the question I’d like to answer today at the initiation of our methyl amphetamine and stimulant series is what is methamphetamine withdrawal and detox like that is what has been submitted to us and they really would like me to kind of stay on point here as a lot of you know I always like to begin with a historical evaluation of a substance or drug and
how it came to be developed its uses and the cultural and social media evolved in I’m going to try and shy away from that and really stick to this plant here and the question is what’s methamphetamine withdrawal and detox like and they break it down into three questions what are the symptoms of methamphetamine withdrawal number two how long do methamphetamine withdrawal symptoms last number three how can someone safely
detox off of meth let me start off with what are the symptoms of methamphetamine would cross like excuse me this is an important question because like any substance of abuse that initial acute phase of withdrawal is where there is a very severe or very important marker for potential for relapse is to mitigate these withdrawal symptoms on the other hand there’s
always a question is what are the health consequences of effects and effects of the withdrawal symptoms and that is also important in this case which I’ll answer but again that physiological dependence that one has on the substance sort of creates the psychological and physiological acute phase of the withdrawals and wouldn’t it be great if we can control those
so that the opportunity for relapse is decreased with methamphetamines there’s been quite a bit of studies in the past and I’m just going to try to characterize some of these uh initial withdrawal symptoms to the best I can always remember uh in reality the extent breath and length of the withdrawal symptoms is very dependent on demographic
characteristics of the patient male female age other factors like other substance of abuse and disease State and how long and how heavy have they been using the drug that is in question given all that we can certainly make some general very across-the-board characteristic generalizations of the acute withdrawal symptoms of
methamphetamine type symptoms uh about drugs one thing I want to say is that methamphetamines have one very small chemical difference than regular amphetamine stimulants which is on on the Nitric it doesn’t kind of matter but that one small difference make them makes them a lot more lipid soluble and what that essentially means is that it
much more rapidly and easily crosses the blood brain barrier and that increases the potential for abuse addiction and also contributes to withdrawal so what that really means is how quickly does that drug get in your nervous system the generalized and most common again I’m describing it as gently as I can the most General and common
withdrawal symptom for methamphetamines is what’s called dysphoria and what does that mean it’s actually an old Greek term but dysphoria I want you to think of what does Euphoria mean and you can think of it as thinking feeling extra good dysphoria is in its most General sense although Scholars debate about the meaning of dysphoria both clinicians scientists and linguists but it means we
can say feeling not right could be depression with anxiety a sense of restlessness but I’d like to say that there’s an internal sort of ticking of some way shape or form you don’t feel right and it’s also accompanied by some depression some anxiety maybe some internal restlessness remember you can’t see this thing you have to get this information from the patient and they
have a feeling of dysphoria I won’t get into why we’ll do that a bit later uh video where we describe the neurotransmitters involved here but that is the most common description that you can say other than that there is multiple other and in fact if we went to that old Diagnostic and statistical manual for the psychiatrist and dsm-4 I’m not talking about the newest one which is DSM-5 you have to have this for
you and you have to have two other additional symptoms it hasn’t changed that much but some of these other symptoms are fatigue being tired insomnia that essentially as you all know means that you can’t sleep hypersomnia okay long periods of sleeping and this those first several days and they’re actually uh neurochemical reasons for that um increased appetite right you’ll see someone eating a lot during that time
there could be anxiety associated with it depression and again all of that sort of falls under dysphoria there’s also another thing that you might see which would be psycho motor retardation or agitation that essentially means um watching the fine motor movements of somebody they’re just a little bit off in some way shape or form and again this
has to do with the autonomic drive that has to do with your motor and sensory system they will also have vivid and unpleasant dreams that’s the the general kind of symptom complex that you’ll see in that acute phase I should also add you might also see some aches and pains in the joints different studies over different periods of time in the last 15 20 years have
sort of described all of those and the next question is how long does that acute phase last we can say about seven days okay keep in mind again depending on how much you use and how long you’ve used and your age and everything else that’s going on we can say about seven days where these acute phase withdrawal symptoms are present in addition to that
people will have cravings and again with the Cravings I’m suspicious of the clinical literature description of the Cravings because I’ve seen things all over the board but the Cravings are really psychological no more than cocaine just like cocaine and what that means because eventually anything psychological has a biological and pharmacological explanation and
mechanism but that is where it ends is about seven days supposedly I’m suspect of that kind of characterization but we’re making a generalization after that uh I’m hesitant to make a point about protect protracted withdrawal symptoms because I just see it all over the place uh and I suspect there’s something with
