Harm Reduction: Meth harm reduction: The complete guide for tweakers and meth-heads (III): The final round - The definitive smoke tutorials
Interaction with drugs
Interaction with prescription drugs
Monoamine oxidase inhibitors (MAOIs): Use of methamphetamine with MAOIs can result in a potentially life-threatening condition called serotonin syndrome. Symptoms may include agitation, rapid heartbeat, high blood pressure, tremors, and hyperthermia. This combination should be strictly avoided.
Tricyclic antidepressants (TCAs): Methamphetamine's stimulant effects may be potentiated when used concomitantly with TCAs, leading to an increased risk of cardiovascular effects such as hypertension, tachycardia, and arrhythmias. Close monitoring of blood pressure and heart rate is recommended.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): Combining methamphetamine with SSRIs or SNRIs may further enhance the serotonergic effects, increasing the risk of serotonin syndrome. Caution should be exercised, and close monitoring for symptoms of serotonin syndrome is advised. This risk seems much lower than MAOIs or TCAs and most of these drugs can be used in combination with safety in most cases.
Benzodiazepines: Benzodiazepines are central nervous system depressants, while methamphetamine is a stimulant. Combining the two can mask the effects of each drug, potentially leading to increased risk of overdose or misuse. Caution should be exercised when using both drugs concurrently, and close monitoring for adverse effects is advised.
Pump Protons Inhibitors: A class of medications used to treat a wide variety of pathologies related to the stomach's acid production (Omeprazol, Lansoprazol, Rabeprazol...)lowers the level of toxicity for methamphetamine.
Recreational/scheduled drugs
Alcohol
Impaired metabolism and increased stimulation: Alcohol consumption may inhibit the metabolism of methamphetamine, leading to increased absorption and distribution of methamphetamine in the body. This can result in an amplified stimulating effect of methamphetamine on the brain and heart
Increased cardiac strain: Both methamphetamine and alcohol can independently affect the cardiovascular system. Combining these substances can lead to increased cardiac work, elevated heart rate, decreased systolic blood pressure, and increased myocardial oxygen consumption. This combination can put additional strain on the heart, increasing the risk of adverse cardiovascular events.
Diminished subjective effects of alcohol: The concurrent use of methamphetamine and alcohol can diminish the subjective effects of alcohol. This can lead individuals to underestimate the level of alcohol intoxication, potentially resulting in higher alcohol consumption levels and an increased risk of alcohol toxicity. This combination may also increase the likelihood of engaging in risky behaviors associated with alcohol use.
Impaired judgment and decision-making: Methamphetamine is a stimulant that can increase alertness and decrease fatigue. When combined with alcohol, which is a depressant, the stimulant effects of methamphetamine may mask the sedative effects of alcohol.
Increased risk of overdose and toxicity: Combining methamphetamine and alcohol can lead to increased tolerance to the effects of both substances. This can result in individuals consuming higher amounts of methamphetamine and alcohol to achieve the desired effects, increasing the risk of overdose and toxicity for each substance.
Impaired cognitive and motor function: The combination of methamphetamine and alcohol can impair cognitive function, attention, and motor coordination.
Opioids
Increased stimulation and behavioral effects: When methamphetamine is taken with an opioid, it can lead to heightened stimulation of behavior compared to either drug used alone. This combination may result in increased agitation, restlessness, and impulsivity, potentially leading to risky or dangerous behaviors.
Enhanced analgesic effects: Methamphetamine may enhance the analgesic (pain-relieving) effects of certain opioids. This can lead individuals to take higher doses of opioids, potentially increasing the risk of opioid overdose.
Altered metabolism with methadone: Methadone is commonly used as a maintenance treatment for opioid dependence. When methamphetamine is combined with methadone, it may affect the metabolism of methamphetamine, leading to altered drug concentrations and potential changes in efficacy or side effects.
Increased risk of fatal overdose: Combining methamphetamine with opioids, especially when used concurrently with injected heroin, significantly increases the risk of a fatal overdose. Methamphetamine can mask the sedative effects of opioids, leading individuals to underestimate the respiratory depressant effects of the opioids and increasing the likelihood of overdose.
