Episode 40

Meth popularity is extremely high right now in the US, Australia and the UK. This drug is especially damaging with really visible consequences. This episode will cover the meth facts including how its used and long-term effects. 

Helpful Links

History of the methamphetamine problem – PubMed

History of Methamphetamine | Methamphetamine: Implications for the Dental Team | Continuing Education Course | dentalcare.com

The History of Crystal Methamphetamine – Drug-Free World

History of Meth – HISTORY

How is methamphetamine manufactured? | National Institute on Drug Abuse (NIDA)

Methamphetamine Production | Methamphetamine: Implications for the Dental Team | Continuing Education Course | dentalcare.com

How to Recognize a Meth Lab

5 Ways to Know There’s Methamphetamine in Your Home

Recognizing a Meth House or Structure

Know the Risks of Meth | SAMHSA

Household Contamination with Methamphetamine: Knowledge and Uncertainties

What are the long-term effects of methamphetamine misuse? | National Institute on Drug Abuse (NIDA)

How Meth Destroys The Body | The Meth Epidemic | FRONTLINE | PBS

Breaking Bad and crystal meth – a chemical reaction

Are You Living in a Former Meth Lab? – Scientific American

The Many (Surprising) Health Benefits of Meth – Pacific Standard

Understanding the Feelings of a Meth High

Methamphetamine (Desoxyn): ADHD Drug Side Effects, Addiction & Withdrawal

Methamphetamine Toxicity – StatPearls – NCBI Bookshelf

Meth Has Health Benefits? In Low Doses, It Might Just Cure A Number Of Ailments – GQ

Crystal Meth

Methamphetamine | Effects of Methamphetamine | FRANK

Is There a Safer Way to Use Meth? Some Portlanders Are Trying to Provide One. – Willamette Week

An ex-meth addict describes in detail what it feels like to take meth – it’s a long video but I found it incredibly interesting (and scary) : videos

How is Methamphetamine (Meth) Consumed? | The Recovery Village

Symptoms and course of psychosis after methamphetamine abuse: one-year follow-up of a case. – Abstract – Europe PMC

A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology

Methamphetamine Psychosis: Why It Happens and How You Can Get Help

Frontiers | A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology | Psychiatry

How Is Meth Made? Ingredients and Cutting Processes – Oxford Treatment

Timeline of Meth Withdrawal | Banyan Texas

What are the immediate (short-term) effects of methamphetamine misuse? | National Institute on Drug Abuse (NIDA)

How long does meth stay in the system? | Drug Policy Alliance

Why do people use meth? | Drug Policy Alliance

What Does Using Crystal Meth Make You Feel Like? – Drug-Free World

Methamphetamine Withdrawal Symptoms, and How You Can Get Help

Methamphetamine: What To Expect When Someone Quits

Withdrawal symptoms in abstinent methamphetamine-dependent subjects

Drug Index – Meth – 10 ways to keep well – DrugHelp

IAmA Former meth addict · GitHub

I was a high-functioning meth addict for a decade | SBS Voices

Methamphetamine Psychosis: Epidemiology and Management

Long-Term Effects Of Meth Use

What are the Long-Term Effects of Meth? – San Diego | API

Partial Recovery of Brain Metabolism in Methamphetamine Abusers After Protracted Abstinence | American Journal of Psychiatry

Decreased dopamine activity predicts relapse in methamphetamine abusers | Molecular Psychiatry

Researchers Find A Way To Help People With Meth Addiction Avoid Relapse : NPR

Methamphetamine (Meth) Addiction | Crystal Meth | Hazelden Betty Ford

Desoxyn (Methamphetamine Hydrochloride): Uses, Dosage, Side Effects, Interactions, Warning

Methamphetamine Induces Dopamine Release in the Nucleus Accumbens Through a Sigma Receptor-Mediated Pathway | Neuropsychopharmacology

Explainer: What is dopamine? | Science News for Students

Methamphetamine Regulation of Firing Activity of Dopamine Neurons

Meth In The Body – Meth And The Brain | The Meth Epidemic | FRONTLINE | PBS

What treatments are effective for people who misuse methamphetamine? | National Institute on Drug Abuse (NIDA)

Free Treatment Tool https://betsybyler.com/treatment-tool/


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.  So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 40.

As you listen to this, I’m taking a break. I’m on a two week vacation spending some time with family. I hope that most of you have gotten a chance to take a vacation so far this year. If not, you really should plan on it. It is worth it. As therapists, leaving for vacation means that we have to do a little pre-planning. We can’t just drop off the planet typically. 

