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Perspectives on drugs: health and social responses for methamphetamine users in Europe

 

 

Health and social responses for methamphetamine users in Europe

Introduction

Last update: 27.05.2014

Methamphetamine is an established stimulant drug in many parts of the world (e.g. South-east Asia, US), where it has long caused major public health problems. While methamphetamine use in Europe has historically been confined to the Czech Republic and Slovakia, new pockets and patterns of use are now emerging elsewhere in the EU, in diverse populations. In this analysis, we look at challenges for the provision of health and social responses related to this drug today.

Part of the Perspectives on drugs (PODs) series, launched alongside the European Drug Report package, these designed-for-the-web interactive analyses provide deeper insights into a selection of important issues.

1. Analysis: health and social responses for methamphetamine users in Europe

smoking methamphetamine

Outbreaks of methamphetamine use in the United States and South-East Asia have presented major and well-documented public health problems (see interactive timeline). In many cases in these regions the main form of use has been smoking crystal methamphetamine. In contrast, European drug markets have historically been dominated by the use of amphetamine, with methamphetamine use in Europe largely confined to the Czech Republic and Slovakia (where the drug is known as pervitin). There have been recent reports, however, highlighted by a 2013 trendspotter study by the EMCDDA, of changes and developments in methamphetamine markets in some European countries (EMCDDA, 2014c). These reports have highlighted a number of distinct regional trends, each with their own characteristics and patterns of use, and usually linked with changes in production and trafficking of the drug (EMCDDA, 2014d).

Methamphetamine is a stimulant drug that affects the central nervous system (EMCDDA, 2014a). A range of health-related harms are linked to its use and the route of administration, including somatic and mental health problems as well as an increased risk of transmission of infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV) that are associated with injecting. In particular, the range of public health concerns linked with methamphetamine use make close surveillance of new developments an important policy priority.

Methamphetamine use in Europe

Recent reports from both the Czech Republic and Slovakia indicate that there has been a spread of pervitin use among problem drug users, which is reflected in increases in problem drug use estimates and in the number of people entering treatment for the first time who report pervitin problems (EMCDDA, 2014b). In addition, new pockets of methamphetamine use and associated problems have been identified in a number of other European countries. Germany, for example, reports the emergence of methamphetamine sniffing in recreational drug scenes and its use among treatment populations in regions bordering the Czech Republic. The presence of methamphetamine on some northern European markets has been noted in recent years (Griffiths et al., 2008). In Norway, for example, methamphetamine use appears to be interlinked with the older, more established amphetamine market. Particular challenges have arisen in Greece (and to a lesser extent Cyprus and Turkey) where the smoking of crystal methamphetamine (locally known as ‘s(h)is(h)a’) by injecting opioid users has been identified by low-threshold services and treatment agencies. In a different development, the United Kingdom has reported low, but nevertheless worrying, patterns of methamphetamine injecting (known as slamming) among small populations of men who have sex with men (MSM) (EMCDDA, 2014c).

Increasing awareness of these diverse emerging patterns of methamphetamine use has served to put the spotlight on the range of harms associated with its use, and the availability and adequacy of health and social responses. Each population, with its unique pattern of use, is likely to raise challenges and place new burdens and demands on countries’ public health systems. To date, documentation on Europe’s responses to methamphetamine problems is scarce. Bearing this in mind, this analysis makes a first attempt to identify and highlight emerging challenges for policy and service provision linked with the various manifestations of methamphetamine use that have recently been identified. This includes a brief look at the limited international evidence on the effectiveness of interventions.

Varied problems requiring a range of responses

Although at low levels, methamphetamine is being used by diverse groups of drug users in different ways, and this is clearly raising a variety of challenges and initial responses from service providers. Services currently identified as responding to problems include mental health, low-threshold, drug treatment, youth and sexual health.

Methamphetamine has long been used by problem drug users in both the Czech Republic and Slovakia, with injection as the most common route of administration. In the Czech Republic mental health care and residential treatment programmes applying the therapeutic community model have been at the centre of the response (Kalina, 2007). The focus has been on client assessment, the use of psychosocial interventions and medical treatment, and social reintegration initiatives. Services offering information, including harm reduction advice to methamphetamine users, are also available. An innovative intervention has involved the distribution of empty gelatine capsules by some low-threshold services in order to encourage users to consume the drug orally rather than injecting it (Mravcik et al., 2011). Such measures are designed to reduce the injection-related risks of blood-borne viruses (HIV, HCV).

Crystal methamphetamine smoking among opioid injectors has recently been reported in Greece, in particular among marginalised immigrant sub populations in Athens (EMCDDA, 2013). Methamphetamine smoking is associated with particular problems for users’ health, including respiratory damage and dental corrosion. In Greece, both low-threshold and mental health care services have been involved in responding to the needs of these users. However, a combination of restricted service availability and the marginalised social status of these users has reportedly exacerbated the health problems in this group (EMCDDA, 2013).

Several northern European countries with established patterns of amphetamine use are now also seeing the emergence of methamphetamine use among existing stimulant users. In Norway, for example, these two drugs have been sold interchangeably, with amphetamine users unknowingly consuming methamphetamine. Increased use of the drug has also been observed among problem drug users in Latvia, with more than half of the users in one cohort study reporting methamphetamine as their primary drug in 2010 (EMCDDA, 2014c). In general in these countries, no differentiation has been made between treating users of amphetamine and methamphetamine, and psychosocial intervention is the form of treatment most widely available for stimulant users.

Methamphetamine is also reportedly used by recreational drug users, including clubbers, in several countries, such as the Czech Republic, Slovakia, Germany and the United Kingdom. Given the age profile of these users, youth services have sometimes been involved in delivering responses to them. This has included new multidisciplinary services being developed specifically for methamphetamine users. In London, a specialist clinic treating drug-using clubbers has piloted a set of targeted support for users. It provides drug and sexual health services and uses a unique funding scheme that allows access to services for people who self-refer from across the United Kingdom (Kirby and Thornber-Dunwell, 2013). With a broader target audience in mind, another British online service provides drug education to methamphetamine users. The public health service 'Talk to Frank' presents methamphetamine facts, emergency help, harm reduction and drug treatment information to users.