the What’s called the frontal cortex the executive part of your brain and the midbrain and it’s a lot of it is behavioral and sort of uh a reward circuitry problem and here’s what I’m trying to say after these acute symptoms are gone you’ll see people going back to methylamphetamines okay and so if they truly don’t have any more acute symptoms with physiologically measurable changes
you have to ask yourself why I’m going to leave that to another video and hopefully we can really dig into this but you know I’m going to say you know they’ll say up to what one month four weeks and I personally for my clinical experience I don’t think that’s the case okay there’s a lot of complexity here and certainly if you can go day after day
after day and week after week by keeping someone off of methamphetamines every day that you do that you’re sort of recruiting brain chemistry and architecture to move away from that addiction and withdrawal but nevertheless I’ll see people going back to it and two two weeks three weeks one month three months and six months with a
lot less statistical propensity to do so but nevertheless it is there so there is a complexity here that really uh I want to leave vague because the literature is vague in capturing it what is our goal in capturing it is to minimize relapse and we haven’t really been able to do that in general this has been described as a treatment
resistant addiction which essentially means medication and the interventions that we do doesn’t work for it I’m going to leave that at that and of course there’s nuances and things that fall on the two sides of the bell curve in short again in general for most people those acute symptoms last up to seven days every day that you add to being clean you’re recruiting
psychological and physical factors that will sort of contribute and add to your long-term uh sobriety but these things can definitely go on for a lot more than a month and they’re quite different in the acute withdrawals the second part of this question is how can someone safely detox off of meth and again this is a loaded question and it’s sort of wrong because it’s you know for me to answer
this I’d be answering the wrong thing let’s begin with the most uh sort of mystifying part of this that’s incorrect as detox I I don’t know and I’ve never known what that means whether you’re talking about methamphetamine stimulants or you’re talking about opiates detox is the wrong term I would call it medically supervised acute withdrawal management
okay and why is that important it’s important because if you can manage the acute withdrawals and minimize how bad they are and comfort the patient you’re going to minimize the potential for relapse it’s not detox the term detox implies some sort of a closure and the the addiction issues still have to be dealt with in the long run in a very
significant way yes we’ve gotten somewhere but no we’re not done in my position this is a chronic relapsing remitting disease that you aim for long-term remission so let’s be careful by calling it detox because some of these TV shows and some of the programs the way they sell this stuff off is that okay I get you off it you’re off of it for seven days ten days 30 days you’re okay that’s not true we’re just making
the patient more comfortable because that is the right thing to do and the second question is you know here it talks about safely can detoxing off of methamphetamines be dangerous not really for the most part again each patient is different because they might have other comorbidities as we call them other disease States and factors that can really be exacerbated by coming off of methamphetamines but the only class of
drugs that withdrawing off of can kill you or make you very sick is the class of drugs called sedative hypnotics which includes alcohol barbiturates and benzodiazepines which which we all know we talk about seizures and potentially death for methamphetamine withdrawal you don’t have a danger to your health in particular yeah you might feel horrible and in fact one of the withdrawal symptoms I didn’t
in the acute phase I didn’t discuss is psychosis and paranoia and that goes into the acute stage and the long-term stage but there are some nuances there I’ll just leave it at that but safely detox there’s no issue of safety the most important thing I think you have to do is make sure the patient is well hydrated because when someone’s coming off of methamphetamine Ron they can go into this thing called Rhabdomyolysis
and it’s an incredible amount of protein breakdown that clogs up your kidneys and can shut your kidneys down the most Hallmark classic symptoms are body aches and coca-colored urine so keep the client very well hydrated or the patient and now comes the question or what are the medications during a safe detox I’m going to say in general to this day we have not come up with the medications
in the same way that we have for opiates a lot of things have been studied a lot of classes of medications we can call them the different anti-depressant class of medications we can call them the first generation second generation antipsychotic class of medications we can even talk about the opiate replacement class of medications including buprenorphine products which have to do with your dopamine system which is intimately tied into
methamphetamine use but none of these things have shown statistical significance and different Studies have shown different mixed results we can break it down another way the first idea would be hey in the same way that I use methadone or buprenorphine let me find a replacement for that receptor so that they don’t have cravings and withdrawals
when we failed at that the next thing to look for is supplementary medication that has to do with the dopamine or mood again mixed results I’m going to add one more thing to this issue that is of controversy oftentimes pulse methamphetamine use because of the multiple types of chemicals involved you will see as I said earlier on you’re
going to see a lot of depression you may see anxiety and you may see psychosis and all of those are different constructs and classes of disease in the psychiatric world so a person may have psychosis who else can have psychosis someone with certain types of bipolar or someone with certain types of schizophrenia and you might also see depression or anxiety or Mania
