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News METH | Meth overdoses surpassing heroin deaths ->

mr peabody

Moderator: Music Discussion, PM
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How dangerous is Meth?
If I try Meth, will I become addicted?
How can meth affect my friends and family?
Does Meth make you violent?
What is “chasing the high”?
Why does Meth cause paranoia?
Why do Meth users have open sores?
What is the high from Meth like?
What is Meth-induced psychosis?
What does Meth do to your brain?
What does Meth do to your body?
Will using Meth change how I look?
How can Meth lead to unwanted sex?
What is “Meth Mouth”?
What are “crank bugs”?
Does Meth affect your heart?

 
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mr peabody

Moderator: Music Discussion, PM
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Stevon Williams (right), a homeless veteran, describes the effects of the “goofball,” a potent
combo of meth and fentanyl.


Bay area death toll from drug overdoses passes 10,000*

by Erin Allday and Kevin Fagan | SF Chronicle | Nov 30 2019

More than 10,000 people have died across the Bay Area in the drug overdose epidemic, but the main killer hasn’t been prescription painkillers for several years — methamphetamine is now the biggest cause of deaths, and overdoses on the super-potent opioid fentanyl are spiking.

Nationally, millions of people have died in the opioid overdose crisis, using prescription painkillers and similar street drugs like heroin and fentanyl.

The Bay Area was never as hard hit as other parts of the country by prescription opioid overdoses. But it has endured an epidemic of deaths from a variety of other street drugs that is continuing to evolve and concern public health officials.

A Chronicle analysis of data from the California Department of Public Health found that 10,005 people have died in the nine Bay Area counties since the state began tracking overdose deaths in 2006, though that number is almost certainly an undercount of actual drug deaths.

The data also show that methamphetamine is now the leading cause of overdose deaths in the state. That statistic is reflected in the Bay Area, where meth overdose rates have tripled over the past decade while deaths from prescription opioids have dropped.

The methamphetamine crisis is a new-old problem, public health officials said. Meth was widespread in the 1990s and it never really went away, but the number of people now dying from it — and from dangerous combinations of methamphetamine and potent opioids like fentanyl — is new, and alarming.

“It’s the new speedball,” said 58-year-old Stevon Williams, a homeless Air Force veteran in San Francisco, describing the “goofball,” which is replacing the old combination of cocaine and heroin. “That combo of meth and fentanyl does the same thing. A lot of people like that.”

Though the public health data demonstrates shifting drug-use trends across the state, it is less precise at capturing overdose deaths caused by multiple drugs. Indeed, the state data as a whole is more subjective than most public health experts would like. It’s dependent upon how coroners and others label the cause of death, and some deaths are investigated much more thoroughly than others.

“It’s important when we’re thinking about overdose deaths that what we’re looking at isn’t necessarily the truth with a capital T,” said Dr. Matt Willis, public health officer for Marin County. “There’s a lot of bias built into the reporting.”

But the data backs up what health care providers, addiction experts and users themselves are experiencing firsthand: Drug overdoses, even in communities spared from the worst of the opioid epidemic, are a public health crisis.

Variations among counties: The data was obtained from the California Opioid Overdose Surveillance Dashboard, and the Chronicle analysis is a unique examination of the drug overdose epidemic in the Bay Area as a region.

The Bay Area consistently has had somewhat lower rates of prescription opioid overdose deaths than the rest of the state, especially compared with some rural counties in Northern California where rates were 10 or 20 times higher. But for all drug overdoses, the Bay Area as a whole comes in close to the state average, about 10 to 12 deaths per 100,000 people per year.

And that rate has been climbing — by about 21% since 2010.



Some local counties are notably higher than others. San Francisco has the highest rates of drug overdose deaths — about 23 per 100,000 in 2018. The North Bay counties of Sonoma and Solano also have higher death rates than the Bay Area average, about 15 per 100,000.

Santa Clara and San Mateo have the lowest rates, around eight deaths per 100,000 last year.

“There are marked differences in relatively small geographic areas. I couldn’t tell you why,” said Dr. Scott Morrow, public health officer for San Mateo County.

Drug overdose deaths have been up and down over the past decade in the Bay Area, but they reached a decade high 13 deaths per 100,000 residents in 2018, according to preliminary state data.

The overall death toll doesn’t tell the whole story, though.

Prescription overdose death rates have fallen slightly in the Bay Area, but deaths from heroin have been steadily increasing. And deaths from fentanyl — a synthetic opioid about 50 times more potent than heroin — have exploded in the past four years.

Opioids as a whole are still bigger killers than methamphetamine alone. But meth stands apart as the single largest killer. And that has public health officials concerned — and confused.

“Meth is not usually a very deadly drug,” said Dr. Daniel Ciccarone, a national drug use and policy expert at UCSF.

Opioids, and especially fentanyl, are so deadly because they can quickly shut down the respiratory system. Methamphetamine kills by essentially overstimulating the heart or the brain, leading to a heart attack or stroke. But in the past, only people who already had cardiovascular issues were at risk of overdoing it with meth — now, younger, otherwise healthy people are dying too.

"With meth overdose death rates climbing, it begs multiple questions," Ciccarone said. "Are more people using meth? Is the drug itself different and more potent? Does combining meth with fentanyl make it deadlier?"

Ciccarone said investigations of the drug supply have found that the meth sold in the United States is indeed stronger than what people were using a 10 or 20 years ago, when meth was primarily made in backyard labs. It’s now manufactured by global drug cartels.

“We have a drug coming in that’s at 90% purity and much higher potency. But we need more studies to say if the meth is more deadly,” Ciccarone said.

Deadly combinations

Combining drugs, especially meth with an opioid like fentanyl, is especially concerning to public health officials. It’s difficult to track those deaths, and dual addictions are more complicated to treat.

Purposely taking methamphetamine with fentanyl, one hit after the other, is like juggling dynamite - but hard-core addicts say they need it. The high of the methamphetamine sometimes needs counteracting with the chill-out effect of the fentanyl, they say. Or alternately, the deeply sedated state caused by fentanyl has to be offset by the rush of meth.

“Speed a lot of times gets you geeked out, with your heart racing and your head pounding, and then fentanyl evens you out,” said Shauna Arteago, 45, who has been homeless but currently lives in a San Francisco single-room apartment. “I smoke them one at a time, and you’ve got to be careful because fentanyl can kill you. I’ve overdosed three times, the last time a few months ago.”

Those who work daily with addicts in the street don’t need statistics to tell them the overdose problem is growing — particularly among the homeless.

Capt. Carl Fabbri, commander of the Tenderloin Police Station, said he often feels like he’s shoveling sand into tides when he and his officers try to intervene with addicts on the street, and it’s heartbreaking.

“We’ve made progress on the dealers, but the victims - the users? It’s almost out of our hands, there are so many,” he said. “It is terribly sad.”

A 39-year-old homeless longtime addict who goes by the street name of Country fired up a bubble — pipe load — of meth near the Ferry Building and said overdoses and addictions in the street “have gotten off the hook in the last year or so.”

“It’s so much more than ever, and I’ve seen it all,” he said.

“I makes me sad seeing so many people do so much drugs out here, but we’re stuck. We need help. You think we all want to be addicted to this crap? No way.”

San Francisco public health officials, who have been collecting data on overdose deaths involving more than one drug, say their analyses show that overdose rates with both meth and fentanyl have more than doubled in just the past two years.

A decade ago, meth was only causing a dozen or so deaths a year and fentanyl wasn’t even tracked. In 2018, roughly 50 people died with both drugs in their system — dozens more died from one or the other.

“The reality is that most drug use is poly drug use. It’s not unusual for people to be using more than one drug,” said Dr. Phillip Coffin, director of substance use research for the San Francisco Department of Public Health.

"Combining meth and fentanyl may be especially risky for a lot of reasons, among them that meth, in particular, leads to 'chaotic behavior' that may prevent people from practicing safer drug practices," he said.

For example, harm-reduction experts advise than anyone using fentanyl start with a small dose, and that they never get high alone, so that if they overdose someone can treat them with Narcan. But if they’re using meth too, people may not be thinking clearly enough to take those precautions.

The “goofball” is not just a San Francisco problem. What’s not clear from data and anecdotal information is how often people are choosing to combine meth with an opioid verus being “poisoned” by fentanyl that is sometimes added to other drugs without users knowing it, public health officials say.

Fentanyl isn’t necessarily pervasive in all Bay Area counties just yet — or at least, it’s not being identified as a cause of death. But not all counties have the laboratory resources to test for the specific opioid found in a person after death. When fentanyl is identified in an overdose, it’s often impossible to know whether the person chose to use it or took it by accident.

“The combination of opioids and stimulants is common,” said Dr. Ori Tzvieli, deputy health officer with Contra Costa County. “But did they die because they were a meth addict and they ended up buying some with fentanyl in it? Or did they die because they’re someone with an opioid overuse disorder who’s using fentanyl now?”

*From the article here :
 
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mr peabody

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Deaths involving meth are rising fast*

by Abby Goodnough | New York Times | Dec 17 2019

The teenager had pink cheeks from the cold and a matter-of-fact tone as she explained why she had started using methamphetamine after becoming homeless last year.