Methamphetamine use has emerged in the United Kingdom among small urban populations of MSM (Stuart, 2013). Within this group, methamphetamine is being injected (known as ‘slamming’) at parties where users engage in high-risk sexual behaviours (multiple partners, no protection). In this context, methamphetamine is one of a number of substances used, including synthetic cathinones, GBL and Viagra. These users face long-established health risks related to injecting drugs, in particular the risk of contracting blood-borne viruses. In London, there are reports of users presenting at sexual health clinics to receive post-exposure prophylaxis (PEP) for HIV after attending slamming parties. In some cases, it has been the services dealing with sexual health issues and targeting MSM clients that have been frontline responders. For example, in the United Kingdom a health promotion initiative operated by a London lesbian, gay, bisexual, and transgender health and well-being charity is targeting methamphetamine users (Marshall et al., 2011). It provides drug, alcohol and sexual health counselling, social support groups and telephone advice to users (Bourne et al., 2014; Stuart, 2013).

Evidence for intervention effectiveness

Much of Europe’s drug treatment provision has been developed in response to heroin use and related problems, and there is limited documentation of approaches addressing stimulant problems. Studies examining the health and social responses to problems linked with methamphetamine use come primarily from the United States and Australia, where smoking of crystal methamphetamine predominates. This means the transferability of results to European contexts is not assured. Presently, there is consistent evidence in support of the efficacy of two psychosocial treatment approaches for methamphetamine dependence — cognitive behavioural approaches and contingency management. Cognitive behavioural approaches, in conjunction with pharmacotherapy or as a stand-alone intervention, have been shown to increase treatment attendance and to reduce methamphetamine use and risky sexual behaviour (Lee and Rawson, 2008; McElhiney et al., 2009; Reback and Shoptaw, 2011). Similarly, individuals who have been assigned to contingency management conditions have demonstrated better retention in treatment, lower rates of methamphetamine use and longer periods of sustained abstinence over the course of their treatment experience (Roll et al., 2013).

To date, although there have been a number of efficacy trials of potential methamphetamine pharmacotherapies (e.g. buproprion, modafinil), all candidate drugs have been shown to be no more effective than placebo. Consequently, there are no approved medications for treating methamphetamine dependence, and pharmacotherapy is recommended as an adjunct to psychosocial interventions rather than being a primary component of treatment (Brackins et al., 2011; Karila et al., 2010; Rajasingham et al., 2012).

Conclusion

While methamphetamine is an established drug in other parts of the world and in some European countries, it is now emerging in EU Member States where it has not previously been recorded. It is being used by different populations of drug users, encompassing socially integrated users who sniff or inject the drug and marginalised populations where methamphetamine is smoked. As such, Europe’s current methamphetamine problem has no single face and appropriate responses will need to be adapted, developed and tailored to the local patterns of use and problems observed. This will undoubtedly require service providers to adopt flexible referral practices and develop existing services, for example tried and tested psychosocial interventions, and to build complementary treatments for users. As patterns and these new developments in methamphetamine use continue to evolve within Europe, it will be important to monitor how use of the drug is developing and to continue to shape responses towards users’ needs.

2. Interactive: methamphetamine global timeline

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This interactive feature highlights some key events in the history of methamphetamine use throughout the world. To get started, select a region on the map.

 
 
