2. Methamphetamine: How it Influences the Brain and Behavior of Users Richard A. Rawson, Ph.D Adjunct Associate Professor Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine University of California at Los Angeles

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

4. Methamphetamine: Speed  Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown.  Color variations are due to differences in chemicals used to produce it and the expertise of the cooker.  Other names: shabu, crystal, crystal meth, crank, tina, yaba

5. Methamphetamine: Ice High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge. High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge.

6. Methamphetamine A Brief History  1887  1919  1932 Amphetamine developed Methamphetamine developed Amphetamine & methamphetamine used as decongestant

7. Methamphetamines A Brief History  WW II Extensive use by: - RAF fighter pilots - RAF fighter pilots - German Panzer troops - German Panzer troops - Japanese workers - Japanese workers - Led to Kamikaze fever - Led to Kamikaze fever

8.  According to surveys and estimates by WHO and UNDCP, methamphetamine is the most widely used illicit drug in the world except for cannabis.  World wide it is estimated there are over 42 million regular users of methamphetamine, as compared to approximately 15 million heroin users and 10 million cocaine users Scope of the Methamphetamine Problem Worldwide

9. IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar Year

10. The Eastward Spread of Methamphetamine

13. Methamphetamine: A Growing Menace in Rural America  In 1998, rural areas nationwide reported 949 methamphetamine labs.  Last year, 9,385 were reported.  This year, 4,589 rural labs had been reported as of July 26.  Source: El Paso Intelligence Center (EPIC), U.S. DEA

14. Meth Lab Seizures  A small percentage of labs seized are labeled “Super Labs” and are capable of producing over 10 lbs per batch.  Super Labs are operated by Mexican National Drug Trafficking Organizations (MNDTO’s), and supply the majority of meth to the market.

15. Stove Top Labs  The active ingredient in making methamphetamine is ephedrine or pseudoephedrine, commonly found in over the counter cold remedies.

16. Toxic Effects of Methamphetamine Manufacturing  Fires  Explosions  Toxic gases  Toxic wastes

17. Toxic Effects of Methamphetamine Manufacturing  Manufacturers  Law enforcement officers  Bystanders

18. Children  Children who live in and around the area of the meth lab become exposed to the drug and its toxic precursors and byproducts.  80-90% of children found in homes where there are meth labs test positive for exposure to meth. Some are as young as 19 months old.

19. Children  Children can test positive for methamphetamine by: Having inhaled fumes during the manufacturing process Having inhaled fumes during the manufacturing process Coming into direct contact with the drug Coming into direct contact with the drug Through second-hand smoke. Through second-hand smoke.

20. Cardiovascular problems  ↑ heart rate  Palpitations  Arrhythmia  ↑ blood pressure  Chest Pain Acute Coronary Syndrome  Valve thickening

21. Neurological problems  Seizures  Stroke  Cerebral hemorrhage  Cerebral vasculitis  Mydriasis

22. Respiratory problems  Dyspnea  Pulmonary hypertension  Pleuritic chest pain

23. Other problems  Eye ulcers  Over-heating  Rhabdomyolysis  Obstetric complications  Anorexia / weight loss  Tooth wear, cavities  “Speed bumps”

24. Trauma  Interpersonal trauma Assault Gunshot Knife  Motor Vehicles  Suicide attempts

25. Methamphetamine Acute Physical Effects - Increases -Decreases Heart rate Appetite Blood pressure Sleep Pupil size Reaction time Respiration Sensory acuity Energy

26. Methamphetamine Acute Psychological Effects  Increases Confidence Confidence Alertness Alertness Mood Mood Sex drive Sex drive Energy Energy Talkativeness Talkativeness  Decreases Boredom Loneliness Timidity

28. Methamphetamine Chronic Physical Effects - Tremor - Sweating - Tremor - Sweating - Weakness - Burned lips; sore nose - Dry mouth - Oily skin/complexion - Weight loss - Headaches - Cough - Diarrhea - Sinus infection - Anorexia

29. Methamphetamine Chronic Psychological Effects - Confusion - Irritability - Concentration - Paranoia - Hallucinations - Panic reactions - Fatigue - Depression - Memory loss - Anger - Insomnia - Psychosis

