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Methamphetamine and Other Amphetamine-Type Stimulants
Methamphetamines are a group of substances whose effects vary depending on their chemical structure as well as their route of administration.
In previous decades, the most famous methamphetamine-type substance in our country was MDMA, known by various names, the most famous of which has remained “ecstasy.” In this case, it was taken in the form of tablets by mouth.
Other forms of methamphetamine are prepared for intranasal use or for smoking and therefore pulmonary inhalation, or for injection. Intravenous administration may appear to be the “dangerous” route when addiction is discussed, but inhalation can produce effects just as rapidly. Intravenous administration is generally used to increase the effect-to-dose ratio—that is, to obtain stronger effects without spending more money—despite the risks associated with injection.
This usually characterizes people who are already tolerant to the substance and need larger doses, while at the same time having exhausted their financial resources and therefore needing to economize.
Methamphetamine in crystalline form (translucent crystals) intended for inhalation or injection is known as shaboo, ice, or crystal. The non-crystallized powder is known as speed, meth, or chalk, and is intended for intranasal or oral use. It is odorless and bitter-tasting.
In general, methamphetamine belongs to the category of stimulants, like cocaine. It shares the same general type of action on the brain, although its effects last longer.
Depending on the route of administration, the effects may develop relatively gradually or appear rapidly and then persist for a long time.
Compared with cocaine, the psychiatric risks are greater precisely because any adverse reactions last longer, increasing the potential danger. The same applies to many of its physical effects.
Its cost is relatively low because it is comparatively easy to synthesize and only a small quantity is required to produce a “dose.” For this reason, it has become particularly prevalent in lower-income environments, although this distinction—in terms of both cost and social setting—tends to diminish over time, as happens with most substances.
For example, smoked or injected methamphetamine combines a rapid onset with a long duration of action. A single dose (0.10 g) can therefore cover the period that would otherwise be covered by several doses of intranasal cocaine, amounting to approximately 1 g in total.
An occasional user can therefore save money, and addiction can be sustained even under conditions of severe financial hardship.
The more rapidly the substance is absorbed—for example through inhalation or injection—the more pronounced the immediate and relatively brief effect becomes. This is the “rush,” which can itself become the primary object of desire.
With routes of administration involving a delayed onset, there is greater dependence on the euphoric experience itself or on positive reinforcement—that is, on the things a person is able to do during the prolonged effects, which may last for hours.
Someone primarily seeking the rapid effect may repeat the dose at short intervals, creating a highly toxic accumulation in the brain. In other words, they may grossly intoxicate the brain in order to reproduce an intense effect immediately after the previous one has begun to wear off.
Patterns of use in Europe
In Europe there are areas, such as ours, where cocaine is the main stimulant in use, while in others—particularly Eastern European countries—amphetamines are much more common and cocaine is used relatively little.
This is probably partly a matter of market availability.
First experiences with this substance, particularly among younger people, may occur during trips or stays in Eastern European countries. Just as Amsterdam was for many years a destination for drug-related tourism involving cannabinoid or hallucinogenic substances, Eastern European countries may also become attractive destinations for experimenting with drugs that are characteristic of those regions.
Effects and desired experience
The effects generally sought consist of heightened energy and stimulation lasting for hours without fatigue or boredom, accompanied by a sensation of being constantly “in motion.”
There is a strong urge to talk, interact, and participate in a frenetic and pleasurable way in whatever situation happens to arise, with reduced inhibition.
The person does not experience the disappearance of external stimulation as a reason to stop. They may therefore spend the night leaving clubs as they close and looking for others that are still open, moving from one place to another in search of opportunities for involvement—or simply wandering around without any particular purpose.
Mood may initially be euphoric, but as occurs, to varying degrees, with most stimulants, it may shift toward irritability, quarrelsomeness, and aggression. Acute delusions and confusion may develop, including disorientation in time and space, followed by amnesia concerning the thoughts and perceptions experienced during the episode.
Unlike what occurs with some other drugs, part of the brain’s reaction to stimulants tends to become increasingly explosive and increasingly unbalanced toward an “aggressive” or “paranoid” quality.
