DEPARTMENT FOR PRE-HOSPITAL/EMERGENCY MEDICINE/CRITICAL CARE

EMK Internal CME

Methamphetamine Abuse: A Review of
Literature
By: S. Mori
Registrar -EMK
 Outline
• Definitions
• History
• Burden of Methamphetamine
• Global and Local
• Pharmacology -> The Addiction Basis
• ‘MUD’ Effects:
• Neurological
• Cardiovascular
• Pulmonary
• Psychiatric
• The Meth-Intoxicated Patient
• Management Considerations
Definitions: ‘MUD’
• Methamphetamine Use Disorder (MUD):

• DSM 5 criteria – experience of at least 1 symptom of abuse of 3 symptoms of

dependence in 12months

• Continued use despite persistent or recurrent social or interpersonal problems

caused or exacerbated by the effects of methamphetamine

• Persistent desire (craving) or unsuccessful efforts to stop, cut down or control

methamphetamine use.

American Psychiatric Association, 2013.

History of Methamphetamine: A US
Perspective
• Amphetamine Type Substances (ATS) used in WWII to reduce fatigue and
suppress appetite

• ATS used in 1950-60s to treat depression and obesity

• CDAP&C Act restricted use of ATS since 1970

• Post-CDAP&C Act saw emergence of illicit manufacturing and distribution of

methamphetamine.

Journal of Drug & Alcohol Dependence, 2014

Epidemiology: Burden of
Methamphetamine
• 1.2million people in the US and 17.2million people globally have
reported using methamphetamine1

• In the Washington State rate of psychostimulant-involved

overdose increased by 5-fold from 2008-2017.2

• Methamphetamine is second only to cannabis in global abuse

1. International Journal of Addictive Behaviors, 2018

2. Addictive Behavior Reports, 2021
PNG Burden of Methamphetamine?
• No data available
locally
• Recent (21 Mar
2023) drug bust of
52kg (AU$15mill)
of meth produced
in PNG and
smuggled into
Australia.

Source: Post Courier Online, March 23 2023

Pharmacology Recap: The Addiction Basis
• Group: Phenethylamine and Amphetamine Psychoactive Class

• Stereochemistry: L-isomer and D-isomer (3-5x more powerful)

• The chemical structure of Methamphetamine allows it to influence MAJOR

neural pathways in dopamine, noradrenaline, serotonin and opioid
metabolism

• Hence: Euphoria, Increased Alertness, Analgesia, Satisfaction (Reward), etc.

Journal of Drug & Alcohol Dependence, 2014

 ‘MUD’- Neurological Effects
• BBB Disruption with resultant neurotoxicity due to loss of protective physiological
barrier1

• Neurodegeneration with loss of neurological tissue mass2-3

• Symptoms: Global Cognitive decline affecting memory, speech, attention, executive

functions, verbal learning and memory, visual memory and working memory

1. Journal of Biomedicine & Pharmacotherapy, 2023

2. International Journal of Addictive Behaviors, 2018
3. Journal of Drug & Alcohol Dependence, 2014
‘MUD’- Cardiovascular Effects
• Immediate response is ‘catecholaminergic’
• i.e. Increased HR and BP, positive inotropy, vasoconstriction
• Can persist >24hrs

• Long-Term: Development of Cardiomyopathy

• Multifactorial – can be ischemic related
• Chronic inflammation with resultant fibrosis
• Dilated ventricular chambers

• Symptoms: Heart Failure with Reduced EF (NYHA III-IV), Cardiogenic Shock, Chest
Pain, Hypotension
Journal of the American Heart Association, 2020
‘MUD’- Pulmonary Effects
• Pulmonary Hypertension
• Hypothesis: noradrenergic pulmonary vasoconstriction and smooth muscle
proliferation

• Emphysema and Pneumothorax

• Association with direct inhalation routes

• Pneumonia and Lung Abscess

• Possible effects of MUD on adaptive immunity
• Also risk of polysubstance abuse and high-risk sexual behavior