same thing anxiety is a Class by itself in a psychiatric World depression is a Class by itself in the psychiatric world and I bring this up because a couple of thoughts need to be understood here in general the rule of thumb is to wait six weeks maybe even up to three months before you start somebody on any medication for psychosis or depression or anxiety after they come off of their
methamphetamine or any drug use and this is not a bad rule of thumb because you really shouldn’t make a diagnosis so early afterwards until they go through all of their withdrawal symptoms which are mainly mood changes and psychiatric symptoms and then make your diagnosis and move forward on the other hand there is a school of thought and I think it’s less so nowadays that wants to start these medications right away I I would
say I certainly wouldn’t make a diagnosis early on after coming off of methamphetamines but I certainly do use some of these medications myself to assist and facilitate my acute phase of methamphetamine withdrawals not that it’s dangerous but I use different ones and I make it very clear to the patients that this is not like medication assisted
treatment but it is uh you know you’re basically you’re a little bit shooting in the dark but you’re also using your clinical experience one other idea to keep in mind there is that behavioral interventions there’s been different models and modalities of very strict and regimented behavioral interventions used to intervene during the acute withdrawal phase and again these have been used
with some success and so there’s mixed results and we don’t have mathematical efficacy nevertheless those are useful too so right now where we stand is that the this is a highly addictive class of medications there’s a complexity to it to it because what you see nowadays is you rarely see people being straight
stimulant addicts and even the stimulants out there are no longer pure because they’re very very messy the way they’re made and you also see a very poly substance approach to all of these a lot of people just simply use their stimulants met mix with their opiates kids on the street call it goofball and what used to be called speedball okay and so you see a mix of uses different
ages different classes and you have to really take a look at your patient and decide how you’re going to go about it I’m going to uh sort of finish off with one example or maybe even two examples of two different types of patients uh how I actually treated in an out patient setting and this was methamphetamines and heroin yeah young there’s been a few of these exactly the same way and this
is where chronic disease and harm reduction comes into play young lady maybe early 30s late 20s who’s a poly substance abuse or heroin and methamphetamines and uh she comes in and what I wanted to see if it’s if I get the heroin under control uh is the meth going to get under control and people often say it will and oftentimes it doesn’t so in this young lady’s case we got the heroin under control pretty
quickly with the use of buprenorphine products and that was great and she continued to come in and her urine was positive for methamphetamines but again this is where you have to build a rapport with the patient or they trust you and there’s a professional intimacy built there and they keep coming back in one you need to take care of their opiate abuse two I always have the spirit of we can do this and we’ll
get there I don’t know how long it’s going to take but we will we will get there so what we did with her is uh I think she had minimal Insurance resources or payment resources she couldn’t go into detox for the methamphetamines she was a hairdresser had to Uber all the way out here every week and what we did is okay until you give me a clean urine you’re just going to come in here on every week and describe in detail to
me what it is that cause you to use methamphetamines this week we did this for about six months and at one point and she was actually very disheartened about her progress although she was making a lot of progress and she didn’t realize it what’s important to note is that she made her appointment every week she paid thirty dollars for the Uber to get there every week she was absolutely honest and not judged every week and she didn’t Pat herself on the
back for that in addition we were getting longer and longer days of clean time uh five days 10 days 15 days use they could start again five days 10 days 20 days use we continued this and at some point there was a change a trigger of some sort where our five days turned into 10 days 15 days 20 days 30 days two months three
months well she’s happily living in another state now and all of this seems like a distant foggy memory term there’s a few clients that I’ve actually treated in this exact same way the key here is to not to stop client engagement patient engagement not to judge them and exercise the really really fundamental principles of harm reduction
which is universal human rights she’s using she wants to use I’m going to mitigate damage to her and her immediate surroundings and to Society at large and there is a time where things change whether it’s in our frontal cortex or the behavioral mechanisms that are routine that are the root of substance abuse I am going to continue to engage her neurons if you want to say until
that change occurs and it often does the problem is our system doesn’t support that the payment structure doesn’t support that and the clinician’s time or sometimes bias and judgment or even understanding of what’s really going on here doesn’t support that in addition I use medications and I try different medications with whether it’s for Sleep whether it’s for mood whether it’s for
psychosis symptoms and try to give them some support in this long haul of chronic disease management and they get there I think our problem is that our system doesn’t have a cushion for this sort of care which actually in the short term and long round is a lot cheaper to the individual and the system as well as respecting the dignity and autonomy of
the individual and the public at large if you think about it all of this makes sense thank you very much for watching please press the Subscribe button and that Bell thing we really appreciate your support if you want to see more videos please click up here to my left and you will see more videos of the same kind