Methamphetamine: The Nature of the National Epidemic Richard A. Rawson, Ph.D Adjunct Associate...

Methamphetamine: The Methamphetamine: The Nature of the National Nature of the National

EpidemicEpidemic

Richard A. Rawson, Ph.DRichard A. Rawson, Ph.DAdjunct Associate ProfessorAdjunct Associate Professor

Semel Institute for Neuroscience and Human BehaviorSemel Institute for Neuroscience and Human BehaviorDavid Geffen School of MedicineDavid Geffen School of Medicine

University of California at Los AngelesUniversity of California at Los Angeleswww.uclaisap.orgwww.uclaisap.org

[email protected]@mednet.ucla.edu

Supported by:Supported by: National Institute on Drug Abuse (NIDA)National Institute on Drug Abuse (NIDA)

Pacific Southwest Technology Transfer CenterPacific Southwest Technology Transfer Center (SAMHSA) (SAMHSA)

MethamphetamineMethamphetamine

Methamphetamine is a powerful central nervous Methamphetamine is a powerful central nervous system stimulant that strongly activates multiple system stimulant that strongly activates multiple systems in the brain. Methamphetamine is systems in the brain. Methamphetamine is closely related chemically to amphetamine, but closely related chemically to amphetamine, but the central nervous system effects of the central nervous system effects of methamphetamine are greatermethamphetamine are greater..

Forms of MethamphetamineForms of Methamphetamine

Methamphetamine Powder

IDU Description: Beige/yellowy/off-white powder

Base / Paste Methamphetamine

IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy

Crystalline Methamphetamine

IDU Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’

EPHEDRINE

OH

CC

HHH

3CH 3CH

N

M ETH AM PH ETAM IN E

H

CC

HHH

3CH 3CH

N

MethamphetamineMethamphetamine

The US EpidemicThe US Epidemic

According to surveys and estimates by WHO According to surveys and estimates by WHO and UNODC, methamphetamine is the most and UNODC, methamphetamine is the most widely used illicit drug in the world except for widely used illicit drug in the world except for cannabis.cannabis.

World wide it is estimated there are over 26 World wide it is estimated there are over 26 million regular users of million regular users of amphetamine/methamphetamine, as compared amphetamine/methamphetamine, as compared to approximately 16 million heroin users and 14 to approximately 16 million heroin users and 14 million cocaine usersmillion cocaine users

Scope of the Methamphetamine Scope of the Methamphetamine Problem WorldwideProblem Worldwide

Meth Epidemic; less drama, Meth Epidemic; less drama, more long term risk/dangermore long term risk/danger

Cocaine/Crack epidemic hit fast (in NYC 1986-87, as Cocaine/Crack epidemic hit fast (in NYC 1986-87, as well as other major east coast cities); overnight well as other major east coast cities); overnight emergency, tremendous media attention.emergency, tremendous media attention.

Big federal response (Reagan and Bush I). High visibility Big federal response (Reagan and Bush I). High visibility deaths, stigmatization as a ghetto drug.deaths, stigmatization as a ghetto drug.

Dramatic decreases in indicators by early 1990s, except Dramatic decreases in indicators by early 1990s, except in inner cites of east coast.in inner cites of east coast.

Crack epidemic: Rapid onset; Rapid decreaseCrack epidemic: Rapid onset; Rapid decrease

Meth epidemic: Slow west to east spread. No decrease Meth epidemic: Slow west to east spread. No decrease in western cities. Use becomes endemic?in western cities. Use becomes endemic?

The Methamphetamine Epidemic:The Methamphetamine Epidemic:Admissions/100,000: 1992-2003Admissions/100,000: 1992-2003

0

50

100

150

200

250

300

350

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

California

Hawaii

I owa

Oregon

Washington

It keeps going up

Figure 1. Methamphetamine/Amphetamine Treatment Admission Rate per 100,000 Population Aged 12 or Older:

1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

Figure 2. Methamphetamine/Amphetamine Treatment Admissions, by Route of Administration: 1992-2002

Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

The Eastward Spread of The Eastward Spread of MethamphetamineMethamphetamine

Primary Amphetamine/Methamphetamine Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992TEDS Admission Rates: 1992