note start end timelineStart timelineEnd cat country region label description References
id1 1919   1919     GLOBAL ALL Methamphetamine first synthesized in Japan
Ephedra vulgaris
Crystal methamphetamine was first synthesized from ephedrine by pharmacologist Akira Ogata. Ephedrine had been isolayted from the plant Ephedra vulgaris earlier on, in 1893, by chemist Nagai Nagayoshi.
  • Ogata, A. (1919), ‘Constitution of ephedrine-desoxyephedrine’, Journal of the Pharmaceutical Society of Japan 451, pp. 751–764.
  • Zábranský, T. (2007), ‘Methamphetamine in the Czech Republic’, Journal of Drug Issues, Volume 37, Number 1, pp. 115–180.
id2 1920   1920     GLOBAL ALL Methamphetamine is patented The drug is patented and later on licensed to the pharmaceutical company Burroughs Wellcome.
  • Logan, B.K. (2002), ‘Methamphetamine: Effects on human performance and behavior’, Forensic Science Review 14 (1/2), January, pp. 133–151).
id3 1938   1938     GLOBAL ALL Methamphetamine is produced in Germany under the name ´Pervitin´
German Pervitin
The Berlin-based Temmler pharmaceutical company started production of methamphetamine under the brand name ‘Pervitin’.
  • Griffiths, P., Mravcik, V., Lopez, D. and Klempova, D. (2008), ‘Quite a lot of smoke but very limited fire: The use of methamphetamine in Europe’, Drug and Alcohol Review 27 (3), pp. 236–242.
id4 1940   1940     GLOBAL ALL Methamphetamine is marketed in the United States
Methedrine advertisement
Methamphetamine was first marketed in the United States by Burroughs Wellcome and Co. under the trade name Methedrine and by Abbott Laboratories under the trade name Desoxyn® in 1943.
  • Freeman, P., Talbert, J. (2012), ‘Impact of state laws regulating the pseudoephedrineon methamphetamine trafficking and abuse’, a report by the National Association of State Controlled Substances Authorities.
id5 1939 1945 1939     GLOBAL ALL Methamphetamine use by military forces in WWII
Japanese Philopon
During World War II, Pervitin was widely distributed to German troops to enhance performance and increase concentration became known in Germany as ‘Pilot’s chocolate’. On the Japanese front, from 1942 onwards methamphetamine was supplied to pilots and key war industries under the brand name ‘Philopon’. An estimated 200 million amphetamine and methamphetamine tablets were distributed to US troops during World War II, while an estimated 72 million amphetamine tablets were supplied to British soldiers.
  • ACMD (2005), ‘Methylamphetamine review’, a report by the Advisory Council on the Misuse of Drugs.
  • Tamura, M. (1989), Japan: Stimulant epidemics past and present, Bulletin on Narcotics 1, pp. 83–93
  • UNODC, 2003; Zábranský, 2007 UNODC (2003), Ecstasy and amphetamines global survey 2003, United Nations Office on Drugs and Crime, Vienna, http://www.unodc.org/pdf/publications/report_ats_2003-09-23.1.pdf
  • Zábranský, T. (2007), ‘Methamphetamine in the Czech Republic’, Journal of Drug Issues, Volume 37, Number 1, pp. 115–180.
id6 late 1940s   1947     GLOBAL ALL Legal production and use of methamphetamine in the general population
Desoxyn advertisement
Methamphetamine was initially legally manifactured and then prescribed by medical practitioners for a wide variety of disorders, including depression, attention deficit disorder, alcoholism, obesity and anorexia. There was widespread use, fuelled by the sale of the enormous war surplus, of amphetamine and methamphetamine in North America (notably in the United States), and methamphetamine in Asia (specifically Japan which was known in the population with the name 'shabu' ).
  • ACMD (2005), ‘Methylamphetamine review’, a report by the Advisory Council on the Misuse of Drugs.
  • Case, P. (2005), The history of methamphetamine: An epidemic in context, First National Conference on Methamphetamine, HIV and Hepatitis, The Harm Reduction Project, Salt Lake City, August.
  • NDLERF (2005), The governance of illicit synthetic drugs, Monograph 9, National Drug Law Enforcement Research Fund, Australia
  • Tamura, M. (1989), Japan: Stimulant epidemics past and present, Bulletin on Narcotics 1, pp. 83–93
  • UNODC, 2003; Zábranský, 2007 UNODC (2003), Ecstasy and amphetamines global survey 2003, United Nations Office on Drugs and Crime, Vienna, http://www.unodc.org/pdf/publications/report_ats_2003-09-23.1.pdf
  • Zábranský, T. (2007), ‘Methamphetamine in the Czech Republic’, Journal of Drug Issues, Volume 37, Number 1, pp. 115–180.
id7 1951   1951     GLOBAL ALL Stimulant Control Law in Japan
Police statistics, Japan
Stimulant abuse was criminalized with a very thorough implementation and consequent intensification of law enforcement efforts.
id8 1954   1954     GLOBAL ALL Height of the Japanese methamphetamine epidemic There are estimated to be over 2 million ex-users and  550.000 chronic stimulant users in a population of 88.5 million.
id9 1950s 1960s 1951     GLOBAL ALL Illicit sources of methamphetamine starts emerging worldwide Supply channels for methamphetamine reportedly took three forms: illegal distribution or diversion of domestically manufactured pharmaceutical products; illegal importation of products manufactured abroad; and illicit domestic manufacture. In some instances, pharmaceutical firms supplied such channels while in other cases criminal organisations became involved, such as Japanese gangsters in the 1950s and US biker gangs in the 1960s.
  • ACMD (2005), ‘Methylamphetamine review’, a report by the Advisory Council on the Misuse of Drugs.
  • Case, P. (2005), The history of methamphetamine: An epidemic in context, First National Conference on Methamphetamine, HIV and Hepatitis, The Harm Reduction Project, Salt Lake City, August.
  • ODCCP (2001), Global illicit drug trends 2001, ODCCP Studies on Drugs and Crime Statistics, United Nations Office for Drug Control and Crime Prevention, New York
  • Tamura, M. (1989), Japan: Stimulant epidemics past and present, Bulletin on Narcotics 1, pp. 83–93
id10 1960s   1963     GLOBAL ALL Methamphetamine diversion in the United Kingdom
Speed anthem 'Here comes the nice' by British Mod group Small Faces
Prescribed methamphetamine contained in ‘Methedrine’ brand capsules began to be diverted into the illegal market and widely known as "speed". In London an epidemic of intravenous methamphetamine use was recorded in 1968 and later that year a voluntary agreement was established on the part of the manufacturers with the Ministry of Health and British Medical Council to ban the sale of methamphetamine products from retail pharmacists.
id11 1964   1964     GLOBAL ALL Drugs (Prevention of Misuse) Act restricting (meth)amphetamine possession in the UK The Act introduced the offence of illegal possession of amphetamine-like drugs as well as importing them without  a license.
  • Leslie A. King (2003), The Misuse of Drugs Act: A Guide for Forensic Scientists
id12 1965   1965     GLOBAL ALL First restriction on (meth)amphetamine sales in the United States The Drug Abuse Control Amendments was the first direct prohibition of a drug decreed by the Federal Government. It referred to amphetamines, barbiturates and LSD (added in 1968) as "dangerous drugs" and allowed for the FDA to control them and other related drugs that may later be deemed a problem.
id13 1971   1971     GLOBAL ALL First international restriction under the United Nations Convention on Psychotropic Sunstances
UN Convention
Amphetamine and methamphetamine are listed in Schedule II of the United Nations Convention on Psychotropic Sunstances which contains ´Substances presenting a risk of abuse, posing a serious threat to public health which are of low or moderate therapeutic value´.
id14 1970s late 1980s 1970     GLOBAL ALL Methamphetamine use and illegal production in Czechoslovakia: kitchen labs and Pervitin In Czechoslovakia a simple formula for methamphetamine production, known locally as Pervitin, was rediscovered and  kitchen labs started emerging around the country. In what is now the Czech Republic, small closed groups of users organised around methamphetamine producers and by the late 1980s an estimated 25 000–30 000 users were dependent on pervitin. This figure is comparable to the most recent estimates of problem drug use in the Czech Republic.
  • EMCDDA (2010), ´Problem amphetamine and methamphetamine use in Europe´, Selected issue, Publications Office of the European Union, Luxembourg.
id15 1976   1976     GLOBAL ALL Amphetamine Decree in the Netherlands The Decree places amphetamine and methamphetamine under the Opium Act as illegal drugs, while prior to the decree they were sold as medicine. After this decree, methamphetamine users in Utrecht and Amsterdam turn to heroin.