We have clients who are going to want to know where we are. We have paperwork that needs to be done, and we have appointments that have to be scheduled before and after we leave. So the week before my vacation, I’m spending time putting in as many clients as I can and recording a couple podcasts to make sure that they’re up while I’m gone. 

For the next two weeks, we’re going to be talking about methamphetamine.  Meth is a major drug in the United States, the UK, Australia, and many other places around the world. It doesn’t take much research to find out meth facts online. There are tons of things out there. We’re going to cover meth in its entirety in the next two weeks. Following that I’m going to be bringing you an interview with a woman who found recovery from meth, went to law school and became a judge. That interview is going to be coming to you in the first week of July. 

In order to set the stage, though, we need to talk about meth: it’s history, how you make it, how it’s used, recovery and all the things relating to it. 

Meth Facts: History

 A Japanese chemist first synthesized meth from another stimulant. In 1893, it was used early on as a treatment for narcolepsy  asthma, and as a weight loss drug. During World War II, the Allies and the Axis powers used it to help keep troops awake. After the war was over meth use continued to increase. Meth was difficult to make from the beginning. In 1919, it became a little easier when another chemist streamlined the process. He used phosphorus and iodine to reduce the ephedrine into a crystallized form, creating the world’s first crystal meth.

In 1932 and American pharmaceutical company Smith, Kline, and French began marketing the amphetamine inhaler for use with asthma and nasal congestion. The inhaler medication they called Benzedrine was initially over the counter. What people found though is that it had a euphoric and energizing effect.

It wasn’t too long after that the company started making it in pill form to use for narcolepsy. During World War 2  a German pharmaceutical company Temmler picked up the mantle and began making tablets as non-prescription drugs under the brand name Pervitin. Japanese, US, British and German military personnel are reported to have used the stimulant to increase their endurance and ward off fatigue during the long campaigns. 

Benzedrine or Bennies as they were known were popular during the war, but also became a staple of the beatnik culture in the 1950s. Amphetamine use began falling out of favor  in the later 1950s. That’s when the FDA started requiring a prescription for Benzedrine. It’s also when the wider population began finding out what we know to be true, which is that this form of amphetamine can cause delusions, paranoia, psychosis, abnormal heartbeats, and heart failure. 

In the sixties meth distribution and production moved to motorcycle clubs across the United States.  Anecdotal evidence because I haven’t talked to any bikers from the sixties about it, it was called crank because they would transport it in the crankcase on their bike. This continued on into the seventies  and the laws began cracking down on manufacture and distribution. 

Many of the labs were found in the Southwest and Western  United States. It’s theorized that it’s because the chemicals that they needed  were more easily obtained from Mexico. Meth had begun in a pill form and could be in an inhaler form. During the sixties and seventies, the injectable form  became really popular. 

In the 1980s a pure and smokable form of meth started appearing in Hawaii. During the 1980s, California  became the center of the meth production and trade. It’s reported that Mexican drug cartels set up large labs in Southern California.

In the nineties, that’s when we started having smaller meth labs. Now the meth labs that we were talking about in Southern California, these were large operations  and while  they could produce 50 pounds of product in a weekend, smaller labs were popping up all over the country, especially in rural areas. This is when the meth labs and meth use began moving into the Midwestern states.

Between 2000 and 2004 labs are increasing all over the United States. The state of Oklahoma became one of the first to start banning and limiting access to raw materials used to make meth. In 2005, the Combat Methamphetamine Epidemic Act  set the limit on certain ingredients that were used to make meth. One of the big ones is pseudoephedrine.

This is when cold medications that contain pseudoephedrine started being restricted and placed behind the counter at pharmacies. There were also limits placed  on the number of packages you could buy. In 2007 the Methamphetamine Remediation Research Act directed the EPA, the Environmental Protection Agency to establish voluntary guidelines for cleaning up former meth labs.

During the nineties and into the two thousands, much of the meth in the U S was being created in the U S. However, it’s cheaper now to get it from Mexico and so the majority of the meth on the street is getting shipped in through cartels, cross the border. Much of the meth used in Asia is reportedly being produced in China, Thailand, and Myanmar.

Meth Facts: Current regulation

It’s important to note that meth is also available by prescription currently. It’s not often prescribed, but it is a medication that can be prescribed  in certain instances. And one of those is for ADHD. It has a brand name called Desoxyn. We’ll cover that more later in the episode when we talk about uses for methamphetamine, other than for recreation.

