Oct. 29, 2014
By Laura Selby
Constant headlines and TV shows like "Breaking Bad" may leave the impression that methamphetamine abuse is a new phenomenon. But addiction psychiatrist Michael A. Dekker, DO, says that's far from true. Meth was first discovered in Japan in 1919, lost, and then rediscovered around the time of World War II. Japanese kamikaze pilots were given meth to help them stay alert during long, grueling missions. German military personnel also received the drug, labeled Pervitin; Hitler reportedly took daily doses.
Meth even made it into a plotline of the Captain America comic book series, with The Flash giving Captain America some of the drug. "This was the super serum of World War II," Dr. Dekker explained, noting that Japan became the first country to deal with the ravages of meth abuse as a result of demoralization after the war's end.
Crystal meth was developed in Oregon and spread south and east across the United States. East Coast drug cartels knew the drug was more potent than what they were selling, so they banded together to keep it out of the market; to this day, Dr. Dekker said, meth abuse is less of a problem on the East Coast. "Crystal meth is some serious business," he explained, "because when you smoke it, or you cook it up, you're high for eight to 10 hours, vs. around two hours for cocaine."
Meth and Its Cousins
Dr. Dekker gave an overview of meth and other phenethylamines, the chemical group to which meth belongs:
Meth: Has longer lasting and much more euphoric effects than amphetamines. Crosses the brain-blood barrier. "It has the same basic effects as amphetamines," said Dr. Dekker, "just a whole order of magnitude greater."
MDMA: Also known as ecstasy, the molecular structure of MDMA is "just meth with some other pieces," Dr. Dekker observed. It's an empathogen and an enactogen, meaning it causes feelings of empathy and connectedness.
NBOME: Packaged to look like LSD. Probably what caused the "molly" deaths on the East Coast in the past several years. "LSD won't kill you in these amounts," Dr. Dekker noted, "but this stuff will."
Khat: Plant with origins in sub-Saharan Africa, where it was used to fortify travelers crossing the desert. Chewed in a manner similar to dipping tobacco. Can cause malnutrition, hemorrhoids, and psychotic and depressive reactions.
Bath salts: Not actually bath salts. "Actual bath salts are sold in pounds, not grams. Usually you buy them at Bed Bath & Beyond. These bath salts you get at the gas station or the smoke shop, and they're marked 'Not for human consumption,' " Dr. Dekker clarified. Effects can include euphoria, elevated heart rate and blood pressure, and psychotic behavior.
Kraton: This drug is an opioid, not a phenethylamine. It's considered a "drug of concern" in the U.S., but is legal to purchase. It's often used to help with opioid withdrawal symptoms - at first, it seems to cause a stimulant mechanism, but acts as a true opioid if taken in large doses, complete with opioid withdrawal symptoms.
How to Treat an Overdose
Here are some of Dr. Dekker's tips for treating patients on these drugs who arrive in the ER:
Use benzodiazepines to calm the patient
If the patient is psychotic, use haloperidol or olanzapine
Minimize restraints to reduce the risk of renal failure
Watch for signs of dehydration
Knowing how to treat these patients effectively is critical, Dr. Dekker said. "Don't let these guys die," he told the audience. "These kids do not know what they're dealing with."