What is Methamphetamine Toxicity (Meth Overdose)?
Methamphetamine, a potent drug closely related to amphetamine, is incredibly addictive. It brings about feelings of extreme happiness and stimulation, similar to the effects of cocaine. Additionally, methamphetamine is simple and cheap to make from readily available chemicals. These factors contribute to its widespread misuse all over the world. The United Nations Office on Drugs and Crime estimated a staggering 33 million people were using the drug as of 2016. In the United States, over 150,000 visits to the emergency department were related to methamphetamine poisoning in 2011, according to the Substance Abuse and Mental Health Services Administration. That same year, the Drug Enforcement Agency believed there were approximately 439,000 people in the country who had used methamphetamine in the past month.
What Causes Methamphetamine Toxicity (Meth Overdose)?
Methamphetamine is listed as a Schedule II stimulant under the Controlled Substances Act. This classification means it has a high potential for misuse, even though it has some medical applications. The Food and Drug Administration (FDA) approves the use of methamphetamine hydrochloride for long-term treatment of Attention-Deficit Hyperactivity Disorder (ADHD) and short-term treatment of obesity not caused by any underlying medical conditions.
In 2011, statistics showed that out of children aged 4-17, 11% or 6.4 million had been diagnosed with ADHD at some point in their lives. Additionally, 3.5 million of these kids were taking an ADHD medication. However, using these prescribed medications illegally, especially amongst adult individuals without ADHD, is becoming a major problem.
Methamphetamine can be misused in a variety of ways, such as being snorted, eaten, injected, or smoked. A concerning method of misuse called “parachuting” has become common. In parachute usage, the drug is wrapped in toilet paper or plastic wrap to slow down its absorption into the body.
Risk Factors and Frequency for Methamphetamine Toxicity (Meth Overdose)
Methamphetamine, a drug that was first created in the early 1900s, was initially used as a nasal decongestant, a way to stay alert, and a tool for weight loss. Various militaries utilized it extensively during World War II, the Korean War, and the Vietnam War. By the 1950s, Japan saw high levels of misuse, with the United States following suit in the 1960s. The drug was often transported hidden in the crankcases of motorcycles by biker gangs, which led to its street name “crank”.
From the 1970s to the 1990s, areas including the southwestern states, the west coast, and Hawaii reported the highest misuse. However, over the past ten years, every region in the United States has seen a notable increase in both the number of people using the drug and visits to the emergency department related to its use.
In the US, methamphetamine misuse is most common among white males in their 30s and 40s. However, there has been a recent surge of misuse among teenagers as well. It’s important to note that individuals who misuse methamphetamine often find it difficult to trust health care professionals and may not be honest about their drug use.
Signs and Symptoms of Methamphetamine Toxicity (Meth Overdose)
Methamphetamine use, both short-term and long-term, can lead to negative effects on various body systems. This includes the heart, brain, stomach, kidneys, skin, and teeth. Some common problems often seen include rapid heart rate, high blood pressure, and various heart rhythm problems. Chest pain can also be a sign of heart disease or other serious conditions, and it’s linked to methamphetamine abuse. Low blood pressure may be seen in cases of a methamphetamine overdose.
The drug can cause heart damage directly, as well as indirectly through chronic high blood pressure and decreased blood supply to the heart. Injecting methamphetamine can also lead to infections in the heart. Symptoms of heart failure such as shortness of breath, swelling, and other symptoms can also be seen. Lung problems can arise from both acute short-lived and chronic long-term use of the drug, including lung hypertension and non-heart-related lung edema.
Methamphetamine use can cause severe abdominal pain due to its effects on blood vessels in the gut. It’s also linked to the formation of stomach ulcers and a condition called ischemic colitis. It can lead to kidney failure through several mechanisms, including muscle breakdown, inflammation of the tiny blood vessels, inflammation of the kidneys, or damage to the kidney tubules.
On the skin, methamphetamine use can lead to delusions of having parasites and chronic skin picking, causing sores and a condition called prurigo nodularis. People who inject the drug often have abscesses and cellulitis, commonly blaming these on a “spider bite.” Dental problems are common, particularly severe decay of the teeth, dry mouth, and poor hygiene, often referred to as “meth mouth.”
