Methamphetamine use disorder

Methamphetamine is a central nervous system stimulant that blocks uptake and increases release of noradrenaline, serotonin, and dopamine, causing euphoria, wakefulness, and increased attention (1,2):

• the neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neuro- and excitotoxicity, and neuroinflammation

Illicitly manufactured methamphetamine, sold in crystal or powder forms, is usually smoked. Less common routes are injection (<25%), snorting, oral ingestion, and rectal insertion (1).

Clinical presentation

• acute behavioral effects of methamphetamine include:
  • increased energy and alertness,
  • decreased need for sleep,
  • euphoria,
  • increased sexuality,
  • excessive talking,
  • weight loss,
  • sweating,
  • tightened jaw muscles,
  • grinding teeth
  • loss of appetite

Symptoms exacerbated by methamphetamine can be divided into three factors:

• (1) positive psychotic symptoms such as suspiciousness, unusual thought content, hallucinations, and bizarre behavior;
• 2) affective symptoms including depression, suicidality, guilt, hostility, somatic concern, and self-neglect;
• (3) psychomotor symptoms, such as tension, excitement, distractibility, and motor hyperactivity

The transition from casual to compulsive methamphetamine use can be rapid and some have reported that it takes on average about 50 days from the onset of drug use to the first drug craving, 60 days to regular use, and 85 days to compulsive use (2).

Note that most methamphetamine-associated psychoses are brief lasting hours to days, in some cases psychotic episodes may persist for longer than 6 months and can reoccur during periods of abstinence from the drug (2).

Management (2):

• are no pharmacological treatments for methamphetamine use disorder
• cognitive behavioral therapy, behavioral activation and contingency management show modest efficacy

Reference:

1. Leyde S, Tilhou AS, Tsui JI. Methamphetamine Use Disorder. JAMA. Published online September 03, 2025
2. Paulus MP, Stewart JL. Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review. JAMA Psychiatry. 2020 Sep 1;77(9):959-966