Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Methamphetamine: Acute intoxication

Edward W Boyer, MD, PhD
Steven A Seifert, MD, FAACT, FACMT
Christina Hernon, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Methamphetamine is a sympathomimetic amine that belongs to a class of compounds, the phenethylamines, with a variety of stimulant, anorexiant, euphoric, and hallucinogenic effects. Methamphetamine was first synthesized in 1893. Thirty years later, pharmaceutical formulations were introduced as treatments for nasal congestion and asthma. Methamphetamine was widely used by German, Japanese, and American forces during World War II to increase alertness and decrease fatigue.

Methamphetamine is used clinically for treatment of attention deficit disorder with hyperactivity (ADHD), short-term treatment of obesity, and as an off-label treatment for narcolepsy. Recreational use of methamphetamine and other amphetamine-derived stimulants has reached epidemic proportions in the United States, Southern Asia, the Philippines, and Japan. After cannabis, it is the most widely abused illicit drug worldwide [1]. Approximately 5 percent of the United States population has used methamphetamine in their lifetime, with an estimated 500,000 people using the drug in a given month [2-5].

Methamphetamine may be synthesized via simple reactions using readily available chemicals and over-the-counter cold medicines, such as ephedrine and pseudoephedrine. Although some illicit methamphetamine is diverted pharmaceutical product, the majority of recreational methamphetamine is manufactured specifically for illicit use. The output of thousands of small laboratories in predominantly rural regions of the United States has been supplanted by "superlabs," commonly outside the United States, whose output is kilogram quantities. Clandestine methamphetamine synthesis carries significant risk of explosion or toxic exposure and is responsible for exposing many children to profoundly toxic products [6].

This topic review will discuss the toxicology, diagnosis, and management of acute methamphetamine intoxication. The general management of acute drug overdose and the management of other stimulants, such as cocaine, are discussed elsewhere. (See "General approach to drug poisoning in adults" and "Cocaine: Acute intoxication".)


