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Methamphetamine use disorder
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Methamphetamine use disorder

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Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Methamphetamine, or meth, is an illicit stimulant and sympathomimetic drug. It is available in a crystal, powder, and pill form, but its most common route of administration is intranasal (ie, snorted), which has a longer duration of action. It is known by multiple street aliases, namely speed, ice, chalk, crystal, and crank. Methamphetamine is identified as a Schedule II medicine according to the US Controlled Substances Act.

Methamphetamine hydrochloride (Desoxyn) is a pharmaceutically available product for the treatment of attention deficit hyperactivity disorder (ADHD). It has some utility as a short-term anti-obesity medication.

Methamphetamine use disorder refers to the illicit use of methamphetamines as a drug of abuse. Methamphetamine is a dopamine, norepinephrine, and serotonin reuptake inhibitor. Intoxication results in a hyper-alert, energetic state characterized by feelings of euphoria and increased libido. Insomnia, agitation with paranoia, dry mouth with tooth decay, and cognitive / memory impairment are also associated with methamphetamine use.

The use of methamphetamines as an illicit drug of abuse is increasing in prevalence both in the United States and worldwide. An estimated 2% of the United States population has used methamphetamines. The Midwestern and Western regions have particularly high rates of abuse. Individuals with underlying psychiatric disorders, mood disorders, and ADHD are at increased risk for developing methamphetamine use disorder. Use disorder is associated with little education, early age of drug use, and underlying disability.

Methamphetamine use disorder, or amphetamine-type substance use disorder, falls under the category of stimulant use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and combines the former concepts of methamphetamine abuse and methamphetamine dependence into a single diagnostic concept ranging from mild to severe.

Methamphetamine use often results in high-risk sexual practices, increasing risk of pregnancy and sexually transmitted diseases. Chronic use can predispose individuals to infections secondary to dental decay or intravenous drug use and subsequent septic shock with multiorgan failure. Users are also at risk for cardiovascular disease often driven by hypertension, tachyarrhythmia, or vasospasm including myocardial ischemia, arterial dissection, cardiomyopathy, rhabdomyolysis, and cerebrovascular injury either due to hemorrhage or ischemia. Methamphetamines can function as a direct neurotoxin causing irreversible neuronal injury that may contribute to cognitive impairment associated with long-term use.

Methamphetamine is highly addictive with rapid-onset abstinence symptoms that contribute to the high rate of illicit abuse. Overdose can be fatal.

Methamphetamine use is associated with increased early mortality, with cardiac complications being the leading cause of death (eg, acute myocardial ischemia, aortic dissection, malignant hypertension).

Codes

ICD10CM:
T43.625A – Adverse effect of amphetamines, initial encounter
F15.20 – Other stimulant dependence, uncomplicated

SNOMEDCT:
699449003 – Methamphetamine abuse

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 02/04/2019
Last Updated: 02/28/2019
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Methamphetamine use disorder
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Methamphetamine use disorder : Mania, Personality changes, Tachycardia, Diaphoresis, Xerostomia, Hypertension, Pruritus, Dilated pupils, Skin abscess
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