Management of Acute Withdrawal and Detoxification for Adults who Misuse Methamphetamine: A Review of the Clinical Evidence and Guidelines

Methamphetamine is a highly addictive drug that is created illegally in clandestine laboratories using a variety of household chemicals, including ephedrine or pseudoephedrine, that is extracted from over the counter medications.¹ There is no legally available alternative drug. Methamphetamine comes as a white powder or a crystal format and can be sniffed up the nose or mixed with water and injected.¹ The production of methamphetamine is dangerous and produces large volumes of toxic chemical waste.¹ In 2006, Canada introduced new regulations to limit access to the precursor chemicals needed to produce methamphetamine including the move to keep ephedrine-containing products behind the pharmacy counter.¹ The prevalence of methamphetamine use in Canada is low, with about 0.2% of the population reported to use the substance; however, it would appear that the availability of methamphetamine in Canada has recently increased.¹ There was a 590% increase in the number of methamphetamine-related drug offences and seizures between 2010 and 2017.¹ Methamphetamine has a long half-life and the high experienced when using it can take effect in seconds¹ and last up to 12 hours.¹ Short-term effects associated with its use include elevated breathing, heart rate, and blood pressure, lack of appetite, weight loss, increased body temperature, headache, and dizziness.¹ Longer-term effects may include dental decay caused by extreme dry mouth, paranoia, psychosis or psychotic symptoms, itching, and sleeplessness.¹ The prevalence of long-term use is significantly higher for males than for females.¹ There has been an observed increase in the number of individuals seeking treatment for methamphetamine misuse across a number of Canadian jurisdictions.¹ When the drug wears off, people can experience anxiety and depression and may become agitated or violent and demonstrate unpredictable behaviour.¹ This aspect of behavior can make it difficult to safely care for people who are experiencing methamphetamine withdrawal and detoxification symptoms. The objective of this report is to summarize the clinical evidence and evidence-based guidelines regarding methods to manage acute withdrawal for adults who misuse methamphetamine.