How Can I Recognize Crystal Methamphetamine Abuse in Patients?

Richard S. Ferri, PhD, ANP, ACRN, FAAN


June 21, 2006


There has been a lot of media attention about crystal methamphetamine abuse lately. What is crystal methamphetamine and how can I recognize crystal methamphetamine abuse in patients?

Response from the Expert

Richard S. Ferri, PhD, ANP, ACRN, FAAN 
freelance editor, Medscape

Crystal methamphetamine is a synthetic stimulant that is easy and fairly inexpensive to manufacture. The ingredients are readily attainable over-the-counter products such as ephedrine and drain cleaner. Crystal methamphetamine is commonly known by street names such as "meth," "tina," "crank," and "ice."

While meth is easy to make, it is a highly toxic substance that can contaminate the environment where it is manufactured (known as a "meth lab"). The drug's environmental and human toxicity are so great that most meth labs, once uncovered, must be condemned. When meth is made in multiple dwelling units, such as apartment complexes, meth waste can harm nonusers, including children. Additionally, the manufacturing of meth requires keen attention because it can explode and result in fires, property destruction, and death.[1]

Crystal methamphetamine is highly and virtually immediately addictive. Unlike alcohol abuse, which can take years to result in dependency and harm, meth is a "psychostimulant" that increases the levels of at least 3 important neurotransmitters: dopamine, serotonin, and norepinephrine.[2] The "high" from meth occurs almost instantaneously, rapidly producing feelings of mood elevation, euphoria, elimination of fatigue, increased speech, social and sexual disinhibition, motor movement (also known as "tweaking"), and a sense of increased personal power. The drug's effects can last from several hours to several days, depending on how much drug is ingested.[3] Meth can be smoked, snorted, injected, or inserted anally (anal use is known as a "booty bump").

A patient who uses meth may go without sleep for hours or days, have a decreased or absent appetite, and may become significantly dehydrated. More serious health consequences of meth use are tachycardia, hypertension, hyperthermia, cardiorespiratory diseases, convulsions, and death.[4]

Symptoms of meth abuse include: dramatic weight loss, facial disfigurement, social dysfunction (loss of job, family, friends, or money; schizophrenic-like behavior), and extremely poor dentition ("meth mouth," resulting in broken teeth, severe gum infections, and oral wasting[5]).

Meth use and addiction were once thought to be prevalent primarily in the gay male community. The basis for this belief was that meth dramatically increases sexual desire, acting as a sexual stimulant, and gay men had multiple sex partners when using the drug. However, like any other addictive disease, meth abuse is now widespread and is found in all segments of society.[6]

Meth use can result in social and sexual disinhibition. Users of meth often have multiple sex partners and frequently advertise the term "PNP" on their Internet profiles which stands for "party and play." Individuals using meth often do not use condoms and are seeking "bareback" sex (sexual activity without barrier protection). However, one of the most prominent sexual side effects of meth use in men is the inability to achieve and maintain an erection. Many men overcome this problem by using medications that help correct erectile dysfunction. This has led to increases in the transmission of sexually transmitted diseases, including HIV infection. Men receiving medication for erectile dysfunction should be counseled that these medications do not prevent transmission of sexually transmitted diseases or HIV infection.[7]

Practitioners who suspect meth abuse should perform a comprehensive physical examination focusing on oral manifestations, cardiac disease, and toxicology screening. Psychiatric referral may be necessary if the patient's behavior is violent and out of control.

Treatment for meth intoxication is typically observational, focusing on symptomatic relief, but also may include aggressive interventions if the patient has overdosed.[8] Long-term treatment usually requires interventions such as harm-reduction counseling, peer support, rehabilitation and detoxification, and 12-step support.[9,10]

Crystal meth abuse is a major healthcare problem and clinicians must become familiar with this disease and its treatment. No matter where a professional practices, he or she is most likely to have to treat patients with meth addiction. Nurses, as the front-line responders to any epidemic, and nurse practitioners, who see people in primary care settings, need to be informed, educated, and have the clinical skills to treat people using crystal methamphetamine.


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