- Consultant psychiatrist notes health, legal, and social issues associated with crystal meth addiction
Despite the detrimental impacts of using methamphetamine for recreational purposes, it is misused due to its stimulant properties and euphoric effects. In Sri Lanka, the use of crystal methamphetamine (a form of methamphetamine commonly known as “ice”) is increasing rapidly due to several reasons including its low cost compared to other drugs. Dealing with this worsening menace requires a multifaceted approach, as it is a matter of not only the production or sale of “ice”, but also addiction, which is a health and social issue.
The soaring use of “ice” in Sri Lanka and the various forms of threats that it poses were addressed recently during a discussion organised by mental health services provider Sri Lanka Sumithrayo. An instalment of a series of discussions on mental health organised for World Mental Health Day 2023, the discussion was led by consultant psychiatrist and University of Kelaniya’s Faculty of Medicine Senior Lecturer Dr. Chamara Wijesinghe. During the discussion, he emphasised that remedying this situation should receive urgent attention, as it has resulted in various health, legal, and social issues.
What is methamphetamine?
Describing the history of the use of methamphetamine, Dr. Wijesinghe explained that the widespread and frequent use of methamphetamine was reported during the Second World War and that the Nazi German military dispensed it under the trade name Pervitin, where chocolates dosed with methamphetamine were given to pilots.
The main purpose of Nazi soldiers using it in that manner, he added, was to avoid fatigue, improve alertness, and to take away soldiers’ inhibitions and empathy, especially to help them engage in risky deeds. It also helps the user function with very little food intake, and therefore, at first, doctors prescribed methamphetamine for those who wanted to reduce weight as an appetite suppressant.
“However, users of methamphetamine felt that their strength and confidence was boosted temporarily, which resulted in them abusing it for its euphoric effects,” he said, adding that methamphetamine is now being abused for its “high”.
Methamphetamine is a form of amphetamine, which is a stimulant. Dr. Wijesinghe explained that stimulants are a class of drugs that speed up the messages that travel between the brain and the body and that they can make a person feel more awake, alert, confident, or energetic. Amphetamines are licenced for use in the treatment of attention deficit disorder. Methamphetamine is more potent than its parent compound amphetamine. It can be in the form of tablets, capsules, powder, small clear crystals, or a white or brownish crystal-like powder. This odourless, bitter, and crystalline powder, he said, has various street names including “ice”, “glass”, “meth”, “crank”, “speed”, and “mandy”. In Sri Lanka, smoking methamphetamine is the most common way of using it.
Seven stages of the ‘ice’ experience
Explaining the nature of the various stages of the experience users receive from methamphetamine, Dr. Wijesinghe pointed out seven such stages.
The first one, i.e. the rush, is the initial response of the increased heart rate, blood pressure, and metabolism. The second stage involves the heightened feeling of pleasure, confidence, and energy beyond what the user normally experiences or possesses. In this stage, they experience euphoria or emotional blunting, a misplaced sense of empowerment or the illusion of being more powerful and productive than they actually are, being socially outgoing, experiencing increased self-confidence, and being more talkative.
The third stage, i.e. the binge, refers to the urge to get intoxicated more and more by using more methamphetamine. This also involves being mentally and physically hyperactive. What is called “tweaking” is the fourth stage, regarding which Dr. Wijesinghe said that at the end of a drug binge, when methamphetamine no longer provides a rush or a “high”, the user experiences horrible feelings of emptiness and craving and a loss of sense of identity, resulting in poor sleep and the potential for self-harm. The fifth stage, i.e. the crash, occurs when the user’s body shuts down, often rendered unable to cope with the effects of methamphetamine. The hangover is the sixth stage, in which the user feels starved, dehydrated, and exhausted physically, mentally, and emotionally. The seventh stage is withdrawal.
Physical and psychological impacts of ‘ice’ use
Dr. Wijesinghe said that the harmful physical effects of methamphetamine can affect one’s heart, liver, eyes, mouth, skin, and kidneys, among other organs, and include, hypertension (high blood pressure), arrhythmias (abnormal heartbeats), constipation, myocardial infarction (also known as heart attack, this occurs when a lack of blood flow causes the tissue in the heart muscle to die), stroke (a situation when the blood supply to the brain is interrupted, causing a part of the brain to die), seizure threshold reduction (the minimum intensity of a stimulus required to induce a seizure), kidney diseases, and reduced appetite.
The psychological effects of methamphetamine include insomnia, aggressive behaviour, paranoia, incessant conversations, decreased appetite, increased alertness, irritability, slurred speech, dizziness, confusion, hallucinations, obsessive behaviours, depression, and panic attacks.
