> I like this article overall but I get irritated when I read stuff about drug users that is clearly written by somebody who hasn’t done a lot of drugs.

To be fair, though, medical doctors with personal experience using meth are probably a very small group, and it's unlikely they're in a big hurry to write an article talking about their experience. But who knows...

Unless this is a regional thing I wonder where the doctor even got that idea, I wasn't even aware people snort meth until now. Meanwhile I walked past two people lighting up after leaving a job interview in soma last week. Any doctor who's worked in the ER or psych ward in SF would be familiar with how its used, meth induced psychosis is very common around here.

No such thing as meth-induced psychosis. Yes, people might appear psychotic while under the influence, but that is not psychosis in the clinical sense.

The few that do lose their rationality lose it because they don’t sleep for weeks. They likely also live in an unsafe environment which keeps them in a perpetual state of survival stress.

Survival stress + not sleeping + stimulants —> psychosis. Very rarely any of these alone, unless the individual is predisposed.

I’m not going to say you been in SF but you clearly haven’t walked through the tenderloin and probably not spent a lot of time around people that partake in harder drugs on regular basis. Yes it doesn’t match the clinical description, but that’s because the clinical description wasn’t written by someone who works in the heavily drug ridden areas. More likely by someone who probably only dealt with hard drug users once or twice on their ED rotation during residency

Would you consider the people living in those areas to be living under constant survival stress?

Asking because THAT fucks up people and makes them use drugs to escape their situation.

Possibly, but I've also seen white color workers with steady jobs and nice houses have a psychotic breaks because of heavy meth use. So perhaps it not all survival stress and the drugs have some affect as well.

I don’t know exactly how to respond to this. You’ve clearly got some strong opinions on this and maybe for good reasons.

I suppose I agree that environmental stress, survival stress, and PTSD are all common in the addict community. That’s true.

In my experience though, meth-induced psychosis is a thing. For example, if you understand the following sentence you either have seen or done it!

I once snapped/ghosted 3 points in one draw in order to scare off some gangsters, then the shadow people came.

After that I thought I could talk to programming libraries out loud. Not in a fun way. Meth induced psychosis is absolutely a thing.

We have differing definitions of ”meth-induced psychosis”. The clinical definition of psychosis excludes psychiatric symptoms of intoxication, so your experiences are simply psychiatric effects of meth overdose, not psychosis in the clinical sense.

Now, if those symptoms persist after you (would) pass a piss test, then we are talking about meth-induced psychosis.

I'm not a medical professional, maybe my terms are off but that's what I've seen it called in the media. In any case people are admitted with what appears to be schizophrenia only to end up perfectly lucid a bit later once the drugs have worn off.

The clinical diagnosis of psychosis can only be established if the symptoms REMAIN after the drugs have worn off.

It is meth induced because the meth keeps the person awake. You sound like someone who has not experienced it first hand.

Could just call it "meth induced paranoia hangover". How often is it persistent to be considered psychosis though?

Because it seems to cause cortical thinning https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135731/ which is correlated with psychosis https://www.medscape.com/viewarticle/952628 and so has been associated as partly causal?

These studies are meaningless, as they cannot distinguish between the effects of the drug and the effects of the illegality of the drug: constant survival stress, negative outlook on self imposed by others, social exclusion, paranoia.

Survival stress, as in PTSD, causes cortical thinning, and explains everything in the scenario without the need to arbitrarily assign blame to methamphetamine.

