Methamphetamine Toxicity

Methamphetamine Toxicity

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Methamphetamine is a highly addictive psychostimulant drug that is chemically related to amphetamine. Methamphetamine can produce euphoria and stimulant effects like those from other stimulants such as cocaine. In addition, methamphetamine is easily synthesized from inexpensive and readily obtainable chemicals. Those qualities have led to the widespread and rampant abuse of this dangerous drug.

Methamphetamine use has increased rapidly throughout the world, with more than 30 million users worldwide. [1] Over the past decade, all regions of the United States experienced a significant increase in the number of persons using the drug, and a corresponding increase in the number of patients with medical complications seen in emergency departments (EDs). [1, 2]  Fortunately, this trend seems to have reached a plateau in some areas, with the National Institute on Drug Abuse reporting that  from 2015 to 2016, methamphetamine use in the past year by those 12 years of age and older decreased from 0.6% to 0.5% of the population. [3]  

Methamphetamine is available in powder and crystalline forms. It may be taken orally or intravenously, or be snorted or smoked. The smokable form of methamphetamine (“ice”) produces an immediate euphoria similar to that of crack cocaine, but the effects may last much longer. [4, 5]

Inadvertent absorption of methamphetamine may occur in “body packers”, who swallow packages of the drug for transportation purposes, or “body stuffers”, who insert bags of methamphetamine rectally or vaginally in an attempt to elude drug enforcement. There are also users who indulge in “parachuting”, in which the drug is loosely wrapped to delay absorption and prolong effect. These persons, and body stuffers, are at high risk for toxicity as the drug wrapping may be compromised and allow complete drug absorption. [6]

North American methamphetamine abusers are predominantly white males in their 30s and 40s. [7, 8] Epidemic abuse has been described in adolescents; they cite availability, low cost, and a longer duration of action than cocaine as reasons for their drug preference. [9]

Most cases of methamphetamine toxicity can be managed supportively. In severe overdoses, termination of methamphetamine-induced seizure activity and arrhythmias are of immediate importance. Correction of hypertension, hypotension, hyperthermia, metabolic and electrolyte abnormalities, and control of severe psychiatric agitation are indicated. See Treatment and Medication.

The medical history of amphetamine-like compounds extends back nearly 100 years. [4, 5] A Japanese pharmacologist first synthesized methamphetamine in 1919. A more detailed analysis of the pharmacology of amphetamine derived from the basic phenylethylamine structure was reported in 1930. In the 1930s, amphetamine was introduced in the form of inhalers for rhinitis and asthma treatment. The stimulant, euphoric, and anorectic effects of amphetamine were quickly recognized, leading to its abuse.

In 1937, a report that amphetamine enhanced intellectual performance and wakefulness further contributed to its popularity. Amphetamines were used extensively by Allied and Axis armed forces during World War II and during the recent Iraq and Afghanistan conflicts to increase wakefulness and attention. [4, 10]

In the late 1950s, initial federal controls were enacted; however, in spite of additional regulation and increased enforcement, amphetamines continued to be used by students, athletes, shift workers, long haul drivers, and for weight loss. [4, 5] The Controlled Substance Act of 1970 stringently regulated the manufacture of amphetamine.

Amphetamines stimulate the central nervous system (CNS), which results in clinical effects that include the following [4, 11] :

In the CNS, amphetamines block presynaptic reuptake of catecholamines (ie, dopamine, norepinephrine), causing hyperstimulation at selected postsynaptic neuron receptors. Indirect sympathomimetic effects result from blockade of presynaptic vesicular storage and by reduction in cytoplasmic destruction of catecholamines by inhibition of mitochondrial monoamine oxidase. [12, 13]

Indirectly, these hyperstimulated neurons can stimulate various other noncatecholaminergic central and peripheral nervous pathways. Changes in mood, excitation, motor movements, sensory perception, and appetite appear to be mediated more directly by CNS dopaminergic alterations. It has been postulated that serotonin alterations also contribute to mood changes, psychotic behavior, and aggressiveness. [14]

Long-term exposure to methamphetamine results in significant down-regulation of both presynaptic and postsynaptic aspects of the dopamine system in the striatum. Dysregulation of the dopamine system has been proposed as a mechanism of addiction. [15]  Oxidative stress and neuroinflammation appear to play a role in the psychosis and cognitive deficits induced by repeated low doses of methamphetamine. [16]

In humans, the half-life of methamphetamine ranges from 10-20 hours, depending on the urine pH, history of recent use, and dosage. [12] Metabolism occurs faster in acidic urine. Methamphetamine has greater CNS effects compared with D-amphetamine of equal milligram quantity. The majority of methamphetamine is metabolized to amphetamine, which provides further CNS stimulation.

