Methamphetamine

According to the National Survey on Drug Use and Health, approximately 2.6 million people in the United States (1% of the population) used methamphetamine in 2023. Methamphetamine use is more common among males, homeless, and those with other substance use (cannabis, fentanyl, cocaine, and alcohol).  

Illicitly manufactured methamphetamine is available in crystal or powder forms. It is usually smoked, but may also be injected, snorted or ingested orally or rectally.  On the street, methamphetamine is also referred to as crank, crystal, speed ice, and glass. Methamphetamines can be synthesized from battery acid, kerosene, antifreeze, Coleman fuel, iodine, anhydrous ammonia, Red Devi Lye, hydrochloric acid, red phosphorus, and drain cleaner.

Methamphetamine is a powerfully addictive central nervous system stimulant that causes euphoria by blocking uptake and increasing release of norepinephrine, serotonin, and dopamine.

Chronic use of methamphetamine can lead to tolerance. In an effort to intensify the desired effects, users take higher doses more frequently. They may forgo eating and sleeping while indulging in a form of binging known as a “run. ” This involves injecting as much as a gram every two to three hours over a several day period. The binge may continue until the user runs out of drug or becomes too disoriented to continue. 

Acute methamphetamine toxicity can cause chest pain, palpitations, hypertension, hyperthermia, impulsivity, psychosis, and delirium. Severe complications include cardiac arrhythmias, myocardial infarction, stroke, kidney injury, and suicide. 

Chronic use damages the areas of the brain that process mood and emotion. The result is paranoia, rage, panic, delusions and hallucinations. Early signs of damage include severe depression, insomnia, moodiness and irritability, violent and aggressive behavior, inability to concentrate, memory loss and anorexia. 

Chronic methamphetamine use also increases the risk of cardiovascular disease, schizophrenia, Parkinson disease, sexually transmitted infections, poor nutrition, and poor dental health. Injection of methamphetamine increases the risk of hepatitis B and C infections, HIV, endocarditis, and osteomyelitis. 

Methamphetamine withdrawal typically begins within hours of the last use, peaks at 72 hours, and lasts for days to weeks. Withdrawal symptoms may include dysphoria, fatigue, insomnia, vivid dreams, increased appetite, and psychomotor retardation or activation. 

Methamphetamine can be detected with a urine drug screen and confirmed by liquid chromatography tandem mass spectrometry. Most urine drug screens are designed to detect both amphetamine and methamphetamine. They can be detected in urine within 3 hours of any type of administration and remain detectable up to 3 days after single use and even longer after chronic use. Methamphetamine is metabolized to amphetamine, so confirmation of a positive urine drug screen by liquid chromatography tandem mass spectrometry may detect methamphetamine, amphetamine or both. 

References

Leyde S, Tilhou AS, Tsui J, Methamphetamine Use Disorder, JAMA, 2025;334(13):1192-1193.

Coffin PO, Suen LW, Methamphetamne toxicities and clinical management, NEJM Evid. 2023;2(12):EVIDra2300160.