“Having nowhere to sleep, nothing to eat — that’s where meth comes into play,” said the girl, 17, who asked to be identified by her nickname, Rose. “Those things aren’t a problem if you’re using.”

She stopped two months ago, she said, after smoking so much meth over a 24-hour period that she hallucinated and nearly jumped off a bridge. Deaths associated with meth use are climbing here in Oklahoma and in many other states, an alarming trend for a nation battered by the opioid epidemic, and one that public health officials are struggling to fully explain.

The meth problem has sneaked up on state and national leaders. In Oklahoma, meth and related drugs, including prescription stimulants, now play a role in more deaths than all opioids combined, including painkillers, heroin and fentanyl, according to the Centers for Disease Control and Prevention.

The spending package that lawmakers agreed on this week includes legislation from Senators Jeanne Shaheen, Democrat of New Hampshire, and Rob Portman, Republican of Ohio, that would allow states to address the resurgence of meth and cocaine by using some of the billions of dollars that Congress had appropriated to combat opioid addiction.

Meth use first ballooned in the United States from the 1990s into the early 2000s, when it was often made in small home labs with pseudoephedrine, the main ingredient in many drugstore cold medicines. But today’s meth, largely imported from Mexico, is far more potent.

“It’s way different from the meth people were using 20 years ago,” said Dr. Jason Beaman, the chairman of psychiatry and behavioral sciences at the Center for Health Sciences at Oklahoma State University. “It’s like they were drinking Mountain Dew and now they are injecting Red Bull.”

Nationally, since late last year, meth has turned up in more deaths than opioid painkillers like oxycodone and hydrocodone. In 14 of the 35 states that report overdose deaths to the federal government on a monthly basis, meth is also involved in more deaths than fentanyl, by far the most potent opioid.

Provisional data from the C.D.C. shows there were about 13,000 deaths involving meth nationwide in 2018, more than twice as many as in 2015. That is still far fewer than opioid deaths over all, which passed 47,000, but the pace is accelerating while opioid fatalities have flattened.

The most recent federal data, for example, estimates that from May 2018 to May 2019 there were 25 percent more deaths involving meth and other drugs in its class than in the previous year, compared with 9 percent more deaths involving fentanyl and other synthetic opioids. Deaths involving meth have been concentrated in the western United States but are moving eastward, even to regions that meth barely touched in the past, like New England.

“This is the one thing that keeps me awake at night,” said Dr. Brett P. Giroir, assistant secretary for health at the Health and Human Services Department, at a conference on stimulant abuse on Monday. “Within a few short months, and you can model it any way you want, meth will be secondary only to fentanyl, in terms of overdose deaths.”

Unlike with opioids, there is no way to reverse the effects of a meth overdose, just as there is no medication approved to treat meth addiction and the cravings it creates. "For now, treatment for meth addiction consists largely of behavioral therapies," said Dr. Nora Volkow, the director of the National Institute on Drug Abuse.



For many here in Oklahoma, what treatments do exist are out of reach. Most poor adults in the state do not qualify for Medicaid coverage that would help those with meth addiction gain access to treatment, because the state has chosen not to expand the program under the Affordable Care Act. And while Oklahoma has won a windfall of money — $355 million — from lawsuits against opioid manufacturers, much of it is specifically for fighting opioid addiction.

“We know there is funding coming in for the opioid problem,” said Mimi Tarrasch, the chief officer of Women in Recovery, an alternative sentencing program in Tulsa. “But what I see, and what our community continues to see, is really a lot of addiction to methamphetamine.”

Meth is still not considered nearly as deadly as heroin or synthetic fentanyl, the latter of which has killed tens of thousands of Americans over the past five years, often within minutes, by depressing their breathing. Instead, meth stimulates the central nervous system, causing agitation, sleeplessness, psychosis and gradual damage to the heart, brain and other organs.

“Basically your blood pressure goes up so high that you can rupture your aorta or have a stroke,” said Dr. Andrew Herring, an emergency medicine and addiction specialist in Oakland, Calif.

In many cases, opioids are contributing to meth deaths, as people use both types of drugs together. Opioids were found to play a role in about half of the deaths involving meth in 2017, the most recent year for which detailed toxicology results are available.

Some experts think the number is probably larger. Dr. Daniel Ciccarone, a professor at the University of California, San Francisco, who studies patterns of drug use, said he suspected some coroners and medical examiners were not checking the blood of overdose victims for dozens of fentanyl analogues, which have chemical structures similar to fentanyl but require specialized toxicology testing.

"Meth-related deaths may also be rising simply because the number of users is rising," Dr. Ciccarone said, "including those with underlying heart or other problems."

“It’s embarrassing that we don’t have the answer at our fingertips, and we should,”
Dr. Ciccarone said at the stimulant abuse conference.

Research suggests that in some cases, fear of dying from fentanyl is compelling people to use meth instead. Others are using meth as an upper to rouse themselves after using opioids, which have a sedative effect, or to help with opioid withdrawal. Still others are turning to meth for a high even as they take anti-craving medications to recover from opioid addiction.

"Combining meth and fentanyl could be the most dangerous move of all, although researchers are still trying to figure out how the drugs work together." said Dr. Giroir.

“We definitely want to dissuade people from the notion that somehow a downer and an upper cancel each other out,” he said. “Early data suggests the combination is probably more deadly than the sum of its parts.”

Some deaths involving meth are due to the risky or violent behavior it can cause, not the drug itself. Rose and her 19-year-old boyfriend, stopping to talk to a reporter one morning on their way to a drop-in center where they hoped to shower, said they knew of a man who had hanged himself after a meth-fueled fight with his girlfriend.

Last year in Tulsa, a 25-year-old man with schizophrenia died after he shattered the glass door of a downtown bank while on meth and two police officers, who had been pursuing him, shot him with a Taser 27 times. His autopsy report said the likely cause of death was cardiac arrest “due to methamphetamine toxicity in the setting of physical exertion/restraint,” with cardiovascular disease as a contributing factor. The man’s relatives say excessive force by the police was to blame and are planning to sue, said Damario Solomon-Simmons, a lawyer for the family.

Many autopsies of Oklahoma residents whose deaths involved meth also found heart problems. In one typical case, a 48-year-old receptionist was found dead in a hotel room in May, her body withered to 77 pounds, her heart diseased. The cause of death was found to be acute methamphetamine toxicity.

Dr. Beaman, who sees patients at a psychiatric crisis center here in Tulsa, said psychosis and other mental conditions caused by meth use were taking up more and more resources. In June alone, he said, more than half of the admissions to the crisis center were related to meth.

“I can’t treat people with schizophrenia,” Dr. Beaman said, “because I’m spending all my time treating people who are using meth.”

Shayla Divelbiss, 29, of Glenpool, Okla., considers herself lucky to be in good health now after using meth for six years, during which she ignored a thyroid condition and went days at a time without sleep. After waiting two harrowing months for a bed at 12 & 12, a treatment center for the poor and uninsured, she was able to stop.

“All the responsibilities of being a human just went out the window,” she said of her time on meth. “I quit cooking and eating. I had real bad anxiety. I was skin and bones.”

Daniel Raymond, the director of policy at the national Harm Reduction Coalition, said it was imperative to figure out exactly how meth users were dying so that cities and states could build public health strategies based on that knowledge. For now, those strategies include warning users about the risks of “overamping,” a word used to describe using too much meth, and the best ways to address it, like cooling down, drinking water and sleeping. Syringe exchanges have an important role for those who inject meth, he said, just as they do for opioid users.

At 12 & 12, a former hotel on the outskirts of Tulsa, 64 percent of the clients are addicted to meth, said Bryan Day, the chief executive. State lawmakers have agreed to give the center more money next year to add beds for meth patients and increase their average stay, which is about 30 days. He estimated that 4,000 people in the state need treatment for meth addiction but are not receiving it.

“My belief is that their judgment for a period of time is very, very skewed, leading to frightening choices and decisions and impulses,” Mr. Day said. “The brain takes time to heal. We don’t want to shortchange this population.”

*From the article here:

 
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mr peabody

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Helping your child through difficult times

by Richard Capriola | The Fix | 2 Dec 2020

All too often when we look beyond a child’s drinking or drug use we discover their struggle to manage intolerable thoughts, feelings or memories is a core issue that needs treatment.

I have been a mental health and addictions counselor for over two decades. I’ve treated adults and adolescents diagnosed with serious psychiatric and substance abuse issues at one of the nation’s premier psychiatric hospitals. After informing parents of their child’s substance abuse history the most frequent response I heard from them was “I had no idea this was going on.” Or if they suspected their child was using a substance, they were shocked at how extensive it was.

Adolescent substance abuse continues to invade too many of our families, leaving parents confused and without a roadmap to guide them in finding help for their child. Today, more than 40 percent of seniors and one-third of tenth graders are vaping a substance like marijuana. Twenty percent of teens report abusing prescription drugs like Xanax, Ritalin and Adderall.

