Health Risks
Meth gives people energy, alertness, confidence, and euphoria. With long-term use, however, meth can damage cognitive functioning, create hallucinations, ravage the body, and increase the likelihood of violent behaviors. Meth’s ability to increase energy, sexual libido, and disinhibition leads many users to have sex for hours.
Drying out of the mucosa is also seen in the oral cavity as a result of xerostomia, or dry mouth. “If you eliminate the protective role of saliva from the oral mucosa, you open a gateway for all kinds of pathogens,” explains Fariba Younai, a faculty member of the Pacific AETC and a clinical professor of oral biology at the University of California, Los Angeles.
Xerostomia, combined with the toxic chemicals in meth, causes tooth and gum decay (especially when a person smokes or snorts meth) as well as tooth discoloration, breaks in the teeth, caries, periodontal disease, and oral candidiasis.25,26 Meth can also cause cravings for high-sugar drinks, shrinkage of gingival tissue, bruxism (grinding of the teeth), and poor oral hygiene, all of which lead to “meth mouth.”12,13 Rampant tooth decay in many users leaves few dental options other than extraction.27
Meth also changes the pleasure centers in the brain, and although damaged dopamine receptors can regrow over time, the repair may never be fully complete.4 Meth abstinence can lead to severe depression, which in part fuels the addiction cycle because users will take meth repeatedly to avoid the horrible low that follows. “Coming off meth the crash is so bad,” says Gary, a recovering meth addict at the Los Angeles Gay & Lesbian Center’s CMRS. “I would try to quit and then I would find myself on the couch with so little energy, I thought I couldn’t get up. I felt like I would never get out of this dark place and I just wanted to make it all end.” Former meth users may need the most help from mental health services months after going through detox: 62 percent of chronic meth users remain depressed for 2 to 5 years after abstinence because of severe disruption of dopamine and serotonin distribution in the brain.2,28
Meth poses additional health complications in pregnancy. What little data are available show that meth crosses the placenta and can cause placental insufficiency, abruption, intrauterine growth retardation, preterm birth, prematurity, clefting, cardiac anomalies and, in some cases, death. Meth can also be secreted in breast milk, so mothers should not breastfeed if they may have meth in their system. “Meconium testing is the most accurate method [for testing for meth exposure] in newborns; a positive result indicates perinatal use in the second half of the pregnancy.”9
| Types of Effects | Physiological Consequences |
|---|---|
| Acute physical | Increases: heart rate, blood pressure, body temperature (hyperthermia), convulsions, blood pressure, pupil size, sensory acuity, and energy Decreases: appetite, need for sleep, and reaction time |
| Acute psychological | Increases: confidence, alertness, mood, sex drive, talkativeness, euphoria, impulsive behavior Decreases: boredom, loneliness, and timidity or social inhibition |
| Chronic physical | Tremors, weakness and fatigue, dry mouth and drying of skin, weight loss, malnutrition, cough, sinus infection, sweating, burned lips, sore nose, acne, headaches, diarrhea, anorexia, heart attack, stroke, acute pulmonary hypertension, breakdown of skeletal muscle, hyperventilation, eye ulcers, chronic obstructive lung disease, renal failure, hepatic failure, and sudden death from cardiac arrhythmia |
| Chronic psychological | Anxiety, confusion, insomnia, mood disturbances, violent behavior, memory loss, impaired cognitive functioning, depression, paranoia, panic disorders, lack of concentration, increased risk for suicide, visual and auditory hallucinations, delusions (including “formication,” the abnormal sensation of insects crawling on skin that can lead to skin infections and sepsis from the scratching that results), and full psychosis |
Meth and HIV
It is nearly impossible to discuss the health implications of meth independent of HIV. Comorbidity for meth abuse and HIV infection is far greater among MSM than among any other population. According to Elizabeth Disney, a clinical psychologist at Chase-Brexton Health Services in Baltimore, Maryland, all the clinic’s HIV-positive meth clients are MSM. Rizzo’s clients include MSM and transgender persons. Little literature is available specific to meth use among HIV-positive women.
Because meth use increases sexual libido while decreasing judgment and inhibition, it is often accompanied by unsafe sex practices, thereby increasing risk for HIV transmission.4,24,29 Meth-using men are 4 times more likely to engage in unprotected sex than are non-meth-using men.30 “Meth takes away all your worries,” says Gary. “I had tried other drugs before, but then I tried meth, and it was as if this was the drug for me. It gives you so much energy and makes you feel confident and attractive. I didn’t try it for its sexual allure, but once you have sex on meth, it’s as if the two can’t be separated from one another,” Gary explains.
Ironically, the constricting of blood vessels due to meth can cause temporary impotence and lead to use of sexual enhancement drugs like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).2* According to a National Institute on Drug Abuse (NIDA)–funded study, MSM meth users were more likely than heterosexual meth-using men to report multiple sexual partners (72 percent versus 57 percent).29 “Meth becomes a doorway to explore sexuality, so men engage in more extreme sexual behavior that might otherwise be fantasy,” explains Disney.
“Data on meth use and MSM has shown there is a time-to-response link where the longer or more heavily an individual uses meth, the more likely he is to have HIV,” says Steven Shoptaw, a faculty member of the Pacific AETC and professor of family medicine and psychiatry at the University of California, Los Angeles. A Los Angeles-based study Shoptaw helped conduct found the following:
- 40 percent of non-treatment-seeking “weekend warriors”† were HIV positive.
- 61 percent of meth users entering outpatient meth treatment facilities were HIV positive.
- 86 percent of users in inpatient programs for meth were HIV infected.5*
Similarly shocking is that MSM meth users who inject the drug are 30 times more likely to be HIV positive than are non-MSM meth users who inject the drug. In California, risk for HIV infection is triple among meth-using MSM compared with non-meth using MSM.5
Clinical Interactions
Meth is doubly dangerous. It not only increases behavioral risks for HIV but also acts as an immunosuppressant, decreasing CD4 levels and allowing for more virus to get into cells.24,28 Meth users, particularly because of the drug’s long high, often fail to maintain a treatment regimen, causing their viral load to increase.31 Meth’s interaction with the HIV protease inhibitor ritonavir can result in a 3- to 10-fold increase in meth levels in the bloodstream. Ritonavir prolongs the meth high by increasing absorption and decreasing the metabolism of meth and therefore can cause increased toxicity and potentially severe reactions or overdose.12,24 Delavirdine, a nonnucleoside analog reverse transcriptase inhibitor, also slows the metabolism of meth.12 Providers may need to review treatment regimens if patients are using meth or missing treatments.
* Shoptaw S. Personal Communication. December 10, 2008.
† People using meth regularly on a weekend or every-other-weekend basis.