Definition :

Methamphetamine is a powerful and highly addictive stimulant that acts on the central nervous system.

Also known as meth, blue, ice, and crystal, among many other terms, it takes the form of a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol.

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Chemistry:

Methamphetamine (CAS-537-46-2) is a member of the phenethylamine family, which includes a range of substances that may be stimulants, entactogens or hallucinogens. Thus, methamphetamine is N,α-dimethylphenethylamine.

According to IUPAC, the fully systematic name is N,α-dimethylbenzeneethanamine. The asymmetric α-carbon atom gives rise to two enantiomers. These two forms were previously called the [–]- or l-stereoisomer and the [+]- or d-stereoisomer, but in modern usage are defined as the R- and S-stereoisomers.

Molecular structure:

molecular structure of methamphetamine <<< IMAGE >>>>

Physical form

Methamphetamine base is a colourless volatile oil insoluble in water. The most common salt is the hydrochloride (CAS-51-57-0), which occurs as a white or off-white powder or as crystals soluble in water. Illicit products mostly consist of powders, but the pure crystalline hydrochloride is known as ‘ice’. Tablets containing methamphetamine may carry logos similar to those seen on MDMA and other ecstasy tablets.

Etymology :

Methamphetamine was developed early in the 20th century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Like amphetamine, methamphetamine causes increased activity and talkativeness, decreased appetite, and a pleasurable sense of well-being or euphoria. However, methamphetamine differs from amphetamine in that, at comparable doses, much greater amounts of the drug get into the brain, making it a more potent stimulant. It also has longer-lasting and more harmful effects on the central nervous system. These characteristics make it a drug with high potential for widespread misuse.

During World War 2, methamphetamine — similar in structure to amphetamine — was used to keep military personnel alert and to improve endurance and mood.

In time, it became clear that methamphetamine was dangerously addictive. In the 1970s, the drug was added to the schedule II list of controlled substances.

Methamphetamine has been classified by the U.S. Drug Enforcement Administration as a Schedule II stimulant, which makes it legally available only through a nonrefillable prescription. Medically it may be indicated for the treatment of attention deficit hyperactivity disorder (ADHD) and as a short-term component of weight-loss treatments, but these uses are limited and it is rarely prescribed; also, the prescribed doses are far lower than those typically misused.

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Uses of Methamphetamine HCL:

Read the Medication Guide provided by your pharmacist before you start using methamphetamine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily. During treatment, your doctor may occasionally recommend stopping the medication for a short time to see if there are any changes in your behavior and whether the medication is still needed.

Do not take this medication late in the day because it may cause you to have trouble sleeping.

If you suddenly stop using this medication, you may have withdrawal symptoms (such as severe tiredness, sleep problems, mental/mood changes such as depression). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used methamphetamine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.

When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

Tell your doctor if you do not get better or if you get worse.

Mode of use

Methamphetamine may be ingested, snorted and, less commonly, injected or smoked. Unlike the sulfate salt of amphetamine, methamphetamine hydrochloride, particularly the crystalline form (ice), is sufficiently volatile to be smoked. When ingested, a dose may vary from several tens to several hundreds of milligrams depending on the purity and the isomeric composition.

Overdose:

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: restlessness, shaking (tremor), fast breathing, mental/mood changes, irregular heartbeat, muscle pain/tenderness, weakness, nausea, vomiting, change in the amount of urine.

Notes

Do not share this medication with others. Sharing it is against the law.

Lab and/or medical tests (such as blood pressure, pulse, height and weight in children) should be done while you are taking this medication. Keep all medical and lab appointments.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.Information last revised April 2019. Copyright(c) 2019 First Databank, Inc.

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Control status :

The S-enantiomer is listed in Schedule II of the United Nations 1971 Convention on Psychotropic Substances. The racemate (a 50:50 mixture of the R- and S-stereoisomers) is also listed in the same Schedule, but the R-enantiomer is not separately identified in the Convention.

Side effects of Methamphetamine HCL :

The short-term and long-term impact of the individual

When taken, meth and crystal meth create a false sense of well-being and energy, and so a person will tend to push his body faster and further than it is meant to go. Thus, drug users can experience a severe “crash” or physical and mental breakdown after the effects of the drugs wear off.

Because continued use of the drug decreases natural feelings of hunger, users can experience extreme weight loss. Negative effects can also include disturbed sleep patterns, hyperactivity, nausea, delusions of power, increased aggressiveness and irritability.

Other serious effects can include insomnia, confusion, hallucinations, anxiety and paranoia.1 In some cases, use can cause convulsions that lead to death.

Long-range damage

In the long term, meth use can cause irreversible harm: increased heart rate and blood pressure; damaged blood vessels in the brain that can cause strokes or an irregular heartbeat that can, in turn, cause cardiovascular2 collapse or death; and liver, kidney and lung damage.

Users may suffer brain damage, including memory loss and an increasing inability to grasp abstract thoughts. Those who recover are usually subject to memory gaps and extreme mood swings.< p>

SHORT-TERM EFFECTS OF METHAMPHETAMINE

>Loss of appetite

> Increased heart rate, blood pressure, body temperature

> Dilation of pupils

> Disturbed sleep patterns

> Nausea

> Bizarre, erratic, sometimes violent behavior

> Hallucinations, hyperexcitability, irritability

> Panic and psychosis

> Convulsions, seizures and death from high doses

LONG-TERM EFFECTS OF METHAMPHETAMINE

Permanent damage to blood vessels of heart and brain, high blood pressure leading to heart attacks, strokes and death

> Liver, kidney and lung damage

> Destruction of tissues in nose if sniffed

> Respiratory (breathing) problems if smoked

> Infectious diseases and abscesses if injected

> Malnutrition, weight loss

> Severe tooth decay

> Disorientation, apathy, confused exhaustion

> Strong psychological dependence

> Psychosis

> Depression

> Damage to the brain similar to Alzheimer’s disease,3 stroke and epilepsy

Methamphetamine and Pregnancy:

Taking methamphetamine while pregnant could lead to premature birth, low birth weight, or withdrawal symptoms in a newborn.

Let your doctor know if you are pregnant or might become pregnant before using this medication.

Don’t breastfeed while taking methamphetamine because it can pass into breast milk and may harm a breastfeeding baby.

Methamphetamine can affect growth in children.

Do not give this medicine to a child who is younger than 6 years old or use it to treat obesity in anyone under the age of 12 without speaking to a doctor first.

Methamphetamine Interactions:

Do not take methamphetamine if you have used a monoamine oxidase inhibitor (MAOI) in the past 14 days since a dangerous drug interaction could occur.

MAOIs include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and other drugs used to treat depression or Parkinson’s disease.

Tell your doctor about all the medications you take, start, or stop taking during your treatment with methamphetamine, especially:

> Medication to treat depression (antidepressants) or mental illness

> Insulin

> Blood pressure medication

> Seizure medication

In addition, other prescription and over-the-counter medicines, vitamins, illegal or recreational drugs, or herbal products may also interact with methamphetamine.

Other Methamphetamine Precautions

Methamphetamine can impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Do not take methamphetamine late in the day or you could have problems sleeping.

Avoid drinking cranberry juice or taking vitamin C at the same time you take the medication, because these can result in your body absorbing less of the medicine.

Methamphetamine expert opinion :

Dr. med. Wolf-Dietrich Braunwarth : Practice of psychotherapy, Bayreuth

Members of the consensus group: Klinikum Nürnberg [Nuremberg]

Background

Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad.

Methods

A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique.

Results

The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in randomized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events.

Conclusion

Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptom-oriented treatment is recommended. Psychotherapy and exercise should be offered as well.

Physicians and staff working in hospitals, private medical practices, and addiction treatment centers are now increasingly confronted with abuse of methamphetamine (“meth,” “crystal meth”). In Germany, the problem is at its most severe in certain areas of Saxony, Thuringia, and Bavaria that are near the Czech border. Methamphetamine abuse also seems to be prevalent in particular circles, e.g., MSM (men who have sex with men). So-called “chem-sex,” i.e., sexual intercourse under the influence of drugs, is associated with intravenous use of the drug, which carries greater risks than oral use (1). Methamphetamine is more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. The treatment of methamphetamine-related disorders is challenging for the multidisciplinary drug help facilities as well as for first-aid deliverers and hospital staff. Support is needed, especially because the German and foreign guidelines on treatment for drug abuse do not deal with methamphetamine specifically and are also largely out of date (2).

This S3 guideline was developed by an expert panel between April 2015 and September 2016, according to the criteria established by the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften, AWMF), on the initiative of the German Federal Drug Commissioner and on behalf of the German Medical Association, with funding from the Federal Ministry of Health. Methodological assistance was provided by the German Agency for Quality in Medicine (Ärztliche Zentrum für Qualität in der Medizin). The 21 participating experts included physicians from inpatient and outpatient care settings in multiple specialties, psychotherapists, caregivers, social workers, and representatives of patient self-help groups (eTables 1 and ​and2).2). Further experts were consulted on specific questions.

Categories: STIMULANT

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