As the parent of an addicted child, feelings of helplessness, blame and fear can drown out any sense of hope. But in the pages of my book The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse they receive the information and resources needed to help their child through assessment, treatment and recovery.

Alcohol and drugs have the power to change a child’s brain and influence behaviors so I include a chapter on the neuroscience of substance abuse. In non-technical language parents learn how substances work in the adolescent brain.

Because the best treatment starts with a comprehensive assessment there’s a chapter explaining which assessments are critical for a proper diagnosis. These assessments go beyond looking just at a child’s history of using substances. All too often when we look beyond a child’s drinking or drug use we discover their struggle to manage intolerable thoughts, feelings or memories is a core issue that needs treatment. While not every child using alcohol or drugs has an underlying psychological issue, for those that do, treating the alcohol or drug problem without treating the mental health issue can be a treatment plan doomed to fail.

Other chapters in The Addicted Child address issues such as eating disorders, self-injury, gaming and cell phone use which often accompany a child’s use of substances. Parents learn the warning signs for these disorders and the warning signs that often accompany alcohol and drug use. Parents also learn which drugs are invading today’s adolescent population and how to recognize them.

Parents often need guidance when looking for treatment options. There is no “one size fits all” treatment approach to addiction. For this reason, I have included chapters explaining the important principles of adolescent substance abuse treatment and various treatment options available for families. There is also a chapter listing helpful resources for parents.

Very few things are more destructive to a family than having someone, especially a child, addicted to alcohol or drugs. While working on an adolescent treatment unit I met parents struggling to understand and accept their child’s psychiatric and substance use issues. For most of these families it was a heart-breaking experience. Sadly, many families do not have the financial resources to send their child to a nationally acclaimed hospital like the Menninger Clinic in Houston. Their desperate search for help often leaves them feeling alone and without a roadmap to guide them through the process of their child’s assessment and treatment. It’s for these families that I wrote my book, The Addicted Child: A Parent’s Guide to Adolescent Substance Abuse. You can find The Addicted Child on Amazon and at the following website: https://www.helptheaddictedchild.com

 
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mr peabody

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The rise in meth overdoses, explained*

By German Lopez | Vox | Jan 9 2020

America’s drug overdose crisis is still largely dominated by opioid overdose deaths. But stimulants, especially methamphetamine, are poised for a comeback.

Provisional federal data suggests that national overdose deaths linked to psychostimulants, such as meth, spiked by more than 21 percent from 2017 to 2018.

A recent research letter published in JAMA Network Open analyzing more than 1 million drug testing results from routine health care settings found positive hits for meth were up nearly 487 percent from 2013 to 2019, and positive hits for cocaine were up nearly 21 percent.

Experts worry that the numbers for stimulants could foreshadow a larger epidemic — a potential “fourth wave” in the overdose crisis that’s killed more than 700,000 people in the US since 1999.

“Every opioid epidemic in American history has been followed by a stimulant epidemic,” Stanford drug policy expert Keith Humphreys told me.

The numbers for meth and cocaine are still dwarfed by opioids. In 2018, there were more than 13,000 estimated overdose deaths linked to stimulants, particularly meth, and more than 15,700 linked to cocaine, according to the provisional data. Meanwhile, there were nearly 48,000 overdose deaths linked to opioids. Synthetic opioids excluding methadone — a category that mainly captures fentanyl — were associated with more than double the fatal overdoses linked to cocaine or meth alone. (There’s some overlap between drugs in the figures, because overdoses can involve multiple drugs.)

But there are reasons to believe the crisis is broader than just opioids. A 2018 study in Science found that, while drug overdose deaths spiked in the 1990s and 2000s with the opioid epidemic, there has been “exponential growth” in overdose deaths since 1979. That suggests that America’s drug problem is getting worse in general, regardless of which drug is involved.

“My question: Why are we as a country vulnerable to all of these drugs?” Nora Volkow, director of the National Institute on Drug Abuse, told me. “What has happened that has made it possible for these drugs to take hold in a dramatic way?”

The answers to those questions could require a shift in how America approaches drugs, focusing not just on the substances making headlines but also addiction more broadly and the causes of addiction. It would mean building a comprehensive addiction treatment system that’s equipped to deal with all kinds of drugs. And it could require looking at issues that aren’t seemingly drug-related at first, like whether socioeconomic and cultural forces are driving people to use more drugs.

Drug epidemics are often cyclical

In the 1960s and ’70s, heroin was the big drug of public concern. In the 1980s, it was crack cocaine. In the 1990s and early 2000s, it was meth. Over the past decade and a half, opioid painkillers, heroin, and then fentanyl became the center of America’s drug problem.

It’s not clear if the next phase is here yet — opioids are still a huge problem — but the worry is stimulants will start to pick up if opioids plateau and fall.

“The drugs are driven by fads, a little bit of fashion,” Volkow said. “So you have eras when you have a flourishing of a particular drug and then another one takes over.”

There are now reports of drug cartels producing and shipping more meth than before across the US-Mexico border — a shift from the homegrown market of the 1990s and 2000s. And in general, illicit drugs have become cheaper and, in some cases, more potent over time. Federal data tracking the street price and potency of the drugs tells the story: In 1986, for example, meth was on average $575 per pure gram and on average at 52 percent purity; in 2012, it was $194 per pure gram and 91 percent purity. The price drop is similar for other drugs, though purity levels have fluctuated depending on the substance.

This makes it cheaper for someone to start using drugs. The central focus of the US war on drugs for decades has been to prevent this — by fighting drug traffickers and dealers — but it’s failed as drug cartels have consistently remained ahead of the authorities, bolstered by new technologies and globalization making it cheaper and easier to ship drugs around the world.

New demand for drugs is also a major factor for new epidemics — as people could, for example, want to supplant or enhance their opioid use with stimulants. Maybe they mix opioids with cocaine (a “speedball”) or meth (a “goofball”) because they like the mixed effects. Maybe they use stimulants after heroin or fentanyl to wake themselves up. Maybe they want to stop using opioids, whether due to the risk of overdose or some other reason, and believe stimulants are a better option.

“People get tired of it — have been there, done that, and move on,” Steven Shoptaw, a psychologist and researcher at UCLA, told me. “There is some of that with all addictions. Some people walk away from opioid addiction, which is great. But then they walk away from it by using stimulants.”

Humphreys noted an important factor in this cycle: “Probably more Americans than ever know a drug dealer.” As millions of Americans have misused and gotten addicted to opioids, they’ve established ties with drug dealers that they didn’t have before. That makes it easier to go from heroin or fentanyl to meth or cocaine.

Underlying all of this, Volkow argued, is a sense that something deeper has gone wrong in society. She pointed to the research by Princeton economists Anne Case and Angus Deaton showing that there’s been a rise in “deaths of despair” — drug overdoses, but also alcohol-related mortality and suicides. Case and Deaton have pinned the rise on all sorts of issues, including the collapse of economic opportunities in much of the country, a growing sense of social isolation, and untreated mental health issues.

“If all of these social factors were there, and we didn’t have the supply of drugs, of course people would not be dying of overdoses,” Volkow said. “But it is the confluence of the widespread markets of drugs — that are very accessible and very potent — and the social-cultural factors that are making people despair and seek out these drugs as a way of escaping.”

Not every place in the US is following the same drug trends. According to the Science study and the provisional federal data, meth has historically been more popular in the southwest, while fentanyl has been more widespread in the northeast. Researchers have warned that could change if, for example, fentanyl reaches California in a big way. But it goes to show that what looks like a national epidemic or trendline could also be regional epidemics, with different populations and demographics, separately rising and falling.

Simply building up America’s addiction treatment system isn’t enough to address all of the country’s drug problems. What kinds of treatment are done and how different drugs are treated also matter. And in the case of stimulants, treatment is probably going to produce disappointing results unless treatment facilities adopt an approach many are averse to and until researchers uncover better approaches.

“We do have a problem in the US of tending to think of one drug at a time,” Humphreys said. “During the ’90s, everyone was worried about meth, but there were plenty of people dying of alcohol. During the ’80s, crack cocaine, even though plenty of people were dying of heroin.”

The recent rise in stimulant deaths, though, suggests that America remains unprepared.

*From the article here :
 
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mr peabody

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Researchers have identified a potentially effective treatment for meth addiction.

Naltrexone a promising treatment for meth addiction*

UCLA | Science Daily

A study of Naltrexone's effect on methamphetamine users has found that this medication is a very promising treatment for meth addiction, researchers report.

"The results were about as good as you could hope for," said Lara Ray, a UCLA associate professor of psychology, director of the UCLA Addictions Laboratory and lead author of the new study.

The study, published in the journal Neuropsychopharmacology, was the first in the U.S. to evaluate Naltrexone for treating meth addiction. Researchers analyzed 22 men and eight women who use methamphetamine an average of three to four days a week.

During a four-day hospital stay, each person was each given either Naltrexone -- 25 milligrams the first two days, 50 milligrams on days three and four -- or a placebo daily. Ten days later, the subjects were readmitted to the hospital for four more days; those who had taken Naltrexone earlier were given placebos, and vice versa.

