Addiction

1Like many drugs, amphetamines and their derivatives can cause addiction. The World Health Organisation (WHO) defines drug addiction as “a mental and sometimes also a physical state, resulting from the interaction between a product and an organism”. This interaction causes behavioural changes, and can drive the user to take the product continuously or periodically in order to experience its pleasurable mental effects, if he is not already taking the drug simply to avoid the sickness caused by deprivation. Of course, a single person can be addicted to many products.

2Methamphetamine and other psycho-stimulant drugs rarely cause physical addiction and a resultant state of withdrawal. Hence, weaning, which in the strict sense of the term corresponds to the first step of the detoxification of a person physically dependent on an addictive substance, does not apply here. On the other hand, the methamphetamine user rapidly develops a strong mental addiction to consuming amphetamine derivatives. Tolerance is the pharmacological state of adapting to a drug characterised by a decrease in the effects produced by the same dose of a drug leading to a compensatory increase in quantities of it consumed. Tolerance is not yet clearly demonstrated in the context of the use of psycho-stimulants,1 but it seems to develop slowly in the individual drug user.2

How Methamphetamine Works

3Amphetamine derivatives such as methamphetamines modify the working of the brain over a prolonged period, sometimes permanently. They affect the brain’s production of dopamine, noradrenaline and serotonin, causing large amounts of dopamine and noradrenaline to be released. These amines, being neurotransmitters, act on the central nervous system and result in an intense sensation of well being, pleasure and euphoria in the consumer. Amphetamines “empty” cells of their neurotransmitter contents3 and cause a very steep increase in the extra-cellular concentration of dopamine at the level of the “compensating circuits” of the brain,4 since they also inhibit neural recapture. Amphetamines are therefore stimulants which cause physical and mental hyperactivity, which is why they are sometimes called “wake-up amines”. Prolonged amphetamine usage has an undesirable effect, since after a period of weeks the brain’s ability to release dopamine and therefore enable a normal functioning of the psyche is considerably reduced for some time.5 Research carried out by two teams of the Brookhaven National Laboratory of the U.S. Department of Energy showed that addictive substances increased the dopamine level in the brain when the drug users were “high” and caused them to have far fewer dopamine receptors than non-drug users.6

4Although methamphetamine (a hydrochloride compound) acts in smaller doses than amphetamine (a sulphate compound), at the biochemical level there is no real difference between the two. Technically, the amine NH₂ in amphetamine becomes amino-methyl NH-CH₃ in the case of methamphetamine. The consequence of this chemical difference is particularly significant since “the crossing of the blood-brain barrier is made considerably easier for methamphetamine, which reaches the brain faster and more efficiently than amphetamine”.7 Apart from the speed with which the effects can be felt by the user, one of the striking differences between amphetamine and methamphetamine lies in the duration of their effects — from 3 to 6 hours for the former, and from 8 to 24 hours for the latter.8

5Once the ways these products act on neurons has been clarified, it is possible to understand why they cause a mental and not physical addiction. In fact, “mental addiction results largely but not exclusively from the activation of neurons containing dopamine that belong to the compensatory system of the brain; physical addiction is caused in part by the de-sensitisation of the opiate receptors of the spinal cord”.9

Effects of Methamphetamine

6It is precisely through this chemical action of amphetamine derivatives that the effects desired by the drug user are obtained and reproduced. Amongst these numerous effects — many of which are undesirable — are anorexia (accompanied by an increase in physical activity), hyper-vigilance, hyperamnesia, and anxiety.

7On the strictly physical level, ATS side effects may bring on the appearance of mydriasis,10 tachycardia,11 and strong bursts of hyper- tension, which apart from the irreversible damage they may cause to the brain vessels, may be fatal.12 There are many other side effects that affect the nervous system, including athetosis,13 tremors and convulsions, irri- tability, aggressiveness, extreme nervousness, insomnia, mental confusion, and hyperthermia.14 Moreover, conditions similar to schizophrenia can be brought on by panic attacks, attacks of paranoia, or visual and audible hallucinations. Acute paranoiac psychoses persisting for months have frequently been observed in methamphetamine users.15

8However, mention has been made in numerous folk-medicine traditions of the stimulating action of Ephedra-based decoctions. Ephedra is the plant from which ephedrine — the precursor of methamphetamine — is extracted. Methamphetamine was known as a love drug in the 1970s, and has more recently fuelled rave parties, where it is often ingested as an aphrodisiac. Similar to the drug ecstasy, methamphetamine helps subjects shed their inhibitions.16

9It is not possible to determine the precise danger threshold of metham- phetamine dosage, as this varies according to the metabolism of each individual and the exact composition of the drug. However, overdose can occur with the ingestion of at least 50 milligrams of methamphetamine. Death may be brought on as a result of hyperthermia, hypertension and cardiovascular deficiency. Methamphetamine abuse may incite a physical hyperactivity that, paired with chronic under-nourishment due to its anorectic effects, increases the risk of death. Though consumption of methamphetamine rarely causes death, it can result in serious and permanent cerebral lesions much more severe than those caused by amphetamines.17

10Of course the strength of the dose and the frequency of drug consumption determine its effect on users. This idea is not new: as early as in the 16th century Paraclesus wrote, “There is poison in everything and there is nothing without poison. Whether a poison becomes one or not depends only on the dose.”18

Treatment of Methamphetamine Users

11According to specialists, methamphetamine dependence is the most difficult to treat amongst all addictions. This is first because of the extreme state of excitability and irritability of the users, and second because of their strong physical resistance to any form of treatment as long as the effects of the drug persist. Intoxication generally lasts for 4 to 24 hours after a dose. However, the withdrawal period, during which there is possibility of a relapse, is very long, ranging from six to eight months for an occasional user and up to two to three years for a regular one. Some never totally regain their physical and mental faculties because of the damage caused to the central nervous system.

12Of course, acute amphetamine intoxication can be treated, although mental addiction can never be overcome with certainty. For physical treatment, stomach washes are particularly recommended. The practitioner can also advise ingestion of large quantities of active charcoal (also called “activated coal” and known for its adsorptive capacity), which fixes the toxic substance and prevents blood poisoning. On the other hand, in order to accelerate the elimination of the active substance, urine can be acidified if the renal functions are not impaired. Finally, a symptomatic treatment is often given which consists of administering tranquillisers or anti-anxiety drugs, hydrating, controlling hyperthermia, or administering anti-convulsive and anti-hypertensive medicine.19