30. Methamphetamine Psychiatric Consequences  Paranoid reactions  Permanent memory loss  Depressive reactions  Hallucinations  Psychotic reactions  Panic disorders  Rapid addiction

31. 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

34. Methamphetamine abusers have abnormal brain activity.

35. 0 0 50 100 150 200 0 0 60 120 180 Time (min) % of Basal DA Output NAc shell Empty Box Feeding Source: Di Chiara et al. FOOD Natural Rewards Elevate Dopamine Levels

36. 0 0 100 200 300 400 500 600 700 800 900 1000 1100 0 0 1 1 2 2 3 3 4 4 5 hr Time After Amphetamine % of Basal Release DA DOPAC HVA Accumbens AMPHETAMINE 0 0 100 200 300 400 0 0 1 1 2 2 3 3 4 4 5 hr Time After Cocaine % of Basal Release DA DOPAC HVA Accumbens COCAINE 0 0 100 150 200 250 0 0 1 1 2 2 3 3 4 4 5hr Time After Morphine % of Basal Release Accumbens 0.5 1.0 2.5 10 Dose (mg/kg) MORPHINE 0 0 100 150 200 250 0 0 1 1 2 2 3 hr Time After Nicotine % of Basal Release Accumbens Caudate NICOTINE Source: Di Chiara and Imperato Effects of Drugs on Dopamine Levels

37. Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways

46. Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways

49. Compulsive Drug Use (Addiction) Compulsive Drug Use (Addiction) Voluntary Drug Use Voluntary Drug Use

50. Control > MA 4 3 2 0 1

51. MA > Control 5 4 2 0 1 3

52. Treatment Length by Route P<.05

53. Treatment Completion by Route P<.05

54. MA-Free Samples by Route P<.05

55. BSI Psychiatric Symptoms by Route P<.05 Positive Symptom Total (PST)

56. Depression Symptoms by Route P<.05

57. Psychopathology and Route  IDUs > likely to have a psychiatric disability.  IDUs > likely to have prior hospitalizations for psychiatric problems

58. Hepatitis C by Route P<.05

59. Women and Meth

60. Meth and Women: Typical gender ratio of heroin users in treatment : 3 men to 1 woman Typical gender ratio of cocaine users in treatment : 2 men to 1 woman Typical gender ratio of methamphetamine users in treatment : 1 man to 1 woman * *among large clinical research populations

61. Drug Use by Gender

62. Self-Reported Reasons for Starting Methamphetamine Use

65. My sexual drive is increased by the use of … (Rawson et al., 2002)

66. My sexual pleasure is enhanced by the use of … (Rawson et al., 2002)

67. My sexual performance is improved by the use of … (Rawson et al., 2002)

68. CSAT Methamphetamine Treatment Project: Cross-Site Sample Description  1,016 clients  Average age was 32.8 years  55% female  60% Caucasian  12.2 years of education on average  16% currently married  31% awaiting charges, trial, or sentencing

69. Methamphetamine Use History Avg. years of lifetime use:7.54 Avg. days used in past 30:11.53 Percent that usually smoked:65%

70. Violence Issues in Lifetime  78% experienced violence  39% experienced sexual abuse  81% experienced one or the other  36% experienced both

71. Psychological Issues in Lifetime  60% depressed  56% anxiety  45% memory problems  43% violence control problems  34% suicidal thoughts  32% received medication  9% memory problems

72. Gender Differences in Violence History (% Ever) Female (85%) Male (70%) Partner80%26% Friend16%38% Other14%43%

73. Gender Differences in Partner Violence FemaleMale Ever threatened 63%26% Ever Isolated 65%37% Ever Afraid 27%10%

74. Gender Differences in Sexual Abuse History (% Ever) Female (58%)Male (16%) Parent14%4% Sibling22%6% Partner32%7%

75. Analyses reveal that a history of physical or sexual violence (controlling for gender) is significantly related to a number of negative outcomes. These results suggest the importance of understanding client background factors before they enter treatment.

76. Behavior Symptom Inventory (BSI) Scores at Baseline

77. Beck Depression Inventory (BDI) Scores at Baseline

78. Implications  Physical and sexual violence is related to psychological problems and drug use pattern differences  Different types of traumas may have different outcomes and may affect people in different ways  A history of trauma may be related to treatment engagement and outcome