Meth is surging in the U.S. again, in the shadow of the opioid epidemic, and may not be getting the attention it deserves. Meth addiction is another worsening drug plague, that is increasingly becoming uncontrollable.

In contrast to the last methamphetamine epidemic, which began in the 1990s, rural meth labs are now a rarity and the fires and explosions that made headlines back then are practically nonexistent today. Unfortunately, this has led to a very false assumption that if meth labs are down, meth use is down. But huge quantities of pure, affordable meth from clandestine labs in Mexico have taken the place of local labs all over the country. The majority of methamphetamine is now smuggled across the Southwest border, According to the Drug Enforcement Administration’s 2016 National Drug Threat Assessment Summary. Its purity is high and its street price is relatively low, much cheaper than heroin.

According to the same assessment nearly a third of American law enforcement agencies ranked methamphetamine as the biggest drug threat in their areas, and the problem seems to be growing. In 2016, 43 percent of law-enforcement agencies in the south-east and 71 percent in the south-west listed methamphetamine as the biggest drug threat locally. Nationwide, regular use of the inexpensive and widely available illicit stimulant increased from 3 to 4 percent of the population between the years 2010 and 2015, according to SAMHSA. During the same period heroin use shot from 1 to 2 percent of the population. 4 million people abuse methamphetamine on a regular basis and another 12 million have tried it at least once.  In 2015, the most recent year for which federal data is available, nearly 4,900 meth users died of an overdose, (that represents a 30 percent increase over 2014)

Research on long-time meth users reveals they almost always become addicted and the effects of methamphetamine on chronic users are severe, especially in the brain.

Organic, Behavioral and Psychological Effects of Methamphetamine

Methamphetamine Psychosis

The most infamous effect of meth on long-term users is psychosis, also called “tweaking,” where the user loses contact with reality. Meth psychosis closely resembles acute paranoid schizophrenia and it can be difficult differentiating the two on scene. The definitive diagnosis of methamphetamine psychosis is made after performing a thorough history, physical exam, urine drug screen, and reality testing. However, there are usually additional tell-tale signs of meth induced psychosis when an officer arrives on scene.

Methamphetamine overstimulates the temporal lobe of the brain which can create psychosis; this is also the commonly effected area in human brains in patients with schizophrenia. Studies report that psychosis is experienced by two-thirds of methamphetamine users. Dependence on methamphetamine is the key risk factor for psychosis. Additional factors affect the occurrence and course of psychotic symptoms: number of years of abuse, sleep deprivation, concurrent mental illness (dual diagnosis), and mixing meth with alcohol or other drugs.

The main characteristic of meth psychosis is the presence of three prominent features: hallucinations, delusions and paranoia.

1. Hallucinations: Hallucinations are false perceptions that may be associated with any of the five senses; visual(sight), auditory(sound), olfactory (smell), gustatory (taste), tactile (touch). Another common hallucination experienced by methamphetamine users is “formication” which is the false perception of something being on or under the skin, hallucination of bugs crawling under the skin (“crank bugs” or “meth mites”). It is difficult to distinguish the hallucinations of schizophrenia from those of drug abuse. Schizophrenic hallucinations are usually auditory, whereas, the hallucinations of chronic methamphetamine users are more commonly visual or tactile.

2. Delusions: The other determining factor of methamphetamine psychosis is the presence of delusions which are fixed false personal beliefs that cannot be corrected by reasoning with the person. The most common delusions in meth-induced psychosis include:

· Persecution:  A persistent false belief that harm is occurring, or is going to occur despite the lack of any evidence.

· Grandeur: A false belief that false belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth.

· Reference: A neutral event is believed to have a special and personal meaning. An example is an individual who believes that random traffic signs or signals are leading them to a magical place.

· Control: A fixed belief that one’s behavior is entirely directed by another person, group of people, or external force (including aliens).

· Somatic: The fixed, false belief that one’s bodily functioning, sensation, or appearance is grossly abnormal; or believe that parts of their body are being changed or distorted.

3.Paranoia: Most people who experience psychosis will also experience extreme paranoia. They are overly suspicious of people, including close friends and family, and believe that others are “out to get me”. This can increasingly become overwhelming, with the individuals believing they are constantly under surveillance. This makes it incredibly difficult to interact with them as they will believe law enforcement is there to harm them, rather than help them.

There are many users who experience psychosis even long after they’ve stopped using methamphetamine. Extreme stress, especially, can precipitate the spontaneous reoccurrence of psychosis in a former methamphetamine abuser.

The Additional Consequences

· Aggression: This is obviously one of the most fundamental concerns for law enforcement.  Methamphetamine impairs the frontal lobe of the brain, which controls judgment and impulse control. Meth also over-stimulates the amygdala, our emotional control center. These effects combined with paranoia and delusions can result in aggression and violence. In many cases meth induced paranoia and delusions have resulted in homicide.

· Obsessive Compulsive Behavior: Prolonged meth abuse can cause users to display obsessive-compulsive symptoms and repetitive behaviors. This is often seen in activities such as frantic cleaning, purposeless reorganizing, disassembly and assembly of objects (such as cars, a washing machine, cell phone, toaster, etc.) or washing hands several times in a short time period. It additionally, OCD behavior can cause the grinding of teeth, scratching of skin (usually due to formication) or pulling out hair (trichotillomania).

· Anhedonia: Methamphetamine creates a huge release of dopamine in the reward centers of the brain that magnifies pleasure 10X greater than the brain would normally deliver. However, when the brain’s level of dopamine returns to normal as the drug wears off, anhedonia – an inability to feel pleasure sets in. Long-term meth users report depression and can become suicidal.

Meth Treatment and Overdoses

In methamphetamine overdoes, death is typically caused by a stroke or heart attack, and is characterized by extreme sweating as the body overheats prior to death. Because methamphetamine represents a lower risk of overdose than drugs such as opioids, many use it for decades, which often results in gradual organ failure and death. These deaths are typically not counted in overdose statistics.

There are no FDA-approved medications exist to stop cravings for methamphetamine. As a result, methamphetamine treatment primarily consists of outpatient therapy, often after a brief stay in a residential facility. The drug of choice to treat people going through acute methamphetamine psychosis is Haldol.

Additional Tips for LEOs

Methamphetamine users who experience psychosis can become hostile and aggressive. They will have a high level of energy and will be very alert and unpredictable, which makes them particularly dangerous. Often, attempts to calm or contain them will result in further aggression and violence. It is difficult to negotiate with them because they are not in a rational state of mind.

They may present with excited delirium syndrome; be prepared to activate the EMS system.

According to Kimberly Johnson, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, tackling a new meth addiction wave on top of an opioid epidemic could strain the nation’s health care system. Think about the additional strain to the nation’s law enforcement and legal systems….it is mind boggling.

Resource: National Drug Threat Assessment for 2016