Methamphetamine

Description

Methamphetamine is a very strong synthetic stimulant, which is similar in chemical composition to other amphetamines but has considerably stronger effects and slightly different appearance. It is used recreationally for its intense euphoric and energising effects and commonly as part of chemsex. Tolerance can build quickly with regular use and psychological and physical dependence is common with sustained heavy use.

Methamphetamine is available in a powder and crystalline form. The pure crystal form, known as ‘crystal meth’ or ‘ice,’ refers to the refined salt formulation most commonly associated with smoking. It is also available in tablet (commonly red and very popular around S.E. Asia and the Pacific Rim, known as Ya-Ba), or white or off-white powder form.

The production of methamphetamine is a relatively simple process, which makes it easy to produce in makeshift laboratories.

Unlike most other salts and similar to crack cocaine, a base formulation , methamphetamine can be smoked. It can also be taken orally, snorted or injected. When smoked, the effects are almost instantaneous (marginally slower when snorted) and last about 6-8 hours. Oral use leads to a slower ‘come up’ of about 20-30 minutes and has a longer lasting effect up to 12 hours. When smoked or injected it tends to be much harder on the body and considerably more addictive because it is absorbed into the bloodstream much more rapidly. When snorted, it is reported to be very painful with a strong burning feeling felt in the nose afterwards.

As the quality of methamphetamine in powder form varies, the size of an effective dose is difficult to predict. Users should be very careful about the quantity they use, starting small if they do not know the purity.

Pharmacology

Methamphetamine works mainly by causing a large release of dopamine and noradrenaline in the brain, and to a lesser extent serotonin, while also blocking their reuptake (similar to MDMA). This combination along with its lipophilicity (that allows it to cross the blood brain barrier more easily) is what makes it considerably more potent than amphetamine or cocaine, both in terms of subjective effects and neurotoxic potential.

Taken orally, methamphetamine reaches peak plasma concentration in ≈ 2.5–3.5 hours, with an average elimination half-life of roughly 10 hours (smoked or injected use produces a faster onset but a similar overall half-life). This long half-life is part of why methamphetamine's effects and comedown are typically much longer-lasting than other stimulants.

It's broken down in the liver, mainly by the enzyme CYP2D6, into amphetamine (itself active) and several inactive metabolites. Because a meaningful proportion of the population are "poor metabolisers" of CYP2D6, individual response and comedown length can vary considerably between users. Drugs that inhibit CYP2D6 including some SSRIs (e.g. fluoxetine, paroxetine) can raise methamphetamine levels in the blood and increase the risk of toxicity. Combining methamphetamine with MAOI antidepressants is particularly dangerous, as MAOIs can drastically increase and prolong its effects on noradrenaline release, raising the risk of dangerously high blood pressure.

With repeated heavy use, the brain's dopamine system becomes depleted and desensitised, which is thought to underlie both the severity of the comedown and the psychological dependence that can develop as well as the mood and cognitive difficulties reported by people trying to stop after sustained heavy use.