Cocaine
Cocaine may have an additive stimulant effect , with increased risk of adverse/serious adverse effects. Metabolism of methamphetamine may be decreased also
Psychedelic drugs
Increased hallucinatory experiences have been communicated , particularly when taken with ketamine
GHB
There are some data suggesting that the combination GHB + meth may be cardiotoxic. It also may increase the risk of seizures from GHB
Cannabis
There is an increased risk of paranoid symptoms, particularly in people sensitive to this effect
MDMA and amphetamine
Severity of adverse effects can be increased when meth is combined with other amphetamine-type stimulants , increasing risk of acute amphetamine toxicity . There is an increased risk of serotonin syndrome from combined use with MDMA, although this seems less likely
Meth mouth
The following guidelines can help reduce the harm associated with methamphetamine use and promote oral health:
Maintain good oral hygiene
• Brush teeth thoroughly at least twice a day using a soft-bristled toothbrush and fluoride toothpaste.
• Floss daily to remove plaque and food particles from between the teeth and along the gumline.
• Rinse with an antimicrobial mouthwash to reduce bacteria and plaque buildup.
Stay hydrated
• Drink plenty of water to combat dry mouth, which is a common side effect of methamphetamine use.
• Dry mouth can contribute to dental decay and other oral health issues.
Avoid sugary and acidic foods and drinks
• Limit consumption of sugary foods and beverages as they can increase the risk of tooth decay.
• Acidic foods and drinks can erode tooth enamel. Instead, opt for a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
Limit smoking and alcohol consumption
• Smoking and excessive alcohol consumption can exacerbate oral health problems.
• If possible, reduce or eliminate these habits to minimize the risk of dental complications.
Use protective measures during meth use
• Avoid holding or clenching the methamphetamine against the teeth or gums, as it can cause damage.
• Instead, use alternate methods of administration recommended by healthcare professionals to minimize harm.
Practice oral health care after meth use
After using methamphetamine, rinse the mouth with water to help remove drug residue and reduce the impact on oral health. Do not brush immediately after meth use, as the drug can soften the tooth enamel, making it more susceptible to damage.
Regular dental check-ups
If available and affordable, schedule regular dental check-ups and cleanings to monitor and address any oral health issues promptly.If dental problems, such as tooth decay or gum disease, are present, work closely with a dentist to develop a treatment plan. This may involve fillings, root canals, or other necessary interventions. The earlier this is done, the lesser problems will develop.
Amphetamine psychosis: How to recognize and what to do.
As described in the first part of this guide, acute intoxication (or high doses maintained for a long time) can express itself in the form of an acute paranoid psychosis. Some common symptoms in such situations are:
Belief in being followed or watched: The person may become convinced that they are being constantly monitored, followed, or spied on by unknown individuals or government agencies.
Delusions of persecution: A strong belief that others are plotting against them, conspiring to harm them, or trying to control their thoughts and actions. Ideas of reference: They may interpret neutral or unrelated events or objects as having personal significance or meaning directed towards them. For example, believing that random conversations or television broadcasts are sending secret messages specifically meant for them. Paranoia about being poisoned: They may become convinced that their food, drinks, or surroundings are contaminated or laced with toxic substances . Feeling that people are talking about them: The person may believe that others are gossiping, spreading rumors, or talking negatively about them behind their back. Grandiose delusions: Exaggerated beliefs about their own importance, abilities, or special powers, such as thinking they possess unique knowledge or possess extraordinary talents. Belief in mind reading or thought insertion: They may believe that others can read their thoughts or that external forces are inserting thoughts into their mind without their control or consent.
Delusions of identity confusion: They may question their own identity, believing they have been replaced by a clone or that they are not who they think they are.
Some hints on how to handle such situations initially:
Prioritize safety: Remove any potential triggers or objects that could be harmful if possible. Priorize your own safety and the other´s persons.
Try to find a calm and comfortable environment where you can have a private conversation with the person. Avoid crowded or noisy areas that may increase their distress.
Stay calm and non-threatening: Approach calmly and maintain a non-confrontational posture. Speak softly and avoid sudden movements that might increase their anxiety or paranoia.
Build trust and rapport: Establish trust by introducing yourself and using his preferred name. Show respect, empathy, and non-judgment. Encourage them to share their experiences and emotions.
Validate their experiences: Acknowledge and validate your loved one's feelings and experiences without agreeing with their delusions. Let him know that you understand he´s going through a challenging time and that you're there to support them.
Avoid arguing or challenging beliefs: Refrain from arguing or trying to convince that his delusions are false. Challenging their beliefs may cause more distress. Focus on their emotions and well-being instead.
Psychotic symptoms involve loss of contact with reality and a heightened risk of harm to oneself or others. In most cases, intervention by specialised health professionals is necessary. It is unlikely that the person affected will make this decision on their own and in many cases it will be others who will have to make this decision. Although notifying an Emergency Department is not a pleasant decision, when in doubt it is better to be cautious and put the safety of the person concerned above all other considerations.