Survival stress also impacts liver function leading to poor lipid metabolism which in turn can impact cholesterol absorption and lead to cortical thinning. Which is also an effect that we see from methamphetamine use in various animal models, which by it's nature of being controlled trail seems to exclude the stress factor. https://pubmed.ncbi.nlm.nih.gov/28689763/

I would agree with you in general, but there are situations where prescribed methamphetamines also lead to cortical thinning when not used as recreationally. This seems to suggest that stress may not be the entire player here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870784/

It was likely decided because of the dose of meth found in the persons systems that correlates with various findings on dose-dependence https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

If you would like to read more about PTSD findings as it relates to stress and liver function, I would be happy to expound upon the way that corticosteroids impact gut bacteria that directly affect FXR metabolism and bile acids and further lead to cortical thinning. https://academic.oup.com/cercor/article/30/2/575/5521088

Its really fascinating how a drug like methamphetamine impact neuroactive steroids that impact the same pathways tha stress does. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862925/ We've been able to reverse it in rats https://www.sciencedaily.com/releases/2013/10/131007093739.h...

I felt some of this to be naive. And I think the author may be a psychiatrist, which makes the comments about inexperience with drugs particularly interesting.

Must admit the specifics of doing drugs is not that interesting to me, it's more interesting to ask the question:

How does someone stop doing drugs?

I was incredibly lucky. I got to a point where I felt like I wanted to stop (which happens often to a lot of addicts), which coincided with an opportunity to move far away from my hometown, and then also coincidentally found myself surrounded by a fantastic support system. It’s the addict equivalent of flipping a quarter 50 times and having them all come up head.

As for a general answer to your question, there isn’t one that I’m aware of. Everyone I know that’s gotten clean has wildly different stories.

Can you provide more details on what the "fantastic support system" consists of?

I found myself in a very accepting friend group of people that didn’t use drugs and (for my situation this was key) didn’t know where to get them.

Aside from that, there was no shaming and very little drama. Essentially, my previous situation was that I was surrounded by extremely abusive family and dangerously messed up friends. I more or less made friends with “normal” people, got away from a really bad situation and it all just sort of… worked out.

There’s absolutely no secret sauce or trick in my getting clean. I can’t count the number of my old friends that tried stuff like I did and it didn’t work out.

It was literally just luck.

How long did it take for the change in environment to make a long term difference to stop using drugs? A month? A year?

I don’t know exactly because I managed 0 possible access for a long time, so temptation was low.

About a year after I quit, I made a new friend. He was a nice guy, seemed normal, but one day he casually mentioned that he occasionally used stimulants including amphetamines. I cut off all contact with him immediately (as did all of my close friends. It’s a good example of support in this case.)

I guess I was able to recognize and decisively take action to avoid temptation about a year in. This was likely also luck. I was in a pretty good place with my life in general, had that occurred six months earlier or six months later it could have had a different outcome.

So the answer is either a day or a year or never. It’s been ten years and I’ve only known where to get meth for about one day of it. I still get cravings to this day, I’m just no longer in the habit of indulging them.

I feel bad for the guy who got ostracized by you and your entire friend group because he occasionally did speed and admitted to it. I understand your situation but I also think at some point you need to be able to stand on your own two feet without taking such drastic measures. Strength is both being able to walk away and then to say no in the face of temptation.

I say this as someone who abused drugs when I was younger and came from an extremely abusive family environment.

I think people need to do what they need to do to survive, and if that means not being friends with someone, that other person will have to get by with other friends.

That’s a great point of view and in retrospect, so do I. It wasn’t a great thing to do and I’d probably had a more humane way of eliminating a friend. I just did what I could at the time.

I understand perfectly well why you did what you did, as others here point out you have to take care of yourself before you can help others.

And thanks for sharing and giving some great answers.

I don't feel bad for the guy. The last thing a recovering addict needs is a source for drugs and that's what he is.

Addicts can't just stop and never do drugs again like a normal person. If it's there, they'll take it. It's not about strength and being able to walk away. It never goes away for an addict and the best they can do is avoid situations where drugs will be presented. Isolation from users is the best course of action.

Also, many people abuse drugs and even become addicted, but are not addicts. An addict is wired differently.

Cutting out toxic influences is generally a good thing for most people. In OP's case, temptation of drug use and the risk of backsliding was too much, so yes, important and excellent that they cut out that person.

