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Major Physical and Psychological Harms of Methamphetamine Use

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Major Physical and Psychological Harms of Methamphetamine Use SCII.001.001.0060 Drug and Alcohol Review (May 2008), 27, 253 – 262 Major physical and psychological harms of methamphetamine use 1 1 1 1,2 SHANE DARKE , SHARLENE KAYE , REBECCA MCKETIN , & JOHAN DUFLOU 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, and 2Department of Forensic Medicine, Sydney South West Area Health Service, Sydney, New South Wales, Australia Abstract Issues. The major physical and psychological health effects of methamphetamine use, and the factors associated with such harms. Approach. Comprehensive review. Key Findings. Physical harms reviewed included toxicity and mortality, cardiovascular/cerebrovascular pathology, dependence and blood-borne virus transmission. Psychological harms include methamphetamine psychosis, depression, suicide, anxiety and violent behaviours. Implications. While high-profile health consequences, such as psychosis, are given prominence in the public debate, the negative sequelae extend far beyond this. This is a drug class that causes serious heart disease, has serious dependence liability and high rates of suicidal behaviours. Conclusion. The current public image of methamphetamine does not portray adequately the extensive, and in many cases insidious, harms caused. [Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008;27:253–262] Key words: cardiovascular, methamphetamine, psychostimulants, psychopathology. methamphetamine to include both methamphetamine Introduction and its less potent analogue amphetamine, which are In recent years, there has been mounting concern about sold under the street names of ‘speed’, ‘base’, ‘ice’, the increasing prevalence of methamphetamine use. ‘crystal meth’ and ‘amphetamines’. Where appropriate, The extent of the problem suggests the need for a a distinction between methamphetamine and amphe- comprehensive review of the major harms that are tamine will be made. associated with such use. The current review aimed to examine the nature of the harms associated with the methamphetamine use. In particular, the current Physical harms associated with review aimed to examine: psychostimulant use (i) the major physical health effects of metham- Polydrug use, methamphetamine use and harm phetamine use; (ii) the major psychological effects of methamphe- As is the case with all illicit drugs, methamphetamine tamine use; and users consume a variety of drugs other than their (iii) the risk factors associated with such harm. primary drug of choice. Heavy cannabis use is common, the majority drink alcohol, a substantial The area of psychostimulant use is plagued by proportion have a history of heroin use, and the use terminological ambiguities. This review will refer to of other psychostimulants is common [1,2]. Shane Darke, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, Sharlene Kaye, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, Rebecca McKetin, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia, Johan Duflou, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales and Department of Forensic Medicine, Sydney South West Area Health Service, Sydney, New South Wales, Australia. Correspondence to Professor Shane Darke, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia. Tel: 029 385 0331. Fax: 029 385 0222. E-mail: [email protected] Received 1 August 2007; accepted for publication 10 December 2007. ISSN 0959-5236 print/ISSN 1465-3362 online/08/030253–10 ª Australasian Professional Society on Alcohol and other Drugs DOI: 10.1080/09595230801923702 SCII.001.001.0061 254 S. Darke et al. While extensive polydrug use is associated with myocardial oxygen from the effects of methampheta- poorer clinical profiles and increased levels of harm mine in the presence of respiratory depression from the across a range of drugs [3,4], there are specific harms effects of heroin (see below). that arise from the concomitant use of methampheta- Multiple psychostimulant use is also cause for mine with other drugs. The importance of concomitant concern. The combination of methamphetamine and use of other substances with methamphetamine is that, cocaine has been demonstrated to increase substantially when combined with alcohol, cocaine or opiates, the vasoconstrictive and cardiotoxic effects of both methamphetamine toxicity is increased [5,6]. The drugs [11,12]. Given the cardiotoxic effects of metham- pharmacology of concomitant alcohol consumption is phetamine, it is reasonable to speculate that the distinct from the other major psychostimulant, cocaine. concomitant use of