What are methamphetamine's risks?

Methamphetamine is a stimulant that can be snorted, smoked, or injected. It is less expensive and possibly more addictive than cocaine or heroin. It first became popular as a recreational drug in the 1960s, and acquired many street names, including meth, crystal, speed, ice, and crank. Methamphetamine use reached epidemic proportions in Japan as early as a decade after World War II, and it is still Japan's most popular illicit drug. In the United States, methamphetamine use burgeoned in Hawaii and quickly spread to the West Coast. It is now a countrywide problem, not at all limited to big cities. The highest rates of abuse are found in rural Idaho, Utah, and Iowa.

About 1 in 25 Americans has tried methamphetamine, and the reasons for its popularity are obvious: It boosts energy, induces euphoria, and suppresses appetite. In one study of methamphetamine use in Iowa, women used it to escape their troubles, cope with family problems, improve concentration, increase strength, and lose weight.

But when used habitually, methamphetamine has adverse effects that range from mild to disastrous. Common psychiatric symptoms are insomnia, irritability, and aggressive behavior. The drug causes intellectual deficits, anxiety, and depression. Chronic users become disorganized and unable to cope with everyday problems. The risk of developing psychotic symptoms — hallucinations and delusions — is very high. Despair and suicidal thinking can set in when the stimulant effect wears off. During intoxication, the body (and probably brain) temperature rises, sometimes resulting in convulsions. Methamphetamine can damage blood vessels in the brain, causing strokes. High fevers or collapse of the circulatory system can cause death.

This drug has become frighteningly popular among gay and bisexual men, where it has been linked to an increase in unsafe sex practices. Methamphetamine use — and needle sharing — have been linked to a spike in HIV and hepatitis C infections in this population.

Methamphetamine also harms important nerve pathways, perhaps irreversibly. The drug delivers euphoria by releasing the neurotransmitter dopamine in the brain's reward system. Overstimulation eventually damages or destroys the nerve cells in these circuits, impairing dopamine transport and reducing the efficiency of dopamine receptors; the reward system is, in a sense, worn out. The brain recovers somewhat after months of abstinence, but problems often remain. Former methamphetamine addicts may suffer from chronic apathy and anhedonia (inability to experience pleasure) for years.

Unlike cocaine, methamphetamine is not smuggled into the United States by drug traffickers. Illicit manufacturers use easily available ingredients to quickly set up crude laboratories and move on when they are threatened. Production releases poisonous gases and results in toxic waste that is often dumped down household drains, in a backyard, or at a roadside. Over-the-counter cold medicines (ephedrine and pseudoephedrine) are commonly used in production, which is one reason for federal and state restrictions on their sale.

There are no simple solutions to this growing health problem. Like all drug abuse, methamphetamine addiction is difficult to treat. Standard substance abuse treatment methods such as education, behavior therapy, individual and family counseling, and support groups may be effective for some. Methamphetamine abusers often use other illicit drugs as well, a problem that can be addressed as part of a comprehensive program.

Perhaps the best hope is that, as scientists learn more about what is going wrong in the brains of addicts, they will develop drug treatments to correct the flawed biology that fosters addiction. But despite the growing body of research in this area, reliable treatments are probably still years away.

November 2005 Update