Let’s talk about how meth is made. Many of you probably watched Breaking Bad and maybe got a little bit of an idea of how meth is made. I didn’t watch it because it felt a little too much like work to me. 

Most of us know that meth is dangerous. It’s dangerous to use. It’s dangerous to make. We know that meth is something that can be created in a lab and is available by prescription. Since that prescription isn’t used very often meth has to be created by dealers. 

There are recipes for cooking meth on the internet. I didn’t go look for them because I don’t know that I need somebody coming down thinking that I’m making meth here in my country home. It’s pretty inexpensive to make. A thousand dollars worth of raw ingredients. Is said to create $20,000 worth of meth. That’s a huge return. Depending on the availability meth prices can vary wildly from $20 to $300 a gram.

The DEA, the Drug Enforcement Administration, in the United States reported that from 2007 to 2013 the price of meth decreased more than 70%. While that’s purity increased by 130%. People are able to make meth cheaper and make it more pure. Currently a hit could cost as little as $5 per dose. Although it completely depends on where you are in the world. A dose of meth  is about a quarter of a gram.

Meth Facts: What’s in it

The main ingredient is pseudoephedrine or ephedrine, which is typically found in over the counter cold and allergy medications.  The rest of the ingredients in meth vary from recipe to recipe. Here’s just a list of some of the products that can be used to make meth and hydrous ammonia, hydrogen peroxide, antifreeze, battery acid, benzene, lead acetate, iodine crystals, lighter fluid, lithium from batteries, lye, sodium hydroxide, camp stove fuel nail Polish remover or acetone, Freon, sulfuric acid, or drain cleaner, gasoline or paint center.

So I want you to think about that for a minute. Any one of those is caustic and potentially fatal if ingested. Put those together and people are snorting, smoking and shooting this into their veins. As we talk about this in the next two weeks, one of my goals is to show you why. Because that’s the thing that occurs to people who aren’t drug addicts and even those who are, but I’ve never touched meth. Why on earth would somebody do that? Why would they put this into their body? Turns out there’s actually a really compelling reason.

This isn’t actually a recipe for meth. It’s just letting you know what the process is. So there’s four main steps. The ephedrine or pseudoephedrine is combined with  ammonia and lithium or iodine and phosphorus. It’s mixed in with water. Then a solvent like gasoline is added and the person extracts the methamphetamine.

The mixture is then heated by using the acid or some other substance like gasoline to crystallize the product, the heating process of course is quite dangerous because many of the substances used are flammable or corrosive. The methamphetamine is separated from the waste, which is significant, particularly with the use of phosphorus. The waste materials are highly unstable and combustible. What is in meth is going to vary wildly.

As we’ve talked about for other drugs, dealers are going to be cutting meth with various substances. It’s not necessarily going to be cut to the degree that things like heroin and cocaine are, but there are substances that are added to it. For instance, there’s a powder that’s used for strengthening cartilage and people or animals, and it’s virtually undetectable in meth.

Because of the ingredients and their flammable, caustic, explosive nature making meth is really dangerous. We have all heard about or read about meth labs going up in flames. At least in the United States, if you’ve ever bought a house, you found that one of the things people have to disclose is whether or not meth was ever created on that property. Meth labs can spring up anywhere. For a while it was a lot in the rural part of the country, where it was in the woods and no one can really see what’s happening. I can see how that would easily happen. On our land, we could easily have outbuildings and nobody would ever know what we were doing there. Can’t even see our house from the road so it’s a fairly safe way to make meth.

Meth Facts: Lasting effects on buildings

Smaller meth labs pop up in houses, hotel rooms, and there’s even methods to do meth in a one shot deal sometimes called shake and bake. Where you put  all of the ingredients into some kind of container and it cooks there. It’s really volatile and pretty dangerous because those chemicals interact with each other. It’s not like their safety regulations around this. If you’ve ever wondered if someone using or creating meth in a house or in a structure is really a problem. It is.

The chemicals  that are being used in meth each have their own dangers associated with them. When someone’s cooking them there’s going to be steam and there’s going to be chemicals being put out into the air. Science tells us that it contaminates the house. Possessions and furnishings within it. And that the exposure that people get can come through ingestion, dermal contact, and inhalation of these fumes.  Even when the use is prior to that person being there. It lingers and stays and can cause issues.

Some of the health effects can be behavioral changes, respiratory illnesses and skin related responses. Symptoms could be irritability, anxiety, sleeplessness, weight loss, a persistent cough, and dizziness. Of course, difficulty breathing, nausea, throat, eye, and skin irritations as well. You can imagine that finding out that a structure had meth being made or smoked in it is going to be really difficult. Most meth addicts are not going to admit to that kind of thing and you won’t really know unless someone does testing specifically for it. 

