Methamphetamine is the chemical name for a potent synthetic stimulant that is often know as crystal meth or just meth. Methamphetamine is easily manufactured by private individuals who use relatively common ingredients, such as the medications pseudoephedrine, and combine them with other substances that can be obtained legally. Professionally manufactured methamphetamine retains some medical uses but it is rarely prescribed to private individuals.
The United States Drug Enforcement Administration (DEA) classifies methamphetamine under the Schedule II category of controlled substances. This is the highest classification of drugs that can be used medicinally, and the drug is tightly controlled. Possession of methamphetamine by anyone without some type of prescription or other legal documentation is illegal, and the manufacture of methamphetamine by private individuals is also illegal. Private manufacturers of methamphetamine produce crystal-like substances that appear to be shards of glass (hence, the street name for the drug, glass).
Meth is most often smoked or snorted in a manner similar to cocaine, and it can also be injected. The drug remains a significant drug of abuse even though it has been recently overshadowed by the opioid abuse epidemic.
Can One Develop Physical Dependence to Methamphetamine?
The development of physical dependence on any drug or medication results from a combination of two different but related syndromes: tolerance and withdrawal. Although the signs of a withdrawal syndrome in an individual are most often used to determine if a person has developed physical dependence on the drug, a person will need to develop some level of tolerance to the drug as a result of continuous use before any withdrawal symptoms appear.
Methamphetamine is classified as a central nervous system stimulant drug, meaning that the action of the drug results in an increase in the activity of the central nervous system and the peripheral nervous system. An individual diagnosed with problems relating to methamphetamine abuse would be diagnosed with a stimulant use disorder, according to the formal diagnostic criteria for substance use disorders presented by the American Psychiatric Association (APA).
The formal diagnosis of a withdrawal syndrome associated with an individual discontinuing the use of methamphetamine could also be made according to the specific diagnostic criteria for stimulant withdrawal listed by APA. These formal diagnostic criteria include:
- An abrupt stoppage of methamphetamine or a marked decrease in the amount of methamphetamine the person normally uses leading to the symptoms listed below
- Dysphoria, which is a negative mood state that can consist of issues with anxiety, depression, irritability, or other negative mood states
- The above two conditions and at least two of the following physical changes that occur within a few hours or several days after one stops using methamphetamine:
- Extreme tiredness or fatigue
- Hypersomnia (sleeping excessively more than normal) or insomnia
- Very vivid and unpleasant dreams
- Psychomotor retardation (e.g., moving very slow, feeling as if one weighed down, or decreased reflexes) or psychomotor agitation (e.g., extremely nervous or irritable body movements)
- An increase in appetite
The above symptoms should not be better explained by some other condition, such as a medical condition, being intoxicated or withdrawing from some other substance, or some other mental health condition. The symptoms should cause the person significant distress or impairment.
Thus, according to the formal diagnostic criteria set forth by APA, there is a possibility that individuals who abuse stimulant drugs like methamphetamine can develop physical dependence on these drugs. Methamphetamine use results in a rapid development of tolerance, such that the individual needs more and more of the drug to get the effects that they once achieved with lower amounts of the drug.
As tolerance develops, the system adjusts itself. When levels of the drug begin to decrease, they may begin to experience withdrawal symptoms. This would qualify as a diagnosis of physical dependence.
Mild withdrawal symptoms from methamphetamine can begin very quickly because stimulant drugs like methamphetamine are eliminated from the system relatively rapidly. It is for this reason that individuals often binge on the drug in order to maintain the stimulant effects they seek. When they stop using the drug, they experience what is often referred to as the crash. This crash is experienced as extreme feelings of apathy, depression, and cravings for the drug.
There are numerous research studies investigating the withdrawal process from methamphetamine that have further defined some of the symptoms that may occur. These are based on self-reports of individuals who develop stimulant use disorders as a result of methamphetamine abuse. Because there is no objective medical test that can identify the symptoms of withdrawal in any individual, researchers rely on these self-reports and on the observations of clinicians to develop the profile associated with a withdrawal syndrome.
The research studies suggest the following:
- People with physical dependence on methamphetamine often begin experiencing withdrawal symptoms within 24 hours after stopping the drug.
- Withdrawal symptoms will often reach their peak within 7–10 days after the person stopped using the drug.
- After the symptoms peak, there is a rapid decline in the perceived severity of the symptoms.
- The study suggests that the timeframe for withdrawal symptoms from methamphetamine ranges from 2–3 weeks in most individuals.
- The most common length of withdrawal is about two weeks based on self-reports.
