Learning objectives

• Diagnose and treat methamphetamine toxicity or overdose

Definition and mechanisms

• Methamphetamine is a highly addictive psychostimulant drug that is a derivative of amphetamine and may be snorted, ingested, injected, or smoked
• Methamphetamine hydrochloride is FDA-approved for the long-term treatment of ADHD and the short-term treatment of exogenous obesity
• Methamphetamine promotes the release of the monoamine neurotransmitters dopamine, serotonin, and norepinephrine within central and peripheral nerve endings
• It also blocks the reuptake of dopamine similar to cocaine
• As a result, the drug produces euphoria and stimulant effects similar to cocaine
• Oral administration: peak concentrations are observed within 2-4 hours
• Snorting, smoking, and injection: peak concentrations occur within minutes

Signs and symptoms

• Euphoria
• Tachycardia
• Hypertension
• Sweating
• Restlessness
• Dry mouth 
• Elevated body temperature
• Agitation
• Chest pain
• Coma or unresponsiveness (in extreme cases)
• Heart attack
• Irregular or stopped heartbeat
• Difficulty breathing
• Kidney damage and possibly kidney failure
• Paranoia
• Seizures
• Severe stomach pain
• Stroke

Complications

• Intracranial hemorrhage
• Seizures
• Ischemic stroke
• Coma
• Heart failure
• Arrhythmias
• Delusional behavior
• Extreme paranoia
• Major mood swings
• Insomnia (severe inability to sleep)
• Missing and rotted teeth (called “meth mouth”)
• Repeated infections
• Severe weight loss
• Abscesses or boils

Management

Suggested reading

• Richards JR, Laurin EG. Methamphetamine Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 10, 2022
• Dignam, G., Bigham, C., 2017. Novel psychoactive substances: a practical approach to dealing with toxicity from legal highs. BJA Education 17, 172–177.