Is Meth on the Rise Again?

“When I took those off-white crushed shards up that blue, cut plastic straw—well, my whole world pretty much changed after that. There was a feeling like — my God, this is what I’ve been missing my entire life. It completed me. I felt whole for the first time.” These are the words of Nic Sheff describing his experience with methamphetamine in his autobiography, Tweak.

Known by street names like speed, ice, biker’s coffee, tweak or crystal, methamphetamine — or meth for short — is made in a home or lab. It comes in a white powder or pill form and is bitter-tasting. The form that Nic describes is crystal methamphetamine and looks like glass fragments or shiny, bluish-white rocks. It is a stimulant like caffeine and cocaine, although far more powerful.

In February 2024, USA Today ran a story, “America’s addiction crisis: It’s not just fentanyl. These drugs play a growing role”, referring to methamphetamine. Government actions in 2006 restricted access to pseudoephedrine, a key ingredient used in making meth, resulting in a temporary decline in use. However, meth is on the rise again, largely smuggled in from Mexico. Its purity has been steadily climbing and is now well above 90 percent. It’s also cheap, at $5 or less per hit.

According to the Drug Enforcement Agency’s 2024 threat assessment, meth and other lab-made substances were responsible for 30% of the nearly 108,000 lives lost in 2022. Often meth is showing up in pill form made to look like prescription Adderall or in plain white pills as a fake generic. They can also appear in the colors and logos linked to MDMA.  These fake pills may be attractive to people who are willing to misuse prescription medications as opposed to dealing directly with illegal substances.

There is also the concern that meth is being combined with fentanyl, a highly potent opioid, which has been a major driver of overdose deaths in the U.S.

Like other stimulants, meth increases wakefulness, focus and physical activity. Other effects include faster breathing, a rapid or irregular heartbeat, increased blood pressure and body temperature. Medicinally, it can be used to treat ADHD, narcolepsy and obesity — although due to its side effects, other medications are usually preferred. It’s important to note that when used as medicine, the dosage is much lower than what is typically used illicitly.

Meth produces a sense of well-being and bliss that, at least initially, is beyond the impact of any other substance. It dramatically elevates dopamine, a chemical messenger associated with the brain’s pleasure and reward system. If “normal” dopamine functioning is around 100 units, meth spikes it to 1250 units, well above the pleasure derived from food, sex, alcohol and cocaine. People who use meth report being high for periods of 8 to 12 hours from one hit. Often people engage in a binge and crash cycle, staying up for days or weeks using meth, and then crashing.

Meth can be swallowed, smoked, snorted or injected. Paraphernalia associated with meth use are pipes, needles, crumpled foil, spoons, straws and broken light bulbs. Physical signs of use include heavy sweating as body temperature is elevated, dilated pupils, body odor that smells like ammonia, and burn marks on fingers and mouth. Often a person’s physical appearance deteriorates, especially from skin and/or hair picking, weight loss and dental decay, also referred to as “meth mouth.”

It can also produce significant changes in behavior. People engaged in meth use often stay up for days and then crash. Other signs of use include angry outbursts and mood swings, paranoia with concerns about being watched, and tweaking. “Tweaking” refers to engaging in frantic and compulsive behaviors for hours on end, often feeling hypersensitive, irritable and impulsive. Common tweaking behaviors include repetitively picking at one’s face or arms, obsessive cleaning, or taking things apart for no apparent reason.

Meth has also earned a reputation among some people as significantly enhancing sexual activity by heightening arousal and increasing stamina. That said, impotence can be a common side effect of longer-term use, as well as a sense that sex is no longer enjoyable if one isn’t using meth as part of the experience. Lowered inhibitions can lead to unprotected sex, increasing the risk of transmitting HIV.

Loved ones may also join online meth communities using social media platforms like Twitter, Facebook and Reddit or digital communication tools including Zoom to connect.  The online forums are used to buy and sell meth, post photos and videos of use and share meth-related content. In some cases, online conversations are in support of abstinence.