I think the main criticism in GP was that the friend's group also cut ties, not just the person being put "at risk" by such a friendship. Also, "toxic influence" makes it seem like the friend was, by themself, toxic, while it looks rather than this was a "dangerous relation" (big difference imo).

Wholesome, well adjusted peers to talk and engage in enjoyable activities with.

A safe, clean, and comfortable living environment.

Enough food.

The confidence in oneself, or their support network, to truly believe without fear, that they won’t end up back out on the streets.

A well paying job that isn’t dehumanizing, traumatizing, exploitative, or abusive.

There are two methods I know of. Either you stop doing the thing, or you do other things instead.

The first requires a presence of mind to enter the void left behind by the thing, that people doing drugs probably lack, since they are, in essence, stimulation addicts. Drugs fill a void they avoid facing. Stopping doing drugs would cause them to face that void.

The second is more amenable, because you can taper off with replacement therapy. Switch to using less bad drugs, or indeed anything stimulating. Continuously replace the thing you're getting stimulation from with another, slightly less stimulating thing, until the thing that is left is sufficiently nonstimulating that stopping and accepting the void feels manageable.

I went from putting speed in my morning coffee to eating a pound of chocolate a day.

Chocolate has a lot of PEA which activates the TAAR1 receptor just like amphetamines.

In fact, all amphetamines contain a PEA base - they are substitutes phenylethylamines, for example Alpha-MethylPHenEThylAMINE.

The primary effect of amphetamines (that matters) is VMAT inhibition. While lots of drugs hit lots of receptors, and there are lots of overlap because of this, this does not make different compounds equivalent.

For example, off the top of my head, mescaline is also in the phenylethylamine family but is a wildly different drug with different receptor bonding affinity and subjective effects. I doubt anyone would want to mix up the two.

You are correct. However, PEA alone does have a stimulant effect through TAAR1, and in chocolate it is coupled with other xanthine stimulants.

A strong desire to quit and a big support network (family, friends, recovery centers, etc). We tend to look down on addicts, when in fact, we probably should be looking to help. And the more help there is, the better chance someone will have quitting/recovery. Support also means real support, not a parent there because they have to and so they have disgust on their face, nope nope nope, that can make things worse.

I have a friend who's an addict and he's becoming impossible to talk to. Not about drugs, just about anything. He doesn't want any help, and he starts to live in his own reality. When we meet in a group of friends he doesn't listen to anyone. He can talk non-stop for hours until everybody around is tired from his gibberish. But he doesn't listen to anyone in a sense that feels very selfish. For example, when someone is telling an interesting story, he won't listen and he would make dumb offending jokes.

It feels like drugs made him dumb and also he is living in some kind of parallel reality. It's becoming harder and harder to connect.

Also, in his reality it's perfectly ok to consume drugs, he's also constantly offering to share the experience with all people he meets.

It's sad situation and looks desperate because he's aggressively against any help, he consider himself better than others because of the drugs (he is sure they allow him to "see" more than we see), and he doesn't listen to anyone.

That fucking sucks. I don’t really have much to say about that other than if you’ve got a contact email, let me know.

Have you considered he may be right?

I know he's not right. From experience and from looking at him.

Also, he's unable to function in the society. He's becoming obnoxious, so all his friends and even relatives are starting to avoid him.

He doesn't look healthy, he doesn't look happy, and I know he is unable to achieve any of his goals (the goals I've heard from him that he wants to achieve).

Tough call. Everything you described matches 1:1 with a friend who couldn’t deal with the stress of college and started to flare out with schizophrenia. Drugs came soon after, but the verbosity, obnoxiousness and grandiose ideas came first, coupled with execution incoherent enough to look nonexistent.

Yes!

I had friends, housing, food, a stable day to day routine and _nobody_ looked down on me for my problems. I was able to talk openly about what I was going through and the circumstances that led to my addiction in the first place.

