Harm Reduction: Meth harm reduction: The complete guide for tweakers and meth-heads (III): The final round - The definitive smoke tutorials

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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.

Quitting or cutting down with meth

Withdrawal symptoms

When it comes to reducing or ceasing methamphetamine (meth) use, it's natural to feel apprehensive and uncertain about what to expect. Understanding the potential withdrawal symptoms can be helpful in preparing yourself for the journey. These symptoms can vary in duration, with some being short-lived while others may persist for a longer period. It's important to remember that these symptoms are transient and tend to subside within approximately 1-3 months after discontinuation.

When meth is used regularly and over a prolonged period, your body gets used to having meth in your system. It adapts to this regular presence of meth, and its functioning becomes reliant on it to maintain a sense of normalcy. However, when you decide to stop using meth, your body needs to readjust once again, this time to function without the presence of meth in your system. This period of readjustment is known as withdrawal, during which your body "learns" to operate normally without relying on meth.

Withdrawal symptoms can include:
• Feeling extremely fatigued and lacking energy.
• Sadness, hopelessness, and a loss of interest in activities.
• Sudden and intense shifts in emotions.
• Feeling on edge, easily annoyed, or restless.
• A general sense of low motivation and decreased enthusiasm.
• Difficulties falling asleep or staying asleep.
• General aches and pains, discomfort or muscle aches.
• Headaches.
• Paranoia or strange thoughts: Having unfounded suspicions or unusual thinking patterns.
• Cravings to use again: Experiencing strong desires or urges to use meth again.
• Dysphoria: Feeling acutely unhappy or dissatisfied with life circumstances.

When considering quitting meth use, it's crucial to develop a well-thought-out plan in advance. Organizing a support system is essential to ensure you have the right people around you during the withdrawal process. This support network may include friends, family, your general practitioner (GP), healthcare professionals, or support groups. Additionally, creating a safe environment where you feel secure and are not surrounded by others using meth is important for your recovery journey. This may involve making changes to your living situation or seeking alternative housing options.

Tips for cutting down

Take a Break: Allocate time to understand your reasons for using meth and identify challenging situations when cravings are strongest. Use this break to gain insight into your usage patterns and motivations.

Safer Level of Use: After the break, try using meth at a safer level. For example, limit usage to twice a week, restrict it to weekends only, or consider alternative methods like snorting instead of injecting. y. Follow this plan for a minimum of six weeks, if possible, or longer for better results. Evaluate whether controlled meth use aligns with your goals and desires.

Gradual Reduction: Set realistic short-term goals for cutting back on meth. Start by reducing usage by one day per week and gradually decrease the amount consumed, such as by a quarter of a gram at a time. After two weeks, review and reassess your progress. View the process of cutting down as a step-wise progression, similar to climbing a ladder. Once you successfully reduce usage and maintain it for a while, you may consider further stepping down to the next level.

Dealing with "craving"

Cravings for drugs, known as "urges," are a normal part of addiction and can occur during withdrawal. It's important to understand that cravings are not a result of lack of willpower or motivation, and they do not indicate that the withdrawal process is ineffective.

Cravings are not constant and vary in intensity. They typically last for short periods, usually less than an hour, before subsiding to a more manageable level. Physical or psychological discomfort can trigger cravings, especially during the uncomfortable withdrawal phase. However, as you progress through withdrawal, the frequency and intensity of cravings generally decrease. Certain situations or emotional triggers, such as upsetting events or opportunities to use drugs, can amplify cravings. To navigate withdrawal successfully, it's advisable to avoid these high-risk situations for a while.

Even after completing withdrawal, it's normal to experience occasional cravings. However, they tend to become easier to cope with as you start feeling better overall. The longer you remain drug-free, the less severe cravings typically become. Think of cravings like a stray cat—feeding it will make it return, but denying it sustenance will eventually make it go away.

Awareness and preparedness are key when it comes to managing cravings. Different strategies work for different individuals. Remember, cravings are most intense for a brief period, so the goal is to get through that challenging phase.

Many people find the "three Ds" helpful:

  • Delay the decision: When faced with a severe craving, postpone the decision to use for one hour. Avoid engaging in a battle between the desire to use and the desire to remain drug-free. Instead, make a deal with yourself to delay the decision for an hour. Breaking withdrawal into manageable timeframes makes it easier to handle.
  • Distract yourself: Engage in an activity during that hour to divert your attention. Listen to your favorite music, watch TV or a video, tidy up, have a conversation (not about drugs), or take a walk with a supportive, drug-free companion. Avoid complex tasks that may lead to frustration.
  • Decide after the hour: Once the hour has passed, reassess the craving. It should have settled down, though it may not have disappeared entirely. Before making a final decision, reflect on the reasons you want to quit, the goals of withdrawal, and what you will regain by staying drug-free. Review the list of pros and cons you made at the beginning of detox.

Prescription drugs

Currently, there are no specific medications approved by regulatory authorities for the treatment of meth addiction. However, several medications have shown promise in reducing cravings, managing withdrawal symptoms, and supporting recovery in individuals struggling with meth addiction. It's important to note that medication-assisted treatment for meth addiction should always be combined with comprehensive behavioral therapies and psychosocial support for the best outcomes.

These are some of the prescription drugs used for meth withdrawal/addiction/recovery

Medication Trials Overview
Medication Number of Trials Dose Range Duration Outcomes
Mirtazapine 4 15-60mg Up to 14 days No evidence of change in withdrawal symptom severity or craving, compared to placebo. Some evidence for reduction in anxiety, hyperarousal.
Modafinil 4 200mg Up to 10 days Some evidence of a milder withdrawal syndrome and reduced craving.
Dexamphetamine 2 20mg up to max 110mg Up to 90 days (trials of withdrawal and dependence) Some evidence of significant reductions in withdrawal symptoms and craving, compared to placebo. Well tolerated in both trials under supervised daily dosing protocols.

Credits

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