Methamphetamine is absorbed readily from the gut, airway, nasopharynx, muscle, placenta, and vagina. [17, 18] Peak plasma levels are observed approximately 30 minutes after intravenous or intramuscular routes and 2-3 hours after ingestion. [13] Rapid tissue redistribution occurs with steady-state cerebrospinal fluid levels at 80% of plasma levels. Hepatic conjugation pathways with glucuronide and glycine addition result in inactivation and urinary excretion of metabolites.

When methamphetamine is used with ethanol, increased psychological and cardiac effects are observed. [19] This is presumed to be the result of pharmacodynamic rather than pharmacokinetic interactions. Similarly, the increased toxicity of concomitant opioids and amphetamines (“speedballing”), appear to result from pharmacodynamic interactions.

The euphoric effects produced by methamphetamine, cocaine, and various designer amphetamines are similar and may be difficult to clinically differentiate. [5] A distinguishing clinical feature is the longer pharmacokinetic and pharmacodynamic half-life of methamphetamine, which may be as much as 10 times longer than that of cocaine. Because of the variability in quality and concentration of illicitly purchased methamphetamines, the clinical observation of toxic effects is more relevant than estimated total ingested dose. [20]

United States

Methamphetamine use is widespread in the United States but varies regionally, with higher use in Hawaii, the West, and parts of the Midwest. [21] The Drug Abuse Warning Network estimates that methamphetamine was involved in 102,961 emergency department visits in 2011. [2]

According to the 2016 National Survey on Drug Use and Health (NSDUH), approximately 667,000 people were current methamphetamine users. Approximate numbers of users by age group and percentages of that age group were as follows [22] :

International

 The United Nations Office on Drugs and Crime estimates that worldwide in 2015 there were 37 million users of amphetamine-type stimulants, which includes methamphetamine. Methamphetamine is a feature of amphetamine-type stimulant markets worldwide, but is particularly dominant in East and Southeast Asia and North America  In East and Southeast Asia, the market for both tablet and crystalline methamphetamine is large and growing. [1]

An Australian study that used liquid chromatography–mass spectrometry to analyze wastewater (an increasingly popular method for monitoring trends of illicit drug use) reported that from 2009-2015, methamphetamine consumption increased fivefold. In the study, which involved wastewater from wastewater treatment plants in South East Queensland, methamphetamine residues were consistently detected in both urban and rural catchments. [23]

Acute methamphetamine overdose may result in sympathetic overdrive, intracranial hemorrhage, [24] cardiovascular collapse, rhabdomyolysis, ventricular tachyarrhythmia, and death. Injuries from blunt and penetrating trauma are common. [4, 11, 25, 26]

Long-term methamphetamine use may result in the following [27] :

In a study of 590 patients between 18 and 50 years old with cardiomyopathy or heart failure who were seen at a single medical center from 2008-2012, the 223 patients with a history of methamphetamine use were more likely to have a moderately or severely reduced ejection fraction ≤40%). In addition, male patients were more likely to have worse left ventricular systolic dysfunction. [28]

Methamphetamine abuse has severe adverse effects on oral health, colloquially termed “meth mouth”. As a result of its sympathomimetic effects, methamphetamine results in significantly reduced saliva production and pH, and increased bruxism. Consequently, long-term abusers are at increased risk for caries, dental erosion, periodontal lesions, and temporomandibular joint pain. [29]

Use of methamphetamine during pregnancy has been associated with intrauterine growth restriction and preterm birth. Neonates have an increased incidence of poor cardiorespiratory adaptation, cardiac defects, and floppy muscle tone. [30]  Prenatal exposure may have a long-term impact on cognitive skills that becomes more pronounced with age. [31]

Demographic variations include the following [7, 8] :

United Nations Office on Drugs and Crime (UNODC). World Drug Report 2018. Available at https://www.unodc.org/wdr2018/index.html. June 2018; Accessed: August 15, 2018.

Drug Abuse Warning Network (DAWN). 2011: National Estimates of Drug-Related Emergency Department Visits. Available at https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf. Accessed: August 15, 2018.

National Survey of Drug Use and Health. National Institute on Drug Abuse. Available at https://www.drugabuse.gov/national-survey-drug-use-health. Accessed: December 22, 2017.

Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Dis Mon. 2012 Feb. 58(2):38-89. [Medline].

Richards JR. Amphetamine derivatives. Cole SM. New research on street drugs. New York: Nova; 2006. chap 5.

Hendrickson RG, Horowitz BZ, Norton RL, Notenboom H. “Parachuting” meth: a novel delivery method for methamphetamine and delayed-onset toxicity from “body stuffing”. Clin Toxicol (Phila). 2006. 44(4):379-82. [Medline].

Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW. Methamphetamine abuse and emergency department utilization. West J Med. 1999 Apr. 170(4):198-202. [Medline].

Hendrickson RG, Cloutier R, McConnell KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med. 2008 Jan. 15(1):23-31. [Medline].

Uhlmann S, Debeck K, Simo A, Kerr T, Montaner JS, Wood E. Crystal methamphetamine initiation among street-involved youth. Am J Drug Alcohol Abuse. 2013 Nov 5. [Medline].

Kenagy DN, Bird CT, Webber CM, Fischer JR. Dextroamphetamine use during B-2 combat missions. Aviat Space Environ Med. 2004 May. 75(5):381-6. [Medline].

Panenka WJ, Procyshyn RM, Lecomte T, MacEwan GW, Flynn SW, Honer WG, et al. Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings. Drug Alcohol Depend. 2013 May 1. 129(3):167-79. [Medline].

Volkow ND, Fowler JS, Wang GJ, Shumay E, Telang F, Thanos PK, et al. Distribution and pharmacokinetics of methamphetamine in the human body: clinical implications. PLoS One. 2010 Dec 7. 5(12):e15269. [Medline]. [Full Text].

Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009 Jul. 104(7):1085-99. [Medline].

Krasnova IN, Cadet JL. Methamphetamine toxicity and messengers of death. Brain Res Rev. 2009 May. 60(2):379-407. [Medline]. [Full Text].

Ashok AH, Mizuno Y, Volkow ND, Howes OD. Association of Stimulant Use With Dopaminergic Alterations in Users of Cocaine, Amphetamine, or Methamphetamine: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2017 May 1. 74 (5):511-519. [Medline]. [Full Text].

Shin EJ, Dang DK, Tran TV, Tran HQ, Jeong JH, Nah SY, et al. Current understanding of methamphetamine-associated dopaminergic neurodegeneration and psychotoxic behaviors. Arch Pharm Res. 2017 Apr. 40 (4):403-428. [Medline].

Katsumata S, Sato K, Kashiwade H, et al. Sudden death due presumably to internal use of methamphetamine. Forensic Sci Int. 1993 Dec. 62(3):209-15. [Medline].

Kashani J, Ruha AM. Methamphetamine toxicity secondary to intravaginal body stuffing. J Toxicol Clin Toxicol. 2004. 42(7):987-9. [Medline].

Kirkpatrick MG, Gunderson EW, Levin FR, Foltin RW, Hart CL. Acute and residual interactive effects of repeated administrations of oral methamphetamine and alcohol in humans. Psychopharmacology (Berl). 2011 Jul 12. [Medline].

Zhang JX, Zhang da M, Han XG. Identification of impurities and statistical classification of methamphetamine hydrochloride drugs seized in China. Forensic Sci Int. 2008 Nov 20. 182(1-3):13-9. [Medline]. [Full Text].

DrugFacts: Methamphetamine. National Institute on Drug Abuse. Available at http://www.drugabuse.gov/publications/drugfacts/methamphetamine. February 2017; Accessed: December 22, 2017.

Center for Behavioral Health Statistics and Quality. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Available at https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#illicit9. 2016; Accessed: December 22, 2017.

Lai FY, O’Brien JW, Thai PK, Hall W, Chan G, Bruno R, et al. Cocaine, MDMA and methamphetamine residues in wastewater: Consumption trends (2009-2015) in South East Queensland, Australia. Sci Total Environ. 2016 Jun 17. [Medline].

Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry. 2017 Dec. 88 (12):1079-1091. [Medline].

Swanson SM, Sise CB, Sise MJ, Sack DI, Holbrook TL, Paci GM. The scourge of methamphetamine: impact on a level I trauma center. J Trauma. 2007 Sep. 63(3):531-7. [Medline].

Chiu ZK, Bennett IE, Chan P, Rosenfeld JV. Methamphetamine-related brainstem haemorrhage. J Clin Neurosci. 2016 Jun 23. [Medline].

Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, et al. Toxicity of amphetamines: an update. Arch Toxicol. 2012 Aug. 86(8):1167-231. [Medline].

Neeki MM, Kulczycki M, Toy J, Dong F, Lee C, Borger R, et al. Frequency of Methamphetamine Use as a Major Contributor Toward the Severity of Cardiomyopathy in Adults ≤50 Years. Am J Cardiol. 2016 May 29. [Medline].

Rommel N, Rohleder NH, Koerdt S, Wagenpfeil S, Härtel-Petri R, Wolff KD, et al. Sympathomimetic effects of chronic methamphetamine abuse on oral health: a cross-sectional study. BMC Oral Health. 2016 May 26. 16 (1):59. [Medline]. [Full Text].

Pflügner A, Thome U, Bernhard MK, Vogel M, Bläser A, Nickel P, et al. [Methamphetamine Consumption During Pregnancy and its Effects on Neonates]. Klin Padiatr. 2017 Nov 28. [Medline].

Brinker MJ, Cohen JG, Sharrette JA, Hall TA. Neurocognitive and neurodevelopmental impact of prenatal methamphetamine exposure: A comparison study of prenatally exposed children with nonexposed ADHD peers. Appl Neuropsychol Child. 2017 Nov 29. 1-8. [Medline].

Diercks DB, Kirk JD, Turnipseed SD, Amsterdam EA. Evaluation of patients with methamphetamine- and cocaine-related chest pain in a chest pain observation unit. Crit Pathw Cardiol. 2007 Dec. 6(4):161-4. [Medline].

Hawley LA, Auten JD, Matteucci MJ, Decker L, Hurst N, Beer W, et al. Cardiac complications of adult methamphetamine exposures. J Emerg Med. 2013 Dec. 45(6):821-7. [Medline].

Won S, Hong RA, Shohet RV, Seto TB, Parikh NI. Methamphetamine-Associated Cardiomyopathy. Clin Cardiol. 2013 Aug 27. [Medline].

Turnipseed SD, Richards JR, Kirk JD. Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use. J Emerg Med. 2003 May. 24(4):369-73. [Medline].

Watts DJ, McCollester L. Methamphetamine-induced myocardial infarction with elevated troponin I. Am J Emerg Med. 2006 Jan. 24(1):132-4. [Medline].

Davis GG, Swalwell CI. Acute aortic dissections and ruptured berry aneurysms associated with methamphetamine abuse. J Forensic Sci. 1994 Nov. 39(6):1481-5. [Medline].

Gold MS, Kobeissy FH, Wang KK, Merlo LJ, Bruijnzeel AW, Krasnova IN, et al. Methamphetamine- and trauma-induced brain injuries: comparative cellular and molecular neurobiological substrates. Biol Psychiatry. July 2009. 66:118-27. [Medline]. [Full Text].

Rhee KJ, Albertson TE, Douglas JC. Choreoathetoid disorder associated with amphetamine-like drugs. Am J Emerg Med. 1988 Mar. 6(2):131-3. [Medline].

Bowyer JF, Thomas M, Schmued LC, Ali SF. Brain region-specific neurodegenerative profiles showing the relative importance of amphetamine dose, hyperthermia, seizures, and the blood-brain barrier. Ann N Y Acad Sci. 2008 Oct. 1139:127-39. [Medline].

Granado N, Ares-Santos S, Moratalla R. Methamphetamine and Parkinson’s disease. Parkinsons Dis. 2013. 2013:308052. [Medline]. [Full Text].

Albertson TE, Walby WF, Derlet RW. Stimulant-induced pulmonary toxicity. Chest. 1995 Oct. 108(4):1140-9. [Medline].

Nestor TA, Tamamoto WI, Kam TH, Schultz T. Crystal methamphetamine-induced acute pulmonary edema: a case report. Hawaii Med J. 1989 Nov. 48(11):457-8, 460. [Medline].

Thompson CA. Pulmonary arterial hypertension seen in methamphetamine abusers. Am J Health Syst Pharm. 2008 Jun 15. 65(12):1109-10. [Medline].

Cohen AL, Shuler C, McAllister S, Fosheim GE, Brown MG, Abercrombie D, et al. Methamphetamine use and methicillin-resistant Staphylococcus aureus skin infections. Emerg Infect Dis. 2007 Nov. 13(11):1707-13. [Medline].

