What Is Methamphetamine Use Disorder?

Rates of N-methylamphetamine (methamphetamine) use in rural areas of the US have been steadily increasing, particularly among individuals who are already struggling with opioid use disorder. Despite this alarming trend, there remains a significant gap in our understanding of how methamphetamine use affects treatment response for those undergoing treatment with medications for opioid use disorder (MOUD). This study aimed to explore the predictive role of methamphetamine urinalysis (UA) results at intake in treatment retention and in opioid and methamphetamine use over time among individuals seeking MOUD treatment in four clinics located in rural areas. The study was conducted across four clinics situated in rural areas, where access to addiction treatment services is known to be limited. Clinical data for this study were collected between January and December 2019. A substantial number of participants were enrolled from those patients initiating treatment in 2019 in four clinics in rural Oregon. Data included intake demographics, attendance, and monthly opioid and methamphetamine UA results over a 1-year period. Our primary outcomes were opioid and methamphetamine use, and treatment retention over a 1-year period. Objective verification of opioid and methamphetamine use was determined using UA results collected once per month. Treatment retention was determined considering the number of days elapsed from treatment intake to treatment dropout. Generalized estimating equations were used to compare methamphetamine and opioid use over time, and Kaplan-Maier survival analysis was used to compare treatment retention by methamphetamine UA result at intake. A total of 554 patients enrolled at one of the four rural MOUD clinics, of whom 277 (50%) had a negative methamphetamine and 277 (50%) had a positive methamphetamine UA result at intake. Participants were mostly White individuals (89.5%), half of participants were male (54.5%), and the mean age was 36.8 years (standard deviation 10.8 years). About a third were unemployed (32.3%), more than a quarter reported legal problems (26.2%), and 5.4% were currently homeless. Compared to those testing negative for methamphetamine, patients initiating MOUD treatment with a positive methamphetamine UA were more likely to be unemployed (36.5% v 28.2%; p=0.048) and to have a positive opioid UA result at intake (88.4% v 45.8%; p<0.001). A negative methamphetamine UA result at intake was associated with fewer positive methamphetamine UA results over time (p=0.022) but was not associated with either better treatment response for opioid use over time (p=0.849) or treatment retention (p=0.51). While patients who had negative methamphetamine UA results when initiating MOUD treatment had higher rates of methamphetamine abstinence over time, methamphetamine UA results at intake did not predict worse treatment outcomes in terms of opioid use and treatment retention for patients receiving MOUD in rural areas. Our findings highlight demographic and profile differences between patients who use methamphetamine in MOUD rural settings, and they identify significant gaps in existing knowledge regarding the effects of methamphetamine use on MOUD treatment response. Such findings underscore a critical need for further research to be conducted, specifically among rural populations seeking MOUD treatment.

Purpose: This study aimed to identify the sexual effects of methamphetamine on female users and determine the factors that encourage continued use of this substance. Methods: This structured interview study was approved by the Institutional Review Board at Louisiana State University Health Shreveport. The research participants were female volunteers that reported either currently or previously using methamphetamine. One study team member conducted all the interviews similarly to reduce variability between interviews. This individual was a doctorate-level addiction specialist to ensure the integrity and value of the data collection. All interviews were conducted in private offices at the Council on Alcoholism and Drug Abuse of Northwest Louisiana (CADA) facility in Bossier City, LA, between January 25, 2013, and October 7, 2014. Each volunteer provided informed consent to participate in the study. The specialist asked study subjects open-ended questions, and each conversation lasted approximately one hour. The specialist started each interview with an inquiry regarding the participant’s experiences with methamphetamine. The interviewer would particularly ask about the activities in which that participant would become involved immediately after using methamphetamine. The research subject was given time to discuss any sexual effects of using this stimulant without any prompting by the interviewer. If the study participant did not broach this topic during the interview, the specialist would ask them, “How does methamphetamine make you feel?” This “trigger” question was developed with the primary objective of the study in mind, which was identifying the sexual effects of methamphetamine use on females. Descriptive statistical analysis was performed on the data collected from the interviews. Results: Fifty-six interviews were conducted over 1.5 years. The mean age of the research subjects was determined to be 34.5 (± 10.2; range: 18 to 56). The entire study population was comprised of white females. Fifty (90%) of the study subjects utilized methamphetamine through the intravenous route. Most of these intravenous users (96%) had smoked, snorted, or ingested the substance prior to injecting the substance. Forty-four (88%) of the research participants who engaged in intravenous methamphetamine use reported feeling sexual arousal and an immediate sensation of pleasure indistinguishable from that attributed to orgasm when they injected the substance. The methamphetamine had to be of “sufficient amount and of better quality,” according to these subjects, to elicit this effect. None of the individuals interviewed reported a feeling similar to orgasm when they smoked or snorted methamphetamine. Many subjects stated that they engaged in intravenous methamphetamine use as frequently as every two hours to keep experiencing the sexual response, even if they still felt intoxicated. Twelve (21%) of the subjects reported being directed towards intravenous methamphetamine use by other females describing the sexual effects. Twenty-three (47%) of the participants recounted immediate “vapors,” which were described as “cough” or “taste” of the drug. None of the subjects said they had previously shared the sexual component of their experience with methamphetamine use with medical providers. All participants recounted disinhibition regarding sex but not social interactions. They also declared indifference to the consequences of high-risk sexual behavior and unsafe use of needles. Four subjects admitted avoiding hospital settings because they feared their methamphetamine use would be discovered. Conclusion: Female study participants who currently use or previously used methamphetamine reported a sexual response to intravenous use of the substance. Females who use methamphetamine were drawn toward intravenous use for the sexual experience, and those who use intravenous methamphetamine increase the frequency of use to reexperience the sexual response. These findings indicate that the sexual effects attributed to intravenous methamphetamine may contribute to its ongoing and recurrent use.

