When high wears off, paranoia, health woes lurk

— The Superman feeling of invincibility, loads of energy and effortless weight loss are the immediate effects of methamphetamine use. The heart problems come later.

Researchers are still learning about the effects of prolonged methamphetamine use, but so far, what they know doesn't look good for the drug known as crank, speed, ice and other names.

"Ex-heroin addicts seem healthier than ex-crank addicts," said Catherine Totten, a counselor at Ozark Guidance Center. "It's devastating on the body."

Totten works with methamphetamine addicts at the Springdale center. Many of her meth clients have lost some or all their teeth as a result of meth's effects on the body, she said, and several reported poor blood circulation.

Methamphetamine is a central nervous system stimulant that causes chemical reactions in the brain. Those reactions make the body think it has unlimited energy and gives the user feelings of pleasure and self-confidence. The false energy level eventually fades, leaving the user tired and depressed because the drug has drained energy reserves from wherever it can find them.

Chemical imbalances in the brain caused by the drug and sleep deprivation often lead to hallucinations, paranoia and strange or violent behavior.

"I'm surprised people survive the first injection," Totten said, noting methamphetamine's toxic ingredients. Those range from lye to acetone such as that used in nail polish remover to acids.

Blood circulation and other vascular problems are common among longtime users, conditions stemming from vein and artery deterioration likely caused by methamphetamine's ingredients.

At the national level, researchers continue studying the effects of methamphetamine use and the way it interacts with the human body, but they lament a shortage of information on the drug's interaction.

The National Institute on Drug Abuse received $4.2 million in 1997 from the White House Office of National Drug Control Policy to expand its methamphetamine research program. In 1998, the institute received $2 million more from the National Institutes of Health for more extensive studies. The $2 million was devoted to the development of new medications for meth overdose and addiction.

Sometimes called the "poor man's cocaine," methamphetamine produces many effects indistinguishable from cocaine's effects, but they can last for hours instead of minutes because the drug is metabolized in the body much more slowly. Users develop a tolerance, requiring more of the drug to achieve its effects, federal substance abuse and health officials said.

The drug can be smoked, injected, snorted or swallowed.

The drug abuse institute reports that up to half of dopamine-producing cells in the brain can be damaged after prolonged exposure to meth and serotonin-producing cells may be damaged even more extensively.

Dopamine is a neurotransmitter in the brain that regulates pleasure, emotion, movement and motivation. Serotonin, also a neurotransmitter, affects consciousness, mood, depression and anxiety.

Over time, reduced levels of dopamine production can cause symptoms similar to Parkinson's disease, which severely affects movement, the National Institute on Drug Abuse said.

The institute says even a small amount of methamphetamine can produce euphoria, alertness, increased physical activity, decreased appetite and increased respiration. Other central nervous system effects include irritability, insomnia, confusion, tremors, anxiety, aggression, hyperthermia and convulsions.

The drug can cause high blood pressure and increased heart rate. It can cause irreversible damage to blood vessels in the brain, producing strokes. Malnutrition can result from the lack of food resulting from meth's reduction in a user's appetite.

Psychological symptoms of prolonged methamphetamine abuse include hallucinations, paranoia and repetitive behavior.

In Northwest Arkansas, most patients admitted to the area mental wards have a standing diagnosis of psychosis. Of the remainder, the majority are there for treatment as a result of methamphetamine use, said Dr. Michael Holloman, a psychiatrist at Ozark Guidance Center in Springdale.

Holloman typically sees people in "emerging crises," those who've become suicidal or homicidal or are psychotic. About half of those patients abuse drugs or alcohol, he said. Methamphetamine is the drug of choice for at least one-third of those, he said.

Holloman said the meth wave appears to ebb and flow, but, at times, as much as 70 percent of the patients he has admitted to area hospitals without a pre-existing psychotic diagnosis suffer from meth-induced psychosis.

While alcohol always outranks other drugs as the most abused drug, methamphetamine is second at Ozark Guidance Center, followed by marijuana, Holloman said.

Holloman saw periodic methamphetamine cases as an emergency room doctor in Mountain Home for 12 years before he retrained in Dallas between 1991 and 1994 to specialize in psychiatry.

He saw truck drivers in the 1980s and early 1990s in the emergency room because they were paranoid and having delusions as a result of meth, which they used to drive and work long hours.

The visits were infrequent then, he said. The hospital staff treated about two a year in the emergency room in Mountain Home.

"Now, it has intensified and gone down to the younger populations," Holloman said.