Normally (at least as Americans) we think of addicts as getting all of those things in rehab facilities and getting “fixed” by that few weeks or months. I’ve been in rehabs and mental hospitals and genuinely gotten some necessary help from them, but in my case I only started getting really better after I found myself in a situation where I had all of that support without feeling like it had an expiration date.

Not only that, I always have time to listen to recovered addicts - they know more about persistence and will-power than just about anyone else.

Psychological drug addiction feels a lot like food addiction - if you've ever dieted then thought about how amazing it would be to order pizza, you've experienced the same thing (though ofc to a far lesser magnitude)

You stop doing drugs the same way you stop eating badly, by trying to find substitutes, and by putting distance between you and it (i.e. if I don't want to eat snacks, I avoid buying it at the store, so it's more work for me to eat poorly)

You may get the best answer to that question from people who have stopped rather than never started.

Thanks for sharing.

A lot of people on this board have experience with prescription stimulants. How would you say the experience of "doing meth" differs from taking amphetamine orally? Was a typical experience for you "smoke meth, study or write code all night"?

I like prescription stimulants, but it's hard for me to imagine anyone wanting to take overdose-levels of stimulants for fun, so I'm probably missing something. If I take too much (~40mg), I feel pretty terrible, physically and mentally. I can't imagine how 500mg/day could produce any desirable effects.

If the supply chain for meth wasn't so poor, I'd probably try it once to see what all the hype is about.

Meth taken orally at an equivalent dose is probably indistinguishable from racemic amphetamine subjectively. At least until you come down, anyway. Meth has a longer half-life.

Amphetamine smoked would be the same too, nearly. Maybe slightly slower onset. Negligible difference compared to that provided by smoking versus oral. It's the speed of the come up. The most euphoric part when one takes stimulants orally is usually the first few hours. When rapidly administered, that hits instantly and with full effect and then fades pretty quickly. (So you are very inclined to take another dose an hour or two later.)

My advice? You probably don't want to experience it. I've missed it since the first and second and only times I smoked. Realizing I was strongly craving a drug I had used twice is why I got out of that game. Some experiences cannot be unexperienced. There's nothing much interesting about that state, psychologically or intellectually. It's about what you think it might be if you have some experience with stimulants. Just all at once and very hard and you will be awake for two days after.

Meth is simply dirty. More neurotoxic than amphetamine and lasts too long. In a perfect world, we'd probably move all the meth addicts onto a supply of Dexedrine. Even if they're high as kites at least their brains will rot more slowly.

> If the supply chain for meth wasn't so poor, I'd probably try it once to see what all the hype is about.

As a former smoker and user of various drugs (mostly legal at the time), I highly recommend against usage of highly addictive drugs such as tobacco, heroin, cocaine, and also (meth)amphetamine (there's a difference between physically and mentally addiction here, and there's a good comparison of about 20 different drugs and their differences in dependency).

I recommend against recreational drug usage, too, but that's because I have come to the understanding they're not necessary, and it being dangerous not using drugs without supervision. You don't want those ups and downs (such as 'taking too much', or 'forgetting a dose'), you want stability. Seek help instead, get a diagnosis, and get prescription under supervision.

FWIW, I used amphetamine once, and have been prescribed on Ritalin. That one time I used amphetamine I felt like the biggest asshole in the world. I could finally understand macho men because I felt like one. However, unlike my first time MDMA, I can't say I missed out on it (and that is with only the first time MDMA). Whereas Ritalin, while spikey (no SR such as Concerta, sadly) provides stability if administered on regular intervals. Which can be solved nowadays with alarms on smartphone and such (back when I used it, smartphones were not yet widely in use).

> FWIW, I used amphetamine once, and have been prescribed on Ritalin. That one time I used amphetamine I felt like the biggest asshole in the world.

This made me laugh! I don’t remember where I heard it but a phrase I’m a fan of is “amphetamines cause intense feelings of competency.”

retrac’s response to this is spot on so I’ll only add one thing.

In my experience, there were two factors that got me up to 500mg+/day: tolerance and price breaks.

