Methamphetamine withdrawal

In addition to the hazards associated with meth production, it is becoming increasingly clear that heavy meth users risk a number of health problems. Exposure to very high doses poses a risk of seizures, convulsions, and cardiovascular collapse. Overdose can also produce the paranoid symptoms of stimulant psychosis often associated with violent behavior. A recent study of young adults who were heavy meth users found that over one third of the respondents reported committing acts of violence while under the influence of meth (Sommers, Baskin, Baskin-Sommers, 2006). Chronic users face additional problems. Depression is a common feature of methamphetamine withdrawal... 

Symptoms of withdrawal include depression, altered mental status, drug craving, dyssomnia, and fatigue. Duration of withdrawal from methamphetamine ranges from 3 to 24 days, but these individuals are usually not in acute distress. Occurrence of delirium suggests withdrawal from another drug (e.g., alcohol). 

Once a methamphetamine addict stops taking the drug, the withdrawal symptoms can be very severe and include depression and anxiety, increased appetite, fatigue, paranoia, irritability, aggressive behavior, and intense craving for the drug. Some of these symptoms can be eased with sedative drugs like Valium or antidepressants like Prozac . 

GHB is currently extremely popular in the dance club and rave scene. It is also popular among the gay community as well as with exotic dancers and strippers. It is primarily used for its ability to produce euphoria, intoxication, and enhanced sexual feelings. Others use it as a sleep aid or to enhance bodybuilding. Still others use it intentionally as a date rape drug. Abusers of other drugs, such as cocaine or methamphetamine, often take GHB to reduce the withdrawal... 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

The central nervous system actions that result from taking even small amounts of methamphetamine, on the other hand, include extreme alertness, increased energy, decreased appetite, increased respiration, hyperthermia, and euphoria—generally the effects sought by users. But over time, side effects such as irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness begin to intrude. These symptoms are magnified by lack of sleep. Withdrawal often produces severe depression. 

The diagnosis of GHB withdrawal may be difficult because it is similar to sedative or alcohol withdrawal syndromes, as well as to withdrawal from sympathomimetic agents such as cocaine, methamphetamine, and ecstasy. GHB withdrawal may also be confused with serotonin syndrome (a reaction caused by a combination of drugs, one of which increases serotonin levels in the body, such as Prozac) and neuroleptic malignant syndrome (a rare reaction to an antiseizure medication). 

Few studies have examined the effects of delta opioids on abuse-related effects of other psychostimulants. Naltrindole and naltriben, but not BNTX, attenuated both methamphetamine-induced place preferences and the discriminative stimulus effects of low methamphetamine doses in rats however, naltrindole did not alter the discriminative stimulus effects of a higher dose of methamphetamine [140,142], A single dose of 3 mg/kg naltrindole was also reported to block facilitation of electrical brain stimulation by a single dose of methylenedioxymethamphetamine (MDMA) [143]. Finally, a recent study found that both morphine and TAN-67 prevented mecamylamine-induced place aversions in rats chronically-treated with nicotine. These results were interpreted to suggest that both mu and delta agonists may attenuate some aversive effects associated with nicotine withdrawal [144]. 

Smith L, Yonikura ML, Wallace T, Berman N, Kuo J, Berkowitz C. Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. Dev Beh Pediatrics 2003 24 17-23. 

Many recreational drugs such as benzodiazepines, amphetamines, and opioids are also metabolized by the liver. Although information is scant about the clinical significance and interactions between these drugs and antiretroviral agents, unintentional overdoses with methamphetamine and gamma hydroxybutyrate have been reported in patients using Pis, particularly ritonavir. Pis and NRTIs may alter metabohsm of methadone and precipitate opioid withdrawal (McCance-Katz et al., 2003). 

Phenylpropanolamine (PPA). Until recently, PPA was widely available in a number of nonprescription cold medications and diet control products. Adverse effects are similar to those described for ephedrine. In response to an FDA warning of increased risk of hemorrhagic stroke, especially in women, PPA has been withdrawn from the market by most manufacturers. Before this withdrawal, PPA was another popular starting product for synthesis of S(-f-)-methamphetamine. PPA is also a metabolite of ephedrine and pseudoephedrine. 

Figure 8.34 The Birch reduction. Anhydrous ammonium and sodium or lithium metal are used in an alcoholic solution to reduce (add hydrogen to) the ring. The electron donating or withdrawing nature of R determines where the double bonds will be found. Notice that the Birch method for methamphetamine synthesis does not affect the phenyl ring.

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