Johnson TD, Berenson MM. Methamphetamine-induced ischemic colitis. J Clin Gastroenterol. 1991 Dec. 13(6):687-9. [Medline].

Richards JR, Brofeldt BT. Patterns of tooth wear associated with methamphetamine use. J Periodontol. 2000 Aug. 71(8):1371-4. [Medline].

Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry. Oral Dis. 2009 Jan. 15(1):27-37. [Medline].

Haning W, Goebert D. Electrocardiographic abnormalities in methamphetamine abusers. Addiction. 2007 Apr. 102 Suppl 1:70-5. [Medline].

Smit AA, Wieling W, Voogel AJ, Koster RW, van Zwieten PA. Orthostatic hypotension due to suppression of vasomotor outflow after amphetamine intoxication. Mayo Clin Proc. 1996 Nov. 71(11):1067-70. [Medline].

Yeo KK, Wijetunga M, Ito H, Efird JT, Tay K, Seto TB, et al. The association of methamphetamine use and cardiomyopathy in young patients. Am J Med. 2007 Feb. 120(2):165-71. [Medline].

Richards JR, Derlet RW, Duncan DR. Methamphetamine toxicity: treatment with a benzodiazepine versus a butyrophenone. Eur J Emerg Med. 1997 Sep. 4(3):130-5. [Medline].

Cherner M, Letendre S, Heaton RK. Hepatitis C augments cognitive deficits associated with HIV infection and methamphetamine. Neurology. 2005. 64:1343-47. [Medline].

Richards JR, Johnson EB, Stark RW, Derlet RW. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med. 1999 Nov. 17(7):681-5. [Medline].

Santos AP, Wilson AK, Hornung CA, Polk HC Jr, Rodriguez JL, Franklin GA. Methamphetamine laboratory explosions: a new and emerging burn injury. J Burn Care Rehabil. 2005 May-Jun. 26(3):228-32. [Medline].

Stewart JL, Meeker JE. Fetal and infant deaths associated with maternal methamphetamine abuse. J Anal Toxicol. 1997 Oct. 21(6):515-7. [Medline].

Catanzarite VA, Stein DA. Crystal’ and pregnancy–methamphetamine-associated maternal deaths. West J Med. 1995 May. 162(5):454-7. [Medline].

Ramamoorthy JD, Ramamoorthy S, Leibach FH, Ganapathy V. Human placental monoamine transporters as targets for amphetamines. Am J Obstet Gynecol. 1995 Dec. 173(6):1782-7. [Medline].

Mother of baby killed by meth-contaminated breast milk gets 90 days. Available at http://www.sacbee.com/ourregion/story/1955191.html. Accessed: November 22, 2009.

New meth formula avoids anti-drug laws. Available at http://www.msnbc.msn.com/id/32542373/ns/us_news-crime_and_courts/. August 24, 2009; Accessed: December 22, 2017.

Burton BT. Heavy metal and organic contaminants associated with illicit methamphetamine production. NIDA Res Monogr. 1991. 115:47-59. [Medline].

Conn C, Dawson M, Baker AT, et al. Identification of n-acetylmethamphetamine in a sample of illicitly synthesized methamphetamine. J Forensic Sci. 1996 Jul. 41(4):645-7. [Medline].

Bulakci M, Cengel F. The role of radiology in diagnosis and management of drug mules: an update with new challenges and new diagnostic tools. Br J Radiol. 2016. 89 (1060):20150888. [Medline].

McKinney PE, Tomaszewski C, Phillips S, Brent J, Kulig K. Methamphetamine toxicity prevented by activated charcoal in a mouse model. Ann Emerg Med. 1994 Aug. 24(2):220-3. [Medline].

Thanacoody R, Caravati EM, Troutman B, Höjer J, Benson B, Hoppu K, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila). 2015 Jan. 53 (1):5-12. [Medline].

Richards JR, Albertson TE, Derlet RW, Lange RA, Olson KR, Horowitz BZ. Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend. 2015 May 1. 150:1-13. [Medline].

Derlet RW, Albertson TE, Rice P. Protection against d-amphetamine toxicity. Am J Emerg Med. 1990 Mar. 8(2):105-8. [Medline].

Derlet RW, Rice P, Horowitz BZ, Lord RV. Amphetamine toxicity: experience with 127 cases. J Emerg Med. 1989 Mar-Apr. 7(2):157-61. [Medline].

Safety of Droperidol Use in the Emergency Department (9/7/2013). American Academy of Emergency Medicine (AAEM). Available at http://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf. September 7, 2013; Accessed: December 22, 2017.

