Speed

By Peter Galvin, MD

Methamphetamine, sometimes called meth, ice, speed, or crystal, is a highly addictive stimulant. Illegally manufactured methamphetamine is usually smoked but may be taken by injection, snorting, oral ingestion, or rectal administration. In 2019, there were 15,489 methamphetamine overdose deaths in the U.S., and slightly more than half of these deaths also involved opioids like fentanyl. Approximately 2.6 million people, or 1% of the U.S. population, used methamphetamine in 2023. Its use is more common among people who are male, in a sexual or gender minority group, are homeless, or who use other substances (cannabis, opioids, cocaine, benzodiazepines, alcohol, and tobacco). Among those who have used methamphetamine, about half have stimulant use disorder (methamphetamine addiction).

Acute methamphetamine toxicity (“overamping”) can cause chest pain, high blood pressure, palpitations, increased body temperature, impulsivity, delirium, and psychosis. Severe toxicity can cause stroke, kidney injury, heart attack, heart rhythm abnormalities, tearing of the lining of the aorta (aortic dissection), traumatic injury, and suicide. Long term use of methamphetamine increases the risk of heart disease, neurologic and psychiatric conditions (including cognitive impairment, schizophrenia, and Parkinson disease), sexually transmitted diseases (STIs; such as HIV, syphilis, chlamydia, and gonorrhea), poor nutrition, and dental disease. Injecting methamphetamine increases the risk of acquiring HIV, hepatitis B, and hepatitis C and may cause infection of heart valves (endocarditis) and bones (osteomyelitis).

Stimulant use disorder can be treated with contingency management, which provides prizes such as gift cards or vouchers for cessation of methamphetamine use or engagement in treatment, which is an effective behavioral treatment. Additionally, cognitive behavior treatment (CBT) and multicomponent therapy that includes individual therapy, community engagement, and social support may be helpful. There are no FDA-approved medications for methamphetamine use disorder. However, nonstimulant medications may be helpful and include bupropion, naltrexone, topiramate, and mirtazapine. For those who use methamphetamine frequently, stimulants may help decrease methamphetamine use, however, due to potential side effects, stimulants should only be prescribed in these cases by specialists in addiction medicine or psychiatry.

Clinicians who care for people who use methamphetamine need to monitor their blood pressure closely, screen for infectious diseases such as HIV, hepatitis, syphilis, gonorrhea, and chlamydia, ensure that vaccines are up to date, and consider medications to prevent HIV (pre-exposure prophylaxis) and bacterial STIs (doxycycline postexposure prophylaxis). Psychiatric evaluation and treatment should be offered, and co-occurring substance use disorders should be addressed. Where appropriate, dental care and homelessness services may be helpful to support overall health and well-being. Finally, because methamphetamine overdose deaths often involve opioids such as fentanyl, people who use methamphetamine should be provided with naloxone, which can reverse an opioid overdose.

For more information go to the website of the Centers for Disease Control and Prevention at www.cdc.gov

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