Crystal Meth Withdrawal
This drug can be made with very simple ingredients that can be purchased at drug stores, though it is becoming increasingly available through larger foreign manufacturing sources.
Methamphetamine presents as small bluish and whitish rocks or as small pieces of glass, and is highly addictive. It is known by a number of street names including glass, ice, crank, shards, etc. The drug is typically snorted or smoked.
Meth Comedown: What’s It Like?
Methamphetamine is a potent stimulant, whether it comes as crystal meth, speed, or another form of amphetamine. The drug quickly hits the brain, releasing neurotransmitters like dopamine and serotonin to increase energy, alertness, and sociability.
A comedown is different from withdrawal, although there are a few aspects of the process that appear similar. Comedowns from drugs are closer to hangovers from alcohol, as both are caused by a combination of neurotransmitter imbalances in the brain, chemicals metabolized into toxins that build up in the body, and exhaustion from the euphoria of the drug.
Meth comedown symptoms include:
- Muscle weakness
- Decreased appetite
- Lack of motivation
- Insomnia despite exhaustion
- Headache from dehydration
- Muscle pain, especially in the jaw from clenching
Comedown symptoms may last for a few days after one abuses the drug, especially mental health changes like depression and anxiety. When abused as a party drug, meth may be mixed with other amphetamines, opioids, or alcohol. Mixing drugs together is very dangerous and can cause an overdose; in addition, comedown symptoms will feel worse or more intense when substances are combined. If the individual does not take any more meth, these symptoms will resolve on their own.
Comedowns Can Lead to Binges
It is important to understand the symptoms of a comedown from stimulant drugs like meth because many people who begin to abuse these drugs take more as the comedown symptoms begin to set in. This leads to binges, which can cause a deadly overdose or long-term harm to the brain and body.
Meth binges are called “tweaking.” Too often, to avoid the depression and physical weakness associated with a meth comedown, someone abusing the drug will take more, which increases the intensity of effects and side effects. This, in turn, increases the intensity of depression symptoms when the drug begins to wear off, leading the individual to take more meth.
Tweaking occurs when a person struggling with meth abuse does not sleep for 3-15 days, suffers from intense paranoia, and likely develops temporary psychosis. The original euphoria from meth does not occur after a few doses, but the person still struggles with high energy, overheating, dehydration, loss of appetite, physical pain and twinges, anxiety, irritability, and aggression.
At a minimum, the person develops repetitive behaviors, like taking objects apart and putting them back together or obsessively cleaning. Without enough sleep, the person may experience hallucinations or delusions, leading to psychotic behavior. Formication – hallucinating bugs on or under the skin – causes people suffering from a meth binge to repeatedly scratch or pick at their skin, which can damage this organ and lead to infection. Users may lash out, harming themselves or others in the process.
Coming down, or crashing, after a binge, can lead to complete mental and physical exhaustion. A person may experience malnutrition from failing to eat and is likely to sleep for several days. Mental health side effects can feel very serious, and unfortunately, this intense depression can lead to the individual taking more meth when they wake up.
The attempt to avoid comedown symptoms is likely to lead to tweaking and subsequent dependence and addiction. While comedown symptoms are not generally dangerous, the resulting binge is.
Withdrawal from Crystal MethThere are numerous studies that have documented the effects of withdrawal in chronic methamphetamine abusers. Despite quite a bit of misinformation online, it appears that the timeline for methamphetamine withdrawal is relatively consistent and offers some predictability regarding what clinicians and those in recovery can expect.
Withdrawal symptoms are primarily psychological and emotional with several associated physical symptoms. The withdrawal process from methamphetamine does not appear to be consistently severe, such as with withdrawal from alcohol or opioid drugs.
Withdrawal from crystal meth is most likely not potentially physically damaging unless the individual becomes extremely emotionally unstable and engages in self-harm.
Methamphetamine has a relatively short half-life (an average around 10 hours), and it is a fast-acting drug. In general, according to research, it appears that the timeline for withdrawal from crystal meth is fairly consistent among users:
- It begins within the first 24 hours of abstinence.