Matteucci MJ, Auten JD, Crowley B, Combs D, Clark RF. Methamphetamine exposures in young children. Pediatr Emerg Care. 2007 Sep. 23(9):638-40. [Medline].

Leelahanaj T, Kongsakon R, Netrakom P. A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis. J Med Assoc Thai. 2005 Nov. 88 Suppl 3:S43-52. [Medline].

Misra LK, Kofoed L, Oesterheld JR, Richards GA. Olanzapine treatment of methamphetamine psychosis. J Clin Psychopharmacol. 2000 Jun. 20(3):393-4. [Medline].

Misra L, Kofoed L. Risperidone treatment of methamphetamine psychosis. Am J Psychiatry. 1997 Aug. 154(8):1170. [Medline].

Shoptaw SJ, Kao U, Ling W. Treatment for amphetamine psychosis. Cochrane Database Syst Rev. 2009 Jan 21. CD003026. [Medline].

Lam RP, Yip WL, Wan CK, Tsui MS. Dexmedetomidine use in the ED for control of methamphetamine-induced agitation. Am J Emerg Med. 2017 Apr. 35 (4):665.e1-665.e4. [Medline].

Tobias JD. Dexmedetomidine to control agitation and delirium from toxic ingestions in adolescents. J Pediatr Pharmacol Ther. 2010 Jan. 15(1):43-8. [Medline]. [Full Text].

Ibrahim F, Viswanathan R. Management of agitation following aneurysmal subarachnoid hemorrhage: is there a role for Beta-blockers?. Case Rep Psychiatry. 2012. 2012:753934. [Medline]. [Full Text].

Boehrer JD, Moliterno DJ, Willard JE, Hillis LD, Lange RA. Influence of labetalol on cocaine-induced coronary vasoconstriction in humans. Am J Med. 1993 Jun. 94(6):608-10. [Medline].

Hysek CM, Vollenweider FX, Liechti ME. Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy). Emerg Med J. 2010 Aug. 27(8):586-9. [Medline].

Hysek C, Schmid Y, Rickli A, Simmler LD, Donzelli M, Grouzmann E, et al. Carvedilol inhibits the cardiostimulant and thermogenic effects of MDMA in humans. Br J Pharmacol. 2012 Aug. 166(8):2277-88. [Medline]. [Full Text].

Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE Jr, Ettinger SM, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2011 May 10. 57(19):e215-367. [Medline].

Mancino MJ, Gentry BW, Feldman Z, Mendelson J, Oliveto A. Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study. Am J Drug Alcohol Abuse. 2011 Mar. 37 (2):131-6. [Medline].

Bagheri M, Mokri A, Khosravi A, Kabir K. Effect of Abstinence on Depression, Anxiety, and Quality of Life in Chronic Methamphetamine Users in a Therapeutic Community. Int J High Risk Behav Addict. 2015 Sep 1. 4 (3):e23903. [Medline].

Morley KC, Cornish JL, Faingold A, Wood K, Haber PS. Pharmacotherapeutic agents in the treatment of methamphetamine dependence. Expert Opin Investig Drugs. 2017 May. 26 (5):563-578. [Medline].

McKetin R, Najman JM, Baker A, Lubman DI, Dawe S, Ali R, et al. Evaluating the impact of community-based treatment options on methamphetamine use: findings from the Methamphetamine Treatment Evaluation Study (MATES). Addiction. 2012 May 7. [Medline].

John R Richards, MD, FAAEM Professor, Department of Emergency Medicine, University of California, Davis, Medical Center

John R Richards, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Robert W Derlet, MD Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System

Robert W Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Timothy E Albertson, MD, PhD, MPH Professor of Pharmacology and Toxicology, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Chair, Department of Internal Medicine, University of California, Davis, School of Medicine; Professor of Anesthesiology, Professor of Emergency Medicine and Clinical Toxicology, Davis Medical Center; Chief of Pulmonary and Critical Care, Veterans Affairs, Northern California Health Care System; Medical Director of Poison Control System, University of California, San Francisco, School of Pharmacy

Timothy E Albertson, MD, PhD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: La Jolla Pharm<br/>Received research grant from: UC Davis received from La Jolla Pharm; TEA honorarium for speaking from La Jolla Pharm.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph’s Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine and Medical Toxicology, Excela Health System

Fred Harchelroad, MD, FACMT, FAAEM, FACEP is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor – Chief Editor for Medscape.

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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