What is methamphetamine, and why is it so hard to quit?
Methamphetamine, or meth, is a synthetic stimulant, chemically close to amphetamine. It crosses from the bloodstream into the brain very easily, and at the same dose, far more of it reaches the brain than amphetamine does. Once it is there, it causes a flood of dopamine, the chemical messenger behind reward and motivation, and a feeling of energy and well-being that a person does not forget.
Meth is also very long-acting. The body takes about twelve hours to remove half of a dose, compared with about one hour for cocaine. So, a person can stay awake for days on what is called a run. It can be swallowed, snorted, smoked, or injected. Smoking and injecting deliver the drug fastest and carry the most risk of addiction and overdose, and injecting adds the risk of HIV, hepatitis, and other infections.
Physical dependence is not addiction, and physical dependence is not the main problem here. In fact, meth addiction is addiction in the true sense: a compulsion to keep using that survives the loss of sleep, money, health, and the people who matter. So, is meth really more addictive than cocaine?
Is meth more addictive than cocaine?
It is often said that methamphetamine is more addictive than cocaine. No reliable scale settles that question, and both drugs sit near the top of the list of things people find hardest to quit.
The two drugs do differ. A smoked dose of cocaine lasts minutes, and a smoked dose of meth lasts hours. While a person smoking crack chases the next hit every few minutes, a person using meth may go three days without sleep. Which one is worse? Neither one is the safer choice.
What are the signs of meth addiction?
The early signs are easy to explain away. Pressured speech that never pauses, grand plans, sudden weight loss, and the look of being wired and exhausted at the same time can all be blamed on something else. Is it the coffee? Is it a crash diet? Is it a new job? Sometimes it is.
Sleep is the giveaway. A person using meth may stay awake for several days at a stretch, and showers, meals, and toothbrushes fall away along with sleep. Severe dental problems, sometimes called “meth mouth,” come later, along with skin sores from scratching at a crawling sensation that is not really there.
Meth is cheap and lasts for hours, so the hunt for money is less obvious than with crack. Still, if you notice valuables that disappear and small loans that never come back, pay attention. The later signs are harder to miss: suspicion of everyone in the room, a locked door, a belief that unmarked cars are circling the house. And then there is the crash.
What does meth do to the heart and the brain?
Meth raises heart rate, blood pressure, and body temperature, and it can make the heartbeat irregular. An overdose can cause a stroke, a heart attack, seizures, or organ failure from overheating.
The strain adds up over a run. Imagine a car driven at full throttle for three days without a stop for oil. A young engine may survive it. An older one may not.
While a car is not a person, the pattern is one that doctors who treat addiction see again and again: a person who used heavily in their twenties, quit, and relapsed at fifty, when the heart and blood vessels could no longer take what they once took.
The brain pays too. Long-term use damages the dopamine system and the serotonin-producing nerve cells, and it changes areas of the brain tied to emotion and memory. Fortunately, some of these changes appear to recover, slowly, over a year or more of abstinence.
Fentanyl, a synthetic opioid, is being mixed into other street drugs, including methamphetamine. So, a person who has never used an opioid can stop breathing from a dose they thought was meth. Naloxone, or Narcan, reverses an opioid overdose, and it is now sold without a prescription.
When is methamphetamine use an emergency?
Call 911 or go to the nearest emergency department if a person who has used meth:
- has chest pain, a racing or irregular heartbeat, or trouble breathing
- has a seizure, or someone with them sees one
- is very hot to the touch, confused, or agitated in a way that will not settle
- shows signs of a stroke, such as a drooping face, a weak arm, or slurred speech
- cannot be woken or is breathing slowly, in which case give naloxone if it is available and call 911 anyway
If you or someone near you has thoughts of suicide or self-harm, call or text 988 to reach the 988 Suicide & Crisis Lifeline, at any hour. The crash after a run can bring a deep depression, and it should never be waited out alone.
Are the paranoia and psychosis permanent?
Families ask this after watching someone they love hide behind the blinds, convinced that the neighbors are police. Is this schizophrenia? Has the person lost their mind for good? In most cases, it is the drug.