ABSTRACTBackground: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol and methamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol and methamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users.

‘Ice epidemic’? Trends in methamphetamine use from three Victorian surveillance systems

One of the most notable trends in illegal substance use among Americans over the past decade is the dramatic growth and spread of methamphetamine use. In response to the dramatic rise in methamphetamine use and its associated burden, a broad range of legislations has been passed to combat the problem. In this paper, we assess the impact of retail-level laws intended to restrict chemicals used to manufacture methamphetamine (methamphetamine precursor laws) in reducing indicators of domestic production, methamphetamine availability, and the consequences of methamphetamine use. Specifically, we examine trends in these indicators of methamphetamine supply and use over a period spanning the implementation of the federal Methamphetamine Anti-Proliferation Act (MAPA) (October 2000) and a more stringent state-level restriction enacted in California (January 2000). The results are mixed in terms of the effectiveness of legislative efforts to control methamphetamine production and use, depending on the strength of the legislation (California Uniform Controlled Substances Act versus federal MAPA), the specification of the comparison group, and the particular outcome of interest. Some evidence suggests that domestic production was impacted by these legislative efforts, but there is also evidence that prices fell, purities rose, and treatment episodes increased.

Objective:Methamphetamine and cannabis are two widely used substances with possibly opposing effects on aspects of central nervous system functioning. Use of these substances is prevalent among people with HIV (PWH), though their combined effects on HIV-associated neurocognitive impairment (NCI) are unknown. Adverse effects of methamphetamine use on cognition are well documented. Cannabis may disturb cognition acutely, though its longer-term effects in PWH are not well understood. Our prior analysis of people without HIV (PWoH) found that cotemporaneous cannabis use was associated with better neurocognitive outcomes among methamphetamine users. The aim of this study was to assess how lifetime cannabis and methamphetamine use disorder relate to neurocognitive outcomes in PWH.Participants and Methods:HIV-positive participants (n=472) were on average 45.6±11.5 years of age, male (86.4%), White (60.6%), and educated 13.9±2.5 years. Most participants were on ART (81.9%) and virally suppressed (70%). Participants were stratified by lifetime methamphetamine (M-/M+) and cannabis (C-/C+) DSM-IV abuse/dependence disorder into four groups: M-C- (n=187), M-C+ (n=68), M+C-, (n=82) and M+C+ (n=135) and completed a comprehensive neurobehavioral assessment. Demographically corrected T-scores and deficit scores were used for analyses. Group differences in global and domain NC performances (i.e., T-scores) were examined using multiple linear regression, holding constant covariates that were associated with study groups and/or cognition. Specifically, M+ participants displayed higher rates of Hepatitis C infection (p=.004), higher current depressive symptom scores (p&lt;.001), and higher rates of detectable plasma HIV RNA (p=.014). Multiple logistic regression was used to test for group differences in probability of neurocognitive impairment (i.e., deficit scores&gt;0.5), including the same covariates. Pooling data with a sample of HIV-negative participants (n=423), we used generalized linear mixed effect models to examine how neurocognitive performance and impairment profiles varied by methamphetamine and/or cannabis use group, HIV disease characteristics, and their interactions.Results:Compared to M+C+, M+C- performed worse on measures of executive functions (ß=-3.17), learning (ß=-3.95), memory (ß=-5.58), and working memory (ß=-4.05) and were more likely to be classified as impaired in the learning (OR=2.93), memory (OR=5.24), and working memory (OR=2.48) domains. M-C- performed better than M+C+ on measures of learning (ß=3.46) and memory (ß=5.19), but worse than M-C+ on measures of executive functions (ß=-3.90), learning (ß=-3.32), memory (ß=-3.38), and working memory (ß=-3.38). Generalized linear mixed effect models indicate that detectable plasma HIV RNA (ß=-1.85) and low nadir CD4 T-cell counts (nadir CD4&lt;200; ß=-1.07) were associated with worse neurocognitive performance, and these effects did not differ in size or direction by substance use group.Conclusions:In PWH, lifetime methamphetamine use disorder and both current and legacy markers of HIV disease severity are associated with worse neurocognitive outcomes. Cannabis use disorder does not appear to exacerbate methamphetamine-related deficits in PWH. Instead, results are consistent with findings from preclinical studies that cannabis use may protect against methamphetamine’s deleterious effects. Profile analysis models showed that participants with a history of cannabis use disorder display better overall neurocognitive performance than comparison (M-C-) participants. Mechanisms underlying a potential protective effect of cannabis may be elucidated by examining the temporal relationship between cannabis and methamphetamine consumption and neurocognitive performance.