  • EMCDDA (2010), ´Problem amphetamine and methamphetamine use in Europe´, Selected issue, Publications Office of the European Union, Luxembourg.
id16 1988   1988     GLOBAL ALL International control of methamphetamine precursors The United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988 placed under international control and listed in Table I all three methamphetamine precursors (ephedrine, pseudo-ephedrine and Benzyl Methyl Ketone). However the control regime applied to pharmaceutical preparations containing ephedrine and pseudo-ephedrine (e.g. cold remedies in tablet form) is not as strict.
id17 1996   1996     GLOBAL ALL US Congress passes the Methamphetamine Control Act The Act established new controls over key ingredients (it regulates mail orders and chemical companies selling precursor chemicals) and strengthening criminal penalties for possession, distribution and manufacturing.
id18 2001   2001     GLOBAL ALL Treatment for methamphetamine dependence: a Cochrane systematic review
The Cochrane collaboration
There are currently no particular pharmacological treatments for dependence on amphetamine or amphetamine-like drugs. The most effective treatments so far are psychosocial therapies, such as cognitive-behavioral and contingency-management interventions.
id19 2007   2007     GLOBAL ALL Methamphetamine legal status in Europe Of the European Union Member States countries, all except United Kingdom legally class both amphetamine and methamphetamine equally. Under United Kingdom law, amphetamine is in class B while, following reports of increased use and production, methamphetamine was moved in 2007 from class b to class A, the ´most harmful´ category.
  • EMCDDA (2010), ´Problem amphetamine and methamphetamine use in Europe´, Selected issue, Publications Office of the European Union, Luxembourg.
id20 2008 2009 2008 2009   GLOBAL ALL Control measures to prevent methamphetamine manifacturing in the UK and Czech Republic Following reports that methamphetamine was being illegally manufactured using pseudoephedrine and ephedrine contained in cold and flu remedies, the United Kingdom´s Medecines and Healthcare Products Regulatory Agency (MHRA) limited from 1 April 2008 over-the-counter sales of products containing these precursors. The Czech National Institute for Drug Control also changed from 1 May 2009 the marketing authorization, to restrict over-the-counter medicines containing pseudoephedrine.
  • EMCDDA (2010), ´Problem amphetamine and methamphetamine use in Europe´, Selected issue, Publications Office of the European Union, Luxembourg.
id21 2011   2010     GLOBAL ALL The supply chain: methamphetamine labs around the world
Methamphetamine precursors
Most methamphetamine laboratories continue to be reported by the United States, where their numbers quadrupled from 2,754 in 2010 to 11,116 in 2011. Mexico and Canada reported 159 and 35 laboratories respectively, both showing an upward trend compared with 2010. 350 laboratories were reported by countries in Europe, most of them by the Czech Republic, where 338 laboratories were identified. Clandestine manufacture is also taking place in Oceania, with 109 methamphetamine laboratories reported by New Zealand.
id22 2011   2011     GLOBAL ALL Increase in global seizures of methamphetamine worlwide
UNODC 'World Drug Report 2013'
The United Nations Office on Drugs and Crime declares that 2011 saw the highest level of law enforcement seizures of amphetamine-type stimulants in history. Seizures increased across all regions, with Asia, North America and Europe registering dramatic increases. The overall increase in ATS seizures is mainly due to surging methamphetamine seizures, which grew by 73 per cent from 51 tons in 2010 to 88 tons in 2011.
id23 1942   1942     DEU europe Methamphetamine tablets are controlled in Germany Methamphetamine tablets become controlled in Germany limiting the prescription. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id89 1938   1938     DEU europe Methamphetamine is produced in Germany under the name ´Pervitin´ The Berlin-based Temmler pharmaceutical company started production of methamphetamine under the brand name ‘Pervitin’. Griffiths, P., Mravcik, V., Lopez, D. and Klempova, D. (2008), ‘Quite a lot of smoke but very limited fire: The use of methamphetamine in Europe’, Drug and Alcohol Review 27 (3), pp. 236–242.
id24 1942   1942     JPN eastAsia Philipon available over the counter Philopon, an over-the-counter drug made available, with methamphetamine as a key ingredient. Lankov, A., and Kim, S. (2013), 'A new face of North Korean drug use: upsurge in methamphetamine abuse across the northern areas of North Korea', North Korean Review, 9(1), pp. 45-60.
id25 1980   1980     USA northAmerica Phenylacetone, a methamphetamine precursor, is regulated Phenylacetone (used in the manufacture of methamphetamine) is rescheduled in USA (Schedule II). Ling, W., Rawson, R., Shoptaw, S. and Ling, W. (2006), 'Management of methamphetamine abuse and dependence', Current Psychiatry Reports, 8(5), pp. 345-54.
id26 since 1980s   1980     SWE europe Methamphetamine appears on the market Methamphetamine appears sporadically in Swedish amphetamines market. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id28 after 1980   1981     USA northAmerica Methamphetamine produced with the use of ephedrine and pseudoephedrine Illicit manufacturers begin making methamphetamine using ephedrine and pseudoephedrine (large quantities of both smuggled from Mexico for use in 'super labs' in the southern Californian desert). Ling, W., Rawson, R., Shoptaw, S. and Ling, W. (2006), 'Management of methamphetamine abuse and dependence', Current Psychiatry Reports, 8(5), pp. 345-54.
id29 early 1990s   1990     POL europe Methamphetamine appears for the first time in Poland Methamphetamine appears for the first time in Poland. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id30 since early 1990s   1990     PHL southEastAsia 'Crystal methamphetamine 'shabu' is the most widely used drug The country is a major producer and an estimated 1.8 million people use the drug. Two decades later (2010), methamphetamine still ranks as the most common primary drug of use among those treated. Ahmad, K. (2003), 'Asia grapples with spreading amphetamine abuse', The Lancet, 361, pp. 1878-79.
id31 1991 1993 1991 1993   CHN eastAsia Increased number of methamphetamine-related deaths Sharp increase in methamphetamine use evident in a rise in methamphetamine-related fatalities across China. Shaw, K. (1999), 'Human methamphetamine-related fatalties in Taiwan during 1991-1996', Journal of Forensic Science, 44(1), pp. 27-31.
id32 1995   1995     USA northAmerica Increase in (meth)amphetamine-related emergencies Across the United States, (meth)amphetamine-related accident and emergency discharges increase by 54%. Gruenewald, P. J., Johnson, F. W., Ponicki, W. R., Remer, L. G. and Lascala, E. A. (2010), 'Assessing correlates of the growth and extent of methamphetamine abuse and dependence in California', Substance Use and Misuse., 45(12), pp. 1948-70.
id33 mid-1990s   1996     USA northAmerica Extensive methamphetamine use and related problems The epidemic is sustained by domesticly manufactured methamphetamine and 'ice' imported from Far Eastern sources into Hawaii and then the West Coast. The proliferation of methamphetamine use spreads geographically, beyond the Pacific Rim to eastern states, as well as in terms of target groups, from sub-cultures (e.g. rave and dance clubs) into more diverse settings (e.g. college bars, pubs, house parties, concerts). Ling, W., Rawson, R., Shoptaw, S. and Ling, W. (2006), 'Management of methamphetamine abuse and dependence', Current Psychiatry Reports, 8(5), pp. 345-54.
id27 since 1990s   1991     DEU europe Methamphetamine appears in recreational environments in Germany Methamphetamine appears in the recreational environments. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id34 1996   1996     CHN eastAsia The number of users in China doubles within 2 years Among all newly reported drug users in Hong Kong, the number of young (<21 years of age) users more than doubled (from 7.6 to 13.3%) between 1996 and 1998. It remained constant (10-12%) thereafter, possibly related to the increase in MDMA and ketamine. Joe-Laidler,K., Hodson, D., Traver, H. (2000) The Hong Kong Drug Market, Centre of Criminology, University of Hong Kong.