In two decades of treating addiction, Dr. Leeds has watched the paranoia, the hallucinations, and the apparent change in personality of active meth use lift as the drug leaves and sleep returns. Psychotic symptoms can sometimes persist for months or longer, and stress can bring them back in someone who once had them, so a doctor should stay involved. Yet, most of what looked like a broken mind was a poisoned one.
The same families ask whether a brain scan could show that a person is too far gone, and the towns hit hardest by meth get described as full of “zombies.” Is there such a thing as too far gone? In those two decades, Dr. Leeds has not met a living person who was beyond recovery from methamphetamine. The people that word is used about are real people, with parents and children, and while the brain heals slowly, it heals.
Why do people fail to quit meth?
Not because of withdrawal. Meth withdrawal is miserable, with depression, anxiety, exhaustion, and days of sleep, but unlike alcohol or benzodiazepine withdrawal it is not medically dangerous. The one real danger is suicide, because the depression can be severe. It passes.
Cravings are what pull people back. They arrive weeks and months after the last dose, out of nowhere, and they feel less like a wish than like an itch that has to be scratched.
Unfortunately, in addiction medicine, we have a habit of treating “the addiction” and ignoring whatever the drug was doing for the person. The useful question is what meth was doing for you, and whether that need can be met in some safer way. Another stimulant is not the answer. The rest of that conversation belongs with your own doctor.
Is there a medication for meth addiction?
For opioid addiction there is buprenorphine, and for alcohol there is naltrexone, but for methamphetamine and cocaine there is no FDA-approved medication yet. Nothing has been shown to counteract the drug or to keep a person off of it, though combinations of existing medications are being studied. There is no shortage of rehabs willing to sell a thirty-day program for it anyway.
That leaves the treatments that work on behavior. Cognitive-behavioral therapy and contingency management, a structured system of rewards for staying off of the drug, are the approaches with the best track record. Neither is a pill, and both require a person who has decided, at least for today, to try.
Some people also find peer support helpful, and that is a choice for you to make, not a prescription. No drug fixes this, and people recover anyway.
What about a person who uses both meth and opioids?
The opioid is the drug that kills. Street pills and powders are often made with fentanyl, and the risk of death from a single dose is far higher than anything meth does in a week.
So, a person who is addicted to both should start buprenorphine for the opioid addiction now, without waiting until they have stopped stimulants. While it is ideal to stop everything at once, it is not required, and continuing to use meth is not a reason to withhold Suboxone or to end treatment.
Dr. Leeds prescribes buprenorphine films and tablets by telemedicine to new patients in Florida, with in-office visits available in Fort Lauderdale. The first doses are taken at home with phone support, and when fentanyl is involved he can begin with a low-dose start.
How should a family respond?
Families ask what they should do, and the honest answer starts with what not to do. “Tough love,” meaning eviction and the withdrawal of food, shelter, and contact, does not treat addiction. It removes the person’s last safe place and puts them where the fentanyl is.
Harm reduction means protecting a person’s safety until they can get out of harm’s way. In practice that means staying in contact, keeping naloxone in the house, and making sure they know there is a bed and a meal at your house when the run ends. Of course, it can also mean locking up the checkbook, because a boundary around money is not a boundary around the person.
And, it means patience with the crash. The person who emerges from days of sleep is usually far more reachable than the one who went in. That is the moment to talk about seeing a doctor.
Where does a doctor fit when there is no medication?
A visit with a doctor will not end in a prescription that removes the cravings. Whether Dr. Leeds can help a particular person is something he decides with that person at a consultation.
What he offers motivated patients is work: on their resources, on their family situation, and on their own life, using approaches such as motivational interviewing and cognitive-behavioral therapy within medical care. This is not a program with a start date and a discharge date. It is medical care, one patient at a time, and when a patient needs a counselor of their own, Dr. Leeds refers them out.
If you are in Florida and would like to talk with Dr. Leeds about methamphetamine addiction, for yourself or for someone you love, send a message through the contact form to ask about a consultation.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
