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A 40-year-old woman with diabetes comes to the clinic with blood sugars 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 250-1) 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 250-1

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. (Reproduced with permission from Andrew Schechtman, MD.)


Methamphetamine is a powerfully addictive stimulant that can be smoked, snorted, or injected. This drug can be produced using common household products and pseudoephedrine. Methamphetamine is similar chemically to other stimulants, contains many adulterants, and is manufactured illegally.1 There is a worldwide epidemic of methamphetamine abuse and addiction.


Meth, crank (powder), ice (crystal meth), croak (with cocaine), shabu (with cocaine), twisters (with crack), speed kills, crystal, and yaba (oral tablets).2


  • Worldwide, compared to other drugs of abuse, only marijuana is used more often than amphetamine/methamphetamine.1-3

  • According to the 2015 report of the United Nations Office on Drugs and Crime, between 14 and 55 million people worldwide are estimated to use amphetamines/methamphetamines, and ages varies between 15 and 64.2

  • The lifetime prevalence ("ever-used") rate for methamphetamine was 1.2%, 0.7%, 0.6% for 12th, 10th, and 8th graders respectively, in the 2016 Monitoring the Future study, which surveys 45,500 students in 8th, 10th, and 12th grades in 372 schools nationwide annually.3 In 2014, an estimated 569,000 people age 12 and older were meth users. These statistics were similar to previous trends for most years in between 2002 and 2014.4

  • Stimulants (methamphetamine and amphetamine) accounted for 12.8% of nationwide emergency department visits involving use of illicit drugs in 2011, with the highest incidence in those from 18 to 44 years old.5 The number of emergency room visits increased 71% from 2009 to 2011.5 Net numbers of emergency room visits involving methamphetamines were 67,954 in 2007 and 102,961 in 2011, with congruent patterns for males and females.6

  • Methamphetamine use is associated with white, Native American, Hispanic, ...

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