id35 mid-1990s   1994     MMR southEastAsia Increase in methamphetamine pills (yaba) manufacture and trafficking in the region In Myanmar, methamphetamine pills came to rival both opium and heroin as the most profitable product in the narcotics trafficking business. Established routes running through the Golden Triangle, which for centuries had been a commerce hub, were reported to serve increasingly for yaba trafficking in the region. Chouvy, P. A. and Meissonnier, J. (2011), Yaa Baa:  Production, trafficking and consumption of methamphetamine in mainland Southeast Asia, Singapore University Press.
id36 1995   1995     THA southEastAsia Treatment admissions rise sharply Treatment admissions for methamphetamine use increased from 1,211 to 19,253, displacing heroin as the drug of choice among new treatment entrants. Chaiyawong, A. (2013), 'Drug situation and drug information system in Thailand', in: Global workshop on drug information systems: activities, methods and future opportunities, United Nations International Drug Control Programme, Vienna.
id37 late-1990s   1998     THA southEastAsia 'Yaba' epidemic in Thailand Use of methamphetamine 'yaba' pills rose to epidemic proportions. Devaney, M., Reid, G., Baldwin, S. (2006), Situational analysis of illicit drug issues and responses in the Asia-Pacific Region, Australian National Council on Drugs, Canberra.
id38 2000 2010 2002 2005   ZAF southernAfrica Increase of clients in treatment for methamphetamine use Western Cape Province: proportion of treatment clients with methamphetamine as a primary drug of use increased (2000: <1%; 2010: 34%). Pluddemann, A., Parry, C., Bhana, A., Harker, N., Potgieter, H. and Gerber, W. (2010), 'Monitoring alcohol and drug abuse trends in South Africa (Phase 27)', SACENDU Research Briefing, 9, pp. 291-300.
id39 2000 2001 2000 2001   AUS australAsia Methampetamine seizures Methamphetamine comprises 91% of amphetamines seizures. Degenhardt, L., Roxburgh, A., Black, E., Bruno, R., Campbell, G., Kinner, E., and Fetherston, J. (2008), 'The epidemiology of methamphetamine use and harm in Australia', Drug and Alcohol Review, 27, pp. 243-52.
id40 2000 2001 2000 2001   ALL southEastAsia Epidemic peaks Methamphetamine epidemic identified as having peaked in the region. McKetin, R., Kozel, N., Douglas, J., Ali, R., Vicknasingam, B., Lund, J., Li, J-L. (2008), 'The rise of methamphetamine in Southeast and East Asia', Drug and Alcohol Review, 27(3), pp. 220-28.
id41 2000s   2000     ALL Europe Increased prevalence in the Nordic countries Methamphetamine gradually takes over an increasing proportion of amphetamines in the Nordic countries Norway and Sweden, with some evidence from Finland and the Baltics, especially Latvia. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id42 mid-2000s   2004 2006   CZE europe Spread into high-risk drug using scene Methamphetamine spreads into the high-risk drug using scene in the Czech Republic and Slovakia. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id43 early-2000s   2000     IRN westernAsia Increased availability and use of methamphetamine due to domestic manufacture Methamphetamine enters the country from Southeast Asia. Domestic manufacture contributes to increased availability and uptake among young people. Shariatirad, S., Maarefvand, M. and Ekhtiari, H. (2013), 'Emergence of a methamphetamine crisis in Iran', Drug and Alcohol Review, 32(2), pp. 223-24.
id44 early-2000s   2000     USA northAmerica Continued methamphetamine epidemic In San Diego, drug treatment admissions for primary methamphetamine use increase from 37% in 2001 to 49% in 2005. In addition, methamphetamine-related deaths show a 48% increase between 2001 and 2005. In San Francisco, recent methamphetamine injection (i.e. injections in the past 30 days) peaks at 60%. Pollini, R. A., and Strathdee,  S. A. (2007), 'Indicators of methamphetamine use and abuse in San Diego County, California: 2001-2005', Journal of Psychoactive Drugs, Supplement 4, pp. 319-25.
id45 early 2000s   2000     ZAF southernAfrica Methamphetamine first appears in the country Methamphetamine, 'tik', is introduced through gang culture. Pluddemann, A., Dada,  S., Parry, C., Kader, R., Parker, J., Temmingh, H., van Heerden, S., Clercq, C. and Lewis, I. (2013), 'Monitoring the prevalence of methamphetamine-related presentations at psychiatric hospitals in Cape Town, South Africa', African Journal of Psychiatry, 5, pp. 45-9.
id46 since 2000s   2001     SVK europe Spread into recreational drug scene Methamphetamine spreads into recreational drug scenes in Slovakia and the Czech Republic. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id47 2002 2003 2002 2003   MMR southEastAsia Increase in methamphetamine use Increase in methamphetamine use, particularly among young people, although the overall level of drug use is low compared with neighbouring countries. UNODC (2013), Transnational organised crime threat assessment, United Nations Office on Drugs and Crime, Vienna.
id48 2004 2007 2004 2007   CHN eastAsia Levels of methamphetamine use almost reaching those of heroin use Considerable increase among registered methamphetamine users across China, in some regions approaching levels of heroin use among entrenched drug users (heroin: 46%, Bingdu (methamphetamine): 32%). Huang, K., Zhang, L. and Lui, J. (2011), 'Drug problems in contemporary China: a profile of Chinese drug users in a metropolitan area', International Journal of Drug Policy, 22, pp. 128-32.
id49 since 2004   2004     PHL southEastAsia The primary drug for the majority of treatment clients is methamphetamine Methamphetamine users have accounted for almost 63% of the persons receiving drug treatment. UNODC (2013), Patterns and trends of amphetamine-type stimulants and other drugs: challenges for Asia and the Pacific, United Nations Office on Drugs and Crime, Global SMART Programme, Vienna.
id50 since 2004   2008     NZL australAsia Increase in methamphetamine-related convictions Methamphetamine (locally known as 'P') related convictions are on the rise (2004: 1 167 convictions; 2008: 2 058 convictions; 2009: 2 435 convictions). UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id51 2005 2006 2005 2006   CAN northAmerica High rate of admissions to treatment with methamphetamine as the primary drug About 20% of all youth admissions to residential drug treatment are due to primary methamphetamine use. Callaghan, R. C., Tavares, J., Taylor, L. and Veldhuizen, S. (2007), 'A national survey of primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005 to 2006', Canadian Journal of Psychiatry, 52(10), pp. 684-88.
id52 2005   2005     LAO southEastAsia Increased methamphetamine use along trafficking routes Methamphetamine use escalates along trafficking routes adjacent to the Mekong River (reported by government authorities). UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id53 mid-to late-2000s   2006     IDN southEastAsia Increased availability and use of crystal methaphetamine Availability and use of crystal methaphetamine increases. By 2010 crystal methamphetamine surpasses cannabis as the primary drug of use in the country. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id54 early 2000s   2002     PRK eastAsia Manufacture of methamphetamine for illicit export and military use Methamphetamine is manufactured at state-run pharmaceutical plants for illicit export and restricted military use. Lankov, A., and Kim, S. (2013), 'A new face of North Korean drug use: upsurge in methamphetamine abuse across the northern areas of North Korea', North Korean Review, 9(1), pp. 45-60.
id55 around mid-2000s   2005     KOR eastAsia Peak in availability and use of crystal methamphetamine Availability and use of crystal methamphetamine (commonly known locally as 'philopon' or 'hiroppon') peaks. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id56 2008   2008     THA southEastAsia Use of methamphetamine in the country shows no signs of decline The use of methamphetamine pills (yaba) and crystalline methamphetamine shows an upward trend since 2008. There are around 600 000 methamphetamine users, the majority of whom appeared to consume yaba. The most popular method of use is by smoking crushed yaba tablets from either a tin foil lining from a cigarette pack or specially formulated bamboo straws. UNODC (2013), Transnational organised crime threat assessment, United Nations Office on Drugs and Crime, Vienna.
Chomchai, C., and Manaboriboon, B. (2012),' Stimulant methamphetamine and dextromethorphan use among Thai adolescents: implications for health of women and children', Journal of Medical Toxicology, 8(3), pp. 291-94.
