LIKE A BAD PENNY – THE RESURGENCE OF METHAMPHETAMINE

By John Giordano, Doctor of Humane Letters, MAC, CAP

Some things in life are like a bad penny. No matter how hard you try to shake it, they just keep coming back around at the most inopportune times. That pretty much sums up my sentiments towards methamphetamine, a.k.a. meth and crystal meth. This deadly narcotic gained popularity on the streets about the same time I began my treatment career and it never fully left. Meth hasn’t been in the news very much, presumably because prescription opioid painkillers, heroin, and fentanyl have been grabbing the headlines. But make no mistake; it’s just as dangerous and deadly.

Methamphetamine was first synthesized in 1893 by a Japanese chemist. In the 1970’s, in the United States, it was assigned a Schedule II controlled substance status. Medically, it’s used primarily for ADHD and obesity in both adults and children. It’s sometimes prescribed off label for narcolepsy. However, the FDA requires a box warning for its consumers, advising them of the high potential for addiction. Meth has a very narrow medicinal value and its recreational use far exceeds all medical applications in the U.S.

Users of the illicit street meth say they get an immediate sense of euphoria when they use the drug. It floods the reward and pleasure centers in the brain with dopamine, the primary neurotransmitter of the anticipation of reward and pleasure. Many also use it as an aphrodisiac. In fact, National Geographic did an entire expose a few years back, documenting a subculture who abuse meth during prolonged sexual activity. In mild doses, methamphetamine can elevate mood, increase alertness, concentration, energy, and reduce appetite. It’s on YouTube if you’re interested.

Perhaps one of the widest uses of methamphetamine in history was during World War II. The German army handed out small pocket size containers of methamphetamine under the brand name Pervitin to its soldiers across all branches of their military. Infantryman told superiors the drug gave them an extended boost of energy, while Luftwaffe pilots raved about its ability to sharpen their focus for long periods of time. It’s been widely reported that Hitler himself had an addiction to Pervitin.

However, the program was cut back in the early 40’s due to complications. Infantry soldiers experienced a ‘drug hangover’ for days after a battle. It was said they looked more like walking zombies than an elite fighting force. There were also reports of fights breaking out among the troops and foot soldiers killing their commanding officers as a direct result of the drug.

And there in-lies the rub with this deadly narcotic. It seduces its users like the sweet melody of a siren song luring wayward sailors into shallow waters, crashing their ship on the rocks in the  choppy sea and killing all aboard.

Chronic high dose use of methamphetamine can shrink the gray matter in the brain, cause rapid mood swings, paranoia, hallucinations, delirium, delusions and violent behavior. Physically, methamphetamine can cause a loss of appetite, hyperactivity, excessive sweating, increased movement, dry mouth (‘meth mouth’) and teeth grinding, headache, irregular heartbeat, high and low blood pressure, low blood, high body temperature, diarrhea, constipation, blurred vision, dizziness, twitching, numbness, tremors, dry skin, pale appearance and convulsions.

Methamphetamine is also directly neurotoxic to dopamine and serotonin neurons. This is important because both dopamine and serotonin are neurotransmitters known to be associated with addiction. Consequently, withdrawal symptoms can last for months beyond the typical withdrawal period. Additionally, methamphetamine neurotoxicity is associated with an increased risk of Parkinson’s disease.

All of this adds up to one deadly drug. Five years ago, Methamphetamine was ranked the eighth deadliest among illicit drugs. The most recent study reveals meth as the fourth behind fentanyl, heroin and cocaine.

Experts cannot fully explain the resurgence of this deadly narcotic. In some geographic regions, where prescription opioid painkillers and heroin are in short supply, drug dealers have flooded the area with inexpensive meth supporting the supply/demand theory. A Washington University researcher, Theodore Cicero, who is immersed in the study of illicit drug consumption, has a different opinion. He has observed that some addicts use meth in conjunction with opioids to offset the downer effects.

Although the majority of methamphetamine found in North America comes from Mexico, there is a growing trend of home ‘shake and bake’ labs popping up in residential communities across the country. These are smaller labs that extract pseudoephedrine from behind-the-counter cough medicine to manufacture meth. The number of busts of these small labs across the country has grown significantly in the last few years.

Whatever the reasoning behind the popularity of this toxic cocktail, the results are deadly. The numbers are staggering and the trend is very concerning. Last year alone, over72,000 people died an avoidable death from drug overdoses – the highest number of overdose deaths in a single year in U.S. History. Almost all of these deaths involved multiple drugs. Nearly 11,000 of those deaths were directly related to methamphetamine – or a 500% increase in one decade. This also represents nearly 15% of the total overdose deaths in
2017, up from 5% in 2010.

According to the Journal of the American Medical Association (JAMA) the number of hospitalizations due to methamphetamine has also skyrocketed, up 245% from 2008 to 2015. An emergency room physician in Los Angeles and Santa Clara counties, Dr. Tarak Trivedi says that, “There is not a day that goes by that I don’t see someone acutely intoxicated on methamphetamine. It’s a huge problem, and it is 100 percent spilling over into the emergency room.”

The study also found that the cost of amphetamine-related hospitalizations had jumped from $436 million in 2003 to nearly $2.2 billion by 2015 with Medicaid being the primary payer.

Jane Maxwell, an addiction researcher at the University of Texas at Austin, says that nobody is paying attention. “The surge in hospitalizations and deaths due to amphetamines is just totally off the radar,” she said.

Moreover, a recent study showed that more women are abusing methamphetamine during pregnancy than ever before, particularly in rural areas. The study published in the American Journal of Public Health found that the rate of amphetamines detected in pregnant women has more than doubled in the last decade from 1.2 per 1,000 delivery hospitalizations in 2008 to 2009 to 2.4 per 1,000 in 2014 to 2015. Hospitals do not delineate between illicit and prescription amphetamines; however, researchers stated that by far the vast majority of the new mothers shown to have amphetamines in their system were abusing meth during pregnancy.

Up until now, methamphetamine abuse has been overshadowed by prescription opioid painkillers, heroin, and fentanyl. I believe this is a result of the way we think about our drug epidemic and we do it a tremendous disservice. We tend to look at it as if it’s this great big monolithic epidemic, when in reality there are several sub-epidemics that combine to make the whole. There is no one answer for the epidemic as a whole. However, addressing the sub-epidemics individually will show improvement, reduce the number of people addicted to drugs and save lives.

The only path to reducing methamphetamine abuse and curbing the drug epidemic in general runs directly through our government that is woefully unprepared to meet the challenge. Already efforts in Washington are under way to address the opioid crisis, but not a word has been spoken about other surging drugs of abuse like meth, cocaine and benzodiazepines that are increasingly causing overdose deaths. The growing abuses of these drugs are material evidence that the drug epidemic in America is spinning wildly out of control and the “War on Drugs” is an abject failure. Washington lawmakers seem to always be a step behind this epidemic. If we are to be successful we need to have a better understanding of the reality on the ground and redefine this epidemic. I’ve used this analogy in the past; this epidemic is like the game whack-a-mole in that when you defeat one, another drug just pops up in its place. If we are to be successful in reducing overdose deaths, we need a plan that addresses all the sub-epidemics within.

John Giordano is the founder of ‘Life Enhancement Aftercare & Chronic Relapse Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute
for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on
the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites:
www.PreventAddictionRelapse.com
www.HolisticAddictionInfo.com