The testing is not necessarily easy because you’re not testing just for meth. You’re testing for a number of different chemicals and it depends on which surfaces absorbed it. Some surfaces are of course more porous than others, but this testing isn’t necessarily going to be widely available either.

There are methods for removing the contaminants from a structure. I won’t go into the different methods because it’s pretty confusing and I’m not really sure it’s necessary for us. It’s just that it’s pretty difficult. Think about going into a building or a home and  trying to figure out what has been contaminated. It’s not a matter of just cleaning the things because we’re talking about what has been absorbed into the pores of the structure itself. Of course, it’s easier to get rid of things like carpets or wallpaper and other furniture structures that have been left inside the house or the building.

But we’re talking about basic things like walls, sheet, rock wood, those are things that have to be tested and cleaned. I’ve often wondered myself if it’s not easier to just demolish a place and rebuild, but that’s also really expensive. I think what ends up happening is people either don’t know or they just decide to live with it.

There really aren’t international standards for cleaning up meth lab places. If you’re interested in the guidelines,  I’ll include a link to an article about what the remediation standards are for the United States, Australia and New Zealand

There are reports of people getting sick from contaminated homes all over the place. For example, a woman and her husband had bought their first home in Salt Lake City, Utah. The three bedroom house was in a nice neighborhood. Trees lined the streets, kids riding their bikes. After they moved in and the neighbor informed them that their house used to be a meth lab They called their realtor and the realtor said, don’t worry it’s been decontaminated and had a certificate from the local health department saying it had been decontaminated.

The family, however, started getting sick.  The woman and her husband developed sinus problems and required surgery for that. After their baby was born, he had serious lung issues that caused him to stop breathing a couple of times, he also wasn’t gaining weight.

The family decided to have their house tested for methamphetamine and the results made them put their kids in the car and drive away from their home, leaving all their earthly belongings. The house level of methamphetamine contamination was reportedly 63 times higher than the level at which a house in Utah would get condemned.

Some of the typical symptoms that people find is that when moving into a structure that they would develop respiratory, sinus issues and potentially migraines. Also could be some skin irritation or burns from different surfaces. 

In terms of thinking about how dangerous these labs are all we need to do is look at what the crew is like  when they go clean a lab up. They have to have respirators, Tyvec suits, shoe coverings, gloves, and eye goggles.

They remove the meth making hardware and chemicals and hire professional cleaning companies to sanitize the house. I saw a statistic from Missouri and they stated that since 1998 they’ve seized 12,354 meth labs. And out of those labs 251,000 pounds of solid waste and 118,000 pounds of toxic waste.

Typically where their meth was made they’re going to be scrubbing all the surfaces, repainting the walls, replacing the carpets and the air filters and air out the property. However, there’s no national standard for meth lab cleanup. Regulations differ from state to state and country to country.  In some states in the U S getting a license to decontaminate a house is as easy as taking a few hours of a class and a written test.

Meth Facts: Identifying a meth house/lab

There’s a number of articles on the internet telling you things to look for to see if your house might’ve been used in meth production. On the outside they tell you to watch for things like dead vegetation, because they have to get rid of leftover chemicals and often will pour them outside.

Elaborate security is also a warning. meth tends to make people paranoid and those making it are going to be especially so. Strange. Ventilation is also a key. Meth makers have to find ways to get the fumes out of the structure and may employ kind of odd things that are hodgepodge together in order to make that happen. Covered windows, of course, because they don’t want people looking in.

They’ll tell you to look for meth ingredients, like empty packages of allergy medication batteries that have been ripped apart. Used coffee filters with colored stains or powdery residue, empty containers with puncture holes in them of antifreeze, ether, Freon, lie, drain opener, paint thinner, those kinds of things.

Plastic soda bottles with holes near the top. Often with tubes coming out of them and plastic or rubber hoses, duct tape, rubber gloves, or respiratory masks. 

What they’re making with all of this is a powder or a crystal. It’s normally in the form of a white powder that has no smell and tastes bitter, but it can also appear in a semi-transparent crystallized form or in a pill form made from compressed powder. When it’s in a crystal form or a rock form. Think of like rock candy kind of. It’s called crystal meth. 

The main difference between methamphetamine and amphetamines is that methamphetamine is a more potent form and crosses the blood brain barrier faster than amphetamines.