Depending on the route of administration, the drug can rapidly generate a desire to use it again. People who become dependent therefore often report that a strong attachment to the substance developed very quickly, sometimes almost immediately.
Biologically, addiction is defined when craving is no longer accompanied by a corresponding desire for pleasure. In other words, the person is no longer motivated by the pleasure they expect to obtain, yet the behavior continues automatically, as though it were responding to external stimuli or activating on its own.
Psychiatric and physical harm
The types of harm include addiction and other mental disorders.
While addiction is influenced by the way the drug’s effects develop—that is, by the route of administration and the way the substance is distributed throughout the body—other psychiatric disorders may occur independently of these factors.
MDMA, for example, can produce various mental disorders even when it has not caused addiction. These effects are not always transient and may range from persistent disturbances in bodily perception to psychosis.
Destructive behavior, actions carried out while hallucinating, homicide, and aggression may occur.
As with any other drug, mental disorders induced by methamphetamine may represent the first manifestation of an underlying psychiatric disorder to which the person is predisposed through biological or hereditary factors, but which might otherwise not have become apparent for years—or perhaps ever—in a fully developed form.
Alternatively, there may be adults with no significant or only mild previous psychiatric history who develop severe mental decompensation under the influence of methamphetamine, with long-lasting consequences.
Methamphetamine withdrawal and recovery
Withdrawal from methamphetamine can be particularly challenging because the drug’s long duration of action depletes cerebral neurotransmitter reserves and alters receptor functioning in such a way that, to put it simply, the receptors remain shifted toward an “off” position.
The brain of a methamphetamine user takes a long time to return to its original state—months—and recovery occurs gradually. Even after many months, functioning may still be reduced.
This applies both to mood, vitality, initiative, the ability to experience pleasure, and negative feelings, as well as to intellectual abilities, speed of thought, language comprehension, and memory.
Rehabilitation of a person who has developed methamphetamine-related disorders can therefore be challenging.
It is important to distinguish between people who have developed psychiatric problems after a short period of use and those who have become dependent on methamphetamine.
Treatment is possible, but treating methamphetamine-induced depression requires complete abstinence from further use of stimulants or other drugs. It also requires eliciting a slow and gradual response so as not to produce anxiety, mood instability, or other forms of psychiatric decompensation.
MDMA
MDMA has an action involving both pronounced dopaminergic and serotonergic stimulation. Its effects are often described as entactogenic, meaning a sense of communion and closeness with others, increased ease of verbal expression, and a feeling of understanding, sharing, and intimacy.
The resulting psychological damage, which is not always reversible, can encompass a wide range of manifestations, from mild transient depression to chronic psychosis.
The symptoms can be said to reproduce, almost as a “stamp,” the acute effects of the drug. The person may therefore be tormented by delusions or obsessive thoughts concerning other people’s judgment, the possibility of being physically deformed, an inability to control their thoughts, a feeling of no longer being “connected” to their body or to the world, difficulty communicating spontaneously, feeling awkward or strange, or believing that their gaze is disturbing other people.
These experiences may progress to classic ideas of reference or persecutory delusions and to frank perceptual disturbances.
There may also be alternating periods of apathy and aggression, together with a prominent anxiety component resembling panic or occurring continuously in the context of depression.
Amphetamines and prolonged wakefulness
Amphetamines are often used to prolong wakefulness, sometimes for studying and sometimes for entertainment or to engage in activities at a frenetic pace, such as dancing or having sex.
This state of hyperactivity generally combines reduced appetite with increased energy expenditure, dehydration, and sustained muscular exertion.
Damage to muscle tissue (rhabdomyolysis) may occur, with a risk of acute kidney injury. Other complications include severe hyperthermia, accompanied by widespread muscle contraction, metabolic acidosis, and hypotonic dehydration caused by drinking large quantities of water after intense sweating associated with hypertonic dehydration.
Cardiovascular stress can also be complicated by various acute events.
Some variants, particularly those resembling MDMA—such as Nexus, TNT, Eve, Love Drug, Golden Eagle, and Blue Mystique—can produce serotonin syndrome, a combination of several clinical manifestations, particularly when they also act on MAO-A, as in Flatliner, in addition to inducing serotonin release in a manner similar to MDMA.