- What it is. - How & Why people use it. - Effects: (Physiological; Psychological; Behavioural). - Short-term risks. - Long-term consequences. - Risk Reduction: (Strategies; Behaviours). - Working with intoxication. - Why now? Again! - Community responses. - Supports & Resources.

1. Methamphetamine
Updated: November, 2013

2. What we‟ll go over…
• What it is.
• How & Why people use it.
• Effects:
– Physiological; Psychological; Behavioural.
• Short-term risks.
• Long-term consequences.
• Risk Reduction:
– Strategies; Behaviours.

3. What we‟ll go over…
•
•
•
•
Working with intoxication.
Why now? Again!
Community responses.
Supports & Resources.

4. Methamphetamine is a stimulant drug:
1. Yes.
2. No.
3. I‟m not sure.
80%
11%
1
2
9%
3

5. Methamphetamine affects the
neurotransmitter(s):
1.
2.
3.
4.
5.
Dopamine
Serotonin
Both
Neither
I‟m not sure
64%
14%
14%
6%
1
2
3%
3
4
5

6. Methamphetamine can cause
irreversible heart damage:
1. Yes.
2. No.
3. I‟m not sure.
71%
Well... It can with
long-term or heavy
use.
26%
3%
1
2
3

7. “Meth” irreversibly lowers a person’s
intelligence and impairs cognitive
functioning:
67%
1. Yes.
2. No.
3. I‟m not sure.
25%
Well... It’s more
complicated than
that...!!
8%
1
2
3

8. Carl Hart...
Associate Professor at Psychology & Psychiatry Department,
Columbia University, New York, NY
• Is Cognitive Functioning Impaired in
Methamphetamine Users? A Critical Review
Neuropsychopharmacology (2012) 37, 586–608;
doi:10.1038/npp.2011.276; published online 16 November 2011
Carl L Hart, Caroline B Marvin, Rae Silver and Edward E Smith
• Video: "Methamphetamine: tempering
hysteria with data" - Carl Hart
http://youtu.be/2wNS_aRxTqs

9. I know who this is:
58%
Walter White,
main character
1. Yes.in Breaking
2. No. Bad TV series.
30%
12%
3. I‟m not sure.
1
2
3

10. Methamphetamine use is going up
amongst high school students in Ontario:
1. Yes.
2. No.
3. I‟m not sure.
61%
36%
3%
1
2
3

11. Ontario Student
Drug Use & Health Survey
Survey of 9,288 Ontario students in grades 7 to 12
during the 2010-2011 school year.
http://www.camh.ca/en/research/news_and_publications/ontariostudent-drug-use-and-health-survey/Pages/default.aspx
*Remember this survey is administered IN SCHOOL, so
does not represent all youth in Ontario, and likely under
reports use.

15. Percentage Reporting Lifetime and Past Year Drug
Use, Grades 7 to 12, 2005 OSDUS
Alcohol
Cannabis
Cigarettes
Other Hallucinogens
Solvents
Stimulants
Ecstasy
Cocaine
Ritalin
Glue
Methamphetamine
Crack
LSD
Barbiturates
Tranquillizers
Ketamine
PCP
Rohypnol
OxyContin
Heroin
Ice
GHB
65.5%
31.1%
33.0%
7.9%
8.4%
5.6%
5.2%
5.3%
3.3%
4.6%
2.9%
2.5%
2.4%
2.1%
2.2%
1.9%
1.4%
1.1%
1.3%
1.2%
1.2%
0.7%
100
80
1.2% (2011)
60
40
% Lifetime Use
20
1.0% (2011)
0
20
40
60
62.0%
26.5%
14.4%
6.7%
5.3%
4.8%
4.5%
4.4%
2.4%
2.3%
2.2%
2.0%
1.7%
1.7%
1.6%
1.3%
1.1%
1.0%
1.0%
0.9%
0.9%
0.5%
80
% Past Year Use
100

16. People in Ontario drug treatment
programs are reporting more use of
methamphetamine:
1. Yes.
38%
38%
2. No.
3. I‟m not sure.
24%
1
2
3

17. DATIS – Drug Treatment Admission Data, Ontario

18. Drug Treatment Numbers
• Only reflect people that actually made it to
treatment:
– geography; housing; mental health; stigma; types or
treatment available
• Do people honestly report all use  stigma?
• More people in treatment does not necessarily
mean more people using.
– Long-term users presenting now?
• Are people voluntarily coming or being “forced”
(by courts/families)?