- It reaches its peak within the first 7-10 days following discontinuation of the drug, and there is a steady decline in the intensity of symptoms following this peak.
- It has an average duration of about 14-20 days, with 14 days being the most commonly reported duration of the withdrawal syndrome.
According to the same research and several other studies, it appears that the primary symptoms during this withdrawal period consist of:
- Feelings of fatigue, lethargy, and excessive sleepiness (typical of withdrawal from stimulant medications) are common.
- Increased appetite, dry mouth, and some episodes of jitteriness generally occur.
A significant number of individuals report feelings of depression, which were also noted to decline in a linear fashion over the course of the withdrawal time period. These depressive symptoms can be significant and associated with thoughts of suicide. In addition, research has indicated that a good number of individuals who relapse do so because of feelings of depression, apathy, hopelessness, etc.
Extreme cravings for methamphetamine also occur during the withdrawal process but have been noted to decline rapidly. Cravings for methamphetamine during withdrawal appear to be associated with the level of depression occurring in the individual. In addition, as one would expect, research indicates that the more intense and frequent the cravings an individual in withdrawal from methamphetamine experiences, the higher the probability that the individual will relapse during the withdrawal syndrome.
Psychotic symptoms, such as paranoia, hallucinations, and delusions, also occur in many individuals. These symptoms need to be addressed in a professional treatment environment.A large meta-analysis indicated that the most dangerous symptoms associated with methamphetamine withdrawal are severe depression and the potential to develop psychosis. It did not reveal any significant overall risk for the development of other health issues, although in individual cases, there may be health risks associated with withdrawal from methamphetamine. These risks may be more salient in older individuals or individuals with pre-existing medical conditions.
There is also some research to indicate that at least following short-term recovery, individuals with methamphetamine use disorders exhibit some cognitive deficits in the areas of mental processing speed, attention, memory, and planning that are not fully resolved within six months of abstinence. Research looking at the longer-term cognitive effects of crystal meth abuse is ongoing.
Medications to Assist in the Withdrawal Process
There are no medications approved by the FDA that are specifically designed to be used in the detox withdrawal process from crystal meth. However, there are several different medications that can help to manage some of the symptoms that occur during this process of withdrawal:
Wellbutrin (bupropion): This drug is an antidepressant that has been approved for and used in smoking cessation programs. It also has a good body of research indicating that it is useful in reducing the symptoms of withdrawal in individuals who have abused crystal meth. It appears to reduce the significant cravings associated with the withdrawal process and appears to be more appropriate for light to moderate methamphetamine use disorders.
Provigil (modafinil): This medication is a mild stimulant medication that is used in the treatment of ADHD and in the treatment of narcolepsy. The mild stimulant properties of the medication can assist in reducing issues of with disruptive sleep patterns and may also help those in recovery with increasing energy and enhancing concentration.
Selective serotonin reuptake inhibitors: Paxil (paroxetine) is a selective serotonin reuptake inhibitor (a specific type of antidepressant medication) that has been shown in some studies to relieve cravings in abstinent crystal meth users going through withdrawal; however, the research on the efficiency of this drug for treatment during crystal meth withdrawal is mixed. There is research that has suggested that Prozac (fluoxetine) may be useful in the treatment of crystal meth addiction during the withdrawal process.
Remeron (mirtazapine): Remeron is an atypical antidepressant that has its primary mechanism of action on both serotonin and norepinephrine. There is evidence that its use can help to prevent relapse during the withdrawal process.
In the management of the withdrawal process from crystal meth, physicians are free to use any medications to address any specific symptoms that occur in individuals. For instance, in individuals who develop psychotic-type behaviors, such as paranoia, delusions, and/or hallucinations, physicians are free to administer antipsychotic medications to these individuals if the symptoms are judged to be severe enough to require direct treatment.
Physicians may also attempt to directly manage depressive symptoms through the use of antidepressants; however, because most antidepressants do not begin to exert their effects until 2-4 weeks after initial administration, this may not be an effective means of coping with depression in the withdrawal process. Other medications can be used to address specific symptoms that occur during withdrawal from methamphetamine.