alcohol or cocaine with metham- The concomitant ingestion of cocaine and alcohol phetamine may increase the risk of a toxic reaction. produces cocaethylene, an active metabolite of cocaine Compared with cocaine [13,14], few data are which is not only more toxic than cocaine itself, but available examining the role of polydrug use in fatal which has a synergistic effect in increasing the toxicity methamphetamine toxicity. Consistent with what is of cocaine [7 – 9]. The combination of alcohol and known and speculated about drug interactions, multi- methamphetamine does not produce a new psychoac- ple substances are detected in approximately half of tive substance, but does increase heart rate and blood fatal methamphetamine toxicity cases, most commonly pressure beyond that seen for methamphetamine use alcohol (10 – 25%), cocaine (12 – 25%) and morphine alone [6,10]. (20 – 30%) [15,16] (Table 1). The combination of heroin and methamphetamine may produce a situation where there is increased Toxicity and mortality myocardial oxygen demand due to methamphetamine with a contiguous depression of respiration due to Whereas heroin overdose is indicated by a specific heroin. It may be speculated that respiratory depression diagnostic triad of signs (reduced level of consciousness, may induce cardiac failure, particularly among people miosis, respiratory depression) [17], psychostimulant where cardiac disease is present, due to increased overdose is defined less clearly. Methamphetamine Table 1. Major physical harms associated with methamphetamine use Variable Comment Polydrug use Alcohol Increases heart rate and blood pressure beyond methamphetamine use alone Opioids Increased myocardial oxygen demand from psychostimulants with respiratory depression from opioids Cocaine Increases vasoconstrictive and cardiotoxic effects of these drugs Mortality Demographics Mostly male, aged, on average, in their mid-30s Cause of death Typically caused by seizures, cardiac arrhythmias, or respiratory failure Dose Toxic reactions can occur irrespective of dose, frequency of use, or route of administration Cardiotoxicity Cardiovascular system Places heavy demands upon the cardiovascular system. Can cause myocardial ischaemia and infarction Coronary artery disease Premature and accelerated development of coronary artery atherosclerosis Non-fatal presentations Chest pains, palpitations, tachycardia and hypertension most common complaints among methamphetamine users presenting to hospital Cerebrovascular accidents Increases risk of ischaemic and haemorrhagic stroke. Higher associated risk of death after stroke Dependence Chronicity May be chronic, or involve bingeing with brief drug-free periods Route of administration Strongly associated with injecting and smoking of the drug Potency Methamphetamine potency appears to increase dependence liability Blood-borne viruses Risks Increased risk of blood borne virus transmission through sexual risk behaviour and needle sharing Sex Increases sexual arousal. Some users take methamphetamine specifically to enhance sex Sexual Use consistently higher among HIV positive gay men with HIV. Elevated incidence of HIV seroconversion SCII.001.001.0062 Methamphetamine and harm 255 toxicity may manifest as a variety of acute physical and similar rates might be expected for methamphetamine. psychological symptoms. The presentation of a Indeed, given the wider availability of methampheta- methamphetamine overdose can vary among indivi- mine, rates may well be higher. duals and does not necessarily entail a loss of Deaths due to methamphetamine toxicity occur consciousness. Indeed, overdose signs such as excited typically among male, experienced drug users, aged in delirium, which may result in cardiac arrest and death, their mid-30s [10,12,15,23,28,29]. The older age by definition preclude loss of consciousness. Physical profile of fatalities may simply reflect the cumulative symptoms of psychostimulant overdose include nausea risk exposure of repeated use. The effects of repeated and vomiting, chest pain, tremors, increased body psychostimulant administration are, however, quite temperature, increased heart rate, breathing irregula- distinct from those seen in the use of opioids. Repeated rities and seizures. Psychological symptoms such as administration of either cocaine or methamphetamine extreme anxiety, panic, extreme agitation, extreme results in a cumulative risk of cardiac and coronary paranoia, hallucinations and excited delirium are also artery disease, most commonly ventricular hypertrophy indicative of methamphetamine overdose [9,18]. and coronary artery atherosclerosis [9,10,12,15] (see Psychostimulant-related
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