19. Methamphetamine contains:
1. Anhydrous Ammonia
79%
(fertilizer)
2. Red Phosphorus
(matchboxes)
3. Lithium (batteries)
4. All of the above.
5. None of the above.
Well... These are all used in the
production. “Good” pure meth
won’t actually contain these!
Often lots of impurities, especially
in “home-cooked” meth though.
7%
1
10%
3%
2
0%
3
4
5

20. What is methamphetamine?
• Stimulant.
• Amphetamine family:
– Amphetamine-type stimulants (ATS).
– Amphetamine first synthesized in 1887.
– Various versions over the years.
• Methamphetamine - more potent
amphetamine:
– Particularly strong stimulant;
– Potentially more “addictive”/problematic than
many other drugs (e.g., E, K, G)… but this varies
from individual to individual.

22. Methamphetamine…
• Has been in Ontario for years.
• Not hard to find & relatively inexpensive.
• Local & International production:
– Individuals vs. Labs
• Canada now exports to other countries.
• Common names:
– Crystal; Meth; Tina; Tweak; Crank; Ice
– “Jib” (90‟s Toronto rave term)

23. How is it made?
•
•
•
•
•
•
•
•
•
•
•
2 Boxes Contact 12 hour time released tablets
3 Bottles of Heet (antifreeze)
1 Bottle of Rubbing Alchohol
1 Gallon Muriatic Acid (Used for cleaning concrete)
1 Gallon of Coleman's Fuel
1 Gallon of Aceton
4 Bottles Iodine Tincture 2% (don't get the declorized it
won't work)
2 Bottles of Hydrogen peroxide
1 Can Red Devils Lye (sodium hydroxide)
4 Books Matches (try to get the ones with brown/red
striker pads)
2 gallons distilled water
= 2 - 3 grams of meth

24. Methamphetamine Production

25. Production Concerns
• Concerns with poisonous chemicals and
fumes.
• Highly volatile chemicals  fires and
explosions.
• Toxic waste disposal.

27. Crystal Methamphetamine
• Price = ~$50-60 / bag (0.25 – 0.3 gram)
• White to off white powder; crystal shards
(like glass)

28. Methamphetamine
Can also look like…

30. How is it taken?
• Smoked (technically vaporized)
• Injected (“slamming”)
• Snorted
• Swallowed:
•As pills
•“Parachuting” (wrapped in paper)
• Inserted rectally (“booty bumping”)
• Smoking and injection appear to
be the most common ways.

31. Routes of Administration
Effects felt
•
•
•
•
Inject
Smoke
Snort / rectal
Swallow
< 2 mins
< 1 mins
5-10 mins
20-60 mins
Duration (one dose)
3-7 hrs
3-7 hrs
4-10 hrs
5-12 hrs
• Doses are repeated:
– Every 3 - 8 hrs (to stay awake)
– Every 0.5 - 4 hrs (to remain “high”)
• Half-life:
– How long it takes for half the drug to leave your body
– Very long = 12 hours
(cocaine = 2; mdma (ecstasy) = 4; ketamine = 1)
Intensity
of High /
Euphoric
Rush

32. How does it work?
• Stimulates CNS (acts like Adrenaline)
• Release of neurotransmitters
- Dopamine (pleasure / reward system)
- Norepinephrine (energy / alertness)
- Serotonin (mood / eat / sleep cycles)
• Ecstasy  predominately serotonin
• Cocaine  predominately dopamine

33. Neural Pathways

34. Brain Physiology 101
Neurons: brain signals and messages
axon
dendrite
Source: http://www.dancesafe.org/drug-information/ecstasy-slideshow

35. Brain Physiology
Synapse: site of communication

36. Brain Physiology
Synapse: normal communication

37. Brain Physiology
Synapse: under the influence

38. The Role of Dopamine
• While all stimulants release some dopamine,
crystal meth releases much larger amounts:
– Cocaine releases 400% more dopamine
– Crystal meth releases almost 1500% more
dopamine