(per 100,000 aged 12 and over)(per 100,000 aged 12 and over)

35 - 5812 - 35

< 12No data

> 58

< 12



35 - 5812 - 35

< 12No

data

> 58



127+< 5

5 - 5960-126

Incomplete Data

Inter-generational Use & CookingInter-generational Use & Cooking

Anhydrous Ammonia Tank Tips Anhydrous Ammonia Tank Tips Officers to Possible Meth LabOfficers to Possible Meth Lab

5/4/04 Omaha, Neb. – A large

anhydrous ammonia tank

helped Sarpy County

Sheriff’s deputies bust

a suspected

methamphetamine

lab Tuesday.

SOURCE: TheOmahaChannel.com

Methamphetamine: A Growing Menace Methamphetamine: A Growing Menace in Rural Americain Rural America

In 1998, rural areas In 1998, rural areas nationwide reported 949 nationwide reported 949 methamphetamine labs. methamphetamine labs.

Last year, 9,385 were Last year, 9,385 were reported. reported.

This year, 4,589 rural labs This year, 4,589 rural labs had been reported as of had been reported as of July 26.July 26.

Source: El Paso Intelligence Center (EPIC), Source: El Paso Intelligence Center (EPIC), U.S. DEAU.S. DEA

MethamphetamineMethamphetamineAcute Physical EffectsAcute Physical Effects

- - IncreasesIncreases --DecreasesDecreases

Heart rate Heart rate AppetiteAppetite

Blood pressure Blood pressure Sleep Sleep

Pupil size Pupil size Reaction Reaction timetime

RespirationRespiration

Sensory acuitySensory acuity

EnergyEnergy

MethamphetamineMethamphetamineAcute Psychological EffectsAcute Psychological Effects

IncreasesIncreases

– Confidence Confidence – Alertness Alertness – MoodMood– Sex driveSex drive– EnergyEnergy– TalkativenesTalkativenes

ss

DecreasesDecreases – BoredomBoredom– LonelinessLoneliness– TimidityTimidity

MethamphetamineMethamphetamineChronic Physical EffectsChronic Physical Effects

-- Tremor Tremor - Sweating- Sweating- Weakness - Weakness - Burned lips; - Burned lips;

sore nosesore nose- Dry mouth - Dry mouth - Oily - Oily

skin/complexionskin/complexion- Weight loss - Weight loss - Headaches- Headaches- Cough - Cough - Dental Problems- Dental Problems- Sinus infection - Sinus infection - Anorexia- Anorexia

Prenatal Meth ExposurePrenatal Meth Exposure

Preliminary findings on infants exposed Preliminary findings on infants exposed prenatally to methamphetamine (MA) and prenatally to methamphetamine (MA) and nonexposed infants suggest…nonexposed infants suggest…– Prenatal exposure to MA is associated with an Prenatal exposure to MA is associated with an

increase in SGA (small for gestational size).increase in SGA (small for gestational size).– Neurobehavioral deficits at birth were identified in Neurobehavioral deficits at birth were identified in

NNNS (Neonatal Intensive Care Unit Network NNNS (Neonatal Intensive Care Unit Network Neurobehavioral Scale) neurobehavior, including Neurobehavioral Scale) neurobehavior, including dose response relationships and acoustical analysis dose response relationships and acoustical analysis of the infant’s cry. Lester et al 2005of the infant’s cry. Lester et al 2005

Source: The New York Times, June 11, 2005.Source: The New York Times, June 11, 2005.

“METH Mouth”“METH Mouth”

METH Use Leads to Severe Tooth Decay

Meth Use in HawaiiMeth Use in HawaiiAs of the middle of May, not even halfway through the As of the middle of May, not even halfway through the year, the city medical examiner's office already recorded year, the city medical examiner's office already recorded 38 deaths connected to crystal methamphetamine. So, 38 deaths connected to crystal methamphetamine. So, we're well on the way to exceeding last year's total of 68.we're well on the way to exceeding last year's total of 68.