Harm Reduction

• Start low, go slow: Take a small amount and wait until you can feel the effects before taking more/anything else.
• Try not to use alone: If something goes wrong, someone is there to get help.
• Be careful mixing: Combination with other stimulants or with MAOI’s increases cardiovascular strain and the risk of dangerous blood pressure spikes..
• If injecting: use new, sterile equipment every time and never share needles, syringes or other injecting equipment. When methamphetamine is injected and any injecting equipment is shared (needles, syringes, spoons, filters, tourniquets or other paraphernalia), there is a risk of contracting Hepatitis B and C, HIV (which can lead to AIDS) and other blood-borne diseases. These viruses are extremely resilient, and normal cleaning will not eliminate them, particularly in the case of Hepatitis, which can live outside the body in optimal laboratory conditions for three months. People who are infected with these viruses usually appear healthy, and may not develop the disease for years. From the moment someone is infected however, they carry the virus in their blood, and can infect others through sexual intercourse (particularly with HIV) and sharing any injecting equipment, even spoons and filter. Methamphetamine can cause damage to the immune system.
• Injecting Meth can be dangerous because of variations in purity and because of the compulsive use nature of the drug due to the dopaminergic effects. It can put the circulatory system under intense strain
• If smoking, avoid sharing pipes, as burns and shared mouthpieces can also transmit blood-borne viruses
• Long binges without sleep increase the risk of paranoia and psychosis; if you notice this happening to yourself or someone you're with, try to get to a calm, safe environment and, if it doesn't settle, seek medical help
• If using during sex (chemsex), consider your sexual health alongside the drug use regular STI/HIV testing, condoms and PrEP (where appropriate) reduce risk, and it's worth thinking in advance about consent and capacity to consent while under the influence
• Test your stuff: Purity and adulterants in the illicit supply vary. Find out how to send a sample to WEDINOS for testing here: https://www.wedinos.wales, or pick up test strips at our Harm Reduction Hub
• Methamphetamine is not physically addictive in the same way as drugs like heroin and withdrawal is not life threatening or overtly somatic however it can be strongly psychologically addictive and stimulant use disorder does involve real neuroadaption with dopamine depletion. Users can become dependent on using the drug with use becoming more and more frequent; tolerance also develops with users needing to take more to get the same effect. When this happens, the side effects also increase and heavy users can develop ‘amphetamine psychosis’, a condition that may lead to a temporary psychosis. If you think this is happening, see your doctor as soon as possible.
• The side effects are similar to those of amphetamine but they can be more intense. Paranoia and edginess are common with this drug especially when it starts to wear off. The drug effects can last too long for some users, with insomnia lasting as long as 24 hours or more after taking the drug.
• Amphetamines were originally developed as a slimming aid and methamphetamine is an appetite suppressant. This may be considered a benefit for some users but can lead to malnutrition in heavy users. Smoking the drug may also damage the lungs. Snorting may cause some nasal damage. There is strong anecdotal evidence that chronic meth use is damaging to dentition.
• Methamphetamines are often associated with polydrug use (the use of several different drugs over a short period of time, or two or more drugs used simultaneously), often including alcohol. Most stimulant users use some form of ‘come down’ drug, such as cannabis or benzodiazepines/tranquillisers.
• Methamphetamines and other amphetamines should not be taken in combination with the group of drugs known as Monoamine Oxidase Inhibitors (MAOI’s), a group of anti-depressants with stimulant action or Ayahuasca, as the mix is potentially dangerous. Check with your doctor if you are not sure whether your prescription medication is an MAOI. Methamphetamine is also contra indicated with the use of retroviral drugs and combination therapies. As meth is perhaps widely used on the gay drug scene, this should be made explicit to at risk individuals.

How you can inject more safely

• Those who inject can protect themselves from HIV/AIDS and Hepatitis by always using clean equipment, obtainable from needle exchanges and some chemists, and not sharing with anyone else.

History

Methamphetamine (as distinct from amphetamine) was first synthesised from ephedrine by the Japanese scientist Nagai Nagayoshi in 1893. However, it was not until 1919 that another Japanese scientist, Akira Ogata, managed to synthesise it in the crystalline form in which it is most commonly known today.

During the Second World War, amphetamine and dextroamphetamine (UK and US) and methamphetamine (Germany and Japan) were all used extensively to give greater stamina and tolerance to the psychological traumas of warfare to soldiers. It is reputed that as many as 40 million tablets of Pervitin and Isofan (both containing methamphetamine) were deployed to German troops and airmen during the Blitzkrieg of 1939-41. Methamphetamine was given to US troops serving in the Korean War (1950-3).

During the 1960s, as ever more substances were restricted in the US, production of methamphetamine began to go underground, and was increasingly used recreationally as ‘crystal meth’. This trend quickly spread to the UK and Europe, and the smoking of it gained popularity in the 1980s, although the incidence of injecting has also increased due to the faster acting and more intense effects.

In the UK, methamphetamine use has historically been far less common than in the US, though it has been associated with some LGBTQ+ chemsex scenes. Although methamphetamine was originally scheduled as a Class B substance under the Misuse of Drugs Act 1971, due to a recommendation to the Home Secretary by the Advisory Council on the Misuse of Drugs in May 2006, methamphetamine was raised to Class A substance in 2007.

Law

• Class A
• Schedule 2

Possible offences

• Possession
  • Maximum sentence – 7 years imprisonment, a fine, or both
• Possession With Intent To Supply
  • Maximum sentence – life imprisonment, a fine, or both
• Supply (including being concerned in supply, conspiracy to supply , aggravated supply and offer to supply)
  • Maximum sentence – life imprisonment, a fine, or both
• Production
  • Maximum sentence – life imprisonment, a fine, or both

In practice maximum sentences are rarely used, for more detailed and accurate information go to our sentencing page.