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Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis

Martin Paulus, MD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Methamphetamine is a psychostimulant that causes the release and blocks the reuptake of monoamine neurotransmitters, including dopamine, norepinephrine, and serotonin. Methamphetamine is most often smoked or snorted and is less commonly injected or ingested orally.

Clinical manifestations of methamphetamine use include increased energy and alertness, euphoria, sympathetic nervous system activation, decreased need for sleep, weight loss, dry mouth leading to tooth decay, and chronic adverse mood and cognitive changes, including irritability, anxiety, aggression, panic, suspiciousness, and/or paranoia, hallucinations, executive dysfunction, and memory impairment. Methamphetamine can also exacerbate existing psychiatric symptoms [1].

The psychiatric diagnoses, methamphetamine abuse and methamphetamine dependence, in DSM-IV-TR were replaced by one diagnosis, amphetamine-type substance use disorder, in DSM-5 listed under the broader category of stimulant use disorders [2]. Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, methamphetamine dependence is approximately comparable to amphetamine-type substance use disorder, moderate to severe subtype, while methamphetamine abuse is similar to the mild subtype.

This topic describes the epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of methamphetamine use disorder. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of other stimulant use disorders are discussed separately. (See "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis".)


Methamphetamine use varies geographically, but overall, amphetamine-type stimulants, which include methamphetamine, are the fastest rising drug of abuse worldwide [3,4]. Amphetamine-type stimulants have become the second most widely used class of illicit drugs worldwide, with use increasing in Asia and Oceania [5].