Deaths:Deaths: 2005 (mid-May) - 38 deaths 2005 (mid-May) - 38 deaths 2004 - 68 deaths 2004 - 68 deaths 2003 - 56 deaths 2003 - 56 deaths 2002 - 62 deaths 2002 - 62 deaths 2001 - 54 deaths 2001 - 54 deaths 2000 - 34 deaths2000 - 34 deaths

Trauma in MA UsersTrauma in MA Users

MA + n (%)MA + n (%) Non-MA n (%)Non-MA n (%) pp

IntentionalIntentional 21 (37%)21 (37%) 34 (22%)34 (22%) <.04<.04

AdmittedAdmitted 52 (91%)52 (91%) 108 (70%)108 (70%) .001.001

Mean (SEM)Mean (SEM) Mean (SEM)Mean (SEM)

LOS (days)LOS (days) 2.7 (0.4)2.7 (0.4) 1.7 (0.1)1.7 (0.1) .003.003

ChargesCharges 15,617 (1866)15,617 (1866) 11,600 (648)11,600 (648) .01.01

Tominanga et al., 2004Tominanga et al., 2004

Adolescent Meth Abuse Treatment Adolescent Meth Abuse Treatment AdmissionsAdmissions

Matrix Matrix (Boys)(Boys) (Girls) (Girls)– 2002 2002 16%16% 63%63%– 2003 2003 25%25% 67%67%– 2004 2004 22%22% 69%69%

Phoenix Phoenix (Boys)(Boys)– 2002 2002 25%25% 43%43%– 2003 2003 23%23% 51%51%– 2004 2004 27%27% 53%53%

MethamphetamineMethamphetamineChronic Psychological EffectsChronic Psychological Effects

- - Confusion - IrritabilityConfusion - Irritability

- Concentration - Paranoia- Concentration - Paranoia

- Hallucinations - Panic - Hallucinations - Panic reactionsreactions

- Fatigue - Depression- Fatigue - Depression

- Memory loss - Anger- Memory loss - Anger

- Insomnia - Psychosis- Insomnia - Psychosis

MethamphetamineMethamphetaminePsychiatric ConsequencesPsychiatric Consequences

Paranoid reactionsParanoid reactions

Protracted memory lossProtracted memory loss

Depressive reactionsDepressive reactions

HallucinationsHallucinations

Psychotic reactionsPsychotic reactions

Panic disordersPanic disorders

Rapid addictionRapid addiction

MA Psychosis Inpatients from 4 CountriesMA Psychosis Inpatients from 4 Countries

Psychotic symptomPsychotic symptom LifetimeLifetime CurrentCurrent

Persecutory delusionPersecutory delusion

Auditory hallucinationsAuditory hallucinations

Strange or unusual beliefsStrange or unusual beliefs

Thought readingThought reading

Visual hallucinationsVisual hallucinations

Delusion of referenceDelusion of reference

Thought insertion or made actThought insertion or made act

Negative psychotic symptomsNegative psychotic symptoms

Disorganized speechDisorganized speech

Disorganized or catatonic behaviorDisorganized or catatonic behavior

130 (77.4)130 (77.4)

122 (72.6)122 (72.6)

98 (58.3)98 (58.3)

89 (53.0)89 (53.0)

64 (38.1)64 (38.1)

64 (38.1)64 (38.1)

56 (33.3)56 (33.3)

35 (20.8)35 (20.8)

75 (44.6)75 (44.6)

39 (23.2)39 (23.2)

27 (16.1)27 (16.1)

38 (22.6)38 (22.6)

20 (11.9)20 (11.9)

18 (10.7)18 (10.7)

36 (21.4)36 (21.4)

19 (11.3)19 (11.3)

14 (8.3)14 (8.3)

No. of patients having No. of patients having symptoms (%)symptoms (%)

Srisurapanont et al., 2003Srisurapanont et al., 2003

MA PsychosisMA Psychosis

69 physically healthy, incarcerated Japanese 69 physically healthy, incarcerated Japanese females with hx MA usefemales with hx MA use– 22 (31.8%) no psychosis22 (31.8%) no psychosis– 47 (68.2%) psychosis47 (68.2%) psychosis

19 resolved (mean=276.219 resolved (mean=276.2±222.8 days)±222.8 days)8 persistent (mean=17.6±10.5 months)8 persistent (mean=17.6±10.5 months)20 flashbackers (mean=215.4±208.2 days to initial 20 flashbackers (mean=215.4±208.2 days to initial resolution)resolution)

– 11 single flashback11 single flashback– 9 Recurrent flashbacks9 Recurrent flashbacks Yui et al., 2001Yui et al., 2001

Polymorphism in DAT Gene associated with MA Polymorphism in DAT Gene associated with MA psychosis in Japanesepsychosis in Japanese

Ujike et al., Ujike et al., 20032003

A Major Reason People Take a Drug is they Like

What It Does to Their Brains

A Major Reason People Take a Drug is they Like

What It Does to Their Brains

00

5050

100100

150150

200200

00 6060 120120 180180

Time (min)Time (min)

% o

f B

asal

DA

Ou

tpu

t%

of

Bas

al D

A O

utp

ut

NAc shellNAc shell

EmptyEmpty

BoxBox FeedingFeeding

Source: Di Chiara et al.Source: Di Chiara et al.

FOODFOOD

100100

150150

200200

DA

Co

nce

ntr

ati

on

(%

Bas

elin

e)D

A C

on

cen

tra

tio

n (

% B

asel

ine)

MountsMountsIntromissionsIntromissionsEjaculationsEjaculations

1515

00

55

1010

Co

pu

latio

n F

req

ue

nc

yC

op

ula

tion

Fre

qu

en

cy

SampleNumberSampleNumber

11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717

ScrScrScrScrBasBasFemale 1 PresentFemale 1 Present

ScrScrFemale 2 PresentFemale 2 Present

ScrScr

Source: Fiorino and PhillipsSource: Fiorino and Phillips

SEXSEX

Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels

Natural Rewards Elevate Dopamine Natural Rewards Elevate Dopamine LevelsLevels

00

100100

200200

300300

400400

Time After CocaineTime After Cocaine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

DADADOPACDOPACHVAHVA

AccumbensAccumbensCOCAINECOCAINE

00

100100

150150

200200

250250

00 11 22 3 hr3 hr

Time After NicotineTime After Nicotine

% o

f B

as

al

Re

lea

se

% o

f B

as

al

Re

lea

se

AccumbensAccumbensCaudateCaudate

NICOTINENICOTINE

Source: Shoblock and Sullivan; Di Chiara and Imperato

Effects of Drugs on Dopamine ReleaseEffects of Drugs on Dopamine Release

100

150

200

250

0 1 2 3 4hrTime After Ethanol

% o

f B

as

al

Re

lea

se

0.250.512.5

Accumbens

0

Dose (g/kg ip)

ETHANOLETHANOL

Time After Methamphetamine

% B

as

al

Re

lea

se

METHAMPHETAMINE

0 1 2 3hr

1500

1000

500

0

Accumbens

Prolonged Drug Use ChangesProlonged Drug Use Changesthe Brain In Fundamentalthe Brain In Fundamentaland Long-Lasting Waysand Long-Lasting Ways

Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.

Decreased dopamine transporter Decreased dopamine transporter binding in METH users resembles binding in METH users resembles

that inthat in Parkinson’s Disease patients Parkinson’s Disease patients

%ID/cc

Control Methamphetamine PD

Partial Recovery of Brain Dopamine Transporters in Methamphetamine

(METH)Abuser After Protracted Abstinence

Normal Control METH Abuser(1 month detox)

METH Abuser(24 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Methamphetamine: Methamphetamine: Neurochemical MechanismsNeurochemical Mechanisms

Methamphetamine enters the brain and is Methamphetamine enters the brain and is removed from the synapse by dopamine removed from the synapse by dopamine transporterstransporters


Enters dopamine vesiclesEnters dopamine vesicles

Vesicles deplete themselves of dopamineVesicles deplete themselves of dopamine


Free-floating DA produces “free radicals” Free-floating DA produces “free radicals” (neurotoxins), so it is forced out of the (neurotoxins), so it is forced out of the neuron.neuron.

The synapse is flooded with dopamine, The synapse is flooded with dopamine, producing a profound sense of pleasure.producing a profound sense of pleasure.