Methamphetamine use among American Indians and Alaska Natives in the United States

Comparative impact of methamphetamine and other drug use on viral suppression among sexual minority men on antiretroviral therapy

Introduction: The effect of methamphetamine use on angiogram-negative subarachnoid hemorrhage (ANSAH) outcomes has not been examined. Herein, our goal is to evaluate the effect of methamphetamine use on radiographic vasospasm following ANSAH. Methods: This is a retrospective cohort analysis that was performed between 2011 and 2022 among consecutive ANSAH patients presenting to our institution. Methamphetamine positivity (MP) was defined as presence of methamphetamine on urine toxicology and/or by patient report. Outcomes of interest included radiographic vasospasm, clinical vasospasm, and discharge home and were evaluated using multivariate logistic regressions. Results: 101 patients met inclusion criteria and had a median Hunt and Hess score of 2 (range 1–4). Eight (7.9%) MP patients were younger (47.5 ± 3.3 v. 60.8 ± 1.2 years, p = 0.004) than methamphetamine-negative patients. In univariate analysis, MP patients were nearly 12 times more likely to experience radiographic vasospasm (odds ratio (OR) 11.6; 95%: confidence interval (CI): 1.4–98.3; p = 0.008) but there was no significant difference in clinical vasospasm or discharge home (p > 0.05). In multivariate analysis, MP was associated with increased radiographic vasospasm (OR 18.8; 95%CI: 1.7–210.5, p = 0.017) but not clinical vasospasm (OR: 5.1; 95%CI: 0.9–28.7; p = 0.063) or discharge home (OR: 1.3; 95%CI: 0.1–15.6; p = 0.843) Conclusions: Methamphetamine-positive ANSAH patients have increased odds of radiographic vasospasm compared to MN patients. While limited by sample size, this preliminary study adds to our understanding of the increased risk of radiographic vasospasm following ANSAH for patients who use methamphetamine. Future multi-center prospective registry studies should include methamphetamine history as this may modulate vasospasm risk.

