoses fabricated ADHD symptoms as stimulant addiction and treats accordingly in the patient’s best interest. He doesn’t exploit it as an opportunity to dismiss a patient and deny treatment based on his arrogantly shameful disdain of patients he deems unworthy of care. Dermatologist? Podiatrist? Cosmetic plastics, catering exclusively to elective “patients” whose only symptom is vanity?

  9. Methamphetamine users are stigmatized as “dirty,” so I sympathize with Navarre’s resentment of his experience unfairly subjecting him to derision in spite of his well established habits of healthy hygenic practices. Tooth decay among users isn’t simply hygienic, no. It is one of many common causes in many situations, though. Poor hygiene doesn’t necessarily result in decay, and diligent hygienic care won’t necessarily prevent decay, either. Poor hygiene does significantly increase the potential for tooth decay, and good hygiene often though not always, can decrease potential decay. Many factors that contribute cannot be managed, though. A young adult practicing good hygiene as a user, is likely to suffer rapid decay anyway caused by Poverty and Disadvantage if, say, their dental healthcare throughout childhood was insufficient or non-existent. Navarre could have never used amphetamines ever, and probably would have still experienced significant decay due to long term xerostomia that was probably going on long before methamphetamine use.

  10. David,

    You objectively addressed facts observable in the data on drug use populations that so many in the U.S. addiction recovery industry and government agencies conveniently choose to ignore in typical propaganda fear-mongering.

    We teach in public schools that one hit is all it takes, that’s it, and everyone learns about addiction in the context of rats in a cage choosing the drug over food and water until they die. Rats in a cage, not even remotely comparable to rats in their healthy, natural rat habitats. No one learns of the rat studies conducted later, controlling for environmental and social variables, which failed to replicate the earlier results. Rats in rat-like environments not isolated from a typical rat social network, end up ignoring the drugs they mistook for food or water upon exposure. The implication is, physiology is not the primary factor driving addiction, and certainly not solely responsible. Low rates of drug use resulting in addiction in humans, consistently among various substances that trigger dopamine response -coke, meth, chocolate -reflects findings of the improved rat studies. It’s hard to believe addiction rates of 10% and less, though, for anyone indoctrinated according to faulty rat-in-A-cage assumptions. (There are further implications considering social factors at work when NA works, and what’s ineffective and even counter-productive when A&E-style Intervention ultimatums forget ultimatums aren’t healthy and *don’t work).

    The conventional wisdom on methamphetamine addiction recovery rates is skewed. Recovery rates cannot be accurately measured simply using relapse rates -not without isolating relapsed dependency from relapsed use that doesn’t lead dependency. Ninety percent use again after a period of abstinence -but a significant number of those “relapses” never result in relapsed dependency, and are instead a critical reinforcement securing successful recovery long-term.

    It’s unfortunate that in pointing out the shocking fact most won’t believe anyway, that methamphetamine is legally prescribed under the trade name Desoxyn, that you neglected to include its most commonly known and commonly approved use -to manage the debilitating symptoms of narcolepsy. Given the blog’s topic and tendency to objectively address some of the peskier facts, it’s an especially surprising omission. Narcolepsy is a sleep disorder caused by failure of orexin neuropeptides to fire wake messages. One consequence of orexin’s failure to send wake-up calls, is suppressed dopamine function. Insomniac orexin, on the other hand, doesn’t stop firing wake messages. A new class of medication, suvorexant, for treating insomnia, acts directly on orexin receptors, turning off the wake messages and shifting orexin chemistry closer to a narcoleptic’s.

    I can appreciate that this blog is several years old and suvorexant’s potential for treating methamphetamine and other addictions was as yet unheard of, however, findings suggesting narcoleptics are “immune” to dopamine-related addiction, first noticed because they didn’t present with symptoms of developing addiction to the methamphetamine prescribed, were well-documented. Narcolepsy and methamphetamine or cocaine or heroin, is like lighting a match in a room full of prop dynamite free of explosives.

    I find the addiction recovery industry’s cheerleading for keeping opiate addicts, addicted, troubling. Why is this industry NOT talking about suvorexant’s potential to treat these kinds of addictions? Suvorexant is not addictive. It’s not psychoactive. So, why are we still giving opiate addicts, opiates??

    To be clear, I’m not suggesting methamphetamine is non-addictive. I’m only pointing out, some people are addiction-disabled in that a chemical imbalance prevents addiction to even the most addicting substances.

    Thank you,
    Sara

  11. Paul,

    If you are in the habit of friending strangers on Facebook who are like-minded and share your genuine commitment to advocacy and outreach, please consider adding me. I expect your profound insight and updates on the work you are doing will prove welcome additions to my news feed.

    Respectfully,
    Sara
    Facebook.com/saraelizabethwalters

 

Join the Conversation!

We invite you to share your thoughts and tell us what you think in this public forum. Before posting, please read our blog moderation guidelines. A first name or pseudonym is required and will be displayed with your comment. Your email address is also required, but will be kept private. (Please note that we use gravatars here, which are tied to your email address.) A website/blog/twitter address is optional.

Post a Comment: