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Research Report Revised October 2019
Methamphetamine Research Report
Table of Contents
Methamphetamine Research Report Overview What is methamphetamine? What is the scope of methamphetamine use in the United States? How is methamphetamine misused? How is methamphetamine manufactured? How is methamphetamine different from other stimulants, such as cocaine? What are the immediate (short-term) effects of methamphetamine misuse? What are the long-term effects of methamphetamine misuse? What are the risks of methamphetamine misuse during pregnancy? Are people who misuse methamphetamine at risk for contracting HIV/AIDS and hepatitis B and C? What treatments are effective for people who misuse methamphetamine? What treatments are under development for methamphetamine use and addiction? Where can I get further information about methamphetamine? References
Methamphetamine Research Report
Provides an overview of the latest scientific findings on methamphetamine, including short- and long- term health consequences, effects on pregnancy, and potential prevention and treatment options.
This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Overview
The misuse of methamphetamine—a potent and highly addictive stimulant—remains an extremely serious problem in the United States. In some areas of the country, it poses an even greater threat than opioids, and it is the drug that most contributes to violent crime.
36 According to data from the 2017 National Survey on Drug Use and Health (NSDUH), over 14.7 million people (5.4 percent of the population) have tried methamphetamine at least once. NSDUH also reports that almost 1.6 million people used methamphetamine in the year leading up to the survey,
1 and it remains one of the most commonly misused stimulant drugs in the world.
37
The consequences of methamphetamine misuse are terrible for the individual—psychologically, medically, and socially. Using the drug can cause memory loss, aggression, psychotic behavior, damage to the cardiovascular system, malnutrition, and severe dental problems. Methamphetamine misuse has also been shown to contribute to increased transmission of infectious diseases, such as hepatitis and HIV/AIDS.
Beyond its devastating effects on individual health, methamphetamine misuse threatens whole communities, causing new waves of crime, unemployment, child neglect or abuse, and other social ills. A 2009 report from the RAND Corporation noted that methamphetamine misuse cost the nation approximately $23.4 billion in 2005.
1
But the good news is that methamphetamine misuse can be prevented and addiction to the drug can be treated with behavioral therapies. Research also continues toward development of new
What is the scope of methamphetamine use in the United
States?
All data refer to the United States population.
How many people use methamphetamine?
Among people aged 12 or older in 2020, 0.9% (or about 2.6 million people) reported using methamphetamine in the past 12 months. Source: 2020 National Survey on Drug Use and Health
How many young students use methamphetamine?
In 2021, an estimated 0.2% of 8 graders, 0.2% of 10 graders, and 0.2% of 12 graders reported using methamphetamine in the past 12 months. Source: 2021 Monitoring the Future Survey
th th th
How many people have a methamphetamine use disorder?
Among people aged 12 or older in 2020, an estimated 0.6% (or about 1.5 million people) had a methamphetamine use disorder in the past 12 months. Source: 2020 National Survey on Drug Use and Health
How many people die from methamphetamine overdose?
In 2020, approximately 23,837 people died from an overdose involving psychostimulants with abuse potential other than cocaine (primarily methamphetamine). Learn more about overdose death rates. Source: CDC WONDER Database
How is methamphetamine misused?
Methamphetamine comes in several forms and can be smoked, snorted, injected, or orally ingested. The preferred method of using the drug varies by geographical region and has changed over time. 37,38,
Smoking or injecting methamphetamine puts the drug very quickly into the bloodstream and brain, causing an immediate, intense "rush" and amplifying the drug’s addiction potential and adverse health consequences. The rush, or "flash," lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria—a high, but not an intense rush. Snorting produces effects within 3 to 5 minutes, and oral ingestion produces effects within 15 to 20 minutes.
4
As with many stimulants, methamphetamine is most often misused in a "binge and crash" pattern. Because the pleasurable effects of methamphetamine disappear even before the drug concentration in the blood falls significantly, users try to maintain the high by taking more of the drug. In some cases, people indulge in a form of binging known as a "run," foregoing food and sleep while continuing to take the drug for up to several days.
37,38,
How is methamphetamine manufactured?
Currently, most methamphetamine in the United States is produced by transnational criminal organizations (TCOs) in Mexico.
44 This methamphetamine is highly pure, potent, and low in price. The drug can be easily made in small clandestine laboratories, with relatively inexpensive over-the-counter ingredients such as pseudoephedrine, a common ingredient in cold medications.
To curb production of methamphetamine, Congress passed the Combat Methamphetamine Epidemic Act in 2005, which requires that pharmacies and other retail stores keep logs of purchases of products containing pseudoephedrine and limits the amount of those products an individual can purchase per day. Restrictions on the chemicals used to make methamphetamine in the United States have dramatically reduced domestic production of the drug. In 2010, there were 15,256 domestic methamphetamine laboratory incidents—a figure that has fallen over 80 percent to 3,036 in 2017.
44
Data on drug seizures indicate that most domestic production of methamphetamine is now conducted in small laboratories that make two ounces or less of the drug using common household items.
44
Mexico has also tightened its restrictions on pseudoephedrine and other methamphetamine precursor chemicals. But manufacturers adapt to these restrictions via small- or large-scale "smurfing" operations: obtaining pseudoephedrine from multiple sources, below the legal thresholds, using multiple false identifications. Manufacturers in Mexico are also increasingly using a different production
Although both methamphetamine and cocaine increase levels of dopamine, administration of methamphetamine in animal studies leads to much higher levels of dopamine, because nerve cells respond differently to the two drugs. Cocaine prolongs dopamine actions in the brain by blocking the re-absorption (re-uptake) of the neurotransmitter by signaling nerve cells. At low doses, methamphetamine also blocks the re-uptake of dopamine, but it also increases the release of dopamine, leading to much higher concentrations in the synapse (the gap between neurons), which can be toxic to nerve terminals.38,
Methamphetamine versus Cocaine Methamphetamine Cocaine
Stimulant Stimulant and local anesthetic
Man-made Plant-derived
Smoking produces a long-lasting high Smoking produces a brief high
50% of the drug is removed from the body in 12 hours 50% of the drug is removed from the body in 1 hour
Increases dopamine release and blocks dopamine re-uptake Blocks dopamine re-uptake
Limited medical use for ADHD, narcolepsy, and weight loss
Limited medical use as a local anesthetic in some surgical procedures
What are the immediate (short-term) effects of
methamphetamine misuse?
As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. Methamphetamine can also cause a variety of cardiovascular problems, including rapid heart rate, irregular heartbeat, and increased blood pressure. Hyperthermia (elevated body temperature) and convulsions may occur with methamphetamine overdose, and if not
treated immediately, can result in death.
37,
The exact mechanisms whereby drugs like methamphetamine produce euphoria (the pleasurable high) are still poorly understood. But along with euphoria, methamphetamine use releases very high levels of the neurotransmitter dopamine in the reward circuit, which "teaches" the brain to repeat the pleasurable activity of taking the drug. Dopamine is involved in motivation and motor function and its release in the reward circuit is a defining feature of addictive drugs. The elevated release of dopamine produced by methamphetamine is also thought to contribute to the drug's deleterious effects on nerve terminals in the brain.
Short-term effects may include: increased attention and decreased fatigue increased activity and wakefulness decreased appetite euphoria and rush increased respiration rapid/irregular heartbeat hyperthermia
What are the long-term effects of methamphetamine misuse?
Long-term methamphetamine abuse has many negative consequences, including addiction. Addiction is a chronic, relapsing disease, characterized by compulsive drug seeking and use and accompanied by functional and molecular changes in the brain.
As is the case with many drugs, tolerance to methamphetamine’s pleasurable effects develops when it is taken repeatedly. Abusers often need to take higher doses of the drug, take it more frequently, or change how they take it in an effort to get the desired effect. Chronic methamphetamine abusers may
Recovery of Brain Dopamine Transporters in Chronic Methamphetamine (METH) Users Methamphetamine misuse greatly reduces the binding of dopamine to dopamine transporters (highlighted in red and green) in the striatum, a brain area important in memory and movement. With prolonged abstinence, dopamine transporters in this area can be restored.
Methamphetamine misuse also has been shown to have negative effects on non-neural brain cells called microglia. These cells support brain health by defending the brain against infectious agents and removing damaged neurons. Too much activity of the microglial cells, however, can assault healthy neurons. A study using brain imaging found more than double the levels of microglial cells in people who previously misused methamphetamine compared to people with no history of methamphetamine misuse, which could explain some of the neurotoxic effects of methamphetamine.
13
Some of the neurobiological effects of chronic methamphetamine misuse appear to be, at least, partially reversible. In the study just mentioned, abstinence from methamphetamine resulted in less excess microglial activation over time, and users who had remained methamphetamine-free for 2 years exhibited microglial activation levels similar to the study’s control subjects.
14 A similar study found that while biochemical markers for nerve damage and viability persist in the brain through 6 months of abstinence from methamphetamine, those markers return to normal after a year or more without taking the drug.
15 Another neuroimaging study showed neuronal recovery in some brain regions following prolonged abstinence (14 but not 6 months).
16 This recovery was associated with improved performance on motor and verbal memory tests. Function in other brain regions did not recover even after 14 months of abstinence, indicating that some methamphetamine-induced changes
are very long lasting. Methamphetamine use can also increase one’s risk of stroke, which can cause irreversible damage to the brain. A recent study even showed higher incidence of Parkinson’s disease among past users of methamphetamine.
17
In addition to the neurological and behavioral consequences of methamphetamine misuse, long-term users also suffer physical effects, including weight loss, severe tooth decay and tooth loss, and skin sores.
38 The dental problems may be caused by a combination of poor nutrition and dental hygiene as well as dry mouth and teeth grinding caused by the drug. Skin sores are the result of picking and scratching the skin to get rid of insects imagined to be crawling under it.
38
Long-term effects may include: addiction psychosis, including: paranoia hallucinations repetitive motor activity
changes in brain structure and function deficits in thinking and motor skills increased distractibility memory loss aggressive or violent behavior mood disturbances severe dental problems weight loss
who misuse methamphetamine than among other drug users, and some epidemiologic reports are already showing this trend. For example, while the link between HIV infection and methamphetamine misuse has not yet been established for heterosexuals, data show an association between methamphetamine misuse and the spread of HIV among men who have sex with men.
Methamphetamine misuse may also worsen the progression of HIV disease and its consequences. In animal studies, methamphetamine has been shown to increase viral replication.
27 Clinical studies in humans suggest that current methamphetamine users taking highly active antiretroviral therapy (HAART) to treat HIV may be at greater risk of developing AIDS than non-users, possibly because of poor medication adherence.
28, Methamphetamine users with HIV also have shown greater neuronal injury and cognitive impairment due to HIV, compared with those who do not misuse the drug.
30, 31, 32
NIDA-funded research has found that, through substance use disorder treatment, prevention, and community-based outreach programs, drug users can change their HIV risk behaviors. Drug misuse and drug-related risk behaviors, such as needle sharing and risky sexual practices, can be reduced significantly, thus decreasing the risk of exposure to HIV and other infectious diseases. Therefore, drug treatment is HIV prevention.
Dopamine Pathways In the brain, dopamine plays an important role in both movement and the reinforcement of rewarding behaviors. As a major chemical messenger in the reward pathway, dopamine is manufactured in nerve cell bodies located within a group of neurons called the ventral tegmental area and is released in the nucleus accumbens, which is a key brain region for learning to repeat pleasurable activities, as well as in the prefrontal cortex, which is responsible for higher cognitive functions like decision-making and self-control. Dopamine’s regulation of motor functions is linked to a separate pathway: Cell bodies in the substantia nigra manufacture and release dopamine into the striatum, which is involved in executing and inhibiting movements and reward-seeking behavior.
What treatments are effective for people who misuse
methamphetamine?
The most effective treatments for methamphetamine addiction at this point are behavioral therapies, such as cognitive-behavioral and contingency management interventions. For example, the Matrix Model—a 16-week comprehensive behavioral treatment approach that combines behavioral therapy, family education, individual counseling, 12-step support, drug testing, and encouragement for non- drug-related activities—has been shown to be effective in reducing methamphetamine misuse.
33,
Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective. Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR), an incentive-based method for promoting cocaine and methamphetamine abstinence, has demonstrated efficacy among methamphetamine misusers through NIDA’s National Drug Abuse Clinical Trials Network.
35
Although medications have proven effective in treating some substance use disorders, there are currently no medications that counteract the specific effects of methamphetamine or that prolong abstinence from and reduce the misuse of methamphetamine by an individual addicted to the drug.
What treatments are under development for
methamphetamine use and addiction?
Pharmacological Treatments
There are currently no medications that counteract the specific effects of methamphetamine or that prolong abstinence from and reduce the use of methamphetamine by an individual addicted to the drug. NIDA has made research on the development of medications to treat addiction to stimulants and other drugs a priority, and NIDA-funded researchers are investigating a number of pharmacological approaches for treating methamphetamine use disorder.
When developing drug treatments, researchers typically examine the impact of potential medications that have neurobiological effects that may counter the known physiological consequences of chronic methamphetamine use. They may also test medications that have shown promise in treating other
Hormones: The hormones cholecystokinin-8 and oxytocin have both shown promise in reducing the rewarding properties of methamphetamine in animals.
Nonpharmacological Treatments
Nonpharmacological treatments do not involve use of medications. Such therapies may instill behavioral changes by altering brain activity patterns (TMS), helping people learn how to monitor and control brain activity to curb symptoms of addiction (neurofeedback), or keeping drugs out of the brain (vaccines). Although further research is needed on these approaches, they may provide additional options for treatment providers and patients.
Transcranial Magnetic Stimulation: TMS is a noninvasive method of stimulating the brain using magnetic pulses for therapeutic purposes. Researchers are studying this approach as a treatment for substance use disorders, but this work is in very early stages.
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Neurofeedback: Neurofeedback (also called neurotherapy or neurobiofeedback) is a type of biofeedback that uses real-time displays of brain activity—most commonly electroencephalography—to teach people how to regulate their own brain function. In one study, neurofeedback to treatment for methamphetamine use disorder reduced addiction severity and improved mental health and overall quality of life.
53
Vaccines and antibodies: Methamphetamine vaccines, which recruit the body’s immune system to keep the drug from entering the brain, are currently being tested in animals,
54 and a human clinical trial is currently underway to test an immunologic agent called a monoclonal antibody, which binds to methamphetamine and neutralizes it before it can exert its effects.
Where can I get further information about
methamphetamine?
What’s on the NIDA Web Site
Information on drugs of abuse and related health consequences
NIDA publications, news, and events Resources for health care professionals Funding information (including program announcements and deadlines) International activities Links to related Web sites (access to websites of many other organizations in the field)
Other Resources
Information on drug misuse and other mental disorders is also available through these websites:
National Institute of Mental Health (NIMH) National Institute on Alcohol Abuse and Alcoholism (NIAAA) Substance Abuse and Mental Health Services Administration (SAMHSA)
This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
References
- The RAND Corporation. The economic cost of methamphetamine use in the United States, 2005. The RAND Corporation, 2009. Available at: http://www.rand.org/content/dam/rand/pubs/monographs/2009/RAND_MG829.pdf. Last accessed March 22, 2013.
- Substance Abuse and Mental Health Services Administration. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Available at: https://www.samhsa.gov/data/report/results-2016-national-survey-drug-use-and-health-detailed- tables. Last accessed July 3, 2018.
- Groman, S.M.; Morales A.M.; Lee, B.; London, E.D.; Jentsch, J.D. Methamphetamine-induced increases in putamen gray matter associate with inhibitory control. Psychopharmacology 229(3):527-538, 2013. Abstract.
- Sekine, Y.; Ouchi, Y.; Sugihara, G.; Takei, N.; Yoshikawa, E.; Nakamura, K.; Iwata, Y.; Tsuchiya, K.J.; Suda, S.; Suzuki, K.; Kawai, M.; Takebayashi, K.; Yamamoto, S.; Matsuzaki, H.; Ueki, T.; Mori, N.; Gold, M.S.; and Cadet, J.L. Methamphetamine causes microglial activation in the brains of human abusers. J Neurosci 28(22):5756–5761, 2008.
- Ibid.
- Salo, R.; Buonocore, M.H.; Leamon, M.;Natsuaki, T.; Waters, C.;Moore, C.D.;Galloway, G.P.; and Nordahl, T.E. Extended findings of brain metabolite normalization in MA-dependent subjects across sustained abstinence: A proton MRS study. Drug and Alcohol Dependence 113(2-3):113-138,
- Wang G-J; Volkow, N.D.; Chang, L.; Miller, E.; Sedler, M.; Hitzemann, R.; Zhu, W.; Logan, J.; Ma, Y.; and Fowler, J.S. Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence. Am J Psychiatry 161(2):242–248, 2004.
- Kuehn, B.M. Meth use linked to risk of Parkinson disease. JAMA 306:814, 2011.
- Wouldes, T.; LaGasse, L.; Sheridan, J.; and Lester, B. Maternal methamphetamine use during pregnancy and child outcome: What do we know? N Z Med J 117:U1180, 2004.
- Smith, L.M.; LaGasse, L.L.; Derauf, C.; Grant, P.; Shah, R.; Arria, A., Huestis, M.; Haning, W.; Strauss, A.; Della Grotta, S.; Liu, J.; and Lester, B.M. The Infant Development, Environment, and Lifestyle Study: Effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics 118(3):1149–1156, 2006.
- Smith, L.M.: LaGasse, L.L.; Derauf, C.; Grant, P.; Shah, R.; Arria, A.; Huestis, M.; Haning, W.; Strauss, A.; Della Grotta, S.; Fallone, M.; Liu, J.; and Lester, B.M. Prenatal methamphetamine use and neonatal neurobehavioral outcome. Neurotoxicol Teratol 30(1):20–28, 2008. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2358984/. Last accessed April 9, 2013.
- Kiblawi ZN, Smith LM, Diaz SD, et al. Prenatal Methamphetamine Exposure and Neonatal and Infant Neurobehavioral Outcome: Results from the IDEAL Study. Substance abuse: Official publication of the Association for Medical Education and Research in Substance Abuse. 2014;35(1):68-73. doi:10.1080/08897077.2013.814614.
- Wouldes TA, LaGasse LL, Huestis MA, DellaGrotta S, Dansereau LM, Lester BM. Prenatal methamphetamine exposure and neurodevelopmental outcomes in children from 1 to 3 years. Neurotoxicology and teratology. 2014;42:77-84. doi:10.1016/j.ntt.2014.02.004.
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- Himes SK, LaGasse LL, Derauf C, et al. Risk for Neurobehavioral Disinhibition in Prenatal Methamphetamine-Exposed Young Children with Positive Hair Toxicology Results. Therapeutic drug monitoring. 2014;36(4):535-543.
- Smith LM, Diaz S, LaGasse LL, et al. Developmental and behavioral consequences of prenatal methamphetamine exposure: a review of the Infant Development, Environment, and Lifestyle (IDEAL) Study. Neurotoxicology and teratology. 2015;51:35-44. doi:10.1016/j.ntt.2015.07.006.
- Eze N, Smith LM, LaGasse LL, et al. School-Aged Outcomes following Prenatal Methamphetamine Exposure: 7.5 Year Follow-Up From The Infant Development, Environment, and Lifestyle (IDEAL) Study. The Journal of pediatrics. 2016;170:34-38.e1. doi:10.1016/j.jpeds.2015.11.070.
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- Ellis, R.J.; Childers, M.E.; Cherner, M.; Lazzaretto, D.; Letendre, S.; and the HIV Neurobehavioral Research Center Group. Increased human immunodeficiency virus loads in active methamphetamine users are explained by reduced effectiveness of antiretroviral therapy. J Infect Dis 188(12):1820–1826, 2003.
- Fairbairn, N.; Kerr, T.; Milloy, M.-J.; Zhang, R.; Montaner, J.; and Wood, E. Crystal methamphetamine injection predicts slower HIV RNA suppression among injection drug users. Addict Beh 36(7):762–763, 2011.
- Chang, L.; Ernst, T.; Speck, O.; and Grob, C.S. Additive effects of HIV and chronic methamphetamine use on brain metabolite abnormalities. Am J Psychiatry 162:361–369, 2005.
- Rippeth, J.D.; Heaton, R.K.; Carey, C.L.; Marcotte, T.D.; Moore, D.J.; Gonzalez, R.; Wolfson, T.; and Grant, I. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc 10:1–14, 2004.
- Blackstone, K.; Iudicello, J.E.; Morgan, E.E. et al. Human immunodeficiency virus infection heightens concurrent risk of functional dependence in persons with long-term methamphetamine use. Journal of Addiction Medicine 7(4):255–263, 2013.
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