Destructive Drugs Crystal Meth Dennis Wardman MD FRCPC

Destructive Drugs – Crystal Meth Dennis Wardman MD FRCPC MCM ABAM Deputy Medical Health Officer FNIHB –SK Region

Objectives What is Crystal Meth? Prevalence of use Short and long term effects How to have conversation Detox Treatment

What is it? Use of Methamphetamine (MA) dates back to 1887 when first synthesized from ephedrine and used as a medicine in China MA is known for its stimulant properties, and often confused with other drugs that have similar effects, such as ephedrine, amphetamines, caffeine, other chemicals, and both legal and illicit drugs.

What is it? Produced in clandestine laboratories using commonly available chemicals and over-the counter medications such as ephedrine, pseudoephedrine, phenylpropanolamine, iodine, red phosphorous, hydrochloric acid, ether, hydriodic acid, and anhydrous ammonia. Much is homemade, so color and appearance vary depending on skill and materials used. Dangerous to use and highly combustible, so dangerous to manufacture

Highly Toxic Substances Drain cleaner Battery acid Antifreeze Over-the-counter asthma medicine containing ephedrine or pseudoephedrine Match-box striker (Red phosphorous) Hydrochloric acid Lye Lantern fuel (KCI)

What is it? MA is also called crystal meth, jib, speed, crank, crystal, teck, zip, glass, ice and shards. Can be swallowed, smoked, injected or snorted. Appearance varies depending on how it is used. Typically, it is a white, odourless, bitter tasting powder that easily dissolves in water.

Forms In tablet or powder form or in a waxy form known as “base”, “paste”, “wax” or “point”. “Crystal” or “ice” (d- MA hydrochloride) is a more potent form of MA that consists of a recrystallized powder (dissolve and crystalize from solution, in order to purify).

Prevalence 4. 6 % of the Canadian population have tried MA at least once. Although only 0. 5% said to have used it in the past year For 2013 past year: one of five illicit drugs use was 2%; Ecstasy 0. 4% ; 1. 2% used hallucinogens, cocaine or crack 1. 2% or speed/MA 0. 2%;

Factors for Use increased by 61% between 2010 and 2014, new users increased by 71%. Purity is at an all-time high of 70%. Use is facilitated by its use in many ways (mouth, snorted, injected, or smoked), which allows preference and comfort level.

Substance Use in Canada Use of cannabis among adults 7. 9%. Use of alcohol among adults 35. 7% light infrequent drinkers, 32. 2% light frequent drinkers, and 4. 3% heavy frequent drinkers.

Legal Implications

Opioids and CM Use

Overdose Deaths

Mechanism of Action MA acts on the central nervous system by releasing large amounts of the neurotransmitter dopamine. Dopamine is the body’s mechanism to encourage behaviours that are important for survival. MA use, once initiated, can rapidly lead to dependence because of this mechanism. (i. e. , mother’s love)

Short Term Effects If MA is smoked or injected, it can create an intense feeling of euphoria or rush/flash, and lasts a few minutes. Depending on the amount and route of administration, the effects of MA can last up to 12 hours or more (the high). Experience a specific set of stimulant side effects - decreased appetite; increased energy, metabolism (weight-loss), and libido.

Short Term Effects Nervousness, dry mouth, sweating, tremors, hot flashes, seizures Mental confusion, irritability, paranoia, aggression, risky sexual behaviour, insomnia and depression �Heart palpitations, chest pain, hypertension, cardiovascular collapse (no blood to the body) and stroke Once the effects subside, users usually experience extreme fatigue

CM Dance https: //youtu. be/rx. Qc. Otj. Qmuw

Methamphetamine use and pregnancy Possible effects found in the few human studies that exist include increased rates of premature delivery, placental abruption (early separation of a normal placenta from the wall of the uterus), retarded fetal growth, and cardiac and brain abnormalities.