Phenethylamines comprise a class of central nervous system (CNS) stimulants (figure 1). Various substitutions on the basic phenethylamine structure determine the degree of CNS penetration, likelihood of degradation by monoamine oxidase (MAO), receptor binding affinity, and the range of effects.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Apr 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. United Nations Office on Drugs and Crime, World Drug Report 2015 https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf (Accessed on November 14, 2016).
  2. Drug Policy Information Clearinghouse Fact Sheet: Methamphetamine. Office of National Drug Control Policy, Rockville, MD, November 2003 www.whitehousedrugpolicy.gov (Accessed on June 15, 2007).
  3. Hendrickson RG, Cloutier R, McConnell KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med 2008; 15:23.
  4. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). http://www.samhsa.gov/data/ (Accessed on November 14, 2016).
  5. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
  6. Drug Fact Sheet: Methamphetamine. https://www.dea.gov/druginfo/drug_data_sheets/Methamphetamine.pdf (Accessed on November 14, 2016).
  7. 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; 44:379.
  8. Cantrell FL, Breckenridge HM, Jost P. Transrectal methamphetamine use: a novel route of exposure. Ann Intern Med 2006; 145:78.
  9. Kashani J, Ruha AM. Methamphetamine toxicity secondary to intravaginal body stuffing. J Toxicol Clin Toxicol 2004; 42:987.
  10. Chiang WK. Amphetamines. In: Goldfrank's Toxicologic Emergencies, 9th ed, Nelson LS, Lewin NA, Howland MA, et al (Eds), McGraw-Hill, New York 2011. p.1078.
  11. Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatry 2005; 13:141.
  12. Desoxyn Drug Insert/Information.
  13. West PL, McKeown NJ, Hendrickson RG. Methamphetamine body stuffers: an observational case series. Ann Emerg Med 2010; 55:190.
  14. Gray SD, Fatovich DM, McCoubrie DL, Daly FF. Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation. Med J Aust 2007; 186:336.
  15. Derlet RW, Rice P, Horowitz BZ, Lord RV. Amphetamine toxicity: experience with 127 cases. J Emerg Med 1989; 7:157.
  16. Chan P, Chen JH, Lee MH, Deng JF. Fatal and nonfatal methamphetamine intoxication in the intensive care unit. J Toxicol Clin Toxicol 1994; 32:147.
  17. Richards JR, Bretz SW, Johnson EB, et al. Methamphetamine abuse and emergency department utilization. West J Med 1999; 170:198.
  18. Swanson SM, Sise CB, Sise MJ, et al. The scourge of methamphetamine: impact on a level I trauma center. J Trauma 2007; 63:531.
  19. Tominaga GT, Garcia G, Dzierba A, Wong J. Toll of methamphetamine on the trauma system. Arch Surg 2004; 139:844.
  20. Methamphetamine: Dose. Erowid. https://erowid.org/chemicals/meth/meth_dose.shtml (Accessed on November 14, 2016).
  21. Turnipseed SD, Richards JR, Kirk JD, et al. Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use. J Emerg Med 2003; 24:369.
  22. Hawley LA, Auten JD, Matteucci MJ, et al. Cardiac complications of adult methamphetamine exposures. J Emerg Med 2013; 45:821.
  23. Mowry JB, Spyker DA, Brooks DE, et al. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila) 2015; 53:962.
  24. Blostein PA, Plaisier BR, Maltz SB, et al. Methamphetamine production is hazardous to your health. J Trauma 2009; 66:1712.
  25. Santos AP, Wilson AK, Hornung CA, et al. Methamphetamine laboratory explosions: a new and emerging burn injury. J Burn Care Rehabil 2005; 26:228.
  26. Nestor TA, Tamamoto WI, Kam TH, Schultz T. Crystal methamphetamine-induced acute pulmonary edema: a case report. Hawaii Med J 1989; 48:457.
  27. Schaiberger PH, Kennedy TC, Miller FC, et al. Pulmonary hypertension associated with long-term inhalation of "crank" methamphetamine. Chest 1993; 104:614.
  28. Chin KM, Channick RN, Rubin LJ. Is methamphetamine use associated with idiopathic pulmonary arterial hypertension? Chest 2006; 130:1657.
  29. Gotway MB, Marder SR, Hanks DK, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics 2002; 22 Spec No:S119.
  30. Johnson TD, Berenson MM. Methamphetamine-induced ischemic colitis. J Clin Gastroenterol 1991; 13:687.
  31. Oro AS, Dixon SD. Perinatal cocaine and methamphetamine exposure: maternal and neonatal correlates. J Pediatr 1987; 111:571.
  32. Sperling LS, Horowitz JL. Methamphetamine-induced choreoathetosis and rhabdomyolysis. Ann Intern Med 1994; 121:986.
  33. Alldredge BK, Lowenstein DH, Simon RP. Seizures associated with recreational drug abuse. Neurology 1989; 39:1037.
  34. Olson KR, Kearney TE, Dyer JE, et al. Seizures associated with poisoning and drug overdose. Am J Emerg Med 1993; 11:565.
  35. Zweben JE, Cohen JB, Christian D, et al. Psychiatric symptoms in methamphetamine users. Am J Addict 2004; 13:181.
  36. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352:1112.
  37. elSohly MA, Jones AB. Drug testing in the workplace: could a positive test for one of the mandated drugs be for reasons other than illicit use of the drug? J Anal Toxicol 1995; 19:450.
  38. Nixon AL, Long WH, Puopolo PR, Flood JG. Bupropion metabolites produce false-positive urine amphetamine results. Clin Chem 1995; 41:955.
  39. Cody JT, Valtier S. Detection of amphetamine and methamphetamine following administration of benzphetamine. J Anal Toxicol 1998; 22:299.
  40. Valentine JL, Kearns GL, Sparks C, et al. GC-MS determination of amphetamine and methamphetamine in human urine for 12 hours following oral administration of dextro-methamphetamine: lack of evidence supporting the established forensic guidelines for methamphetamine confirmation. J Anal Toxicol 1995; 19:581.
  41. Lan KC, Lin YF, Yu FC, et al. Clinical manifestations and prognostic features of acute methamphetamine intoxication. J Formos Med Assoc 1998; 97:528.
  42. Espelin DE, Done AK. Amphetamine poisoning. Effectiveness of chlorpromazine. N Engl J Med 1968; 278:1361.
  43. Richards JR, Derlet RW, Duncan DR. Methamphetamine toxicity: treatment with a benzodiazepine versus a butyrophenone. Eur J Emerg Med 1997; 4:130.
  44. Ruha AM, Yarema MC. Pharmacologic treatment of acute pediatric methamphetamine toxicity. Pediatr Emerg Care 2006; 22:782.
  45. Martel M, Sterzinger A, Miner J, et al. Management of acute undifferentiated agitation in the emergency department: a randomized double-blind trial of droperidol, ziprasidone, and midazolam. Acad Emerg Med 2005; 12:1167.
  46. Delbridge TR, Yealy DM. Wide complex tachycardia. Emerg Med Clin North Am 1995; 13:903.
  47. Paratz ED, Cunningham NJ, MacIsaac AI. The Cardiac Complications of Methamphetamines. Heart Lung Circ 2016; 25:325.
  48. Chen JP. Methamphetamine-associated acute myocardial infarction and cardiogenic shock with normal coronary arteries: refractory global coronary microvascular spasm. J Invasive Cardiol 2007; 19:E89.
  49. Wijetunga M, Bhan R, Lindsay J, Karch S. Acute coronary syndrome and crystal methamphetamine use: a case series. Hawaii Med J 2004; 63:8.
  50. Hick JL, Smith SW, Lynch MT. Metabolic acidosis in restraint-associated cardiac arrest: a case series. Acad Emerg Med 1999; 6:239.
  51. Chyka PA, Seger D, Krenzelok EP, et al. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43:61.
  52. Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2015; 53:5.
  53. Zhong N, Jiang H, Du J, et al. The cognitive impairments and psychological wellbeing of methamphetamine dependent patients compared with health controls. Prog Neuropsychopharmacol Biol Psychiatry 2016; 69:31.
  54. Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care 1998; 14:385.
  55. Schep LJ, Slaughter RJ, Beasley DM. The clinical toxicology of metamfetamine. Clin Toxicol (Phila) 2010; 48:675.
  56. Farst K, Duncan JM, Moss M, et al. Methamphetamine exposure presenting as caustic ingestions in children. Ann Emerg Med 2007; 49:341.
  57. Grant P, Bell K, Stewart D, et al. Evidence of methamphetamine exposure in children removed from clandestine methamphetamine laboratories. Pediatr Emerg Care 2010; 26:10.
  58. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila) 2010; 48:979.
  59. Information Bulletin: Children at Risk, National Drug Intelligence Center, Publication no. 2002-L0424-001. www.usdoj.gov/ndic/pubs1/1466/index.htm (Accessed on August 22, 2007).
  60. Bellemare S. Dangers for children in the care of drug users. CMAJ 2008; 179:164.
  61. Kitanaka J, Kitanaka N, Takemura M. Neurochemical consequences of dysphoric state during amphetamine withdrawal in animal models: a review. Neurochem Res 2008; 33:204.
  62. 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.