Events such as the Australian heroin shortage are rare. They have been even less often studied systematically using the rich array of data available in the Australian case. The interpretation of ecological data is fraught with difficulties, so we welcome the insightful commentaries on our paper [1]. Our responses to them are divided into two broad categories: comments on the consequences of the heroin shortage and our interpretation of them; and the policy implications to be drawn from the shortage. We agree that the huge drop in fatal and non-fatal overdoses was the most striking consequence of the Australian heroin shortage. Gossop [2] queried two of our interpretations: first, could we be sure, he asked, that a reduction in numbers of syringes dispensed by needle and syringe programmes meant that injecting drug use had declined? His substantive point is that frequency of injection may have changed; this could have been the case for VIC, but was less clear for NSW. Our interpretation was based upon two key findings: the sustained reduction in numbers of syringes distributed in NSW after a decade long increase in numbers, and a drop in HCV notifications among young people [3], which suggests that there was not a huge increase in numbers engaging in stimulant injecting. Moreover, the interpretation of these data was supported by key experts and other data derived from those working with the population, who reported reductions in the number of young people presenting to services [3, 4]. Secondly, can we be sure that the heroin shortage has produced a ‘net gain’? We believe so for the study period to date. The main reason is the very large reductions in heroin-related mortality (of the order of 300–400 fewer deaths) and morbidity and either no increase or a small reduction in property crime. The reduction in mortality alone is a very large gain in life years among young adults, and it was not obviously outweighed during the period of study by any offsetting increases in problems related to methamphetamine and cocaine use, which increased only very modestly. We agree with Weatherburn that the net positive consequences of the shortage to date may not have occurred if other circumstances had not been so propitious, including reductions in cocaine availability (after the increases initially seen in NSW [5, 6]), increased treatment access (and other forms of demand and harm reduction that are well-established in Australia), and increased male employment. Jaffe [7] comments on the fact that there did not appear to be a switch from smoking or snorting of heroin to injection as a consequence of the reduction in quality and increase in price of the drug. It is important to note that most heroin users in Australia were already using injection as a route of administration; his concern—that such a supply change in countries where intranasal or smoking as routes of administration were common—might be an issue of concern, and it reinforces our belief that harm and demand reduction efforts (discussed below) are critically important alongside supply side interventions, to attempt to reduce the harm resulting from any such shifts. The very modest effects on crime might be considered puzzling, given the long-standing assumption (supported by reasonable evidence and a moderate aetiological fraction) that some proportion of property crime in Australia is heroin-related. Reuter [8] and Caulkins [9] were less puzzled, suggesting that modest effects should be expected because of the shift in drug purchases to others drugs and an inelasticity of demand for heroin and other drugs among more dependent heroin users who were less likely to cease heroin use and more likely to switch to methamphetamine. Caulkins [9] also argues that more economically informed structural modelling analyses of the time-series would not have tested for the effects that we did. We agree that more economically informed modelling is desirable. The time-series analyses of the effect of the heroin shortage were developed on the fundamental assumption that we have limited knowledge about heroin price, availability and purity measures that could be used to assess direct effects of the shortage on heroin markets. We therefore examined indicators of heroin-related harms, in order to describe the major effects of an abrupt change in a heroin market and how these would be manifested across the different jurisdictions under study. We feel that economists should consider using the results of this data-based modelling strategy to infer new information about drug markets, which they can perhaps then test with innovative research methods on the available indicator data. Time-series modelling was largely to decide which changes could not be attributed to chance. The comments of Mann [10] were interesting in that he felt that they corresponded to predictable, previously documented phenomena in the alcohol field. We would welcome the collaboration of experts in more detailed and economically informed analyses of the time-series data that we have collected. Several commentators have essentially asked the question as to whether the Australian heroin shortage represents a victory for supply side drug policies [11-13]? The rush by some to proclaim the Australian heroin shortage as a ‘victory’ for supply control policy has been answered by an equally swift and reflexive rejection of this possibility by some proponents of demand and harm reduction policies. Both responses are understandable. The supply-side of the drug policy debate has not had many unequivocal wins; and sceptics of supply side efforts often point to studies in Australia, Canada, the United Kingdom and the United States that have failed to detect any impact of drug seizures on drug price and other indicators of drug use [14, 15]. Mark Tyndall's commentary [12] represents one example of understandable concern that our work is not taken to represent a view that aggressive supply-side interventions should be the sole or major focus of drug policy, a view that we strongly support. Unfortunately, the polarization of opinion about the causes and policy lessons of the Australian heroin shortage has hampered the task of describing and understanding the event and its most immediate consequences. Before extracting policy implications from the event, we considered it important to carefully document its effects. We did not discuss the causes of the shortage in this paper for the reasons just given. Several of the authors have done so in detail elsewhere, where they came to the conclusion (largely on the basis of the implausibility of any of the alternative explanations) that supply reduction efforts by law enforcement, targeted at high level internationally run trafficking syndicates, contributed in part to the shortage [16], the effects of which were mediated by steep increases in the price of heroin, as indicated by Reuter [8]. We feel that it was the successful disruption of high level trafficking syndicates, rather than the scale of seizures per se, that was important in this instance [16]. The longer-term effects of the shortage may not prove to be as positive as they have been in the short term. We agree with Caulkins [9] and Gossop [2] that these changes are likely to prove transitory in the longer term and that the public health and order effects of the shift to methamphetamine injecting may prove very unwelcome. Some front-line police and health staff are already comparing the effects of methamphetamine use on injectors unfavourably with the effects of heroin use. There are also strong reasons to doubt the reproducibility of the Australian experience in other similar countries, whatever we take its causes to be. As Weatherburn [13] points out, the application of Australia's experience is limited given Australia's geography, the small size of its population and drug market in international terms, and its distance from the major source countries. Further, the differences in the way in which the shortage was manifested across the different jurisdictions suggests that local conditions will also affect outcomes. It may not even be possible to apply lessons from heroin to methamphetamine in Australia because methamphetamine is, in large part, domestically produced, which presents a very different set of problems for law enforcement and health. Finally, we think it important to remember that Australia has a history of timely and innovative implementation of novel harm reduction measures, and good implementation of demand reduction measures that (in this case) importantly include steadily increasing treatment places for opioid pharmacotherapy and widespread needle and syringe programmes. Without such established programmes, reductions in heroin supply may have had dramatically different (and negative) outcomes. Rather than signalling a ‘win’ for supply reduction, we argue that the results of this study [6, 17-19] suggest that a modicum of success in one facet of drug policy may be better achieved in the context of established success in the others.