Tolerance Develop tolerance quickly, require greater amounts to achieve the desired high, placing at risk for overdose and further dependence. Over time - after a period of persistent stimulant intoxication - dopamine receptor activity is severely impaired, which can cause perceptions of decreased happiness and pleasure

Long-term effects: What will happen in the future Methamphetamine destroys the endings of dopamine containing nerve cells

Shane’s Story At the height of his crystal meth addiction, Shane was once awake for 10 days. "It gets to the point where you kind of nod off for 20 minutes, half an hour, " he said, "and then it seems that you slept for two days, and then you do a little more meth and you're good to go for three, four days. “ "It starts out that it gives you a lot of energy, you go to work and what not, and your life seems pretty good, " he said. "But then you start not sleeping and eating, or drinking water. And you start needing to use more meth to function because your body's slowly depleting but the meth keeps you going. "

Long Term Effects MA users can rapidly develop a strong psychological dependence. Chronic use is often characterized by a “binge and crash” pattern associated with higher doses and higher frequency of use. Attention, judgement and problem solving, memory, movement issues, emotional control, psychological and psychiatric issues,

Long Term Use Effects Psychological effects can include memory loss, hallucinations, paranoia, mood disturbances, repetitive behaviours and formication (sensation of insects crawling on skin - sores from picking). Breathing problems associated with smoke inhalation. Blood vessel problems –MI and Strokes

Long Term Effects of Use Severe crystal meth abuse can also cause outward signs of aging in users. Since the drug destroys tissues and blood vessels and hampers the body's ability to heal, users often develop acne, and the skin takes on a dull look and loses its elasticity. The teeth can begin to decay and crack, resulting in a condition known as "meth mouth. “

Skin Picking https: //youtu. be/d. Jcol. Ha. SF 8 w • Boundary issue can be complex

Tweaking When the crystal meth no longer yields a high, the user enters a stage sometimes referred to as "tweaking. " During this time, they may feel intense cravings and despair. It is at this point where psychotic symptoms present— with users sometimes struggling with delusions and other altered perceptions of reality. Display obsessive behaviours, such as skin picking

Psychotic https: //youtu. be/Nrp 6 Rj. Fb. FIo • May need police and health care providers to assist

Long Term Effects Possible long-term effects may include structural changes to the brain, memory loss, difficulty completing complex tasks and permanent psychotic symptoms

Partial Recovery of Brain from Methamphetamine After Abstinence 3 0 ml/gm Normal Control METH Abuser (1 month abstinent) METH Abuser (14 months abstinent) Source: Volkow, ND et al. , Journal of Neuroscience 21, 9414 -9418, 2001. Dopamine improvements after 1 year, but not cognitive and motor functioning

Start a Conversation Gather information Have a clear idea of what it is that concerns you about their use. Arrange a suitable time to talk when you will have some privacy. Ask questions; don't make assumptions about their knowledge of MA. Don't tell them what to do and try not to be judgemental. Let them know you care about them. Be trustworthy and supportive so they know that they can rely on you in a time of need.

Do’s Stay calm and keep your emotions in check. Adopt a passive and non-threatening body posture (e. g. hands by your side with empty palms facing forward, body at a 45 degree angle to the aggressor). Let the client air his/her feelings and acknowledge them. Ask open-ended questions to keep a dialogue going. Be flexible, within reason. Use the space for self-protection (position yourself close to the exit, don’t crowd the client). Structure the work environment to ensure safety (e. g. have safety mechanisms in place such as alarms and remove items that can be used as potential weapons). Make sure other clients are out of harm’s way.

Do’s Try when he or she is sober and talk about going into treatment. Expect to encounter some difficult emotions including denial, anger, and justifications of their use and the problems caused by it. Avoid argument where trying to dispute what they're saying and prove that you're right. Instead, approach them with empathy. Avoid blaming and say concerned about their drug use. calmly lay out clear boundaries of what you'll accept in the future, but avoid making threats.

Don’ts Challenge or threaten the client by tone of voice, eyes or body language Say things that will escalate the aggression. Yell, even if the client is yelling at you. Turn your back on the client. Rush the client. Argue with the client. Stay around if the client doesn’t calm down. Ignore verbal threats or warnings of violence. Tolerate violence or aggression. Try to disarm a person with a weapon or battle it alone.

