Amphetamines and Ice: An Overview

Amphetamines

• Amphetamines are psycho-stimulant drugs that speed up messages between the brain and the body.
• Some amphetamines are prescribed to treat conditions like ADHD and narcolepsy.
• Others, like speed, are produced and sold illegally.
• Crystal methamphetamine (ice) is a potent form.

What is Ice?

• Crystal methamphetamine (ice) is a colorless, odorless stimulant.
• It's stronger and more addictive than powdered methamphetamine (speed).
• It comes as small, chunky crystals, sometimes looking like ice or fragments of glass, or as a white or brownish crystal-like powder.
• Ice has a strong smell and a bitter taste.
• Other names for ice include crystal meth, shabu, crystal, glass, and shard.

Methods of Use

• Ice can be smoked, injected, snorted, or swallowed.
• Smoked ice produces an almost immediate effect.
• Injected ice takes 15-30 seconds to take effect.
• Swallowed ice takes 15-20 minutes to take effect.
• Snorting ice produces an effect in 3-5 minutes.
• Purity level affects duration and intensity of effects.

Why is Ice Illegal?

• Crystal methamphetamine is a Schedule II substance under the Controlled Substances Act.
• Schedule II substances, like cocaine and PCP, have a high potential for abuse.
• Abuse of these drugs can cause severe psychological or physical dependence.

How Ice Affects the Body

• Indirect agonist for dopamine, noradrenaline, and serotonin (5-HT).
• Mechanism: Blocks monoamine reuptake, inhibits MAO metabolism, and inhibits vesicular storage, and reverse reuptake.

Effects of Ice on Organs

• Neurologic: Delirium, tremors, choreiform movements, intracranial hemorrhage.
• Psych: Anxiety, paranoia, hallucinations, delusions, suicidal or homicidal behavior, compulsive behavior (skin picking/formication, hair pulling).
• ENT: Dry mouth (xerostomia), teeth grinding (bruxism), poor oral hygiene, nasal injuries.
• Cardiovascular: Tachycardia, hypertension, dysrhythmias, myocardial infarction, dilated cardiomyopathy.
• Pulmonary: Pulmonary hypertension, acute respiratory distress syndrome (ARDS).
• Gastrointestinal: Nausea, vomiting, diarrhea, ischemic colitis.
• Renal: Acute kidney injury, rhabdomyolysis.
• Musculoskeletal: Rigidity, rhabdomyolysis.
• Skin: Diaphoresis, soft tissue infections (abscesses).

Long-Term Effects

• Anxiety, confusion, sleep problems
• Hallucinations, delusions
• Methamphetamine psychosis, Psychotic behavior
• Chronic depression
• Severe weight loss
• Brain damage

Clinical Presentation

• Symptoms include hyperthermia, euphoria, dilated pupils, sweating, insomnia, tachycardia, arrhythmia, decreased appetite ,increased alertness and energy.

Mood Symptoms

• Anxiety, restlessness, panic
• Aggression
• Racing thoughts, severe depression following binges, violent mood swings, delusions of grandeur.

Behavioral Symptoms

• Risky sexual behavior
• Avoidance of hobbies and pleasurable activities
• Borrowing/stealing money
• Preoccupation with the next high
• Pulling away from friends/family
• Engaging in unsafe activities.

Physical Symptoms

• Marked weight loss, cardiac arrhythmias, malnutrition, respiratory problems
• Acne, picking scars, loss of skin elasticity, "meth mouth"
• Brain damage, seizures

Psychological Symptoms

• Confusion, memory loss
• Disorganized lifestyle
• Paranoia
• Psychosis, hallucinations
• Total break from reality.

Other Health Risks

• Injecting ice increases risk of tetanus, infection, and vein damage.
• Sharing needles increases risk of hepatitis B & C, and HIV/AIDS.
• Snorting ice can cause nasal passage damage and nosebleeds.

Overdose

• Symptoms include chest pain, breathing problems, fits, agitation, confusion, clumsiness, headache, unconsciousness, stroke, heart attack.

Treatment

• Physical/chemical restraints can be used to prevent harm.
• Aim to treat life-threatening symptoms (compromised airway, seizures, tachycardia, hyperthermia).
• Gastric lavage with antidotes, activated charcoal, intravenous fluids to eliminate the drug.
• Intravenous phentolamine, nitroprusside or nitroglycerin for end-organ failure
• Supportive care like antibiotics for infections, sedation (diazepam, chlorpromazine).

Coming Down

• Recovery can take days, potential effects include difficulty sleeping, exhaustion, headaches, dizziness, blurred vision, paranoia, hallucinations, confusion, and irritability.

Addiction Cycle

• Use of depressant drugs (alcohol, benzodiazepines, cannabis) to manage come-down effects can lead to dependence on both types of drugs.

Autopsy Findings

• Recent needle marks (cubital fossa, arms, ankles, groin, neck).
• "Crank Bugs" (itching, scratching).
• Extreme weight loss, prominent bones and ribs.
• "Meth Mouth" (severe tooth decay/damage)

Additional Notes

• Pathological changes in the heart (cardiac arrhythmias, myocardial fibrosis, coronary artery fibrosis).
• Systemic infections (Hepatitis B/C)
• Severe burns.
• The drug boosts dopamine release leading to intense elevated mood and increased addictive behavior.