On the last day of each hospital visit, all participants were given intravenous doses of meth. Three hours later, the researchers asked how they felt and how much they wanted more of the drug.

The scientists found that Naltrexone significantly reduced the subjects' craving for methamphetamine, and that it made them less aroused by meth: Subjects' heart rates and pulse readings both were significantly higher when they were given the placebo than when they took Naltrexone. In addition, participants taking Naltrexone had lower heart rates and pulses when they were presented with their drug paraphernalia than those who were given placebos.

Ray said the results indicated that Naltrexone reduced the rewarding effects of the drug -- those taking Naltrexone did not find meth to be as pleasurable and were much less likely to want more of it.

Naltrexone was well tolerated and had very minimal side effects. The researchers found that men and women both were helped by taking Naltrexone, although the positive effect on men was slightly smaller. It made no difference whether the participants were given Naltrexone during their first hospital stay or their second.

Methamphetamine use disorder is a serious psychiatric condition that can cause psychosis and brain damage, and for which no FDA-approved medication exists. An estimated 12 million Americans have used meth, nearly 400,000 of whom are addicted to it, according to recent estimates.

Although the new study is promising, it needs to be backed up by clinical trials, said Ray, who is also a member of the UCLA Brain Research Institute. The next step in evaluating Naltrexone's effectiveness for treating people addicted to meth is already underway: the National Institute on Drug Abuse is sponsoring clinical trials.

*From the article here:

 
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Artist Riley Stolte, a former meth user, poses with some of her paintings.

A medication for meth use?*

by Sydney Brownstone and Scott Greenstone | Seattle Times | 13 Jul 2020

Artist Riley Stolte grew up in Seattle around family members who struggled with substance use disorders.

By age 14, Stolte had started using drugs herself, and for the next 16 years battled heroin and methamphetamine addictions. That was until Stolte started taking Suboxone, an opioid-treatment medication that removed her desire for heroin.

But there wasn’t any medication like that for meth. And because meth helped Stolte focus on her art, she struggled to stop using it — even though, she says, it made her “psychotic.”

“I told myself in my head, ‘I can’t do my art or paint without a little meth,’” Stolte said. “And I believed that, too.”

The Seattle Times’ Project Homeless is funded by BECU, The Bernier McCaw Foundation, The Bill & Melinda Gates Foundation, Campion Foundation, the Paul Allen Family Foundation, Raikes Foundation, Schultz Family Foundation, Seattle Foundation, Starbucks and the University of Washington. The Seattle Times maintains editorial control over Project Homeless content.

Medications like Suboxone, which partially bind to the same opioid receptors in the brain as heroin without the high, are now considered a best practice for treating opioid-use disorder. But addiction to methamphetamine, which has rapidly overtaken heroin as the most common drug associated with overdose deaths in King County, has no equivalent drug treatment — conclusive research on it simply doesn’t exist.

Data from overdose deaths in King County shows that most involve a combination of opioids and stimulants, but deaths that involved methamphetamine hit a recorded high last year — 204, more than quadruple the number in 2013 when it began to rise. Local research shows that it’s harder for patients to get help and remain in treatment for opioid use disorder alone if they also struggle with methamphetamine.

The deaths are disproportionately striking King County’s Black, Indigenous and homeless populations. Nearly 20% of all King County overdose deaths involving stimulants in 2019 were among people reported to be homeless. Nearly 16% of people who died were Black, even though Black people represent less than 7% of King County. American Indians and Alaska Natives represented more than 3% of the deaths, though they make up less than a percentage point of the overall King County population.

Coronavirus has made the search for an effective treatment for methamphetamine use disorder even more urgent. Restrictions on travel have disrupted global drug production and supply chains, according to a United Nations report on drug trafficking trends published in May.

As some users in the United States find methamphetamine more expensive or harder to come by, a new report from health care workers and advocates argues now might be a prime opportunity to get people into treatment — and that it’s time for cities to fund the research looking for solutions, specifically to see whether drug-based treatment for methamphetamine use disorder could help people.

But not everyone is optimistic.

Promising signals, but nothing conclusive — yet

The lack of treatment options for methamphetamine users is frustrating for Dr. Richard Waters, medical director of Neighborcare Health’s Housing and Street Outreach Team. Nine years ago, when he started his residency in Seattle, meth use wasn’t widespread. But in the past six years, it’s skyrocketed alongside the West Coast’s homelessness crisis, during which some people living on the street have reported using meth as a survival tool to stay awake and protect themselves at night.

According to a 2019 survey of clients at syringe exchange programs across Washington, nearly half who used methamphetamine said they were interested in reducing or stopping their use.

“I’ve had patients come to my office and cry because they want to stop using meth, but … despite their strong desire to stop, they keep falling back in that cycle of craving use and then withdrawal,” Waters said.

International research has given some signs of hope for a meth treatment medication.

In Australia, where 1.4% of people over age 14 have reported using methamphetamine or amphetamine within the past year, finding treatments for methamphetamine addiction has become a government priority.

Dr. Krista Siefried, a clinical researcher with The National Centre for Clinical Research on Emerging Drugs (NCCRED), published an Australian government-supported study in March reviewing the evidence for drug treatment in methamphetamine and amphetamine use disorder. "The study looked at 43 different clinical trials testing 23 different medications, and found that five studies using a class of drugs known as psychostimulants showed 'promising signals' for possible treatment," Siefried said.

The two psychostimulants that had research available to look at were methylphenidate, known as Ritalin in the United States, and dextroamphetamine, a stimulant used to treat ADHD and narcolepsy.

While the trials didn’t show these drugs were successful at getting people to cut off their meth use completely, some studies had subjects who reported that they used meth less frequently or had fewer withdrawal symptoms.

Researchers’ findings weren’t particularly conclusive. Results were mixed and the studies measured and selected their outcomes differently, making them more difficult to analyze.

“We haven’t yet struck that medication substitute that we can say really works,” Siefried said. “We need more research.”

To that end, the Public Defender Association’s Yes to Drug User Health project put together a report with Seattle-based researchers, advocates and health care workers asking local government to invest in the kind of research that would further investigate stimulant substitution therapy.

Dr. Judith Tsui, one of the authors of the report and an associate professor at the University of Washington Department of Medicine, has proposed a clinical trial to look at whether long-acting methylphenidate could be effective for people who are already prescribed methadone to treat their opioid addiction.

Her interest in finding a potential drug treatment stemmed from her own experience as a primary care provider at a methadone clinic, where patients would show up with various medical complications associated with their meth use, like heart problems, dental problems and psychosis.

“I think as a physician I felt helpless not having more options to have to offer more patients who were struggling with their methamphetamine use disorder,” Tsui said.

Waters, of Neighborcare Health’s Housing and Street Outreach Team, supports the idea of a randomized controlled trial like the one Tsui is proposing.

“I think that would be perfect for what needs to happen,” Waters said. “There have been studies on methylphenidate before and the results offer a glimmer of hope.”

But some in the addiction medicine community are skeptical — including the doctor who treated Stolte’s meth use with ADHD medicine, Dr. Richard Ries.

Ries, founder of the Mental Health and Addiction Services Department at Harborview Medical Center, said that from years of working with patients and conducting and reviewing research, he’s only seen a very specific group of people benefit from medication: people with ADHD who are very committed to quitting their meth use and whose lives are otherwise relatively stable.

When Ries prescribed Stolte methylphenidate, or Ritalin, for her ADHD, she stopped using methamphetamine quickly.

“I noticed it right away pretty much. My thoughts slowed down, I felt kind of peaceful a little bit more — and less running around and creating ruckus in the psych ward,” Stolte said, laughing.

That was a year ago. On June 11, she woke up before 5 a.m. with a huge smile on her face. She’d been sober for a whole year, the first time since she was 14.

"But people with ADHD are most likely a minority among meth users, although percentages vary widely study to study," Ries said.

"One of the reasons Ries doesn’t expect a substitute to work is because the high from methamphetamine is so much more powerful and releases so much more dopamine than heroin or prescribed ADHD meds," Ries said.

“To put it in alcohol terms, you’ve got a person who’s drinking two fifths a day, and you say, ‘OK, we’re going to give you … two shots of alcohol,’” Ries said. “If you’re going to prescribe it and think that you’re going to substitute it, you’re going to have to find doctors somewhere who are willing to prescribe astonishing amounts.”



Safe supply

Dr. Caleb Banta-Green, a principal research scientist at the UW’s Alcohol and Drug Abuse Institute, convened a “meth summit” last year in Seattle to discuss interventions like the one Tsui has proposed studying. Banta-Green believes “there is some evidence for some medications that have had some benefits for some populations,” such as prescribing Ritalin for meth users with ADHD or mirtazapine for users with depression." Banta-Green says it deserves more research.

“Pinning all your hopes on one particular medication doesn’t make sense to me,” Banta-Green said. “There’s something there (with methylphenidate) … but it’s not as convincing, nearly, as what we’ve been seeing for opioids. And we’ve been looking for a long time.”