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Literature review current through: Oct 2017. | This topic last updated: Jun 15, 2017.
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  1. McKetin R, Dawe S, Burns RA, et al. The profile of psychiatric symptoms exacerbated by methamphetamine use. Drug Alcohol Depend 2016; 161:104.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  3. Degenhardt L, Mathers B, Guarinieri M, et al. Meth/amphetamine use and associated HIV: Implications for global policy and public health. Int J Drug Policy 2010; 21:347.
  4. Unodc. World Drug Report 2010, United Nations Publication, Vienna 2010.
  5. UNODC. World Drug Report 2012, Contract No: E.12.XI.1, United Nations Publication, New York 2012.
  6. Anglin MD, Burke C, Perrochet B, et al. History of the methamphetamine problem. J Psychoactive Drugs 2000; 32:137.
  7. Durell TM, Kroutil LA, Crits-Christoph P, et al. Prevalence of nonmedical methamphetamine use in the United States. Subst Abuse Treat Prev Policy 2008; 3:19.
  8. Rawson RA, Anglin MD, Ling W. Will the methamphetamine problem go away? J Addict Dis 2002; 21:5.
  9. Maxwell JC, Brecht ML. Methamphetamine: here we go again? Addict Behav 2011; 36:1168.
  10. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
  11. Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
  12. Center for Behavioral Health Statistics and Quality. Substance Abuse and Mental Health Services Administration (SAMHSA). Rockville, 2015.
  13. Gonzales R, Mooney L, Rawson RA. The methamphetamine problem in the United States. Annu Rev Public Health 2010; 31:385.
  14. United Nations Office on Drugs and Crime, United Nations, Vienna 2016.
  15. Salo R, Flower K, Kielstein A, et al. Psychiatric comorbidity in methamphetamine dependence. Psychiatry Res 2011; 186:356.
  16. Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatry 2005; 13:141.
  17. Zorick T, Sugar CA, Hellemann G, et al. Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. Drug Alcohol Depend 2011; 118:500.
  18. Kay-Lambkin FJ, Baker AL, Lee NM, et al. The influence of depression on treatment for methamphetamine use. Med J Aust 2011; 195:S38.
  19. Kuo CJ, Liao YT, Chen WJ, et al. Causes of death of patients with methamphetamine dependence: a record-linkage study. Drug Alcohol Rev 2011; 30:621.
  20. Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 2012; 379:55.
  21. Schürer S, Klingel K, Sandri M, et al. Clinical Characteristics, Histopathological Features, and Clinical Outcome of Methamphetamine-Associated Cardiomyopathy. JACC Heart Fail 2017; 5:435.
  22. Gibson DR, Leamon MH, Flynn N. Epidemiology and public health Consequences of methamphetamine use in California's Central Valley. J Psychoactive Drugs 2002; 34:313.
  23. Forrest DW, Metsch LR, LaLota M, et al. Crystal methamphetamine use and sexual risk behaviors among HIV-positive and HIV-negative men who have sex with men in South Florida. J Urban Health 2010; 87:480.
  24. Zapata LB, Hillis SD, Marchbanks PA, et al. Methamphetamine use is independently associated with recent risky sexual behaviors and adolescent pregnancy. J Sch Health 2008; 78:641.
  25. Hittner JB. Meta-analysis of the association between methamphetamine use and high-risk sexual behavior among heterosexuals. Psychol Addict Behav 2016; 30:147.
  26. Barr AM, Panenka WJ, MacEwan GW, et al. The need for speed: an update on methamphetamine addiction. J Psychiatry Neurosci 2006; 31:301.
  27. Wang GJ, Smith L, Volkow ND, et al. Decreased dopamine activity predicts relapse in methamphetamine abusers. Mol Psychiatry 2012; 17:918.
  28. Volkow ND, Chang L, Wang GJ, et al. Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Am J Psychiatry 2001; 158:2015.
  29. Lee B, London ED, Poldrack RA, et al. Striatal dopamine d2/d3 receptor availability is reduced in methamphetamine dependence and is linked to impulsivity. J Neurosci 2009; 29:14734.
  30. Johanson CE, Frey KA, Lundahl LH, et al. Cognitive function and nigrostriatal markers in abstinent methamphetamine abusers. Psychopharmacology (Berl) 2006; 185:327.
  31. Sekine Y, Minabe Y, Ouchi Y, et al. Association of dopamine transporter loss in the orbitofrontal and dorsolateral prefrontal cortices with methamphetamine-related psychiatric symptoms. Am J Psychiatry 2003; 160:1699.
  32. Volkow ND, Chang L, Wang GJ, et al. Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. J Neurosci 2001; 21:9414.
  33. Martins T, Baptista S, Gonçalves J, et al. Methamphetamine transiently increases the blood-brain barrier permeability in the hippocampus: role of tight junction proteins and matrix metalloproteinase-9. Brain Res 2011; 1411:28.
  34. Yu S, Zhu L, Shen Q, et al. Recent advances in methamphetamine neurotoxicity mechanisms and its molecular pathophysiology. Behav Neurol 2015; 2015:103969.