When we’re talking about how people use the meth typically they’re going to start with smoking it. This is sort of the entry way that a lot of people start using meth.  So when we’re talking about smoking meth, they have to have a way to burn it and inhale the fumes. There are pipes for such a thing that you can buy from head shops for about 10 or $20. They’re glass tubes with a bowl on the end that you put the meth in, then you light it and heat it up  and inhale the smoke from there.

In a pinch,  you can use a light bulb, which  you take the metal part off, break it off and take the filament stuff out. Put the meth inside the light bulb and then light it from there. You’d need a stopper and a tube on top  so that a person can direct the smoke in order to inhale it. This is pretty dangerous and ends up burning people’s hands pretty often, but it is something that people use when they don’t have a pipe available or a bubble as it’s called, at least in my neck of the woods.

So when you’re thinking about paraphernalia, if you’re finding things like a light bulb that’s been burned out, random bits of tin foil, Or a stopper with a tube in it, or needles or tourniquets or any of those kinds of things. Those are signs that someone’s using. –

In different podcasts we’ve talked about the route of administration and the fact that it changes over time. I’ll briefly go over that now,  just so that it’s clear what I’m talking about. Route of administration changes as people grow their tolerance to a drug. If they’re starting with smoking and eventually it’s not going to be as good of a high as they had in the beginning.

When you use something like meth or heroin or even cocaine for that matter, there’s an initial high that you get that’s pretty amazing. . You won’t really get that high back though. I mean, yeah, you’ll get high and you’ll feel the good that you’re looking for, but it’s not going to be that quote, amazing rush that it was in the beginning. Until you change routes of administration.

So for meth, you start by smoking it and eventually your tolerance goes up. You have to smoke more and more. If you change it and start snorting it which is called hot railing in my area of the country. Then  you get that euphoric effect again. When it comes to snorting versus smoking, smoking actually gets meth into the system faster and snorting makes it go in more slowly, but it’s more concentrated. That’s why it would be the second step. 

Well, you get used to that as well and your tolerance continues to build eventually snorting meth. Isn’t going to be any more effective for you or any faster for you and so the next step is to start injecting it or shooting up. That again is going to give you that euphoric effect because it’s getting into your bloodstream infinitely faster than smoking or snorting. There isn’t really anywhere else to go though once you’ve started injecting. 

Of course meth could also be swallowed in pill form or in some other form that someone chooses and there are reports of people using it rectally, but I don’t think it’s terribly common. I’ve actually never had anyone admit to that. But anything that gets the drug into your system faster is what people are after and rectally there’s going to be  a pretty direct route to the bloodstream.

Somebody might start out somewhere else, but that’s not super typical. People are far more willing to smoke something than they are to put something in their nose or to inject something. But if they’re with somebody who is injecting meth and people are often willing to inject others for them. That might be how they start. It’ll just depend.

How long the effects last and how long it stays in your system depends on the amount you have taken, your size, whether you’ve eaten and what other drugs you might’ve taken. Smoking the pure form of meth produces a really intense high, similar to that produced  by crack, but as much longer lasting. The effects can last between four to 12 hours.

How fast it gets into the system of course depends on how they take it. It could be a few seconds, or it could be several minutes depending on route. The injectable form of course is the fastest of the most common methods. meth stays in the body between one to four days. 

There’s a lot to meth in terms of what it’s supposed to do in the body, what some side effects are and the long-term effects. We’ll go over these, but this isn’t necessarily the why of why people would continue to use meth. We’ll get into that in the next episode,

The purpose of meth is supposed to be a feeling of exhilaration. Make someone alert and awake. Give them euphoria. It’s supposed to increase enjoyment of sex sometimes called chem sex, which is short for chemical sex.  It affects appetite, a loss of inhibition and increased sociability.

Sometimes people use it to feel more confident. Sometimes people use it to deal with depression. It can also cause agitation, paranoia, confusion,  and some aggression.

Typically euphoria is the main feeling people are after.  Meth stimulates the brain, creating a rewarding feeling that makes people want to continue to use the drug. That’s typically the massive flood of dopamine. Other emotions tend to be blunted, meaning they’re less aware of their feelings. And that can be a motivating factor for people who want to escape  from regular life. While on meth, a lot of people report feeling more powerful and more productive than they normally feel.

Being high on meth does have a pretty significant physical effect. In addition to generally feeling more stimulated, it can cause changes to a person’s heart rhythm or breathing. They can be sweating, feeling hot or cold as well as nausea and vomiting.