A more favored approach among research scientists doesn’t involve medicine at all. Called “contingency management,” it’s a system where patients get rewards for using drugs less frequently or stopping completely. "But while multiple studies have reported the approach’s success, it’s not as effective for people living homeless, who are eight times more likely than housed participants to drop out of the treatment," one of the leading researchers told The Seattle Times last year.

British Columbia is trying a different tack. In late March, fearing that the pandemic would make the street drug supply even more dangerous, British Columbia started allowing health care workers to provide prescriptions of replacement drugs to users of street drugs. The strategy, called “safe supply,” is intended to cut down on the number of overdoses for vulnerable people on the street, and for people who would be at risk of greater exposure to coronavirus through drug use.

Providence Healthcare’s Crosstown Clinic, in Vancouver, B.C., had already been prescribing long-acting dextroamphetamine to a small group of meth users since 2016.

“Many who have tried it have cut down on their use,” said Crosstown Clinic’s physician lead, Dr. Scott MacDonald. “We think it’s effective, [but] it doesn’t work for everybody in our population.”

"People looking for energy throughout the day tend to do better with the sustained-release dextroamphetamine tablets,"
MacDonald said, "rather than people looking for an immediate effect."

But while policymakers and health care workers debate treatments, Tsui stresses that the progress made in treating opioid use disorder could be undercut by failure to address co-occurring meth addictions.

“We have made great strides in improving access to opioid use disorder treatment,” Tsui said. “But if we cannot adequately address concurrent methamphetamine use, it may stand in the way of allowing patients to achieve their best treatment outcomes.”

*From the article here :
 
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mr peabody

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Iboga appeared as an African warrior, and said he was there to help me. I immediately began thinking about my father, as I have much childhood trauma associated with him. Iboga clapped his hands, and my dad appeared. He looked drunk and had an angry expression on his face, with his fists in the air like he was about to beat me. Suddenly, Iboga clapped his hands again, and instantly my father was transformed into a scared little boy, around age eleven, crying about being beaten by his grandfather (his primary caregiver during his childhood). Then I felt the massive resentment I held towards my father uprooted out of me by Iboga.

Next, came my mother. Iboga did something very different this time: he transformed me into my mother, and all of a sudden I felt all the pain and suffering that I had caused her during my addiction through lying, stealing, manipulating. This vision humbled me to a level I had never felt before, and since then, I cannot bring myself to lie to her without bawling my eyes out, precisely because I was her and I felt all the pain I had caused her. Iboga allowed me to forgive myself for the pain I caused the woman who loved me more than anyone else in the world, but he emphasized that I must never again cause her that type of pain.

I remember my hallucinations. I saw shamans in my closed eye visuals, and a jaguar just staring into my eyes. The worst part was when I saw my mom crying. When I would use drugs, my mom would cry sometimes, but when I was high I didn't care. When I saw my mom crying, I felt so shitty, like I owe her for all her happiness that was lost.

I laid there and I had deep locked thoughts from my childhood, flashbacks of all the negative experiences I had, and realized exactly why I used drugs to begin with. I did also see open eye visuals. There was one moment where I saw a pair of non-human eyes floating above, then all of a sudden a long tongue dropped to my bed where the eyes were, this hallucination was very shocking. It was like the same shock experienced when you hear a loud and unexpected sound. Ibogaine had a lot of those moments. Ibogaine is like a stern teacher or parent teaching you a lesson, it is not fun and games. Towards the end, I felt very peaceful.

I was at peace with everything. I accepted my fate..., that I had died trying to save myself from a lifetime of misery, as well as everyone around me. The ibogaine was working a miracle and saving my life. It totally cleansed my body from every toxin I had put in it for 20 years. It defragmented my brain and allowed me to reboot. I was laying there like a dead man, and all of a sudden the power came back on.


https://thethirdwave.co/ibogaine-treatment/
 
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Clinical trial to evaluate psilocybin for the treatment of meth use disorder*

Psilocybin Alpha | 2 Sep 2020

Revive Therapeutics nas announced that the Company has entered into a Clinical Trial Agreement (CTA), with the Board of Regents of the University of Wisconsin System (UWS) to conduct a clinical study entitled, “Phase I Study of the Safety and Feasibility of Psilocybin in Adults with Methamphetamine Use Disorder.” Under the terms of the CTA, the Company has an exclusive option to obtain an exclusive, worldwide, royalty-bearing commercialization license to all rights, title and interest that UWS may have or obtain in any invention that results from the clinical study.

“We are delighted to be collaborating with clinical researchers at the University of Wisconsin to advance development of psilocybin as a possible treatment for methamphetamine use disorder,” said Michael Frank, Revive’s Chief Executive Officer. “We are building a pipeline of clinical-stage psychedelic-derived therapies for addiction disorders with a focus on psilocybin with unique dosage forms.”

Christopher R. Nicholas, Ph.D., Assistant Professor at the University of Wisconsin School of Medicine and Public Health, and clinical psychologist at the school’s Program for Research Outreach Therapeutics and Education in the Addictions (“PROTEA”) in the Department of Family Medicine and Community Health, will serve as principal investigator for this initial safety study. The study will be conducted at the University of Wisconsin Schools of Medicine and Public Health and Pharmacy, which hold a Wisconsin special authorization and Drug Enforcement Administration license to perform clinical research with psilocybin. Members of the PROTEA team previously conducted research on the pharmacokinetics of high-dose psilocybin and are also currently investigating psilocybin as a treatment for opioid use disorder.

About methamphetamine use disorder

Methamphetamine use disorder occurs when someone experiences clinically significant impairment caused by the recurrent use of methamphetamine, including health problems, physical withdrawal, persistent or increasing use, and failure to meet major responsibilities at work, school or home. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey on Drug Use and Health, there are approximately 1.1 million people aged 12 or older who have a methamphetamine use disorder in the U.S. Based on the most recent year for which data is available, the economic cost in the U.S. is approximately $23 billion, according to data from the Rand Corporation. There is no pharmaceutical treatment approved for methamphetamine dependence and the current treatment strategy is behavioral therapies, such as cognitive-behavioral and contingency management interventions.

*From the article here :
 
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Packets of buprenorphine, which is used to treat opioid use disorder.

Stigma is killing people with substance use disorders*

by Richard Bottner, Christopher Moriates, and Matthew Stefanko | STAT | 2 Oct 2020

"It was dehumanizing,” Slade Skaggs told us about how health care providers treated him when he turned to them for help with his substance use disorder. “They made me feel like I was drug-seeking and that I was not deserving of their time or care.”

Fortunately, he finally got the help he needed and is now in recovery, serving as a peer-support specialist for others with substance use disorders.

Stigma — society’s negative attitudes and behaviors towards individuals because of their substance use disorders — propagated by people working in health care causes feelings of shame, limits access to care, and ultimately contributes to vicious cycles of addiction. This is particularly true for people living with opioid use disorder.

In the setting of Covid-19 and physical distancing, it is more important than ever to dismantle such stigma and develop effective continuums of care for vulnerable patients, including those with substance use disorders. In fact, economic uncertainty, social isolation, and burdened health care delivery systems contributed to a 42% increase in overdoses in the U.S. in May alone — the sharpest increase since 2016. Now is the time to improve attitudes toward and knowledge about substance use disorders among health care providers.

Historically, the medical community has not been supportive when treating people with substance use disorders. Stigmatizing patients with opioid use disorder deepens prejudicial feelings among health care providers such as fear, anger, or disgust. Such emotions result in discriminatory clinical care. A Massachusetts survey found that 24% of emergency, family, and internal medicine providers believed that their practices would attract undesirable patients if they treated individuals with opioid use disorder.

Also worrisome is the lack of faith physicians have toward using medication to treat opioid use disorder. Many do not think that treating this disorder with medication is any more effective than treatment without it, despite ample evidence that buprenorphine and methadone are highly effective and save lives. The belief that these medications do not work is built on a foundation of bias, not science.

Stigma from the provider community isn’t surprising. There are meaningful gaps — including limited quality measurement related to outcomes for people with substance use disorder, poor reimbursement practices for treating people with substance use disorders, and inadequate education of clinicians about how to best care for people struggling with addiction — that get in the way of the community coming to terms with the importance of treating individuals with substance use disorder with the highest quality medical care accompanied by genuine respect and compassion.

The Massachusetts study we mentioned earlier also showed that only 1 in 4 respondents who went to graduate medical school or social work school had received addiction-related training during medical education, a startling statistic relative to other chronic diseases.

Stigmatizing perceptions directed toward people with opioid use disorder actually increase during time spent in formal medical education, revealing the “hidden curriculum” of negative bias towards individuals with this condition. Stigmatizing language commonly used in medical records, such as “drug abuser,” influences the attitudes and prescribing behaviors of physicians, nurses, and other health care providers.

The impact of stigma on access to quality care and patient outcomes is significant. Because of the attitudes of health care professionals, people with opioid use disorder may defer seeking care for infections or other medical conditions until they are serious or life-threatening. Once they seek treatment, individuals are likely to downplay their substance use history out of fear that revealing it will affect the quality of the care they receive.