39. FOOD
200
% of Basal DA Output
NAc shell
150
100
Empty
50
Box
Feeding
0
0
60
120
Time (min)
Source: Di Chiara et al.
180

40. 200
150
100
15
10
5
0
Scr Scr
Bas Female 1 Present
Sample
Number
1
2
3
4
5
Scr
Scr
Female 2 Present
6
7
8
9
10
Mounts
Intromissions
Ejaculations
Source: Fiorino and Phillips
11
12
13
14
15
16
17
Copulation Frequency
DA Concentration (% Baseline)
SEX

41. Effects of Drugs on Dopamine Release
Accumbens
1000
500
0
0
1
2
400
Accumbens
DA
DOPAC
HVA
300
200
100
Time After Cocaine
% of Basal Release
Time After Methamphetamine
250
Accumbens
Caudate
250
NICOTINE
200
150
100
COCAINE
0
3hr
% of Basal Release
% Basal Release
1500
% of Basal Release
METHAMPHETAMINE
Accumbens
ETHANOL
Dose (g/kg ip)
0.25
0.5
1
2.5
200
150
100
0
0
1
2
3 hr
Time After Nicotine
0
0
1
2
3
Time After Ethanol
Source: Shoblock and Sullivan; Di Chiara and Imperato
4hr

42. Immediate Physiological Effects
“What the drug is doing to the body.”
• Fight or Flight response…
• Increases heart rate & blood pressure:
– Your pulse will beat faster
• Raises body temperature:
– Feel warmer; Sweat more.
• Decreases appetite, sleep and pain
– You probably won‟t feel like eating; You may not get
hungry even if you are physically active when high
(like with sex or dancing)

43. Immediate Physiological Effects
“What the drug is doing to the body.”
• Decreases saliva; dry mouth; thirst.
• Enlarges pupils.
• Constricts blood vessels:
– Less blood will flow to the surface of the body so your
hands and feet may feel cold to the touch.
– Hard to get an erection.
• Jaw grinding/clenching

44. Short-Term Psychological &
Behavioural Effects
Remember: Effects vary with Drug, Set and Setting
• Increased sense of energy & wakefulness
• Increased mental focus
– Able to focus on a specific tasks “Tune things out”
– ADHD  Adderall / Ritalin
• Increased libido & sexual confidence
– Get Horny; Experience “other forms of sex”
– Intensifies sexual experience & prolongs sex play
– Shame & Guilt; Body image

45. Short-Term Psychological &
Behavioural Effects
Remember: Effects vary with Drug, Set and Setting
• Decreased depression
– Things that bothered you seem more
manageable; Think less about the people, &
situations that hurt or upset you; Feel happier
or more content
• Decreased inhibitions (may or may not be
good)

46. Short-Term Risks
• Dehydration; heat stroke
• Stroke / heart attack (esp. if mixing drugs)
• Do something you regret
– Impaired judgment & decision making
regarding risks
• Infection
– Sharing snorting/smoking/injecting equipment
– Unsafe sex
• Oral abrasions

47. Short-Term Risks
• Missed medication doses
• Enlarged pupils (people maybe able tell
you‟re under the influence)
• Miss school/work if still high or crashing
• Heavy or extended “run”:
– Paranoia / psychosis
– Formication (feeling of bugs under the skin)

48. Binge & Crash Cycle

49. Withdrawal Symptoms
• Tolerance dependent.
• Symptoms can occur when use is stopped
abruptly.
– fatigue; long, disturbed periods of sleep; irritability;
intense hunger, and moderate to severe depression.
• People may hide or disappear for several days.
• Length and severity related to how much and
how often amphetamines were used.
• Sleep!! Eat!!

50. Long-Term Consequences
• Dependence
– psychological; non-life-threatening withdrawal
• Weight loss
– some people weight gain
• Poor dental hygiene
– “meth mouth” (similar is true of other drugs)
• Sinus infection/damage if snorting
• Skin irritations
• Strains on internal organs (esp. heart)

51. Long-Term Consequences
•
•
•
•
Mood / sleep disorders
Depression
Anxiety
Loss of sex drive or inability to have sex
without using
• Loss of finances; school; job; friends
• Isolation; loneliness

53. Anhedonia / Depression:
Remember those post-synaptic receptors?
• Dendrite will “prune” receptor sites to account for constant
over-stimulation.
• Loss of receptors makes it harder to receive messages.