id57 2000   2000     JPN eastAsia Methamphetamine arrests in Japan About 80% of all drug-related arrests in the country have involved methamphetamine. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id58 2010   2010     KHM southEastAsia The majority of drug users consume methamphetamine Users of methamphetamine in both pill and crystalline form account for about 70% of all illicit drug users. Methamphetamine is ranked as the most common primary drug of use among those treated. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id59 2009   2009     LAO southEastAsia Methamphetamine is the most common primary drug among treatment clients Prevalence of methamphetamine use in the coutry is estimated to be around 40 000 yaba users  (although surveys rarely differantiate between pills and crystal meth) and methamphetamine is the most common primary drug of use among those treated. UNODC (2013), Patterns and trends of amphetamine-type stimulants and other drugs: challenges for Asia and the Pacific, Global SMART Programme, United Nations Office on Drugs and Crime, Vienna.
id60 2009   2009     NZL australAsia Seizures peak in the country Peak in seizures, almost 5.4 million pills are seized. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id61 2007   2007     MYS southEastAsia Rise of crystal methamphetamine seizures Crystal methamphetamine seizures increase ten-fold from 2007 to 679 kg and increase by another 70% in 2009 to 1 160kg. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id62 2008   2008     GEO westernAsia Rise of methamphetamine treatment clients An increase is noted in the number of patients attending addictions clinics with methamphetamine as primary drug. Javakhisvili, J., Sturau, L., Otiashvili, D., Kirtadze, I., Zabransky, T. (2011), Drug situation in Georgia, 2010 Overview, Tbilisi.
id63 2009   2009     USA northAmerica Methamphetamine diversion Methamphetamine comprises 85.3% of all stimulants identified for diversion by federal, state and local forensic labs (while amphetamine only 3.6%). Maxwell, J.C. and Brecht, M-L. (2011), 'Methamphetamine: here we go again?' Addictive Behaviors, 36(12), pp. 1168-73.
id64 2010   2010     THA southEastAsia Methamphetamine pills as primary drug for patients in treatment More than 80% of all persons who received drug treatment in specialised treatment facilities and correctional institutions report methamphetamine pills as the primary drug of use. UNODC (2011), Amphetamines and ecstasy, 2011 Global ATS Assessment, United Nations Office on Drugs and Crime, Vienna.
id65 2010 2011 2010 2011   DEU europe Increased prevalence and related harms Increase of methamphetamine use and related harms (particularly in Saxony and Bavaria). EMCDDA (2014), Exploring methamphetamine trends in Europe, EMCDDA Paper, Publications Office of the European Union, Luxembourg.
id66 2011   2011     GRC europe Increased methamphetamine prevalence in Greece Sharp increase of 'sisa' (methamphetamine) in the open drug scenes of downtown Athens. EMCDDA (2013), SISA, Greek Documentation and Monitoring Centre for Drugs — Greek Reitox Focal Point of the EMCDDA.
id67 2013   2013     IRN westernAsia Increased methamphetamine use Rising incidence of methamphetamine use among methadone maintenance patients and people who inject drugs. Shariatirad, S., Maarefvand, M., and Ekhtiari, H. (2013), 'Methamphetamine use and methadone maintenance treatment: an emerging problem in the drug addiction treatment network in Iran', International Journal of Drug Policy, 24(6), 115-16.
id68 2009   2009     westafrica Africa Methamphetamine started being produced in West Africa From mid-2009, high-purity crystalline methamphetamine originating in various West African countries starts being seized in East Asia, with Japan, Malaysia, the Republic of Korea and Thailand being some of the main destination countries. UNODC (2013), World Drug Report 2013, United Nations Office on Drugs and Crime, Vienna.
id69 2013   2013     westafrica Africa Emerging methamphetamine trafficking route in West Africa UNODC highlights increasing diversions of precursors, seizures and methamphetamine manufacture in this region. UNODC (2013), World Drug Report 2013, United Nations Office on Drugs and Crime, Vienna.
id70 2011   2011     NGA Africa Methamphetamine manufacture in Nigeria In July 2011, Nigeria becomes the first, and so far only, country in West Africa to officially report illicit methamphetamine manufacture. UNODC (2013), World Drug Report 2013, United Nations Office on Drugs and Crime, Vienna.
id71 2011   2011     ALL northAmerica Most of the world’s methamphetamine seizures are reported in North America The highest methamphetamine seizures are reported by Mexico, where they more than doubled, from 13 tonnes to 31 tonnes in 2011, and surpassed for the first time those of the United States, which seized 23 tonnes in 2011 (up from 15 tonnes in 2010). UNODC (2013), World Drug Report 2013, United Nations Office on Drugs and Crime, Vienna.
id72 2006   2006     AUS australAsia Rise in crystal methamphetamine smoking among regular ecstasy users Substantial increase in methamphetamine smoking among regular ecstasy users - with smokers more likely to be male and more likely to identify themselves as gay, lesbian or bisexual than other methamphetamine users. Kener, S.A. and Degenhardt, L. (2008), 'Crystal methamphetamine smoking among regular ecstasy users in Australia: increases in use and associations with harm', Drug and Alcohol Review, 27, pp. 292-300.
id73 2003 2007 2003 2007   AUS australAsia Increase in weight of methamphetamine seizures Steady increase in the weight of crystal methamphetamine is detected at the Australian border; also an increase is reported in the number of precursor chemical seizures (i.e. ephedrine and pseudoephedrine) for the production of meth/amphetamine (from 404  in 2003/04 to 526 in 2006/07), and the number of clandestine methamaphetamine laboratory detected across Australia. Degenhardt, L., Roxburgh, A., Black, A. et al. (2008), 'The epidemiology of methamphetamine use and harm in Australia', Drug and Alcohol Review, 27, pp. 243-52.
id74 late-1980s   1988     USA northAmerica Implementation of ephedrine/pseudoephedrine control The United States implements ephedrine/pseudoephedrine import, domestic distribution, and export controls beginning in the late 1980s. Cunningham, J. K., and Lium L-M. (2003), 'Impact of federal ephedrine and pseudoephedrine regulations on methamphetamine related hospital admissions', Addiction 98, pp. 1229-37.
Cunningham, J.K. and Liu, L-M. (2005), 'Impact of federal precursor chemical regulations on methamphetamine arrests', Addiction 100, pp. 479-88.
id75 early 2000s   2002     CAN northAmerica Implementation of ephedrine/pseudoephedrine control Canada implements import, domestic distribution and export ephedrine/pseudoephedrine controls in the early 2000s. Callaghan, R.C., Cunningham, J.K., Victor, J.C., Liu, L-M. (2009), 'Impact of Canadian federal methamphetamine precursor and essential chemical regulations on methamphetamine-related acute-care hospital admission', Drug and Alcohol Dependence, 105, pp. 185-93.
id76 2005 2008 2005     MEX northAmerica Ephedrine/pseudoephedrine restrictions in Mexico In 2005, Mexico begins the progressive implementation of increasing restrictions on the import of ephedrine/pseudoephedrine. In 2007, the Government of Mexico announces a prohibition on the methamphetamine chemicals imports into Mexico for 2008 and a ban on the use of the two chemicals in Mexico by 2009. (Mexico does not manufacture ephedrine/pseudoephedrine and thus must import it.) NDIC (National Drug Intelligence Center), (2010),  National Threat Assessment 2010, US Department of Justice, Washington DC.
id77 2007   2007     USA northAmerica Decline in methamphetamine in the US As a result of precurspor chemical (ephedrine/pseudoephedrine) restrictions, methamphetamine manufacture declines in Mexico in 2007 and early 2008, and consequent drug availability indicators decrease in the United States. Cunningham, J., Maxwell, J., Campollo, O., et al. (2013), 'Mexico's precursor chemical controls: evidence of less potent types of methamphetamine in the United States', Drug and Alcohol Dependence, 129(1-2), pp. 125-36.
id78 2009   2009     MEX northAmerica Upsurge in methamphetamine manufacture in Mexico using the 1-phenyl-2-propanone (P2P) method Limited access to ephedrine/pseudoephedrine has prompted methamphetamine manufacturers in Mexico to increasingly use non-ephedrine-based methamphetamine manufacture methods.  According to the United States federal law enforcement agency at the U.S. Department of Justice, Mexican drug trafficking organisations conduct large-scale nonephedrine-based production operations in Mexico, particularly using the P2P method. As a result, by late-2008-early-2009 methamphetamine availability indicators began increasing reaching by 2013 pre-ephedrine/pseudoephedrine control levels. NDIC (2010) National Drug Intelligence Center. National Threat Assessment 2010. US Department of Justice, Washington, DC; Maxwell, J. (2013) Exibits for the Testimony of Jane Carlisle Maxwell, Ph.D. to the Committee on Science, Space, and Technology, September 18, 2013.