Clinicians must be educated and empowered to use patient-first and recovery-centered language, and to apply evidence-based medicine to their practice.

The first step is to widely share best practices that are likely to reduce the amount of stigma and bias experienced by people with opioid use disorder. There are simple things clinicians can do, such as replacing “drug addict” with “person with a substance use disorder” in conversations and in medical records, that have been shown to shape people’s perceptions and attitudes. One study conducted with more than 500 trained mental health and addiction clinicians found that those asked to read a patient vignette with the label “an individual with substance use disorder” were less likely than those who read vignettes containing the term “substance abuser” to say the patient was personally responsible for his or her illness and punitive action should be taken.

This should start in every U.S. health care organization today. “Every time a doctor talks to me in a way that allows them to look me in the eye and not be a paper on a clipboard, they’re reducing harm because all of a sudden I don’t feel shame,” says Skaggs in an interview we filmed with him. “I feel like I’m being treated as a human being worth loving.”

Beyond language, organizations should look closely at practices that may, purposely or inadvertently, result in discrimination toward patients with substance use disorders. Health care organizations must actively engage clinicians in professional development about substance use disorders and stigma; ensure that medications for opioid use disorder such as buprenorphine and methadone are part of the formulary and no barriers exist to initiating or continuing these lifesaving treatments; and support and advocate for institutional, state, and federal policy that allows for substance use disorders to be cared for as chronic medical conditions similar to diabetes or hypertension. Such systems improvements must be done within a health equity framework.

Another component of reducing stigma associated with substance use disorders is creating easily accessible tools to teach the basics around stigma reduction, such as the Reducing Stigma Educational Tools (ReSET) program we recently released. It features videos of Skaggs and other people with lived experiences related to substance use and stigma from the medical community. The two modules include pragmatic steps that any medical professional or health care trainee can take to improve care for this vulnerable group of patients. Shatterproof, the national nonprofit organization dedicated to transforming addiction treatment that one of us (M.S.) works for, recently launched a nationwide initiative to combat stigma.

Every organization has a role to play in controlling addiction, and this is especially true for the health care community.

There is no time to waste. The Covid-19 pandemic has not only made treatment and recovery support more difficult to access, but it is also intensifying the existing fear, uncertainty, and lack of social connection and cohesion that those with substance addictions already feel. The first, necessary, and immediate step to propelling solutions forward is looking inward at ourselves and our organizations to end stigma.

*From the article here :
 
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mr peabody

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"Then I saw something on the other side of all that, something bright and luminous. I knew I had to get there but I was stuck in all this shit and noise, and the
terrible things I've done to people, and the even worse things people have done to me. And every time I'd try to get out, I'd get sucked right back in, feel that
rage rising up again, and I would do anything to make it stop! It's like, do I have to die?! And then this very clear voice said: "Don't die. Forgive."


The meth addiction epidemic*

INTEGRIS | 24 Sep 2020

Deaths associated with meth use are climbing in Oklahoma and in many other states, an alarming trend that public health officials are struggling to explain. In Oklahoma, meth and related drugs, including prescription stimulants, now play a role in more deaths than all opioids combined, including painkillers, heroin and fentanyl, according to the Centers for Disease Control and Prevention.

Writing about the increase in cases of meth addiction in recent times, The New York Times said, "Meth is still not considered nearly as deadly as heroin or synthetic fentanyl, the latter of which has killed tens of thousands of Americans over the past five years, often within minutes, by depressing their breathing. Instead, meth stimulates the central nervous system, causing agitation, sleeplessness, psychosis and gradual damage to the heart, brain and other organs."

But in many cases, opioids are contributing to meth deaths, as people use both types of drugs together. Opioids were found to play a role in about half of the deaths involving meth in 2017, the most recent year for which detailed toxicology results are available.

While state and local officials are right to concentrate on opioids, which accounted for nearly 70 percent of overdose deaths in 2017, the CDC warns that the dangers of cocaine, meth and other illicit drugs should not be ignored.

Meth never went away

Methamphetamine is once again scouring communities and ruining lives. According to a report on DrugAbuse.org, overdose deaths involving meth more than quadrupled from 2011 to 2017 in the U.S. Admissions to treatment facilities for meth are up 17%.

Hospitalizations related to meth also jumped by about 245% from 2008 to 2015. What’s more, 70 percent of law enforcement agencies in the Midwest and West still rank meth as their biggest drug threat.

The CDC goes on to show that 14,000 cocaine users and 10,000 meth users died in the United States in 2017, an increase of more than a third compared with 2016 and triple the number of deaths in 2012.

The meth epidemic isn’t just nationwide. In Oklahoma, more and more meth cases are being investigated or treated as well. In fact, according to the Oklahoma Bureau of Narcotics (OBN), there were 335 drug deaths in Oklahoma involving methamphetamine in 2018.

In 2018, the OBN told CNN that the number of lethal meth overdoses in the state has more than doubled in recent years, rising from 140 in 2012 to 335 deaths in 2016. In 2017, there were 327 meth overdose deaths.

Mark Woodward, the spokesman with the OBN, told CNN that while everyone was focused on the opioid epidemic, Oklahoma’s single most deadly individual drug was methamphetamine.



The ugly face of meth

Methamphetamine is a highly addictive stimulant drug that gives users powerful feelings of euphoria and energy when it’s abused. Because it is so addictive, meth is extremely difficult to stop using once a person has developed a habit of regular use.

Methamphetamine is a stimulant that is smoked, snorted, injected or even eaten. It can be made from cheap ingredients like over-the-counter cold medicine and household chemicals, but the results of meth addiction are shocking.

DrugAbuse.org said that long term use of meth can cause addiction due to how quickly drug users become tolerant of the pleasurable effects of the drug. As they take more and more to reach that high, they can start to show signs of addiction like significant anxiety, confusion, insomnia, mood disturbances and violent behavior. They also suffer from hallucinations and delusions and psychotic behaviors.

Methamphetamine is neurotoxic and can damage dopamine and serotonin neurons in the brain and usually includes toxic substances. Some studies show that long term meth use also leads to some irreversible changes in the brain associated with emotion and memory and could lead to a number of side effects like paranoia, irritability, increased sexual promiscuity, skin sores, rotting teeth, skin infections, premature aging and more.

Many long term meth users have what is called “meth mouth,” or severe tooth decay. One reason is that meth oftentimes includes acidic ingredients that eat away the enamel—ingredients like drain cleaner, battery acid or hydrochloric acid.

Users often neglect to take care of their teeth while high as well, and some crave sugary drinks, which leads to more oral hygiene problems.

Of course, the biggest risk to meth users is overdose death, which is on the rise throughout America.

*From the article here :
 
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Medication-assisted treatment for meth addiction found effective in new study*

by Brian Mann | NPR | 14 Jan 2021

For the first time, a medication regime has been found effective for some patients with meth addiction in a large, placebo-controlled trial.

It's welcome news for those working with the growing number of people struggling with meth addiction.

"It's progress and it's quite significant," says Dr. Nora Volkow, director of the National Institute on Drug Addiction, which funded the two-year clinical trial involving roughly 400 patients.

The study was published Wednesday in The New England Journal of Medicine.

Unlike opioid addiction, for which medication-assisted treatment is the standard of care, no medication has been approved by the Food and Drug Administration for use with meth.

In the research trial, patients in clinics around the U.S. suffering from methamphetamine use disorder were treated for 12 weeks with a combination of medications — naltrexone and bupropion — or placebo. The treatment helped 13.4% of patients with their addiction, compared with 2.5% of the placebo group.

While a success rate of just over 11% may not sound like a home run, Volkow noted that other medications used to treat brain disorders, including mental illness and addiction, often have similar response rates in patients. This medication therapy provides another tool for doctors to try with patients.

"As we understand the complexity of the human brain, it becomes very much of a magical thinking that one pill will solve the problem of addiction," she says.

The project's lead researcher, Dr. Madhukar Trivedi at the University of Texas Southwestern Medical Center, says the findings were strong enough to give new hope to people struggling with methamphetamine use disorder.

"Patients who are struggling with meth use disorder should definitely have a conversation with their treating physicians to consider whether this option is something they should try," Trivedi said in a statement.

Lara Ray, a psychologist who studies medical treatments for addiction at UCLA and was not involved with this research, says the study changes the treatment landscape for roughly 1.6 million Americans who are addicted to methamphetamines.

"So far we have come up empty," Ray says. "I believe this clinical trial is really a breakthrough in many ways, because there have been so many failed trials."

The treatment regimen in the trial combined two medications that have been studied separately for treating methamphetamine addiction with limited success.

Patients received injections of extended-release naltrexone and oral doses of bupropion. Naltrexone, which is already used for treating opioid addiction, blocks opioid receptors in the brain and is proven to reduce cravings in some patients. Bupropion is often used to treat depression.

Researchers say it's not entirely clear why these drugs worked more effectively in tandem.

Volkow says one theory is that naltrexone reduced physiological cravings for meth, while buproprion's "antidepressant effects" eased the anxiety people experience when they stop using. Unless treated, that emotional distress can trigger a relapse.

