Robert Ali

INTRODUCTION TO METHAMPHETAMINES

WHY DO PEOPLE USE DRUGS?

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•  FUN (pleasure) •  FORGET (reduce pain) •  FUNCTIONAL (purposeful)

EFFECTS ON AN INDIVIDUAL ARE AFFECTED BY: •  Drug used (eg type, route, amount) •  Individual (eg health, emotional state) •  Environment (eg where, with whom, legality)

PSYCHOACTIVE SUBSTANCES ALTER

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• mood • thinking • behaviour

PATTERNS OF DRUG USE

Dependent

Intensive Purposive

Experimental NONE

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THORLEY’S MODEL

Dependence

Regular UseIntoxicationAccidentsHigh Risk BehaviorPoisoningAbsenteeism

HealthFinancesRelationship

Impaired ControlDrug Centered BehaviorIsolation/social problemWithdrawalPsychiatric disordersPhysical problems

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DETERMINANTS OF RISKY SUBSTANCE USE

METHAMPHETAMINE

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…you just feel like you need to have ice to function. And I couldn’t get out of bed without a smoke of ice. My life evolved around this pipe. I’d clean it, and I’d go crazy if someone touched it. The come-downs were just disgusting. The paranoia, hearing things, delusional state. Just thinking about where my next hit of ice was going to come from”. .

•  Prevalence  of  methamphetamine  use  es7mated  in  Australian  surveys  remains  stable  (2.1%,  in  2010  and  2013  NDSHS)    

•  However,  a  shiH  towards  using  crystal  over  other  forms  among  those  who  use  methamphetamine.    

•  21.7%  in  2010    •  50.4%  in  2013  

•  There  has  also  been  an  increase  in  the  frequency  of  use,  weekly  methamphetamine  use  increased  in  2013    

•  9.3%  reported  weekly  or  more  use  in  2010    •  15.5%  in  2013  

Prevalence  of  methamphetamine  use  as  measured  in  household  surveys  

(a) Used in the previous 12 months Source: 2013 National Drug Strategy Household Survey

Es7mated  number  of  regular  and  dependent  methamphetamine  users  aged  15-­‐54  years  in  Australia,  2002-­‐2014    

0

50000

100000

150000

200000

250000

300000

350000

400000

450000 20

02-3

20

03-4

20

04-5

20

05-6

20

06-7

20

07-8

20

08-9

20

09-1

0 20

10-1

1 20

11-1

2 20

12-1

3 20

13-1

4*

Num

ber o

f reg

ular

use

rs

regular users - lower CI

regular users

regular users - upper CI

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

Num

ber o

f dep

ende

nt u

sers

dependent users - lower CI

dependent users

dependent users - upper CI

Source: Degenhardt et al, (MJA 2016)

METHAMPHETAMINE

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•  Hydrochloride salt can be sold as powder. - Bitter-tasting crystalline powder easily dissolves in water or alcohol and injected

•  Crystalline methamphetamine produced by - acidification of methamphetamine base

- Smoked form. often referred to as “ice,” or “crystal,”

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PHARMACOLOGY

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Cause massive increase in Dopamine = the “pleasure chemical” in the brain

•  Also block reuptake of dopamine and inhibit the enzyme that breaks it down

•  Also enhances release of serotonin and norepinephrine

EFFECTS: ONSET AND DURATION

Psychostimulants

1 min 3min 60 min 6 hours

Effect Intensity

Injection

Intranasal

Swallowed

Duration of effect

ACUTE  STIMULANT  EFFECTS  

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Desired •  feeling of wellbeing or euphoria •  increased energy •  wakefulness •  alertness •  reduced hunger •  increased clarity of thinking •  increased competence •  feelings of sexuality •  increased sociability •  improved mood

SHORT - TERM STIMULANT EFFECTS

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Physical  

•  Increased  heart  rate  •  Increased  blood  pressure  •  Increased  pupil  size  •  Increased  respira7on  •  Increased  body  temperature  

LONG-TERM EFFECTS OF STIMULANTS

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Adverse •  Psychological consequences

- sleep problems, anxiety, panic attacks - mood swings - depression, paranoia, hallucinations

•  Adverse behavioural consequences - violent or aggressive behaviour

•  Addiction •  methamphetamine - induced psychosis

LONG-TERM EFFECTS OF STIMULANTS

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Methamphetamine Induced Psychosis • First reported in 1930’s

• Typically presents after chronic, high dose use

• Associated with rapid routes of administration and sleep deprivation

• Characterised by

• persecutory delusions and ideas of reference

• hallucinations (auditory, visual, tactile & olfactory)

• Usually abates in weeks but persists longer in some

WHO IS AT RISK OF PSYCHOSIS

•  Regular heavy users and rapid onset routes of administration

•  Family history of schizophrenia or depression

•  Higher risk of recurrence after first episode psychosis

•  Most episodes respond to conservative care with short term medications (benzodiazepines and/or antipsychotic medications)

Psychostimulants

‘Typical’ Pattern of Use

Pead, et al.

-7 0 2 5 15 20 25 30+ Low

High S

ympt

om S

ever

ity

Using Stopping

Thought disorder Agitation Insomnia Suspicion Increased energy Feel good

Exhaustion Depression Oversleeping Overeating No craving

Anhedonia Lack energy Anxiety Sleepless High craving

Flat mood Emotionally fragile Episodic craving to cues

Days

 12,211      13,213    

 14,208      14,780      15,935    

 17,292      16,588    

 12,739    

10,027  

12,563  

16,875  

22,265  

 -­‐        

 5,000    

 10,000    

 15,000    

 20,000    

 25,000    

•  Number  of  closed  treatment  episodes  where  amphetamine  was  the  principal  drug  of  concern.    

Methamphetamine  treatment  episodes  

Source: Alcohol and Other Drug Treatment Services National Minimum Data Set, AIHW

•  Rates  per  million  persons  of  principal  amphetamine-­‐related  hospital  separa;ons  in  Australia  among  persons  aged  15-­‐54,  1993-­‐2013  

Hospital  separa7ons  for  amphetamines    

Source: Roxburgh, A., and Burns, L. (2013). Drug-related hospital stays in Australia, 1993-2011. Sydney: National Drug and Alcohol Research Centre

S7mulant  psychosis  admissions  

SUMMARY

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•  Number of methamphetamine users has increased •  Significant shift to more frequent use of more potent

formulation •  Methamphetamine has serious consequences following

regular intensive use including the risk of psychosis •  Rapid route administration increases the risks