Their Brains

have been

Re-Wired by Drug Use

Their Brains

have been

Re-Wired by Drug Use

Because…Because…

Control > MA

4

3

2

0

1

MA > Control

5

4

2

0

1

3

Brain Serotonin Transporter Density and Brain Serotonin Transporter Density and Aggression in Abstinent Aggression in Abstinent

Methamphetamine AbusersMethamphetamine Abusers**

**

Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Sekine, Y, Ouchi, Y, Takei, N, et al. Brain Serotonin Transporter Density and Aggression in Abstinent Methamphetamine Abusers. Density and Aggression in Abstinent Methamphetamine Abusers.

Arch Gen Psychiatry.Arch Gen Psychiatry. 2006;63:90-100. 2006;63:90-100.

Objective of StudyObjective of Study

Investigate the status of brain serotonin Investigate the status of brain serotonin neurons and their possible relationship neurons and their possible relationship with clinical characteristics in currently with clinical characteristics in currently abstinent methamphetamine abusers.abstinent methamphetamine abusers.

Results Results 1.1. Serotonin transporter density in global brain Serotonin transporter density in global brain

regions was significantly lower in regions was significantly lower in methamphetamine abusersmethamphetamine abusers

• Suggests that abuse of methamphetamine leads Suggests that abuse of methamphetamine leads to a global and severe reduction in the density of to a global and severe reduction in the density of human brain serotonin transportershuman brain serotonin transporters

2.2. Values of serotonin transporter density in Values of serotonin transporter density in widely distributed brain regions were found widely distributed brain regions were found to negatively correlate with the duration of to negatively correlate with the duration of methamphetamine use.methamphetamine use.

• Suggests that the longer methamphetamine is Suggests that the longer methamphetamine is used, the more severe the decrease in serotonin used, the more severe the decrease in serotonin transporter density.transporter density.

Results (Continued)Results (Continued)

3.3. Magnitude of aggression in methamphetamine abusers Magnitude of aggression in methamphetamine abusers increased significantly with decreasing serotonin increased significantly with decreasing serotonin transporter densities in some brain regions.transporter densities in some brain regions.

• Bitofrontal cortex, anterior cingulate, temporal cortexBitofrontal cortex, anterior cingulate, temporal cortex

4.4. No correlation between a representative measure of No correlation between a representative measure of serotonin transporter density and the duration of serotonin transporter density and the duration of methamphetamine abstinence. Individuals abstinent methamphetamine abstinence. Individuals abstinent for > 1 year still had a substantial decrease in for > 1 year still had a substantial decrease in serotonin transporter density.serotonin transporter density.

• Suggests reductions in the density of the serotonin transporter Suggests reductions in the density of the serotonin transporter in the brain could persist long after methamphetamine use in the brain could persist long after methamphetamine use ceases.ceases.

Treatment OptionsTreatment Options

MA Treatment IssuesMA Treatment Issues

Acute MA OverdoseAcute MA Overdose

Acute MA PsychosisAcute MA Psychosis

MA “Withdrawal”MA “Withdrawal”

Initiating MA AbstinenceInitiating MA Abstinence

MA Relapse PreventionMA Relapse Prevention

Protracted Cognitive Impairment Protracted Cognitive Impairment and Symptoms of Paranoiaand Symptoms of Paranoia

MA “Withdrawal”MA “Withdrawal”

- - DepressionDepression - Paranoia- Paranoia

- Fatigue- Fatigue - Cognitive - Cognitive ImpairmentImpairment

- Anxiety- Anxiety - Agitation- Agitation

- Anergia- Anergia - Confusion- Confusion

Duration: 2 Days - 2 WeeksDuration: 2 Days - 2 Weeks

Meth Treatment Effectiveness?Meth Treatment Effectiveness?

A pervasive rumor has surfaced in many A pervasive rumor has surfaced in many geographic areas with elevated MA geographic areas with elevated MA problems:problems:

MA users are virtually untreatable with negligible MA users are virtually untreatable with negligible recovery rates.recovery rates.

Rates from 5% to less than 1% have been quoted in Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences.newspaper articles and reported in conferences.