Meth typically is something that’s used in a binge and crash kind of way. In the beginning it’s not as much that way. When somebody starts using meth, they’re still able to do pretty typical things. They can still eat, they can still sleep, they can still go to work. It doesn’t affect them  in big negative ways right away.

However, as use increases and as tolerance increases,  the come down from meth is going to be more severe. It’s the comedown that people tend to want to avoid. So it’s a lot like having the flu except far more severe and it lasts several days.

Meth withdrawal typically is around three to four days, depending on how long you’ve been up, meaning how long a binge was or how much you’ve been using. You feel really sick. Anything that can run will run and you just generally need to sleep.

In general withdrawal from meth is unpleasant. The symptoms of withdrawal are going to start as early as 24 hours after the person’s last dose.  Because meth causes an extreme dump of dopamine without it there’s lots of fatigue and feelings of sadness. Other symptoms are sleepiness, headaches, confusion, hallucinations,  depression, cravings,  and increased appetite.

During the first two days it’s usually the crash phase where there’s a decline in energy, nausea, vomiting, stomach cramps, and headaches for. For three to 10 days as the symptoms of the crash go forward, there might be hallucinations, paranoia, anxiety and that kind of depends on how long they’ve been using.

When somebody is at this place of crashing they’ve been up for several days, maybe even up to a couple of weeks. At some point, though, the body has to crash and the person knows it’s coming. They will plan accordingly. They may use until their stash runs out or they may use until the money runs out. But avoiding the crash is something that is very common. The crash is going to last longer if you’ve been using it longer. And like I said, it’s really unpleasant. Not necessarily life-threatening  although it could be depending on cardiac issues, but it’s just something that is like being the most sick you’ve been.

From what I understand, it’s not as bad as say opiate withdrawal because the pain is so bad with opiate withdrawal.  In terms of withdrawal, the most difficult is going to be opiates followed by benzodiazepines, probably followed by meth. In terms of lethality we can’t forget alcohol as well.

So let’s talk about what happens after the comedown is over and long-term effects. In the beginning, meth is something that you can use to give you more energy, make you feel good, make you feel powerful, and it can seem like it’s no big deal. Plenty of people use meth socially and recreationally for a while. It becomes a really easy crutch to be able to use when you’re tired or need to lose some weight or need to get extra things done. 

The majority of people using meth aren’t necessarily who we’re thinking of. I’ve known construction workers, parents, teachers, and other professionals, including in our field who have used meth. Who couldn’t use extra energy, who doesn’t want to feel more confident and the weight loss thing can be really tempting for people.

If they’re using it once in a while, there aren’t the major side effects the way they would normally have. They can go to sleep at night, they can eat normally, they can walk around without looking like they’re on meth. The problem comes when they’re using it more often.

The crashes are really intense and so they stay up for longer periods. The classic meth addict is what we’re seeing when someone’s using it long-term. There are a couple main features of someone who’s using meth in a long-term way. 

One of those has to do with the physical aspects where their skin starts to look bad. They may have sores on their face, arms, or other places on their body.  Their hair becomes brittle and their movements are a little jerky and they seem to be twitching. Specifically they start moving their mouth in a way that’s called “jaw jacking” and it’s like, they’re trying to pop their jaw. This is not something that they’re doing on purpose, but just something that’s related to meth use. 

One of the symptoms that’s most prominent is the skin sores. This is about skin picking. Oftentimes people who are using meth can feel like there are bugs crawling on their skin. This is related to the nerves all firing and pushing at the same time. They feel like there’s something on them and so they’re picking at it. People who are using meth regularly, aren’t also the greatest at hygiene and so a lot of times those sores can get infected because they’re not really taking care of them very well. 

The two biggest symptoms that last longer term are psychosis and what’s called meth mouth. We’ll talk about psychosis first. Meth makes people paranoid. They’ll talk about seeing shadow people and quite often talk about conspiracies. They’re concerned that the cops are out to get them and that there’s someone following them. I’ve worked with people who were so convinced that they had someone following them and investigating them that they had the police come and look at their house and even look inside the walls to be sure that there was no one there. 

Psychosis for people who are using meth  has tactile visual auditory, hallucinations, and delusions typically of someone out to get them or turning them in or something to do with law enforcement. Oftentimes someone who is high on meth will be looking out the window fairly often, have trouble sitting still, trouble concentrating, pacing, back and forth  all of those sorts of hypervigilant activities.

I have not met someone who was using meth on a binge basis with regularity that did not have some form of psychosis going on. The question is how severe it is and what happens after they quit. I haven’t been able to find research that tells us how many people end up having psychosis that sticks around and how many people’s psychosis abates once they quit using. 