54. Brain & Early Recovery
• Tough scenario:
- Can‟t produce reward messages.
- Cravings because you want just “feel better”
or “feel normal”.
- Judgment centre in the frontal cortex has
been impaired
- can lead to poor decision making.
- This can all lead to using again or “relapse”.

55. Brain & Early Recovery
• Some damage can be permanent but, with
sustained non-use, people can “get
better”.
• Important to remind people of this.
• Brain plasticity:
– Brain can return to “normal” or find new ways
of coping.
– This may take several months, even years.

56. Staying Off Crystal
• “Contains thoughts and advice from many gay
and bisexual men who have walked this same
path before...or still walk it. We don’t claim to be
role models for perfect recovery. We’ve made
some mistakes, and we don’t have all the
answers. But we do offer hope and a belief that
you can make it!”
• Published by Seattle King County Public Health; adapted
by the AIDS Committee of Toronto:
http://www.actoronto.org/home.nsf/pages/act.docs.1770/$file/Stayin
g%20Off%20Crystal.pdf

57. Drug : Set : Setting
Upper/Downer/Hallucinogen/
Strength/Purity/Cost
DRUG
Experience
& Risks
Psychological
state/ Physical
size and health/
Reason(s) for
using/ Financial
situation
SET
SETTING
Physical
location/ Who
else is there/
Socio and
cultural norms

58. Drug : Set : Setting
Three interrelated factors affecting a person‟s
experiences and risks:
Drug
The drug, medication, pill being consumed.
Set
The person taking the substance.
Setting
The context in which it is taken.

59. Drug
What substance(s)?
• The specific pharmacology of the substance(s)
– Effects on physiology and neurochemistry.
– Half-life: How long does it take the body to eliminate it?
• How much is taken
– Potency.
– For some drugs you can take tiny amounts, others require a lot.
• How it is taken (route of administration) affects:
– How quickly the feeling “comes on”.
– How intense it feels.
– How long it lasts.
• Quality of illicit substances
– It may be hard to know what you‟re getting; the ingredients can include
anything. What are they cut with?
– A dealer may say a substance is one thing but sell something else.
– It may look like the stuff from last time but it might be stronger or
weaker, or have different ingredients.

60. Set
Who’s taking the substance?
•
•
•
•
•
•
Size and body weight.
Physical, mental, psychological state.
How tired you are.
Your mood before using.
Reason(s) for using.
Genetics.
– How does your body metabolize drugs?
• Experiences with this or other substances.
– Tolerance; Habituation; Sensitization
• Expectation, or anticipation, of how the substance will
feel or effect you.
• Did you eat recently if swallowing a drug?
• Are you using other substances at the same time?

61. Setting
What’s the context?
• Where are you?
– Alone; with friends; with strangers?
– Indoors or outdoors?
– Quite setting or lots of people and noise?
• What time of day?
• What type of music is playing?
• Rules and regulations.
– Community and social attitudes towards certain
substances or ways or taking them.
– The legal status of different substances.

62. Stereotypical Situations
•
•
•
•
•
Hetero male, 20, living on the streets
Gay male, 54, HIV+(15yrs)
Hetero female, 18, concerned with weight
Bi male, 21, likes clubbing all night
Hetero male, 36, long or late shifts

63. Risk Reduction
• Plan ahead before using; you may need a
few days to recover.
• Limit what you buy:
– The longer you are high, the rougher you‟ll
feel after.
• Smoking & injecting seem to be more
problematic.
• Try to avoid sharing equipment.
• Try to avoid mixing with other stimulant
drugs.

64. Risk Reduction
• Try to eat something while high:
– Protein shakes or fruit juices with healthy
supplements are better than nothing. Feed
your body the fuel it needs.
– Keep hydrated
• Use extra lube if having sex.
• Accept the comedown:
– Lack of sleep. Lack of food.
Physically/mentally exhausted.
• Spread out the use… not every week.
– Neurotransmitters take time rebuild.

