Methamphetamine use disorder and diagnosis

INTRODUCTION

Methamphetamine is a psychostimulant that induces the release and inhibits the reuptake of monoamine neurotransmitters like dopamine, norepinephrine, and serotonin. The most common routes of methamphetamine administration are smoking and snorting, with less frequent methods being injection and oral ingestion.

The use of methamphetamine manifests in clinical forms as hyperactivity, heightened alertness, euphoria, stimulation of the sympathetic nervous system, hypersomnia, weight reduction, dry mouth resulting in dental caries, and adverse chronic mood alongside cognitive changes such as irritability, anxiety or panic, aggression, suspicion and/ or paranoia, hallucinations, executive dysfunction, and amnestic syndrome. Further, methamphetamine can worsen preexisting mental illness symptoms.

This topic outlines the epidemiology, pathogenesis, clinical features, course of the illness, assessment and diagnosis of methamphetamine use disorder. Other stimulant use disorders’ epidemiology, pathogenesis, clinical features, course, assessment, diagnosis, and treatment are covered in separate articles. (See “Cocaine use disorder: Epidemiology, clinical features, and diagnosis” and “Stimulant use disorder: Treatment overview.”)

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EPIDEMIOLOGY

Geographic patterns of methamphetamine use are variable, but in general, methamphetamine and other amphetamine-type stimulants are considered the most abused drugs of the emerging markets. Amphetamine-type stimulants have become the second most popular class of non medical drugs used worldwide, particularly in Asia and Oceania, where the rate of use is growing exponentially.

Prevalence – As many as 4.7 million Americans, approximately 2.1% of the population, have reported ever using methamphetamine. There appears to be a remarkably similar rate of use of methamphetamine in the United States between males and females (0.32 versus 0.23 percent).

Short-term effects

Even at low doses, methamphetamine can cause appetite suppression, hyperactivity, alertness, tremors, hyperthermia, increased respiration, tachycardia, and hypertension. A few of these effects can cause death among first-time users, depending on one’s medical history.

Long-term effects

Chronic abuse of stimulants can result in severe medical complications, especially dependency. Stimulant addiction, like all other addictions, has neurobiological mechanisms and involves the reward system becoming excessively responsive to the stimulant. Long-term use of the drug is often associated with dramatic physiological changes that can be so profound that they deteriorate the person’s quality of life and create the need for extended medical care.

Symptoms of the disorder

The most prominent symptoms in an individual suffering from stimulant use disorder are the inability to control the frequency of usage, the yearning for the drug, increased consumption over time to achieve the same effects, termed as tolerance, and persistent consumption of the drug despite negative consequences and instances of dysfunction in daily life. Also, noted is a disorder when there are withdrawal issues with reduction in drug frequency and amount or total cessation thereof. These withdrawal symptoms can last anywhere from days to weeks, months, or in some cases even years, depending on how frequently and in which dosages the subject used the drug. Some of these symptoms include but are not limited to heightened appetite, fatigue, depression, lack of motivation, anxiety, insomnia, restlessness, and drug hunger. Without aggressive medical and psychological therapies, the chance of relapse remains astronomically high.

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