As the most populated Persian Gulf country in West Asia, methamphetamine use in methadone maintenance treatment (MMT) is a new health concern in Iran. Methamphetamine use in MMT can originate in methadone misconceptions or the stimulant effects of methamphetamine use. Several research studies have highlighted the prevalence of methamphetamine use in Iran and conducting further studies on this issue is being developed. Opiate use is treated with MMT. But, there is no effective pharmacological treatment for methamphetamine use and cognitive-behavioral interventions have still remained the best practice. As a psychostimulant drug, methamphetamine use can lead to poor treatment outcomes or even treatment failure among patients in MMT. Therefore, the implementation of methamphetamine education and prevention programs in MMT is required. Prescribing adequate methadone dose and the treatment of comorbidities as well as, doing a series of activities outside treatment is underscored. Methamphetamine use has a chronic nature and methamphetamine treatment is a long-term procedure with a high rate of relapse. Therefore, the implementation of long-term motivational interviewing, teaching necessary skills to prevent relapse and case management is highlighted. A long-term collaboration between treatment teams, patients and their families is suggested to manage methamphetamine use in MMT.

Methamphetamine use causes spikes in blood pressure. Chronic hypertension is a major risk factor for cerebral small vessel disease (cSVD). The aim of this study is to investigate whether methamphetamine use increases the risk of cSVD. Consecutive patients with acute ischemic stroke at our medical center were screened for methamphetamine use and evidence of cSVD on MRI of the brain. Methamphetamine use was identified by self-reported history and/or positive urine drug screen. Propensity score matching was used to select non-methamphetamine controls. Sensitivity analysis was performed to assess the effect of methamphetamine use on cSVD. Among 1369 eligible patients, 61 (4.5%) were identified to have a history of methamphetamine use and/or positive urine drug screen. Compared with the non-methamphetamine group (n = 1306), the patients with methamphetamine abuse were significantly younger (54.5 ± 9.7 vs. 70.5 ± 12.4, p < 0.001), male (78.7% vs. 54.0%, p < 0.001) and White (78.7% vs. 50.4%, p < 0.001). Sensitivity analysis showed that methamphetamine use was associated with increased white matter hyperintensities, lacunes, and total burden of cSVD. The association was independent of age, sex, concomitant cocaine use, hyperlipidemia, acute hypertension, and stroke severity. Our findings suggest that methamphetamine use increases the risk of cSVD in young patients with acute ischemic stroke.

This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth). At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30. After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use. Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.

Context: Methamphetamine (MA) use and the mortality it causes are increasing worldwide. The neurobiological mechanisms underlying the destructive effects of MA use are complex; however, there is much evidence that MA induces the dysfunction of monoaminergic transmission and causes oxidative stress, neuroinflammation, gliosis, and apoptosis. These toxic effects are associated with cardiotoxicity and neurotoxicity and with an imbalance in the autonomic nervous system, which altogether manifest themselves in clinical symptoms, such as neuropsychiatric disorders and cardiovascular diseases. Evidence Acquisition: There is no approved treatment for methamphetamine use disorder (MUD) despite all efforts made to date. The behavioral and pharmacological approaches currently used for the treatment of MUD are not completely effective. In this study, it is hypothesized that the stimulation of the vagus nerve and biological pathways underlying the processes of this stimulation might be effective as adjunctive therapy. Results: Despite the potential effects of vagus nerve stimulation (VNS) to improve MUD, no study has yet examined the clinical potential effects of VNS in patients with the disorder. Conclusions: Therefore, further studies, including experimental and clinical trials, are needed to examine the effects of VNS on MUD.

The emergence of cardiac changes following the self-administration of methamphetamine