Ray says the success rate of the naltrexone-buproprion combination may be improved as doctors refine the method and when supported with other treatments, including behavioral therapy.

This clinical trial was successful enough that the National Institute on Drug Addiction's Volkow says she expects to move forward toward securing FDA approval. Meanwhile, she predicts some clinicians helping people in recovery will begin using the treatment immediately.

"Doctors are going to be reading about it and may prescribe the medications off-label to their patients," Volkow says. The trial did not reveal significant side effects.

This new medical treatment strategy arrives at a time when addiction to methamphetamines has come roaring back, fueled by cheap imports from Mexico.

"It's almost like methamphetamines are falling from the sky right now, with the amount that's coming through the border and on boats and planes," says Matthew Donahue with the U.S. Drug Enforcement Administration.

According to the DEA, seizures of meth on the Southwestern border with Mexico have more than doubled in the last two years, to more than 170,000 pounds. Donahue acknowledged that effort hasn't put a dent in the supply.

"We see it down in Alabama, Mississippi and the Kentucky area where it's really taken off," Donahue says. He added that lack of medical treatments for those addicted to meth has complicated efforts to curb demand for the drug.

The human cost has been catastrophic. Researchers say overdose deaths linked to meth increased fourfold over the last decade.

In a public health alert issued last month, the Centers for Disease Control and Prevention warned meth fatalities spiked again more than 30% during the pandemic.

Even users who don't overdose often experience damage to the heart and other tissues, and can see their lives spiral out of control.

Jessica Martinez began using the drug when she paid her way through college as a sex worker. "I was shooting up every day, sometimes two to three times a day," she says.

Martinez, who has been in recovery for two years, now works with a Washington, D.C.-based group called HIPS helping others with meth addiction. She says when she started her recovery, it was hard in part because there were no medical treatments to help with cravings and withdrawal.

"For heroin users, there's methadone, there's suboxone. I just wonder why we haven't researched treatments for this drug yet," she says.

Martinez says she's hopeful more of her clients will now be able to get medical treatment for their meth addiction, rather than wind up caught in the criminal justice system. "It's about evidence-based care, it's about empathy and it's about survivability," she says.

*From the article here :
 
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ControlDaddy

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If I understand correctly, the most effective treatment modality is repeated low dose of ibogaine for meth addiction. This is not available in the US, although there are repeated low dose ketamine therapies for depression now.

Any suggestions, or experiences, that can be shared on what an American might do to get this treatment would be helpful. I have some money saved and may be able to afford to do the therapy overseas.

thanks!
 
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mr peabody

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Ibogaine is an indole alkaloid isolated from the root bark of the African tree Tabernanthe Iboga, known to cause Long QT Syndrome (LQTS) — a dangerous condition that can lead to cardiac arrhythmia and death. But the risk is manageable. Dr. Bruno Chaves of Brazil has performed over 1200 treatments with ibogaine in hospital without a single adverse event. 62% of those treated by Dr. Chaves remain abstinent long term. Dr. Chaves is currently accepting new patients for treatment in hospital in São Paulo. For more information, contact Dr. Chaves directly : [email protected]
 

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Meth users nearly twice as likely to have two or more chronic medical conditions*

by Robert Preidt | HealthDay News | 4 Jun 2021

Methamphetamine users are nearly twice as likely as non-users to have two or more chronic medical conditions. In addition, they were more than three times as likely to have mental illness, and more than four times as likely to have a substance use disorder involving drugs such as heroin, prescription stimulants, prescription opioids, cocaine and sedatives.

Many meth users have a combination of medical, mental and substance use issues, including all three at the same time, according to the report published June 3 in the Journal of General Internal Medicine.

The study also found that meth users had higher rates of liver disease (hepatitis or cirrhosis), lung disease (chronic obstructive pulmonary disease or asthma), and HIV/AIDS than non-users.

"Our results do not suggest that meth use causes most of these conditions, but they should inform clinicians that this population is at risk," said study co-author Joseph Palamar. He is a researcher at the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU School of Global Public Health, in New York City.

Palamar said more study is needed to learn how dose and frequency of use relates to these conditions — for instance, occasional use on a night out versus chronic use that can lead to a host of adverse effects on the body.

"We also confirmed the well-known link between meth use and HIV, which can result from injection drug use or sexual transmission, but more research is needed to determine the extent to which meth use increases risk for [sexually transmitted diseases] due to the drug's libido-enhancing effects," Palamar added.

Study co-author Dr. Benjamin Han explained that meth use adds complexity to the already challenging care of adults with multiple chronic conditions.

"Integrated interventions that can address the multiple conditions people are living with, along with associated social risks, are needed for this population," added Han, a clinician-researcher at the University of California, San Diego, who is also a researcher at CDUHR.

*From the article here :
 
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mr peabody

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Dr. Jonathan Brett and clinical Dr. Elizabeth Knock at St Vincent’s Hospital are running a clinical trial
to investigate the effects of psilocybin in therapy for meth addiction.

Psilocybin for meth users: Sydney trial aims to conquer addiction*

by Kate Aubusson | Sydney Morning Herald | 22 Mar 2021

A world-first clinical trial in Sydney aims to find out if giving psychedelics to people who use methamphetamines can help conquer their addiction.

Researchers at St Vincent’s Hospital in Darlinghurst will use psilocybin – the active ingredient in magic mushrooms – to turbocharge therapy for patients dependent on “meth” or “ice.”

Head researcher Dr Jonathan Brett, staff specialist in clinical pharmacology, toxicology and addiction medicine at St Vincent’s is acutely aware of the pressures to conduct such a trial within the most rigorous ethical and scientific boundaries.

“You can’t just give it a crack and see how it goes,” Dr Brett said.

“We wouldn’t at all be encouraging people to try this at home … it needs an established treatment protocol behind it.”

All participants will have at least three counselling sessions with specialised therapists before they get anywhere near psilocybin.

They’ll build a therapeutic relationship, understand their addictive patterns and have a clear understanding of what they hope to get out of treatment.

Participants then take their 25mg capsule of pharmaceutical grade psychedelic under supervision, followed by three or more therapy sessions.

“It’s good bang for your buck,” co-researcher, clinical psychologist Dr Elizabeth Knock said, referring to the treatment’s two-to-three-month time frame.

“That is a short period of psychosocial treatment, which is what excites me about this research – the potential to speed up, enhance or maximise on the conversations that we have as counsellors with these patients.”

The dosage used seems to be the optimal amount to avoid unwanted side effects – such as hallucinations – but still trigger a psychedelic effect, she said.

“It is really about people feeling freer to tell stories in their heads without being tied down to their value,” Dr Knock said.

“It’s this internal psychological and spiritual experience that people describe as transformative … they describe being transported back to childhood or back to where they can have conversations with people and resolve situations.”

One way to think about it, Dr Brett said, is to imagine the mind as a landscape of rolling hills, valleys and troughs.

“The troughs represent deeply held values and you can really get stuck in those troughs which is where the addiction sustains itself. Psilocybin allows the valleys to be flattened and people to shift their values more freely,” he said.

The trial will recruit 15 participants in August from among patients over 25-years-old who are already seeking treatment for meth addiction at St Vincent’s.

“These will be people who may have tried to achieve their goals but have not had success,” Dr Brett said.

The eligibility screening process will be strict. Patients can’t be taking any medication that may interact with the psychedelic, and will need to see a nurse, an addiction specialist and their psychiatrist before they are accepted.

Anyone with a history of schizophrenia or bipolar disorder or a family history of either will be excluded.

“We won’t start with heavy users,” Dr Brett said. “They’ll be people who use over a long weekend or Fridays to Mondays. That is the safest place to start this research. If it’s safe and feasible in that population then we can expand it.”

The trial – funded by the National Centre for Clinical Research on Emerging Drugs – will use functional magnetic resonance imaging (fMRI) to measure brain activity before and after the psilocybin-augmented therapy.

The trial will focus on the default mode network – regions of the brain that activate when we’re awake but not focused on any particular task of mental exercise.

The network is responsible for introspection and mental time travel to experiences, and central to defining who we are, Dr Brett said, and previous research suggest psilocybin stabilises this network.

“We are looking for evidence of causation: that this treatment is effective for this reason,” he said.

The history of psychedelic research has been dogged by controversy since entering the mainstream in the 1930s.

“There were some very well-intentioned researchers, but they weren’t necessarily up to today’s standards,” Dr Brett said.

Then the political war on drugs in the 1970s stoked fear of the drugs among the public, and overzealous psychedelic researchers performed experiments that compromised the integrity of the field, he said.

The researchers stressed they are not suggesting psilocybin is a standalone treatment.

“We must tread very carefully and follow the ethical and scientific processes,” Dr Brett said.

Last Wednesday, the federal government launched $15 million in grants for clinical trials to investigate whether psychedelic drugs could be potential breakthrough therapies for mental illnesses.

The announcement followed an interim decision by the Therapeutic Goods Administration in February that rejected a push to allow psychiatrists to prescribe MDMA and psilocybin led by not-for-profit organisation Mind Medicine Australia.

