Methamphetamine (tik) in South Africa
Methamphetamine is readily available and is spreading rapidly across South Africa and especially the Western Cape. Methamphetamine is psychologically addictive during the binge and high-intensity patterns of abuse, with users becoming paranoid and unpredictable.
What is methamphetamine?
Methamphetamine is commonly known as speed, meth and chalk. In its smoked form it is often referred to as ice, crystal, crank and glass, and in South Africa as tik. It is a white, odourless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. It is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpensive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.
What is its history?
The drug was developed early this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine’s chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last six to eight hours. After the initial rush, there is typically a state of high agitation that in some individuals can lead to violent behaviour.
Methamphetamine is a Schedule II stimulant in the USA, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. There are a few accepted medical reasons for its use, such as the treatment of narcolepsy, attention deficit disorder, and – for short-term use – obesity; but these medical uses are limited. In the 1980s, a smokeable form of methamphetamine nicknamed ‘ice’ came into use. Ice is a large, usually clear crystal of high purity that is smoked in a glass pipe like crack cocaine. The smoke is odourless, leaves a residue that can be re-smoked, and produces effects that may continue for 12 hours or more.
How is methamphetamine used?
Methamphetamine comes in many forms and can be smoked, snorted, orally ingested, or injected. The drug alters moods in different ways, depending on how it is taken. Immediately after smoking the drug or injecting it intravenously, the user experiences an intense rush or ‘flash’ that lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria – a high but not an intense rush. Snorting produces effects within three to five minutes, and oral ingestion produces effects within 15 to 20 minutes. As with similar stimulants, methamphetamine most often is used in a ‘binge and crash’ pattern. Because tolerance for methamphetamine occurs within minutes – meaning that the pleasurable effects disappear even before the drug concentration in the blood falls significantly – users try to maintain the high by binging on the drug.
What are the effects of methamphetamine on the brain?
Dopamine plays an important role in the regulation of pleasure. In addition to other regions, dopamine is manufactured in nerve cells within the ventral tegmental area and is released in the nucleus accumbens and the frontal cortex. It appears that the drug stimulates excess release of dopamine, contributing to the effects on the user.
What are the short-term effects of using methamphetamine?
As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. A brief, intense sensation, or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion or snorting produces a long-lasting high instead of a rush, which reportedly can continue for as long as half a day. Both the rush and the high are believed to result from the release of very high levels of the neurotransmitter dopamine into areas of the brain that regulate feelings of pleasure. Short-term effects include:
- increased attention
- decreased fatigue
- increased activity
- decreased appetite
- euphoria and rush
- increased respiration
Methamphetamine has toxic effects. In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. The large release of dopamine produced by methamphetamine is thought to contribute to the drug’s toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.
What are the long-term effects of methamphetamine use?
Long-term methamphetamine abuse results in many damaging effects, including addiction. Addiction is a chronic, relapsing condition characterised by compulsive drug-seeking and drug use, which is accompanied by functional and molecular changes in the brain. In addition to being addicted to methamphetamine, chronic methamphetamine abusers exhibit symptoms that can include violent behaviour, anxiety, confusion and insomnia. They can also display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances and delusions (for example, the sensation of insects creeping on the skin, called ‘formication’). The paranoia can result in homicidal as well as suicidal thoughts. A methamphetamine-dependent individual may have the following symptoms:
- decreased appetite and weight loss
- disregard for consequences of negative behaviours
- feelings of isolation
- feelings of well-being
- irritability and mood swings
- legal problems
- ravenous appetite
- recurrent failure to meet responsibilities at work, school or home
- sleep disorders
- use of amphetamines when it is dangerous, such as while driving
Someone who is addicted to amphetamines may show the symptoms of dependence, as well as these additional symptoms:
- excessive sweating
- lethargy and fatigue
- muscle and stomach cramps
With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some cases, abusers forego food and sleep while indulging in a form of binging known as a ‘run,’ injecting as much as a gram of the drug every two to three hours over several days until the user runs out of the drug or is too disorganised to continue. Chronic abuse can lead to psychotic behaviour, characterised by intense paranoia, visual and auditory hallucinations, and out-of-control rages that can be coupled with extremely violent behaviour.