I can tell you from anecdotal evidence over my career, that probably 75% of people with psychosis do disappear. It might be higher than that, but that’s a conservative estimate. The problem lies in the other 25%. For them, psychosis sticks around and in some cases it’s very permanent.

I have known people who have been sober for years who continue to have psychosis. There is a difference between psychosis related to say schizophrenia and psychosis that’s caused by meth. Literature tells us that anything that’s persisted for more than a month after someone quit using is no longer attributed to the substance. In that first month, we have meth induced psychosis as a diagnosis. After that, however, it is now a primary psychotic disorder. 

Both schizophrenia and psychosis have positive symptoms, such as hallucinations and delusions. However, those suffering from psychosis due to meth, typically don’t have as many negative symptoms as people with schizophrenia. Negative symptoms of schizophrenia are things like flattening of an effect,  withdrawal from people,  and trouble with speech. Think of negative symptoms as something that takes away from the person’s life, rather than as adding to it.

Now, the positive symptoms aren’t adding to it in a positive way, but they are adding symptoms to the person that weren’t there before. That’s how I remember the difference between positive and negative symptoms for schizophrenia.  When it comes to psychosis, due to schizophrenia it’s typically associated with more pronounced thought disorder and cognitive deficits mediated in the parietal cortex, such as difficulties with selective visual attention while acute meth induced psychosis has more to do with visual and tactile hallucinations. If you think about that, it makes sense because one of the effects of being on meth is that heightened state and that everything is basically turned up to 11.

And so when they’re using and they’re feeling like bugs are crawling on their skin, or they’re seeing shadow people, those are typically the things that are going to stay around. The hard part of course, in dealing with psychosis is getting the person to recognize that the psychosis isn’t real. In recovery, someone  who has psychosis that’s still lingering, is going to have trouble relaxing  an accepting reality for what it is. Arguing with someone who has psychosis is not advisable.  It is easier to help them focus on other things and manage their anxiety.

When it comes to meth psychosis, I have seen it be helpful to walk people through what meth induced psychosis is and that these things are lingering. I tend to ask them what percentage of them believes that someone is out to get them. And what percentage of them believes that it’s just leftover psychosis?

If they’re at a 50-50, then I know how to proceed. Let’s say they’re at 70%. It’s not real. And 30% it is. That’s a great place to be because the primary part of them believes that it’s coming from the drug and not from external things and so they’re able to manage that a little better.

The use of antipsychotics does get used, although there’s some controversy over how long they should be continued. The hope of course, is that the psychosis due to meth will lift. And there are people that over time as they’re sober, it does tend to lift. Like I said, though, there are people who it becomes permanent.

The other long term side effect is what’s called meth mouth. meth  has  so many dangerous chemicals that are corrosive in nature. They are literally poison. When people are using it, it causes an incredible amount of damage to the mouth and teeth. The oral health issues are numerous including: tooth decay, gum disease, mouth sores, receding, gums, shortened teeth, loose teeth, broken or fractured teeth, sensitive teeth or blackened and stained teeth. Over the years, I’ve seen numerous people have to have all of their teeth pulled in order to deal with this tooth decay.

I remember the first time I encountered this when I was working with a young man who at the time was 27 years old. . He told me that he had dentures and he clicked his teeth at me. He had top and bottom full dentures.

I hadn’t worked with someone who had been a meth addict to that degree, up to that point in my career. And I was like, wow. And he said, “it has battery acid in it and I’ve been smoking it”. What else do you expect? And I thought about that and I was like, huh. You’re not wrong. And it led me to think about why somebody would use meth knowing that that’s happening.

He continued to use meth even after getting full dentures. To my knowledge, he’s still using meth to this day. Occasionally, I see him pop up on the jail roster. So I know he’s still alive and based on what he looks like, pretty sure he’s still using. So what is it about this drug that keeps people coming back, even when they can see in picture form, how they have deteriorated? It’s not that they’re immune to it. It’s not that they can’t tell, it’s that they can’t stop. 

One of the other issues  in the community of people who are using meth regularly is risk of infectious diseases. Most people who are using intravenously, using needles, swore on everything, holy  that they would never touch a needle. There are people who are adamant that they were terrified of needles and they end up using them anyway.

Once you start using needles, you don’t go backwards because it doesn’t feel the same and you’d have to use way more to get the same high. The process of shooting up itself, starts to raise their level of enjoyment, just getting all the things together and the ritual of it. In recovery a lot of times they can have trouble with getting blood draws because the feeling is so similar and it sparks some pretty big cravings.

