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A 40-year-old woman with diabetes comes to the clinic with blood sugar in the 400s because she ran out of insulin a few weeks ago. She appears poorly groomed and has nicotine stains on her fingertips. Excoriated lesions (Figure 238-1) are noted on her forearms and face. She reports no itching at this moment, but when asked confirms that she regularly smokes methamphetamine. The diagnosis of her skin condition is meth mites. She acknowledges that she picks at her skin when she is high on meth. The physician asks her if she wants help to get off the meth so she can care for her health and well-being. She breaks down in tears and says that her craving for meth is very strong, but she is willing to try something because she knows the meth is ruining her body and life.

Figure 238-1

A 40-year-old woman with sores on her arm caused by picking at her skin while using methamphetamine. Also called meth mites, although there are no mites. (Courtesy of Andrew Schechtman, MD.)

Methamphetamine is a powerfully addictive stimulant that can be smoked, snorted, or injected. Methamphetamine can be produced by using common household products and pseudoephedrine. There is a worldwide epidemic of methamphetamine abuse and addiction.

Meth, crank, ice, and crystal.

  • Worldwide, compared to other drugs of abuse, only marijuana is used more often than amphetamine/methamphetamine.1
  • The lifetime prevalence (“ever-used”) rate for methamphetamine was 2.1% for 12th graders in the 2011 Monitoring the Future study, which surveys 50,000 students in 8th, 10th, and 12th grades in 420 schools nationwide annually. This has decreased from 1999, when the lifetime prevalence for methamphetamine use in 12th graders was 8.2%. For comparison, marijuana/hashish had a lifetime prevalence in 12th graders of 45.5% and 49.7% in 2011 and 1999, respectively.2
  • Stimulants (methamphetamine and amphetamine) accounted for 9.6% of nationwide emergency department visits involving use of illicit drugs in 2009, with the highest incidence in those from 18 to 44 years old.3
  • Methamphetamine use is associated with white or Native American race; residence in the west or south; having an ever-incarcerated father; marijuana, cocaine, intravenous drug use; and men who have sex with men (MSM).4
  • Analysis of methamphetamine found in workforce drug testing done nationwide in 2010 by Quest Diagnostics showed the highest rates of use in western and midwestern states, with relative sparing of eastern states. Highest prevalence (more than twice the national average) was found in Hawaii, Arkansas, Oklahoma, Nevada, California, Wyoming, Utah, and Arizona.5
  • Methamphetamine is a Schedule II stimulant with legitimate medical uses, including the treatment of narcolepsy and attention deficit hyperactivity disorder.
  • Methamphetamine is known on the street as meth, crank, ice (Figure 238-2), and crystal. It is abused by smoking, injecting, snorting, or oral ingestion. Smoking or injecting the ...

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