id79 late 1990s   1997 1999   AUS australAsia A shift from amphetamine to methamphetamine for domestic manufacture A shift from amphetamine to methamphetamine for domestic manufacture is evidenced by increased number of clandestine methamphetamine laboratories detected in Australia. McKetin, R., McLaren, J. and Kelly, E. (2005), The Sydney methamphetamine market: Patterns of supply, use, personal harms and social consequences, Monograph Series No. 13, National Drug Law Enforcement Research Fund, Canberra.
id80 late 1990s   1997     AUS australAsia Emergence of import of crystal methamphetamine from Asia The import of crystal methamphetamine in Australia from Asia starts in the late 1990s although large-scale shipments did not occur until 2000/2001). This coincides with the advent of smoking 'ice'. Large-scale shipments of crystal methamphetamine detected at the Australian border appear to be very similar in their characteristics to previously detected large-scale heroin importations, and have involved criminal networks traditionally involved in heroin import.  The majority of these shipments originate from China, although there are also smaller-scale import operations related to other parts of Southeast Asia (e.g. Vietnam, Cambodia, and Laos PDR). McKetin, R., McLaren, J. and Kelly, E. (2005), The Sydney methamphetamine market: Patterns of supply, use, personal harms and social consequences, Monograph Series No. 13, National Drug Law Enforcement Research Fund, Canberra.
id81 late 1990s   1999     AUS australAsia Methamphetamine content of ecstasy tablets The trend of ecstasy tablets containing methamphetamine starts some time in the late 1990s and is most apparent in the early 2000s. Regular methamphetamine users would often know that ecstasy tablets they purchased contained methamphetamine. The tablets appeared to be absorbed within the ecstasy market, rather than being marketed or consumed as a recognised form of methamphetamine. McKetin, R., McLaren, J. and Kelly, E. (2005), The Sydney methamphetamine market: Patterns of supply, use, personal harms and social consequences, Monograph Series No. 13, National Drug Law Enforcement Research Fund, Canberra.
id82 late 1990s   1998 2001   AUS australAsia An increase in both the availability and use of methamphetamine (particularly crystal methamphetamine ('ice'/'shabu'/'crystal meth')  detected and documented in Australia In 1998, methamphetamine had reportedly no presence among injecting drug users in Australia. By 2001, the use of 'ice' among current methamphetamine injecting drug users (defined as those who had used methamphetamine in the preceeding 6 months) has risen from 0% (in 1998) to 58% (in 2001). The amount of crystal methamphetamine detected at the Australian border by the Australian Customs Service increased dramatically between 1997/98 and 2000/01, from less than 1 kg to more than 83 kg. Topp, L., Degenhardt, L., Kaye, S. and Darke, S. (2002), The emergence of potent forms of methamphetamine in Sydney, Australia: a case study of the IDRS as a strategic early warning system.
id83 1991   1991     AUS australAsia Regulation of precursors The import of precursor drugs used in the manufacture of methampetamine (i.e. pseudo/ephedrine, P2P) has been controlled since 1991 (Customs [Prohibited Imports] Regulations 1956, 10 Sept 1991). In 1999, criminal offences were introduced for the illegal import of these substances with a maximum of five years imprisonment and a fine. McKetin, R., McLaren, J. and Kelly, E. (2005), The Sydney methamphetamine market: Patterns of supply, use, personal harms and social consequences, Monograph Series No. 13, National Drug Law Enforcement Research Fund, Canberra.
id84 1960s   1963     GBR europe Methamphetamine diversion in the United Kingdom Prescribed methamphetamine contained in ‘Methedrine’ brand capsules begins to be diverted into the illegal market and widely known as 'speed'. In London, an epidemic of intravenous methamphetamine use was recorded in 1968 and later that year a voluntary agreement was established on the part of the manufacturers with the Ministry of Health and British Medical Council to ban the sale of methamphetamine products from retail pharmacists. ACMD (2005), Methylamphetamine review, a report by the Advisory Council on the Misuse of Drugs.
id85 1964   1964     GBR europe Drugs (Prevention of Misuse) Act restricting (meth)amphetamine possession in the United Kingdom The Act introduces the offence of illegal possession of amphetamine-like drugs as well as importing them without  a licence.  King, L. (2003), The Misuse of Drugs Act: a Guide for Forensic Scientists, RSC Publishing.
id86  2008 2009 2008 2009   GBR europe Control measures to prevent methamphetamine manufacturing in the UK Following reports that methamphetamine was being illegally manufactured using pseudoephedrine and ephedrine contained in cold and flu remedies, the United Kingdom´s Medecines and Healthcare Products Regulatory Agency (MHRA) limited from 1 April 2008 over-the-counter sales of products containing these precursors.  MHRA (Medicines and Healthcare Products Regulatory Agency) (2008), Information update: implementation date announced for tighter controls on nasal congestants.
id87 1970s late 1980s 1970     CZE europe Methamphetamine use and illegal manufacturing in Czechoslovakia: kitchen labs and Pervitin In Czechoslovakia, a simple formula for methamphetamine (locally known as pervitin) manufacture is rediscovered and kitchen labs start emerging around the country. In what is now the Czech Republic, small closed groups of users were organised around methamphetamine manufacturers and by the late 1980s an estimated 25 000–30 000 users were dependent on pervitin. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id88 2009   2009     CZE europe Control measures to prevent the manufacturing of methamphetamine in the Czech Republic From 1 May 2009, the Czech National Institute for Drug Control changes  the marketing authorisation to restrict over-the-counter medicines containing pseudoephedrine. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id90 1976   1976     NLD europe Amphetamine Decree in the Netherlands The Decree places amphetamine and methamphetamine under the Opium Act as illegal drugs, while prior to the decree they were sold as medicine. After this decree, methamphetamine users in Utrecht and Amsterdam turn to heroin. EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue 2010, Publications Office of the European Union, Luxembourg.
id91 1940   1940     USA northAmerica Methamphetamine is marketed in the United States Methamphetamine was first marketed in the United States by Burroughs Wellcome and Co. under the trade name Methedrine and by Abbott Laboratories under the trade name Desoxyn® in 1943. Freeman, P., Talbert, J. (2012), ‘Impact of state laws regulating the pseudoephedrineon methamphetamine trafficking and abuse’, a report by the National Association of State Controlled Substances Authorities.
id92 1965   1965     USA northAmerica First restriction on (meth)amphetamine sales in the United States The Drug Abuse Control Amendments was the first direct prohibition of a drug decreed by the Federal Government. It referred to amphetamines, barbiturates and LSD (added in 1968) as "dangerous drugs" and allowed for the FDA to control them and other related drugs that may later be deemed a problem. Food and Drug Administration
id93 1996   1996     USA northAmerica US Congress passes the Methamphetamine Control Act The Act established new controls over key ingredients (it regulates mail orders and chemical companies selling precursor chemicals) and strengthening criminal penalties for possession, distribution and manufacturing. Methamphetamine Control Act
id94 1951   1951     JPN eastAsia Stimulant Control Law in Japan Stimulant abuse was criminalized with a very thorough implementation and consequent intensification of law enforcement efforts. Tamura, M. (1989), Japan: Stimulant epidemics past and present, Bulletin on Narcotics 1, pp. 83–93.
id95 1954   1954     JPN eastAsia Height of the Japanese methamphetamine epidemic There are estimated to be over 2 million ex-users and  550.000 chronic stimulant users in a population of 88.5 million. Tamura, M. (1989), Japan: Stimulant epidemics past and present, Bulletin on Narcotics 1, pp. 83–93.