President of the Royal Australian and New Zealand College of Psychiatrists Associate Professor John Allan welcomed the funding and the TGA’s decision.

“Research into medicines containing psychedelic substances should only occur under research trial conditions that include oversight by an institutional research ethics committee and careful monitoring and reporting of effectiveness and safety outcomes,” Associate Professor Allan said.

“Trials like these will hopefully improve our knowledge, providing the evidence-based research to comprehensively assess the efficacy, safety and effectiveness of psychedelic therapies to inform future potential use in psychiatric practice.”

*From the article here :
 
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Perforated

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^^ I live 2 miles from this hospital and would have signed up for this trial in a heartbeat but I don’t qualify under a couple of their criteria. I guess I’ll have to persist with my DIY psychedelic treatment program. Unfortunately it lacks the talk therapy component. Unless you count sharing on BL as therapy.
 

mr peabody

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Clinical trial to evaluate psilocybin for the treatment of meth use disorder*

Psilocybin Alpha | 2 Sep 2020

Revive Therapeutics nas announced that the Company has entered into a Clinical Trial Agreement (CTA), with the Board of Regents of the University of Wisconsin System (UWS) to conduct a clinical study entitled, “Phase I Study of the Safety and Feasibility of Psilocybin in Adults with Methamphetamine Use Disorder.” Under the terms of the CTA, the Company has an exclusive option to obtain an exclusive, worldwide, royalty-bearing commercialization license to all rights, title and interest that UWS may have or obtain in any invention that results from the clinical study.

“We are delighted to be collaborating with clinical researchers at the University of Wisconsin to advance development of psilocybin as a possible treatment for methamphetamine use disorder,” said Michael Frank, Revive’s Chief Executive Officer. “We are building a pipeline of clinical-stage psychedelic-derived therapies for addiction disorders with a focus on psilocybin with unique dosage forms.”

Christopher R. Nicholas, Ph.D., Assistant Professor at the University of Wisconsin School of Medicine and Public Health, and clinical psychologist at the school’s Program for Research Outreach Therapeutics and Education in the Addictions (“PROTEA”) in the Department of Family Medicine and Community Health, will serve as principal investigator for this initial safety study. The study will be conducted at the University of Wisconsin Schools of Medicine and Public Health and Pharmacy, which hold a Wisconsin special authorization and Drug Enforcement Administration license to perform clinical research with psilocybin. Members of the PROTEA team previously conducted research on the pharmacokinetics of high-dose psilocybin and are also currently investigating psilocybin as a treatment for opioid use disorder.

About methamphetamine use disorder


Methamphetamine use disorder occurs when someone experiences clinically significant impairment caused by the recurrent use of methamphetamine, including health problems, physical withdrawal, persistent or increasing use, and failure to meet major responsibilities at work, school or home. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey on Drug Use and Health, there are approximately 1.1 million people aged 12 or older who have a methamphetamine use disorder in the U.S. Based on the most recent year for which data is available, the economic cost in the U.S. is approximately $23 billion, according to data from the Rand Corporation. There is no pharmaceutical treatment approved for methamphetamine dependence and the current treatment strategy is behavioral therapies, such as cognitive-behavioral and contingency management interventions.

*From the article here :
 

mr peabody

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Methamphetamine and cardiovascular pathology

Sharlene Kaye, Johan Duflou, Rebecca Mcketin, Shane Darke

There is sufficient clinical evidence to suggest that methamphetamine can have adverse and potentially fatal effects on the cardiovascular system. The existing literature suggests that: (1) meth users are at elevated risk of cardiac pathology; (2) risk is not likely to be limited to the duration of use, because of the chronic pathology associated with methamphetamine use; (3) the risk of cardiac pathology is greatest among chronic methamphetamine users; (4) pre‐existing cardiac pathology, due to methamphetamine use or other factors, increases the risk of an acute cardiac event; and (5) meth use is likely to exacerbate the risk of cardiac pathology from other causes, and may therefore lead to premature mortality.

https://www.researchgate.net/publica...f_the_evidence

-----

Iboga accumulates in the body. It remains in the body for more than 4 weeks. This means that all the drops you take in a 5-week period will accumulate and remain in your body until they slowly wear off. If the dose you take exceeds 10 drops a day, physical and psychological effects can occur. Be aware of that some people respond very sensitively to a few drops only. It is important to listen to the signs of your body at all times, and adjust your dosage accordingly. Do not take the iboga tincture before going to sleep. The plant gives you energy and might cause insomnia.

Whilst treating yourself with iboga, it is advisable to keep stimulants such as coffee to a minimum, as well as tobacco or certain herbs. Your receptors will become very sensitive and you may have an unexpectedly strong reaction to them. It is strongly discouraged to combine iboga with other psychedelics. Iboga should never be combined with anti-depressant medication such as SSRI's. Such a combination would be very dangerous.

Doctors and treatment providers have found that daily low doses of iboga seem to work better for meth addiction than the mind-blowing "flood doses" used on opiate addicts.

https://www.dmt-nexus.me/forum/defau...=posts&t=52279
 
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mr peabody

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At last, some help for meth addiction

Studies show that a behavioral treatment works well and that two medications may also be useful.

by Claudia Wallis | Scientific American | 1 Apr 2021

A decade ago I traveled on assignment to a Rocky Mountain rehab facility where the rich and famous go to dry out and confront their drug habits. It offered every imaginable therapy to its well-heeled clientele and claimed strong results. But I will never forget what the director of operations told me about the clinic's biggest failure: “Our results with meth addicts are dismal,” he admitted.

Poor results remain all too typical for what is more formally known as methamphetamine use disorder. About one million people in the U.S. are addicted to meth, a powerful stimulant that—smoked, snorted, injected or swallowed—ruins lives and contributed to more than 12,000 overdose deaths in 2018. Fatal overdoses appear to have spiked by nearly 35 percent during the COVID pandemic. Unlike people battling alcoholism or opioid misuse, meth users have no approved medications to help them shake their habit. And most behavioral therapies fail.

But this tragic picture at last may be changing. A recent study found that a regimen of two medications helped some users stay off the drug. In addition, a psychosocial intervention called contingency management (CM) has been shown to be especially effective and, while not widely available, is now the first-line therapy for people seeking treatment for meth or cocaine addiction within the U.S. Department of Veterans Affairs health system.

All addictions are tough to beat, but methamphetamine poses a particular challenge. A key way that researchers measure the addictive grip of a substance is to look at how much dopamine (a neurotransmitter associated with pleasure) floods into the brain's major reward center during use, based on animal studies. “Methamphetamine is the drug that produces the largest release,” says Nora Volkow, director of the National Institute on Drug Abuse. “An animal will go crazy pressing a lever in order to get the drug,” she adds. Another metric involves real-world human experience: When you try a new substance, what is the likelihood of becoming addicted? "In this respect, methamphetamine ranks along with heroin among the top addictive drugs,” Volkow says.

The medication study used two substances that target withdrawal. Bupropion, an antidepressant also prescribed for smoking cessation, raises dopamine levels in the brain and thus may buffer the misery of steep drops that occur when people stop using meth. "Naltrexone, the second medication, is an opioid blocker that has an effect on the reward circuit, potentially relieving cravings,” explains the study's lead author, Madhuka Trivedi, a psychiatrist at the University of Texas Southwestern Medical Center. In a trial with 403 heavy users of meth, a regimen of the two medications helped 14 percent stay off the drug, testing meth-free at least three quarters of the time over a six-week period. Only 3 percent of those given placebos achieved that level of abstinence.

Contingency management works on behavior by reinforcing abstinence with prizes. At VA clinics, addicted veterans submit a urine sample twice a week. If the sample is meth-free, they get to pull a slip of paper from a fishbowl. Half the slips show various dollar amounts that can be spent at VA shops, and the rest feature words of encouragement. Two clean samples in a row earn two draws from the fishbowl, three in a row earn three draws, and so on, up to a maximum of eight. But drug-positive urine means no prize. "The key is the immediacy of the reinforcement,” says Dominick DePhilippis, a clinical psychologist at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. "That is important," he notes, "because the rush of meth is also immediately reinforcing, whether it is the euphoric feeling that substance use brings or the escape from fatigue or unpleasant mood states of withdrawal."

A 2018 study with 2,060 VA patients, led by DePhilippis, found that over a 12-week period, participants, on average, showed up for 56 percent of their 24 sessions and that 91 percent of their urine samples were free of the targeted drug. According to a 2018 analysis of 50 trials involving nearly 7,000 patients with meth or cocaine habits, one person benefits from CM for every five treated.

DePhilippis's team is gathering data on CM's long-term efficacy for drug users. If results are good, perhaps more health insurers will overcome concerns about using financial rewards in treatment and cover the therapy. Volkow hopes that meth users will ultimately have a variety of treatments, including some that combine medication with behavioral therapy. "That is how diseases from depression to diabetes are treated. But we stigmatize addiction,” Volkow says, “and insurance is willing to pay much less than for another condition. There's a double standard.”

doi:10.1038/scientificamerican0421-21

 
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