Intervention https: //youtu. be/I 9 z. Gqds. GWQA • NNADAP workers trained in interventions • Sober living facility important

Detox Withdrawal can be profoundly uncomfortable, and sometimes elicit depressive episodes—relapse risks are high during the period of acute detox. Acute symptoms of abuse are often treated with medications to alleviate the discomfort of side effects and withdrawal: – Hyperactivity, agitation or psychotic features—If needed, may be treated with a dopamine-blocking medication, such as haloperidol-an antipsychotic that decreases abnormal excitement in the brain. Other behavioural and psychiatric effects—Benzodiazepine drugs such as diazepam (Valium) may be used to relieve anxiety, muscle spasms, and seizures. Antidepressants?

Detox After the long-term insomnia and loss of appetite, many tend to sleep during the days after "tweaking. " After the crash, will be hungry, thirsty, and fatigued, which can last up to 2 weeks, and can be accompanied with depression.

Treatment Often prove difficult to manage, due to high rates of dropout and relapse, severe craving, acute and prolonged withdrawal, cognitive impairment, violence, poor health conditions, protracted mental health issues (including depression and psychosis), and the inability of some users to experience pleasure in the absence of the drug. Currently, there is no widely accepted model for crystal meth abuse treatment. In the past, antidepressants were utilized, but this treatment was not found to be especially effective in the long run. Short term possibly? The best way to treat meth abuse is a full continuum of care.

CBT Cognitive behavioural therapy (CBT) - teach changing self-destructive pattern and focuses on recognizing signs of cravings, identifying situations that put you at risk, and developing coping skills to deal with them. It’s unknown quite how effective CBT is on own, but helpful in combination with otherapies.

12 -step programs and SMART recovery 12 -step programs, including Crystal Meth Anonymous, stress acceptance of the chronic nature of substance abuse, that surrender to a higher power and the group structure leads to recovery. SMART Recovery views alcohol and drug abuse as a dysfunctional habit rather than a disease and relies on secular, science-based techniques to recover from substance use disorders. Only effective if regularly attend meetings and continue to do so —both have similar success rate

12 -Step Recovery https: //youtu. be/8 n. PEn. B 2 dv 9 o • Historical issues with FN people and God? • Childhood trauma creates feelings of inadequacy, which turned her.

Contingency management (CM) uses rewards like vouchers or cash to encourage abstinence from alcohol and drugs. At the beginning of treatment, the rewards are low, but the longer you remain sober, the more you can receive. Adding CM to other forms of treatment results in more negative urine tests and more counselling sessions attended. Rewards are usually non monetary vouchers for things such as movies, gasoline or other entertainment vouchers; Example is that of the HIV program

Long Term Inpatient Rehab Generally 6 -12 months and treatment portion should last at least 90 days to be effective. Can focus on confronting places to improve psychological and social functioning, and finding employment and social support. Recovery homes as an example

The Matrix Model is a combination of treatments Program lasts four months, allowing brain recover. Combines behavioural therapy and counselling Helps to cope with the depression and anxiety due to meth withdrawal. Relapse prevention - Teaches them to avoid relapse by explaining why cravings happen and how to respond to them positively. Group therapy and Crystal Meth Anonymous support so users can help one another deal with their shared difficulties.

Relapse Addiction is like other chronic diseases, where management involves lifestyle and possibly medication. Addiction relapse is similar to relapse of other chronic disease (50%)

PACE Prevention, Awareness and Community Education Prevention – address risk factors and enhance protective factors; Awareness – drug effects Community Education – various forms of education

Saskatchewan Situation Data from the Ministry of Health shows that crystal meth cases presenting at drug treatment have grown by 200% in one year, from 2015 -2016. There are calls for a strategy dedicated to crystal meth, because the problems are different than opioids.

Objectives What is Crystal Meth? Prevalence of use Short and long term effects How to have conversation Detox Treament

Destructive Drugs – Crystal Meth Dennis Wardman MD FRCPC MCM ABAM Deptuy Medical Health Officer FNIHB –SK Region Tel: (306) 807 -7623 Dennis. Wardman@canada. ca