Speaking of neurotoxicity (damage to the brain or peripheral nervous system caused by exposure to natural or man-made toxic substances) of methamphetamine, he said that methamphetamine is found to have neurotoxic effects, which can lead to the irreversible loss of nerve terminals or neuron cell bodies. These toxic effects can affect one’s sleep and wake cycle, appetite, aggression, sexual behaviour, sensorimotor reactivity, pain sensitivity, learning, control of movement, and the regulation of emotional responses, among other functions of the body. Localised damage to the brain can result in poor decision-making and other cognitive deficits, according to him. Neurocognitive impairment is another issue, regarding which Dr. Wijesinghe said that the use of methamphetamine can affect parts of the brain related to verbal memory performance (the ability to remember what one reads or hears), and result in deficits in tasks that involve perceptual speed and information manipulation. It can also make people choose an immediate reward at the expense of severe negative consequences in the future.
Sri Lanka’s situation
According to Dr. Wijesinghe, Sri Lanka’s situation with regard to the use of “ice” has reached a concerning level in recent memory. He underscored that “ice” remains one of the cheapest intoxicants available in Sri Lanka, compared even to legal ones such as alcohol.
National statistics show that the use of illicit drugs has doubled within the period of five years between 2013 and 2018 and that geographically, the highest incidence of “ice” use is reported from the Colombo, Gampaha, and Kurunegala districts. Explaining this, Dr. Wijesinghe noted that types of drugs and patterns of drug abuse are changing in Sri Lanka from cannabis, opium, and heroin towards different, newer and expensive amphetamines, “ice”, and cocaine. “Ice” is the third most commonly used illicit drug after cannabis and heroin in Sri Lanka, according to him.
Presenting several case studies that show the prevalence of “ice” in Sri Lanka, he pointed out that despite its serious effects, the use of “ice” is considerably prevalent among youth and teenagers.
He pointed out how the use of “ice” leads to other issues, including users placing themselves and others in risky situations, eventually resulting in various familial and social issues. In one case, methamphetamine-induced psychosis had contributed to serious assaults. Raising concerns about the possibility of methamphetamine leading to such issues, Dr. Wijesinghe explained that some individuals with this condition need to be admitted for treatment as they cannot be allowed to be in society unsupervised.
According to him, methamphetamine-induced psychosis closely mimics the symptoms of schizophrenia, and that the symptoms can be difficult to distinguish from paranoid schizophrenia. Paranoid delusions and hallucinations, ideas of reference (false beliefs that random or irrelevant occurrences in the world directly relate to oneself), delusions of misidentification, thought broadcasting (the delusion that one’s thought is projected and perceived by others), and personality alterations are among the common symptoms of this condition. He noted that even casual amphetamine use can precipitate psychotic reactions.
Using drugs to enhance sexual performance or engaging in sexual activities under the influence of drugs, also known as “chemsex” is becoming a more common phenomenon in Sri Lanka, as per Dr. Wijesinghe. Describing a case study where methamphetamine had been used for “chemsex”, he explained that the use of methamphetamine affects the user’s decision-making abilities, which contributes to them engaging in risky sexual activities, in turn increasing the possibility of contracting sexually transmitted diseases, and also sexual crimes such as sexual abuse and rape. “Chemsex” is common with methamphetamine use.
Dealing with ‘ice’ addiction
Testing for methamphetamine use is currently done at several institutions including the National Dangerous Drugs Control Board (NDDCB), which offers the service for around Rs. 2,500, and private hospitals, which charge around Rs. 10,000. Although the necessary test kits are not readily available in many public hospitals, certain public hospitals and Judicial Medical Officers (JMOs) have an allocated amount of test kits which can be obtained if there is a necessity.
“We view this as an issue of young males. But that is not the case. Even fathers who are employed and are in their 40s as well as young girls can also be seen using ‘ice’,” Dr. Wijesinghe stressed, adding that it is important to understand the nature of a methamphetamine user and their surroundings when assisting them.
He noted that when dealing with a person addicted to methamphetamine, it is crucial to be vigilant about the signs of methamphetamine use, get the support of the user’s family members, and understand the environment of a methamphetamine user. In the event of identifying a person who misuses drugs, he explained, the most important steps that need to be followed are gaining their trust, empathising, counselling, and referring them to the relevant parties appropriately. In this process, especially in counselling, the methamphetamine user’s cooperation and willingness to receive support plays an important role, as what medicines can do in this process is limited. In addition to private institutions, most public hospitals have mental health clinics that deal with addiction-related issues, which he said can be accessed for methamphetamine addiction-related issues, including withdrawal, as well.
(If you or someone you know is addicted to any form of substance, you can obtain the assistance of Mel Medura via 0112-693460, or the NDDCB via 0112-868794 or 1927.)