Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, M.D.
 16 February 2005

A STORY ABOUT METHAMPHETAMINE

            Several years ago, a young man home from college came to the clinic to inquire about methamphetamine.  He was a sophomore in college out of state and seen over the Christmas vacation.  He indicated that over the past several months, he had developed an increasing habit of using methamphetamine for a host of reasons.  He said that he got started using the drug in order to stay awake and study for examinations.  He acknowledged that initially he used the drug infrequently but then saw no reason not to use it on a regular basis in order to stay awake at night and study.  He indicated also that the drug seemed to give him more energy during the day and he felt more secure in social situations.

            He seemed to be a sophisticated and intelligent young man and came to the clinic inquiring about the adverse effects of his drug habit.  He mentioned that he tried stopping the drug for several days after he had used it continuously for a month, but that he just felt terrible when stopped the drug.

            The last and most alarming thing that he said was that his need for the drug was increasing.  He came from an affluent family that provided him a liberal allowance. He really didn’t complain about the price of the drug, which was increasing for him, but he wondered why he needed more and more of the drug through the previous several months.

            His specific question was whether the drug was “really all that bad”.  He knew that the drug was against the law which didn’t seem to bother him at all.  He was concerned about the medical effects of the drug.

            To understand what methamphetamine feels like, think back to that time when you had a startle reaction such a near automobile accident or being frightened by a sudden unexpected event.  Your heart beats faster.  You might have broken out in a slight perspiration and for a brief period of time there was a rush of adrenalin with heightened consciousness.  Had you measured it at the time, your blood pressure would have gone up very substantially.  This is due to the release of chemicals in your body called epinephrine and norepinephrine.  These chemicals are the ones that prepare for fight of flight in times of emergency.  Methamphetamine acts to release epinephrine and norepinephrine.  The higher the dose of methamphetamine, the more epinephrine and norepinephrine are released, the greater the excitement and “high’ become.  The person also becomes more vigilant and able to overcome fatigue.

            Methamphetamine would be a wonderful product were it not for two major problems.  Both of these problems relate to how the drug works.  Specifically, methamphetamine works by causing a release of epinephrine and norepinephrine from the nerve ending stores.  As more methamphetamine is used, norepinephrine and epinephrine are released from the nerve endings causing stimulation of the brain.  But over time, the epinephrine and norepinephrine stores   But over time, the nerve endings become depleted.  As norepinephrine and epinephrine become depleted, the high that methamphetamine causes begins to wear off.  It takes a higher dose of methamphetamine to achieve the same high feeling.  This is called tolerance and is why people using methamphetamine tend to increase the dose over weeks and months of time.

            The major problem of tolerance has to do with what happens when the drug is no longer available. As you can imagine, there is very little norepinephrine or epinephrine release from the nerve terminal in emergency needs of fight or flight.  This is when fatigue and depression develop.  Sleep patterns make take several months to re-established in a normal way.  Thus in a true physical sense, methamphetamine users become physically addicted to the drug.  Habitual users are very, very reluctant to stop their drug use.  Even after drug habilitation programs, relapse to again use methamphetamine is very common.

            Thus, the first big problem that develops in methamphetamine users is tolerance and addiction.  The second big problem is the increasing dosage of methamphetamine that addicts seek.  As the dose gets higher and higher, there is a tendency for individuals to become confused, paranoid, and totally ineffective in their daily routines.  Drug-seeking behavior becomes their primary endeavor.  For those with financial restraints, the need for methamphetamine frequently leads to criminal behavior.

            This column was written because I continue to see newspaper articles relating to the increased use of methamphetamine in young professionals and even in our high school students.  The drug is manufactured relatively simply.  The major problem of methamphetamine manufacture is the very foul odor that the process involves. Rural areas that are isolated are often chosen by methamphetamine producers in order to avoid detection.  Last year it was discovered that 25 methamphetamine laboratories in South Dakota were detected and shut down.  Compared to the 1097 such laboratories in the state of Missouri, we are small time operators but the drug does still pose a risk in South Dakota.

            After I had counseled the young man mentioned above, I never saw him again.  And not to my surprise, I subsequently found that he left a false name and address.  Whatever happened to him I don’t know. His characteristics were highly unfavorable and the likelihood of both social and severe medical problems were an expectation in his future.  Our schools have education programs directed to prevent drug use in our students.  Attention to these programs in cooperation with school officials is a critical and highly beneficial for parents.