National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69
3.7 Summary
The primary action of ATS in the brain is to elevate levels of dopamine, serotonin and noradrenaline. Methamphetamine has a stronger effect on dopamine levels while ecstasy is more strongly associated with serotonin levels. The sought after effects of ATS include a sense of wellbeing, euphoria, increased alertness and concentration, diminished appetite, enhanced confidence, sharpened sensory awareness. The short-term adverse effects include restlessness, irritation, anxiety, teeth grinding, insomnia, sweating and increased heart rate.
Prolonged use of ATS can also have several long-term effects in diverse areas of functioning. The primary adverse cognitive effects for all types of ATS appear to be deficits in working memory, attention and executive function. Several psychological problems have been identified in association with ATS use, most notably, depression, anxiety and psychosis. Well documented is the link between use of crystal methamphetamine and psychotic symptoms, which can be associated with violent behaviour. Dependence is another adverse outcome of ATS use, associated more with the use of methamphetamine than ecstasy. Dependence is also more strongly associated with injecting and smoking methamphetamine, than with other routes of administration such as snorting and swallowing. Other effects are specific to route of administration; for example, increased risk of blood borne virus transmission with certain injecting practices. In addition, there are several adverse physical outcomes of ATS use such as hypertension, irregular body temperature, cardiac arrhythmia, metabolic disturbances, poor dental hygiene and lethargy. There is some research on neurotoxicity and overdose associated with ATS use, with deaths more often resulting from use of methamphetamine than ecstasy.
ATS use can also have adverse behavioural and social effects. Many ATS users are polydrug users and use of ATS in combination with other drugs, including alcohol, can increase related harms. Certain contexts of use increase the risk of harm. For example, ATS use can impair driving ability and workplace safety. ATS use has been associated with risky sexual practices, such as a failure to use protection thereby increasing the risk of sexually transmitted infections. There is growing research on the use of ATS in homosexual populations, particularly among gay males. Methamphetamine has also been associated with aggression and violence, and linked to some criminal activity.
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In addition to the effects of ATS use on the individual, there may be a wider impact on family, friends and the broad community. ATS use can have a detrimental effect on relationships, with the user becoming increasingly alienated from social networks. ATS use during pregnancy can negatively affect the developing foetus as can use while breastfeeding. Parental ATS use can result in adverse outcomes for children. Finally, exposure to methamphetamine manufacture represents a potential harm for children and the wider community, including those responsible for cleaning up production sites.
The need for further research into the effects of ATS use was raised during consultations. The most neglected areas of research were seen as epidemiological information about patterns of drug use and related problems; the long-term effects of ATS use; neuropsychological deficits and their impact on the effectiveness of treatment; effects of ATS use during pregnancy; memory deficits associated with use; and strategies to enhance engagement with treatment services.
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