Methamphetamine use during pregnancy can be life-threatening for both the mother and the unborn baby due to its effects on blood vessels in the placenta, potentially leading to miscarriage. It’s also important to note the drug can be passed onto a baby through breast milk.
Testing for Methamphetamine Toxicity (Meth Overdose)
If you or someone else is suspected to have acute methamphetamine toxicity, various medical tests can help understand the situation better. An electrocardiogram, a test that measures the electrical activity of the heart, may be performed to check for possible heart muscle damage and irregular heart rhythms.
The doctor may also run a series of blood and urine tests. These tests could include a complete blood count, a comprehensive chemistry panel, and checks for levels of specific heart indicators like troponin and B-type natriuretic peptide (BNP). Testing for creatine kinase (CK), an enzyme found in the heart, muscles, and other organs, could be beneficial too.
Since those who use methamphetamines often do not disclose information about their recent drug use, a urine toxicology screen, which can detect methamphetamine and other substances, can be very useful. Other conditions can also create similar physical responses to methamphetamines, and this test helps to narrow down the possible causes.
In cases where the person is experiencing symptoms like severe headaches or changes in mental status, a head CT scan might be necessary to rule out bleeding in the brain. If someone is experiencing chest pain or shortness of breath, a chest X-ray can provide vital information about the status of the heart and lungs.
Treatment Options for Methamphetamine Toxicity (Meth Overdose)
Benzodiazepines, a type of medication, are commonly used to treat methamphetamine toxicity, but they often need to be given in larger and increasing doses because methamphetamine users can be less responsive to these drugs. Antipsychotic medicines, like haloperidol and olanzapine, are also helpful for managing agitation. Treatments that combine benzodiazepines and antipsychotics have been shown to work better than using just one type of these medications. Diphenhydramine is frequently added to increase sedation and to prevent muscle stiffness and restlessness. A typical example of this type of combination treatment is “B-52”, which involves haloperidol (5 mg), diphenhydramine (50 mg), and lorazepam (2 mg).
In case of persistent rapid heartbeat and high blood pressure that is not calmed by sedation, the preferred treatment is labetalol, a medication that blocks both beta and alpha signals. Metoprolol, another type of beta-blocker is the preferred treatment when rapid heartbeat is present but there is no high blood pressure. Both of these medicines can enter the brain and block overactive chemicals that cause agitation. Despite some old beliefs, there are no reported cases of dangerous overstimulation from using these beta-blockers to treat methamphetamine toxicity. Nitroprusside, which is easy to control and acts quickly, is recommended for severe high blood pressure without a rapid heartbeat. To help the body get rid of the methamphetamine and to prevent sudden kidney failure, giving a lot of fluids through an IV is also recommended.
Calcium channel blockers might be used, but they don’t directly treat the overactive response caused by methamphetamine, and they are less reliable in slowing down rapid heartbeat and reducing blood pressure than the beta-blockers.
As of now, there are no FDA-approved medicines for treating addiction to stimulants such as methamphetamine, but recent research found that a combination of injectable naltrexone and oral bupropion was safe and effective for treating adults with moderate or severe addiction to methamphetamine.
What else can Methamphetamine Toxicity (Meth Overdose) be?
When a patient comes in with certain symptoms, doctors need to consider many different health problems that might be causing them. Some examples include:
- Severe heart attack
- Dangerously high blood pressure
- Poisoning from hallucinogenic drugs
- Extreme hyperthyroidism, also known as Thyroid storm
- Poisoning from cocaine
- Seizures
- Bleeding in the space surrounding the brain
- A stroke caused by a blocked blood vessel in the brain
Remember, only a healthcare provider can accurately diagnose these conditions.
Possible Complications When Diagnosed with Methamphetamine Toxicity (Meth Overdose)
- High blood pressure
- Bleeding inside the brain
- Seizures
- Stroke due to lack of blood flow to the brain
- Coma
- High body temperature
- Heart failure
- Irregular heartbeat