Meth Treatment StatisticsMeth Treatment Statistics

During the 2002-2003 fiscal year:During the 2002-2003 fiscal year:

35,947 individuals were admitted to 35,947 individuals were admitted to treatment in California under the Substance treatment in California under the Substance Abuse and Crime Prevention Act funding.Abuse and Crime Prevention Act funding.

Of this group, 53% reported MA as their Of this group, 53% reported MA as their primary drug problemprimary drug problem

StatisticsStatisticsA A comparison of treatment outcomes between comparison of treatment outcomes between

individuals diagnosed with methamphetamine individuals diagnosed with methamphetamine dependence and all other diagnostic groups indicated dependence and all other diagnostic groups indicated no between group significant differences in any no between group significant differences in any treatment outcome measures including:treatment outcome measures including:Retention in treatment ratesRetention in treatment ratesUrinalysis data during treatmentUrinalysis data during treatmentRates of treatment program completion.Rates of treatment program completion.

All these measures indicate that MA users respond in an All these measures indicate that MA users respond in an equivalentequivalent manner as individuals admitted for other manner as individuals admitted for other drug abuse problems.drug abuse problems.

Comparability of Treatment Outcome: Cocaine vs Comparability of Treatment Outcome: Cocaine vs MethamphetamineMethamphetamine

Huber, Ling and Rawson (Jnl of Addictive Huber, Ling and Rawson (Jnl of Addictive Diseases, 1997).Diseases, 1997).

Cohorts of methamphetamine dependent Cohorts of methamphetamine dependent patients (N=500) and cocaine dependent patients (N=500) and cocaine dependent patients (N=224) treated with a standardized, patients (N=224) treated with a standardized, outpatient treatment protocol (Matrix Model) at outpatient treatment protocol (Matrix Model) at the same clinic site, by the same staff over the the same clinic site, by the same staff over the same time period, demonstrated very similar same time period, demonstrated very similar treatment response on virtually all treatment treatment response on virtually all treatment participation and outcome measures participation and outcome measures

MA Users(n = 500)

Cocaine Users(n = 224)

Early Recovery Group+ 3.4(4.4) 3.7(3.3)

Relapse Prevention Group+ 23.7(29.0) 21.0(26.8)

Family Education Group+ 11.6(14.0) 12.2(12.8)

Social Support Group+ 4.4(14.9) 4.3(18.2)

Total of Treatment Hours Received+

52.9(51.4)

54.5(49.3)

Weeks in Treatment+ 17.1(22.3) 18.0(21.3)

Urine Sample Collected+ 8.3(8.0) 8.1(7.6)

Percentage of Samples Positive for Primary Drug++

19.3%

13.3%

Table 3. Treatment Experience to Methamphetamine and Cocaine Users

{Treatment Received in Number of Hours}

+ Numbers presented are means and (standard deviations)++ Numbers presented are percentages

Treatments for Stimulant-use Disorders with Treatments for Stimulant-use Disorders with Empirical SupportEmpirical Support

Cognitive-Behavioral Therapy (CBT)Cognitive-Behavioral Therapy (CBT)Community Reinforcement Approach Community Reinforcement Approach Contingency ManagementContingency Management12 Step Facilitation12 Step Facilitation

All have demonstrated efficacy for the All have demonstrated efficacy for the treatment of cocaine dependencetreatment of cocaine dependence

Methamphetamine Treatment: Controlled Methamphetamine Treatment: Controlled Clinical TrialsClinical Trials

– Brief Cognitive Behavioral Therapy Brief Cognitive Behavioral Therapy – Extended Cognitive Behavioral TherapyExtended Cognitive Behavioral Therapy– Contingency ManagementContingency Management– Matrix ModelMatrix Model

SummarySummary

Methamphetamine is a significant public Methamphetamine is a significant public health problem in the US and in the worldhealth problem in the US and in the worldIt produces significant damage to the body It produces significant damage to the body and the brainand the brainRecovery from methamphetamine Recovery from methamphetamine dependence is possible and most brain dependence is possible and most brain changes are reversible.changes are reversible.There are effective treatments for There are effective treatments for methamphetamine dependence.methamphetamine dependence.

Methamphetamine: The Nature of the National Epidemic Richard A. Rawson, Ph.D Adjunct Associate...

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