65. Interactions With Meds
Many recreational drugs may be dangerous when combined with
prescription medications (including HIV meds), based on individual
case reports, and what we know about how the body processes these
drugs. Most interactions between recreational drugs and medications
have not been scientifically studied, nor are they likely to be, given that
most are illegal substances. However, people have shown through
experience that “safer partying / use” is possible, and there are some
specific tips that can help make drug use safer and healthier.
Drug Interaction Tables
Immunodeficiency Clinic
Toronto General Hospital
www.hivclinic.ca/main/drugs_interact.html
“Facts for Youth about mixing Medicine,
Booze and Street Drugs”
http://www.drugcocktails.ca/

66. Protease Inhibitors
• Caution is necessary if you are taking HIV medications
known as “protease inhibitors” (PIs)
• Actual risk assessments of individual situations are hard
to make.
• These often boost the levels of other drugs in the
bloodstream and body.
• If you take recreational drugs while you also taking a
protease inhibitor, you may end up with a stronger effect
than intended, or in an overdose situation.
• Consider taking a smaller dose than you used to before
you started PIs, or quarter or half of the dose that others
are using.

67. Intoxication: What to look for
• Signs of methamphetamine intoxication vary according to the
amount of methamphetamine (and other drugs) taken and can
include the following:
•
•
•
•
Clenched jaw, teeth grinding (bruxism)
Large (dilated) pupils
Sweatiness
Restlessness, agitation, pacing, repetitive
movements

68. Intoxication: What to look for
• Rapid or pressured speech:
– fast, loud and difficult-to-interrupt speech, or jumping
from one topic to another
• Impulsivity or recklessness.
• Suspiciousness or paranoia.
• Anger, irritability, hostility, particularly if it is out
of character.

69. Responding to an Intoxicated Person
• Aims of responding:
– Maintain a calm environment;
– Reduce the chance they become angry or hostile;
– Promote a positive and helpful interaction.
• Remember
– An intoxicated person has impaired judgment and will
probably see the interaction differently to you.

70. What You Should Do
• Maintain a calm, nonjudgmental, respectful
approach.
• Allow the person more personal space than
usual.
• Try to steer the person to an area that is less
stimulating:
– Move away from other people, bright lights and loud
sounds or music.
– Ensure that the client and worker both have an easily
accessible exit.

71. What You Should Do
• Listen and respond promptly to needs or
requests:
– “I hear what you are saying, so let me see what I can
do to help.”
• Use clear communication
– Short sentences, repetition, and ask for clarification if
you are unsure what is said.
– “I really want to help, but I‟m not sure what you need.
Please tell me again.”

72. What You Should Do
• Move around with the person to continue
communication if necessary.
• Have written information available for the person
to take away.
• Provide opportunistic, relevant, brief
interventions if you are able.

73. What You Should Not Do
• Don‟t argue and don‟t use „no‟ messages.
– If you cannot provide what they are asking for, be
clear about what you can provide.
• Don‟t take the person‟s behaviour or any
criticisms personally.
• Do not ask a lot of questions:
– Ask only what is necessary to respond to the
situation;
– The person will have a low tolerance for frustration or
questioning.

74. What You Should Not Do
• Don‟t undertake a lengthy interview or try
to counsel the person:
– If the person has presented for assessment
or counselling, inform him or her that you
cannot continue if he or she is intoxicated and
agree to make a future appointment.
– ???  May want to stay engaged with the
person.