The withdrawal syndrome can be quite different in the perceived severity of symptoms and in its overall length from person to person. In addition to the symptoms listed above, research reports have indicated that the major symptoms that occur across most individuals include:
- Extreme thirst
- Dry mouth
- Increased appetite
- Fatigue and hypersomnia
- Significant feelings of apathy and depression that can include irritability, significant hopelessness, and even suicidal thoughts
- Strong cravings to use methamphetamine that are overpowering in the early stages of the withdrawal syndrome
- Psychotic-like symptoms, such as paranoia or suspiciousness, other delusions, and hallucinations (mostly visual hallucinations)
The withdrawal syndrome associated with some drugs, such as alcohol and benzodiazepines, can be potentially physically dangerous due to the development of seizures that can be life-threatening. For most individuals, withdrawal from methamphetamine is not considered to be physically dangerous; however, any individual who is experiencing severe depression or psychotic-like symptoms is at risk of self-harm due to poor judgment or suicidal thoughts. Individuals who regularly use methamphetamine in conjunction with alcohol may be a risk to develop seizures during withdrawal.
The above cited research has also indicated that some individuals may have longer-lasting cognitive issues six months after undergoing withdrawal from methamphetamine. These issues are most commonly related to the decreased ability to pay attention and concentrate, make complex decisions, and form new memories. This research suggests that there may be potential long-term changes in the brain pathways of some individuals who use methamphetamine, and these changes do not fully remit with continued abstinence.
As mentioned above, the exact experience any single individual will have as a result of withdrawal from methamphetamine can be quite variable. Based on the above information, there is a general timeline for withdrawal that occurs across most individuals.
- Issues with depression, apathy, and cravings appear within 24 hours after stopping the drug.
- If one does not use methamphetamine, the above symptoms will increase in intensity and be followed by other symptoms, such as lethargy, increased appetite, etc.
- The symptoms will increase in intensity for several days and reach their peak within one week to 10 days after they have appeared.
- After the symptoms peak, they will quickly subside in intensity, but lingering symptoms like mild depression, lethargy, and cravings may remain for some time.
- People who have significantly more serious symptoms, such as issues with severe depression or psychosis, may be at risk for self-harm.
The factors that affect the duration and intensity of the withdrawal syndrome to any drug include:
- How long the person was abusing the drug
- How much of the drug the person typically used
- How the person used the drug, such that individuals who inject or smoke drugs will experience a quicker onset of withdrawal symptoms and more intense symptoms than individuals who snort them
- If the person used any other drugs in combination with methamphetamine on a regular basis
- How the person stopped using the drug, such that individuals who suddenly stop using the drug will experience symptoms more quickly than those who slowly cut down on their use
- Individual differences in metabolism, weight, and psychological adjustment
Treating Methamphetamine Withdrawal
The approach to addressing individuals with a withdrawal syndrome as result of methamphetamine abuse is to place them in a physician-assisted withdrawal management program (a medical detox program). During this program, the person is monitored by a physician. The approach most often involves the use of medications to control certain withdrawal symptoms and cravings for the drug.
Medical detox can be performed on an inpatient or outpatient basis. For most individuals who are recovering from methamphetamine abuse, the early stages of the program are best addressed on an inpatient basis to allow for 24-hour medical management.
The approach to treating the withdrawal syndrome from methamphetamine is to address the specific symptoms the person displays. Specific medications and treatments are often used.
- Antidepressant medications appear to have some success in treating the symptoms of withdrawal from methamphetamine. Medications that have been used include some of the selective serotonin reuptake inhibitors, such as Prozac (fluoxetine), Wellbutrin (buproprion), and Remeron (mirtazapine).
- Benzodiazepines such as Xanax (alprazolam) or Valium (diazepam) may be used to treat withdrawal from methamphetamine. These medications are typically only given to individuals who are inpatient programs as they can be substances of abuse.
- Mild stimulants medications such as Provigil (modafinil) have been used to treat lethargy and sleepiness.
- Individuals who experience psychosis may be treated with antipsychotic drugs.
Unlike opiate withdrawal, there are no specific medications that are approved or designed to treat withdrawal from stimulants like methamphetamine, and physicians typically adopt an approach that can be best described as “symptom management.” In addition to medications, individuals are often treated with behavioral management techniques, such as therapy to help them deal with cravings and to address other issues with their substance use disorder. Cognitive behavioral therapy or supportive therapy is most commonly used in conjunction with medications.
The use of medications for the treatment of withdrawal from methamphetamine does not lead to a significant extension of the timeline for the withdrawal syndrome in the same way that the use of opiate replacement medications such as Suboxone extends the timeline for withdrawal from opiates. The reason for this is that these drugs are not replacement medications for methamphetamine; they simply treat the symptoms an individual experiences.
Simply getting through the withdrawal syndrome for methamphetamine is not sufficient for recovery. Medical detox is simply a way to prepare an individual for a long-term recovery program. Anyone who has a substance use disorder as a result of abusing methamphetamine must become involved in a long-term treatment program once they have safely negotiated the withdrawal syndrome.