When I first started meth it was incredibly affordable. I could get high all day off 1/10th of my $10-20 bag. Then it became 1/8th of my bag and then 1/4 etc. At some point it became (in my mind) uneconomical to buy little amounts because the $/dose got lower when I went from buying .1g to 1g, and then steeply went down again when I went from buying 1g to 3.5g. (As an aside I never really figured out the economics of meth at scale but the margins must be astronomical considering how big of discounts that street dealers are able to give for relatively small purchases and still make money)

I thought I was being smart, saving money! It turns out that when I had more, I used more. Tolerance built up rapidly and I found that I had to smoke 50-100mg to feel anything.

I also agree that it’s really not worth trying. Your concerns about the supply chain are valid. The difference between “good shit” and “bad shit” is enormous and can be the difference between having a nice day trying (pointlessly) to teach yourself Ruby and a day in the ER.

How long does a high last?

How many uses during a normal day? e.g. 125 mg 4x daily or all at once or something else?

Does it keep you from sleeping?

The “this feels good” part of the high typically lasts maybe 1-3 hours, after which you smoke more. The actual stimulant effect lasts much, much longer, maybe 12ish hours. That part very heavily depends on the dose size and quality, tolerance and your individual response to it.

Yes, it keeps you from sleeping. At my peak I didn’t really have much use for the concept of separate days since I was normally awake for ~72hrs at a time.

Thanks, that's interesting.

I wonder how much the lack of sleep is what causes the problems, versus other effects of the drug.

Not eating and not sleeping absolutely wrecks your body. Pair that with a general increase in risky behavior (for example, sexually) and you’ve got a recipe for a bad time, eventually.

I’m not aware of meth (or its metabolites) being particularly toxic to the cells in the human body (as opposed to cocaine for example, which is directly cardiotoxic if I remember correctly), my understanding is that the bad stuff tends to be the result of behavior that it induces.

Methamphetamine HCl can be vaporized by itself. What is true for cocaine is not true for other drugs. Freebase methamphetamine is an oily liquid at normal temperatures. Almost all methamphetamine is the hydrochoride salt. It is what gives it the crystalline structure.

Holy shit, I think you’re right.

In my defense I haven’t really been involved with any of this in a decade and it’s entirely possible I mixed up cocaine and meth and their respective likelihoods of pyrolyzation in this case.

For some reason I remember a DEA Microgram bulletin showing crystalline dextromethamphetamine base in brick form, but it’s not available anymore and I can’t find it at the moment. I have had very few conversations with meth chemists over the years but I do distinctly remember the mention of the oily liquid in the latter stages when talking to them.

That being said, snorting meth (even HCl) is incredibly excruciating compared to other drugs and as a result most users that I’ve been around prefer to use it in a different manner.

Thank you!

Congrats on your sobriety. Any advice or insights on how you quit that you’d like to share for anyone struggling with addiction here?

Don’t believe that sober people are good people or that addicts are bad people. That shame is a trap that will keep you there and it’s not even based in reality. If you’re struggling with addiction and you’re worried about yourself, that feeling is a reminder that you’re categorically worth saving.

Not everyone has to do the 12 step thing. My experience with NA was very limited but I quickly figured out that I didn’t fit in there. If you’re feeling out of options, it’s probably worth checking out because it does seem to work for a lot of people. However if it doesn’t work for you, you don’t have to give up. At the end of the day the goal is to not do a thing, whatever way you get there is fine.

Do regular users also get super horny but unable to perform due... shrinkage?

Yes. Erectile dysfunction drugs were common in my friend group.

Having been an addict, what's your views on legislation?

I personally support legalization of recreational drugs and the expansion of education, harm reduction, and rehabilitation. The fear of going to jail never stopped any of my friends from dying by accidental overdose.

Might be a regional thing? I was raised in Southern California, where is smoking is also the preferred method. I believe OP is from New York City. For all we know perhaps inhaling what his upper middle class cohort does.

OP is from California.