Journal of Pulmonology, 2022

‘MUD’- Psychiatric Effects
• Meta-analysis papers show a 43% event rate of Methamphetamine Induced
Psychotic Disorder (MIPD) 1

• Methamphetamine-Induced psychosis, anxiety and depression highest mental

health issues associated with high-risk sexual behavior 2

• Withdrawal Symptomology: anhedonia, hypersomnia, irritability, anxiety,

aggression and deep cravings for methamphetamine 3

1. Journal of Psychiatry Research, 2018

2. Journal of Mental Health and Prevention, 2023
3. Journal of Drug & Alcohol Dependence, 2014
‘The Meth Intoxicated Patient’
• In addition to systemic-related effects, patients may present
acutely with:
• Severe Psychiatric Agitation
• Hyper- or Hypotension
• Hyperthermia
• Metabolic and Electrolyte Derangements

• Medscape, 2023
 Management
• Guided by ABCDs.
• Special Consideration:
• Severe Agitation
• Use Droperidol 10mg IM (If IV not possible) –Observe for QT-Prolongation!

• Hypertension and Tachycardia

• Use Beta-Blockers (labetalol) and Vasodilators (eg. Nitroprusside, hydralazine)

• Acute Coronary Syndrome (Coronary Spasm-Induced)

• Similar to standard ACS Mx – Morphine, Aspirin, Nitrates, Beta-Blockers, Heparin
• If evidence of ST-Elevation: Thrombolytic Mx (Chemical or Mechanical)

• Seizures
• Use Benzodiazepines to stop fit; Load with Phenobarbital to prevent further fits
• Risk of Intracranial Hemorrhage in Meth-Induced Fitting -> CT Brain Indicated

• Rhabdomyolysis
• Hallmark -> Elevated CK levels
• Aggressive fluid resus/Consider Na +-Bicarb/Correct Electrolytes/Monitor Renal Functions

• Medscape, 2023
Management Cont..
• Consider Admission to HDU/Critical Care for patients with:
• Persistent hypertension
• Severe rhabdomyolysis
• Seizures
• Stroke
• Coma
• Hyperthermia
• Congestive heart failure
• Acute coronary syndrome

Medscape, 2023
 Thank You
Comments or Questions..
References
• Courtney KE and Ray LA (2014). ‘Methamphetamine: An Update on Epidemiology, Pharmacology, Clinical Phenomenology, and Treatment
Literature’ Journal of Drug and Alcohol Dependence;
• Fang SC et al (2023). ‘Associations and relative risks of pulmonary hypertension and lung diseases in individuals with methamphetamine
use disorder’ Journal of Pulmonology, DOI: https://doi.org/10.1016/j.pulmoe.2023.01.003
• Njuguna H et al (2021). ‘Increasing rates of methamphetamine/amphetamine-involved overdose hospitalizations in Washington State, 2010–
2017’ Addictive Behaviours Report; vol40
• Pang L and Wang Y (2023). ‘Overview of blood-brain barrier dysfunction in methamphetamine abuse’ Biomedicine and Pharmacotherapy;
vol161
• Pavan KV et al (2020). Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art
Review, Journal of the American Heart Association; 9(e016704)
• Potvin S et al (2018). ‘Cognitive deficits in individuals with methamphetamine use disorder: A meta-analysis’ Journal of Addictive
Behaviours; vol80
• Richards JR et al (2023). ‘Methamphetamine Toxicity Treatment & Management’ Medscape [Online] DOI:
https://emedicine.medscape.com/article/820918-treatment#d10
• Somma V et al (2022). ‘Methamphetamine-associated cardiomyopathy: an addiction medicine perspective’ Internal Medicine Journal; vol53,
pp. 21-26
• Wand H et al (2023). ‘Investigating associations between methamphetamine use, mental health and risky sexual behaviours amongst
Aboriginal and Torres Strait Islander peoples’ Mental Health and Prevention; vol30