 

3. Terms and definitions

Acute adverse effects

Acute methamphetamine intoxication or overdose can lead to severe hyperthermia, renal failure and heart attacks (Lan et al., 1998).

As stimulant effects dissipate, users may experience drowsiness, reduced ability to concentrate and/or impaired judgment and learning (Meredith et al., 2005).

Personality issues and changes commonly experienced are low mood, anxiety, depression, irritability, aggression (Meredith et al., 2005).

Acute paranoid psychosis (psychotic reaction similar to acute paranoid schizophrenia) may develop after single or repeated use of methamphetamine; people with underlying mental health problems are at greatest risk (Chen et al., 2003; Grant et al., 2012).

Chronic adverse effects

Chronic use changes the brain — tolerance develops, leading users to take higher doses.

Smoking methamphetamine can lead to lung complaints including pulmonary hypertension or oedema (fluid retention) (Thompson, 2008).

The skin and the mouth can be affected — teeth and gums decay rapidly due to the acidic nature of the drug and poor dental hygiene (known as ‘meth mouth’) (Hamamoto and Rhodus, 2009).

Sources

www.talktofrank.com/drug/methamphetamine

4. Forms of methamphetamine

crystal methamphetamine

Methamphetamine exists in two optical isomeric forms, d and l. Both are psychoactive, having stimulant effects, however, the d-form is more potent and longer-lasting than the l-form. Illicit methamphetamine in Europe is normally a mixture of both d- and l-forms.

D- and l-methamphetamine can come in two physical forms, base and salt. The pure base is a clear, colourless volatile oil, insoluble in water, which can be easily converted into methamphetamine hydrochloride (the most prominent salt form).

On the illicit drug market, methamphetamine is sold as a crystalline solid or powder. The crystalline solid is often called ‘ice’ or ‘crystal meth’ due to its appearance. ‘Ice’ is suitable for smoking as high-purity methamphetamine hydrochloride can be vaporised without thermal decomposition. In powder methamphetamine, granules of the salt are mixed with other ingredients (e.g. lactose, dextrose, caffeine); the proportion of methamphetamine to the other ingredients determines the purity.

Powder methamphetamine found on the illicit drugs market is similar to powder amphetamine in many ways, including in its purity and appearance, and the two are often indistinguishable to both users and dealers. Powder methamphetamine tends to be administered in the same way as amphetamine powder — either inhaled intra-nasally (snorted) or dissolved and injected.

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Further reading

POD_Methamphetamines
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Page last updated: Tuesday, 27 May 2014