When people are using and shooting up they tend to share needles. I know that it’s easy for those of us who aren’t using or who have never used to sit and think that there’s no way we would share a needle. The problem with that is that we’re underestimating the level of discomfort in withdrawal. 

Withdrawal is really bad. If you have the meth that you need and someone has a needle and you don’t, well, you’re going to use it.  Using dirty needles or sharing needles is very dangerous because of the risk of spreading HIV or Hepatitis. Typically, Hepatitis C is the Hepatitis  that we’re mainly seeing in meth addicts, but definitely there’s other forms of Hepatitis. 

Another risk that they have besides those infectious diseases is the risk of getting an infection, particularly staph infections at an injection site.  People aren’t necessarily super good at taking precautions about cleaning the area and whatnot.

I have personally worked with people who have had staph infections that have gone to their heart, that have gone into bones,  that ever required surgery  and the removal of tissues and in some cases, even bone because of these incredible infections.

 In addition to all of that, the issue of sexually transmitted infections is a huge problem. Because one of the things that happens while you’re on meth is the increase in arousal and the enhancement of sex. Sexually transmitted infections are running pretty rampant through that community.

Safer sex is something we have difficulty getting people to practice when they’re sober, let alone, when they’re high on meth and feeling more powerful or feeling disconnected from reality and distanced from consequences.

In my work, the most common STI is HPV. I am not sure what the statistics are over the years, but if I had to guess, I’d say it’s probably 85% of people using meth that I worked with contracted HPV. That’s not to say that people outside of the meth using community don’t contract HPV because they certainly do.

The risk for these infections is really high because hygiene and safety precautions aren’t really on the forefront of everyone’s mind when they’re using meth. They’ve already ignored tons of other consequences and so ignoring a what if consequence, that’s something that’s really not on their mind.

There is a risk of overdose and death from overdose. When it comes to lethality, meth tends to kill people over time versus immediately.  In contrast, things like heroin and opiates kill people immediately because of respiratory depression. The danger with meth tends to be from cardiac issues, seizure, stroke, those sorts of things. It is a possibility, and it is a danger. 

Something that shifted recently is that there is a lot of fentanyl being cut into meth. Remember that fentanyl is even more powerful than heroin and is being used to cut other drugs in order to make their original drug spread farther.

It is so prevalent in the area in which I live that people who are using meth will often have tests with them to see if their batch of meth has fentanyl in it. Typically meth addicts aren’t carrying Narcan with them because meth isn’t the thing that’s going to cause you to overdose and die.

However fentanyl is, and fentanyl can kill you extremely quickly with a very small amount. There’s even a more potent form of fentanyl and carfentanil; which is infinitely more dangerous because it takes such a minuscule amount in order to cause an overdose. Because of this, the risk for overdose and overdose death has increased dramatically  among people who are using meth.

You can’t tell of course, from looking at it if there’s fentanyl in it or not. When it’s just meth,  there is that original risk of overdose and death. Typically some sort of cardiac related event because of its stimulant properties, rather than with an opiate where we’re talking about respiratory depression.

What I’ve seen over my career is that meth tends to destroy people’s lives over time and they end up dying from some sort of related thing, like an infection or suicide or some sort of crime related event, rather than dying straight up from the drug.

The last thing we’ll talk about today are medical uses for meth. I was pretty shocked myself when I first learned that there was a prescription for meth. Desoxyn is the brand name for meth. It’s not super common as a prescription. Desoxyn is a prescription that is approved for use with ADHD.  It belongs to the CNS stimulant class. 

The serious side effects that they list are the things that happen when you’re on meth, like hallucinations, aggression, hostility, paranoia, seizures, fast heart rate, nausea, vomiting, fever, and headaches among other things. In low pharmaceutical doses meth appears to have some benefit though. Typically Desoxyn tends to be used in cases where nothing else has worked. For things like ADHD, obesity, and narcolepsy. It  can be prescribed to children as young as seven

The over-the-counter nasal decongestant Levomethamphetamine,  can be found in things like the Vicks inhaler, although it’s spelled slightly differently. From what I can tell it’s the same chemical. L-Meth as it’s known, provides a less addictive, shorter lived high that is pretty desirable among drug users. People can and do  use it recreationally. However, abuse of it is kind of rare. 

This is where we’re going to leave our meth discussion for this week.  In the next episode,  we’re going to talk about meth and why it is so addictive that it keeps people coming back. Meth is incredibly hard to recover from. It can feel like you’ll never get over it. 

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues.

If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

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