75. Resource Guide
• Treatment Approaches for Users of
Methamphetamine: A Practical Guide for
Frontline Workers. Jenner L and Lee N
(2008). Australian Government
Department of Health and Ageing,
Canberra
• http://www.nationaldrugstrategy.gov.au/internet/drugstrat
egy/Publishing.nsf/content/8D2E281FAC2346BBCA257
64D007D2D3A/$File/tremeth.pdf

76. Generations…
• World War II
– German, British, US, Japanese troops
• 1960‟s
– Speed Freaks!; Speed Kills!
• 1990‟s
– TRIP! Toronto Raves…”jib”
• tweaker.org
– San Francisco
– 1997
• Popculture
– Law and Order episodes
– Fergie from Black Eyed Peas
– Breaking Bad
“Crissy”

77. Recent years…
• Production:
– Internet: buy/sell/import; “how to make” instructions
– Local vs. imported
– Strength & purity have gone up
• pre-cursor restrictions
• Sub-populations
– Oxycontin Removal
• How it‟s used:
–
–
–
–
Swallow
Bump: nasal / anal
Inject
Smoke/Inhale
“get off” /
addiction

78. Recent years…
• Price point:
– Dealer preference vs. cocaine / ecstasy
• Element of organized crime pushing use:
– Mexican cartels in U.S.; Biker gangs in
Thunder Bay; Ecstasy producers in Toronto
• “Mental health” of communities & nation
– Consider economic & wartime status (esp. in
U.S.)
• The “in” drug for the media…

79. Media
• “Meth explosion!”
– Occasional spikes in endemic use
– Media portray horror stories and often neglect history
• “More addictive than crack and heroin!”
– Different drugs are more/less addictive for different
people.
– However, use can be more problematic than many
other drugs.
• “One hit and you‟re hooked!”
– Simply not true!
• Continue to feed mis-information and hysteria.
• Has become ingrained in “Pop-Culture”…

81. , 2013

83. FALSE ALERT! There is
absolutely no evidence of
this and the email has been
showing up in email inboxes
for years now!

84. Different approaches
• Fear and abstinence based “education”
• Punishment > Support or Treatment
• Harm reduction and pragmatic information
• Support or Treatment > Punishment

87. Hi! My Name Is Tina.com
• Comprehensive web-based:
–
–
–
–
–
Accurate information
Non-judgemental and harm reduction
Practical strategies
Supports and resources
Toronto specific
• Utilize and adapt existing info (e.g.,
tweaker.org, knowcrystal.org, crystalneon).

89. Keep it in check… STILL!
• People always have and likely always will
experience serious meth related concerns.
• Meth is not be the problem, but the result of:
– Loneliness; socializing; self-esteem; body image;
energy
– Mental Health
– HIV
• depression; libido; psychosocial impacts of early AIDS
days

90. Keep it in check…
• “As long as I‟m not doing meth…”
• One concerning major shift…
… ongoing concern

91. Keep it in check…
• Political Climate – especially at the
Federal level in Canada.
• Funding
– Education: Prevention and Harm Reduction
– Treatment
– Law Enforcement
• Balance of Federal Drug Strategy:
Justice > others

93. Keep it in check…
• Methamphetamine isn‟t new and will
always be around.
• We must compare and contrast
communities and sub-populations.
• We need to try and increase the transfer
of generational knowledge and
experiences.
• Ongoing mis-information in the media.

94. Existing Supports (Ontario)
•
DART (info about treatment)
– www.dart.on.ca
– 1.800.565.8603
– 24 hrs; anonymous; confidential
•
Centre for Addiction and Mental Health (CAMH)
– Assessment: 416.535.8501 X 6616
•
Rainbow Services – CAMH (LGBT addictions counselling)
– Weekly meetings; 3 week sessions; (Meth specific group)
– 416.535.8501 x 6784
•
Find a Needle Exchange
http://www.ohrdp.ca/find-a-needle-syringe-program/

95. Resources for Gay Men
• While the following website were generally created for
gay men, by gay men, there is useful (and good)
information for anyone.
• Prevention and safer using info for gay men
– himynameistina.com (Toronto based meth site)
– knowcrystal.org
– tweaker.org
– crystalneon.org
– torontovibe.com (ACT‟s party drug page)
– erowid.org (all about every drug)
• erowid.org/chemicals/meth/meth.shtml (specifically
crystal meth)
– tripproject.ca (info for youth in the “rave” scene)

97. Contact Us
Nick Boyce, Provincial Director
nboyce@ohsutp.ca
CC Sapp, Provincial Trainer
ccsapp@ohsutp.ca
490 Sherbourne St., 2nd Floor
Toronto, ON M4X 1K9
1-866-591-0347 (toll free)
416-703-7348 (t)
www.ohsutp.ca