Barbara Jordan Dillon, a counselor at Clinical & Community Psychology & Counseling, said she treats several adolescents at her Fayetteville office for methamphetamine abuse and addiction. Last year, she treated nearly a dozen people between 14 and 18 for meth addiction.

She recalled one teen from a Northwest Arkansas school who was so hooked on meth her supplier urged her to back off. What began as a way to stay thin and pretty backfired, Dillon said. Her use had ravaged her looks.

"I don't think anyone would be able to think of her as beautiful now," Dillon said.

"This thing is so deceptive," Dillon said. "By the time all the desired effects -- weight loss, more social confidence -- start backfiring, they're hooked."

Most youths don't use drugs, the counselor said. But for those who feel inadequate, drugs are a tempting, if deceptive, solution. Methamphetamine is an easy-to-get, cheap hit.

"A lot of kids feel they would be happier if their life was different, and this is a way to make it different," Dillon said.

Today's emergency room doctors see meth patients more regularly than Holloman's pre-1991 experience.

Northwest Medical Center doctors in Springdale treat about 15 people a month in the emergency room who suffer from complications of "recognized" meth use, said the emergency-room director, Dr. Steven O'Mara. "Recognized" means those patients who admit they're using methamphetamine or who are given a drug test and test positive for meth use.

"Most of what we get are the casual users. They've used it a few times or for the first time. They come in because they haven't slept in three days or their hearts are racing, they're fatigued," O'Mara said. "Some are open about what they've done but some will lie to the end."

The longtime, hard-core user is easier to spot.

"We have lots of people who come in here who are literally scarred. They'll come in and they'll be scratching, picking 'bugs' off themselves," O'Mara said. "They'll pick their skin until they're bleeding. They get the sensation something is crawling on them. Then they hallucinate. They pick and itch and scratch and literally claw themselves."

It's usually not so obvious, O'Mara said. Doctors may be treating a person who's hurt or been in a car accident, only to learn later that the injuries or accident occurred while the person was high on methamphetamine. It's not unusual to treat meth patients who've been in vehicle accidents.

"It's a dangerous drug and there's not a whole lot you can do for these people. Just watch their blood pressure and sedate them if they're psychotic. Mostly, what they need is time," O'Mara said. "But they can have seizures, go into a coma. Stroke is possible. A lot of it depends on what it [meth] is mixed with."

Meth is unpredictable not only because it can be mixed, or "cut," with a variety of fillers, but also because the ingredients and cooking methods vary widely. Couple the varied mix with the tendency of abusers to use alcohol or another drug while using meth, and the resulting behavior or damage can be unpredictable.

"I saw one person in the emergency room have a fight with a chair. He thought it was a man. It gets pretty scary. They have a wild-eyed look. They're seeing, hearing things that are not there. They have a loss of self-control. They can do anything in that state," O'Mara said.

Dr. Robert Irwin, an emergency room doctor at Washington Regional Medical Center in Fayetteville, said he's seen patients for meth-related problems for several years, although the frequency seems to wax and wane.

"Four years ago, cocaine was a problem. We hardly see that anymore. But meth has kind of persisted," Irwin said.

Irwin said most people who visit the hospital on meth are there for psychological problems. Others fear the physical effects. Their hearts may skip beats and hyperventilation can make them numb all over. "They think they're having a heart attack," Irwin said.

While rare, Irwin has seen heart attacks in meth users. Meth causes an increase in blood pressure and a constriction of the heart's blood vessels.

Irwin recalled a truck driver who suffered, and later recovered from, a heart attack. The truck driver reported long-term use of amphetamines, Irwin said. The heart became physically irritated to the point it quit.

"It really wears out the body. People age very quickly with meth," Irwin said.

Besides the immediate symptoms of meth use, O'Mara said the drug can cause a dangerous increase in body temperature and rapid breakdown of muscles, which can have the aging effect some meth users reflect. The byproducts of that deteriorated muscle tissue filter through, and can block, the kidneys.

"It's very dangerous. It can kill your kidneys," O'Mara said.

Meth users treated at area emergency rooms cross all lines of gender and age, O'Mara said. Irwin said most are white and between 18 and 30.

"A lot of them are just ordinary people, like a factory worker who gets involved in the wrong crowd. Then they loose their job. Life kind of goes downhill from there," he said.

O'Mara said most meth patients don't ask for advice or help to quit using the drug. And when he offers it, most of them don't want it.

"A lot are weekend users," Holloman said. They might drag through the workweek because their bodies are worn out from a weekend meth binge. "They're not going to be very good employees."

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