The methamphetamine problem

Methamphetamine (‘meth’) is a stimulant which increases levels of monoamines (particularly dopamine, but also noradrenaline and serotonin) in the central nervous system. Its pharmacological effects occur via a number of neurochemical processes, including disruption of vesicular and transporter functioning, through the inhibition of monoamine oxidase and the facilitation of tyrosine hydroxylase. Like other stimulants, such as cocaine and amphetamine, it produces feelings of euphoria, alertness and increased energy. Unlike cocaine though, a single dose of methamphetamine sustains these effects for many hours. Methamphetamine can be smoked, snorted, injected or swallowed. The psychological effects of long-term use include hallucinations and delusions, depression, suicidality and aggression. Withdrawal may exacerbate these symptoms, while also leading to fatigue and intense craving. Long-term health effects are considerable, and include neural damage and associated cognitive impairment, cardiovascular damage, dental disease and stroke. The drug is also associated with risky sexual behaviour, resulting in a high prevalence of sexually transmitted disease. Methamphetamine is also noted for its addictiveness. Evidence shows that addiction occurs more rapidly than with cocaine and that unlike with amphetamine, methamphetamine-seeking behaviour may persist even when tolerance is reached. The trajectory of methamphetamine use over a 10-year period has been found to resemble that of heroin more so than that of cocaine. Methamphetamine is also associated with criminality and social decline. It therefore represents a major public health, social and political dilemma.