  35. Silva AP, Martins T, Baptista S, et al. Brain injury associated with widely abused amphetamines: neuroinflammation, neurogenesis and blood-brain barrier. Curr Drug Abuse Rev 2010; 3:239.
  36. Sekine Y, Ouchi Y, Sugihara G, et al. Methamphetamine causes microglial activation in the brains of human abusers. J Neurosci 2008; 28:5756.
  37. Wilson JM, Kalasinsky KS, Levey AI, et al. Striatal dopamine nerve terminal markers in human, chronic methamphetamine users. Nat Med 1996; 2:699.
  38. Wood E, Stoltz JA, Zhang R, et al. Circumstances of first crystal methamphetamine use and initiation of injection drug use among high-risk youth. Drug Alcohol Rev 2008; 27:270.
  39. Fowler JS, Volkow ND, Logan J, et al. Fast uptake and long-lasting binding of methamphetamine in the human brain: comparison with cocaine. Neuroimage 2008; 43:756.
  40. Cho AK, Melega WP. Patterns of methamphetamine abuse and their consequences. J Addict Dis 2002; 21:21.
  41. Hart CL, Gunderson EW, Perez A, et al. Acute physiological and behavioral effects of intranasal methamphetamine in humans. Neuropsychopharmacology 2008; 33:1847.
  42. Grant KM, LeVan TD, Wells SM, et al. Methamphetamine-associated psychosis. J Neuroimmune Pharmacol 2012; 7:113.
  43. Son JH, Latimer C, Keefe KA. Impaired formation of stimulus-response, but not action-outcome, associations in rats with methamphetamine-induced neurotoxicity. Neuropsychopharmacology 2011; 36:2441.
  44. Dean AC, Groman SM, Morales AM, London ED. An evaluation of the evidence that methamphetamine abuse causes cognitive decline in humans. Neuropsychopharmacology 2013; 38:259.
  45. Morgan EE, Woods SP, Poquette AJ, et al. Visual memory in methamphetamine-dependent individuals: deficient strategic control of encoding and retrieval. Aust N Z J Psychiatry 2012; 46:141.
  46. Hart CL, Marvin CB, Silver R, Smith EE. Is cognitive functioning impaired in methamphetamine users? A critical review. Neuropsychopharmacology 2012; 37:586.
  47. Price KL, DeSantis SM, Simpson AN, et al. The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina. Am J Addict 2011; 20:447.
  48. Tolliver BK, Price KL, Baker NL, et al. Impaired cognitive performance in subjects with methamphetamine dependence during exposure to neutral versus methamphetamine-related cues. Am J Drug Alcohol Abuse 2012; 38:251.
  49. Homer BD, Solomon TM, Moeller RW, et al. Methamphetamine abuse and impairment of social functioning: a review of the underlying neurophysiological causes and behavioral implications. Psychol Bull 2008; 134:301.
  50. Nestor LJ, Ghahremani DG, Monterosso J, London ED. Prefrontal hypoactivation during cognitive control in early abstinent methamphetamine-dependent subjects. Psychiatry Res 2011; 194:287.
  51. van Holst RJ, Schilt T. Drug-related decrease in neuropsychological functions of abstinent drug users. Curr Drug Abuse Rev 2011; 4:42.
  52. Scott JC, Woods SP, Matt GE, et al. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychol Rev 2007; 17:275.
  53. Newton TF, Kalechstein AD, Duran S, et al. Methamphetamine abstinence syndrome: preliminary findings. Am J Addict 2004; 13:248.
  54. Mancino MJ, Gentry BW, Feldman Z, et al. Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study. Am J Drug Alcohol Abuse 2011; 37:131.
  55. Boileau I, McCluskey T, Tong J, et al. Rapid Recovery of Vesicular Dopamine Levels in Methamphetamine Users in Early Abstinence. Neuropsychopharmacology 2016; 41:1179.
  56. O'Brien MS, Anthony JC. Extra-medical stimulant dependence among recent initiates. Drug Alcohol Depend 2009; 104:147.
  57. Hser YI, Evans E, Huang D, et al. Comparing the dynamic course of heroin, cocaine, and methamphetamine use over 10 years. Addict Behav 2008; 33:1581.
  58. Brecht ML, Huang D, Evans E, Hser YI. Polydrug use and implications for longitudinal research: ten-year trajectories for heroin, cocaine, and methamphetamine users. Drug Alcohol Depend 2008; 96:193.
  59. Hser YI, Huang D, Brecht ML, et al. Contrasting trajectories of heroin, cocaine, and methamphetamine use. J Addict Dis 2008; 27:13.
  60. Brecht ML, Greenwell L, Anglin MD. Methamphetamine treatment: trends and predictors of retention and completion in a large state treatment system (1992-2002). J Subst Abuse Treat 2005; 29:295.
  61. Rawson RA, Gonzales R, Marinelli-Casey P, Ang A. Methamphetamine dependence: a closer look at treatment response and clinical characteristics associated with route of administration in outpatient treatment. Am J Addict 2007; 16:291.
  62. Yen CF, Chang YP. Relapse antecedents for methamphetamine use and related factors in Taiwanese adolescents. Psychiatry Clin Neurosci 2005; 59:77.
  63. Svingen L, Dykstra RE, Simpson JL, et al. Associations Between Family History of Substance Use, Childhood Trauma, and Age of First Drug Use in Persons With Methamphetamine Dependence. J Addict Med 2016; 10:269.
  64. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004; 61:807.