Although there are no physical manifestations of a withdrawal syndrome when methamphetamine use is stopped, there are several symptoms that occur when a chronic user stops taking the drug. These include depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug. In scientific studies examining the consequences of long-term methamphetamine exposure in animals, concern has arisen over its toxic effects on the brain. Researchers have reported that as much as 50 per cent of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. Researchers also have found that serotonin-containing nerve cells may be damaged even more extensively. Whether this toxicity is related to the psychosis seen in some long-term methamphetamine abusers is still an open question.
What are the long-term effects of the condition?
- memory impairment
- coordination impairment
- increased risk of stroke
- being out of touch with reality
- high risk for suicide
- exposure to HIV
- heart problems
- hepatitis B and C, from contaminated equipment
- lead poisoning, from contaminants in the drug
- malnutrition as a result of low food intake
- psychotic disorders
- violent behaviour?
What are the medical complications of methamphetamine use?
Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and, if not treated immediately, these can result in death.
Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers can also have episodes of violent behaviour, paranoia, anxiety, confusion and insomnia. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased.
Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent. Production errors may therefore result in methamphetamine contaminated with lead. There have been documented cases of acute lead poisoning in intravenous methamphetamine abusers.
Foetal exposure to methamphetamine also is a significant problem. At present, research indicates that methamphetamine abuse during pregnancy may result in prenatal complications, increased rates of premature delivery, and altered neonatal behavioural patterns, such as abnormal reflexes and extreme irritability. Methamphetamine abuse during pregnancy may be linked also to congenital deformities.
How is methamphetamine different from other stimulants, like cocaine?
Methamphetamine is classified as a psychostimulant as are such other drugs of abuse as amphetamine and cocaine. We know that methamphetamine is structurally similar to amphetamine and the neurotransmitter dopamine, but it is quite different from cocaine. Although these stimulants have similar behavioural and physiological effects, there are some major differences in the basic mechanisms of how they work at the level of the nerve cell. However, the bottom line is that methamphetamine, like cocaine, results in an accumulation of the neurotransmitter dopamine, and this excessive dopamine concentration appears to produce the stimulation and feelings of euphoria experienced by the user.
In contrast to cocaine, which is quickly removed and almost completely metabolised in the body, methamphetamine has a much longer duration of action and a larger percentage of the drug remains unchanged in the body. This results in methamphetamine being present in the brain longer, which ultimately leads to prolonged stimulant effects.
Other serious problems
Regarding domestic disputes, cities worldwide report increased percentages of domestic violence incidents associated with methamphetamine use. Domestic disputes, ordinarily regarded as dangerous situations for law enforcement, become intensified when a tweaker (habitual user) is involved because of that individual’s unpredictability.
Many motor-vehicle violations and accidents may also involve tweakers. Paranoid and hallucinating, tweakers may decide to travel in their cars. Their delusional state makes moving shapes and shadows appear threatening, and they are very likely to increase their speed and exhibit erratic driving patterns as they attempt to evade the images.
An additional threat to society and themselves may stem from tweakers’ tendency to arm themselves for their personal safety. Interviews with methamphetamine abusers have confirmed that these individuals often maintain weapons in their automobiles, as well as in their residences.
Tweakers may also be present at raves or parties. In addition, to support their habit, tweakers often participate in spur-of-the-moment crimes, such as purse snatching, strong-arm robberies, assaults with a weapon, burglaries, and thefts of motor vehicles.
Methamphetamine toxicity symptoms
A good summary of the clinical toxicity of methamphetamine has been provided by Derlet and Albertson (2004), and may be of interest to medical professionals, or the more medically informed members of the public.