It’s important to intervene early if your loved one is using meth, due to the short-term and long-term effects of the drug.

Continued use of meth appears to impact multiple areas of the brain, including the ability to experience pleasure, remember events, learn and perform basic verbal tasks, motor skills and judgment. It can also lead to the development of a substance use disorder.

A person using meth experiencing high blood pressure, accelerated heart rate, elevated body temperature, changes in breathing, anger or aggression, and paranoia may be experiencing an overdose. A meth overdose can result in a stroke, heart attack, organ failure or death. Factors that can contribute to an overdose can be taking more meth than a person is used to, combining it with other substances (i.e. “speedballing” — using meth and opioids like heroin, but also combining with alcohol, benzodiazepines, etc.) and/or having other health problems while using meth.

A meth overdose requires immediate emergency treatment. It’s important to note that naloxone (i.e. Narcan) will not reverse a meth overdose, but can help if a loved one is exposed to opioids. Some people also believe that taking a sedative of some kind to offset meth’s stimulant effects can be helpful, but this is an extremely dangerous practice that places even more stress on the body.

Withdrawal from meth can result in anxiety, fatigue from disrupted sleep patterns, severe depression, psychosis, excessive appetite and intense drug cravings. The intensity of withdrawal symptoms is one reason given as to why people using meth don’t seek treatment, and continue to use the substance.

As David Sheff, author of Beautiful Boy, writes after meeting with Dr. Edythe London of UCLA, “…meth addicts may be unable, not unwilling, to participate in common treatments, at least in the early stages of withdrawal. Rather than a moral failure or a lack of willpower, dropping out and relapsing may be the result of a damaged brain.” (Sheff 2008, p.135.)

Unlike opioids and alcohol, there are no medications approved by the Food and Drug Administration (FDA) to reduce withdrawal symptoms and manage cravings. That said, some medications prescribed “off label” have demonstrated promise such as bupropion, with and without naltrexone. Topiramate has also provided benefit in reducing the amount of meth use in some research studies. Most often treatment includes behavioral therapies like cognitive behavioral therapy, Contingency Management and the “Matrix Model,” in addition to vitamins, antipsychotics and antidepressants.

In a recent study, the use of “Methamphetamine Assist Packs” was helpful for people seen in an emergency room for psychosis. The pack includes an antipsychotic medication called olanzapine with dosing instructions and referral information. Use of the packs resulted in fewer emergency room visits over the next several months.

In an article published in JAMA Psychiatry, researchers report the use of transcranial magnetic stimulation as promising in treating withdrawal symptoms; however, more studies are needed to confirm its effectiveness. There are also various drugs in development to address cravings and memories associated with meth use although they won’t be available commercially until clinical trials are completed.

Recovery from meth takes time. Brain imaging studies have indicated that it may take two years or more to recover from meth use, and some damage (i.e. related to a stroke) can be permanent. Getting a loved one to a reputable treatment program, whether outpatient or inpatient and supporting recovery, is crucial.

If someone you love is not ready to consider more formal treatment or if waitlists are encountered, there are strategies to reduce the risks associated with meth, especially for IV use.  Using clean needles, having naloxone on hand and using the Brave app or Never Use Alone Service to alert help if there is a suspected overdose can help.  Learn more about harm reduction here.

Other resources to better understand meth are listed below:

The Meth Project
The Meth Project is a large-scale prevention program aimed at reducing Meth use through public service messaging, public policy, and community outreach.

National Institute on Drug Abuse
NIDA’s mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health.

PBS’s Frontline on Meth
An investigation into how and why meth use spiraled out of control and became the fastest-growing drug abuse problem in America.

The Harm Reduction Coalition
Harm Reduction Coalition was founded in 1993 by a working group of needle exchange providers, advocates and drug users, and today is strengthened by an extensive and diverse network of allies who challenge the persistent stigma faced by people who use drugs and advocate for policy and public health reform.

Breaking the Ice in Our Community
A fact sheet providing information on harm reduction for people who use methamphetamine.