History
Amphetamine was first synthesized in 1887 in Germany. Initially called phenylisopropylamine, it was, for a long time, a drug in search of use, trying to find application from decongestion to depression. In the 1930s , it was initially marketed as Benzedrine, as an over-the-counter inhaler to treat nasal congestion and asthma.

Methamphetamine was discovered in Japan in 1919. The crystalline powder was soluble in water, making it a perfect candidate for injection. In the late 30s, it found use for narcolepsy and ADHD (attention deficit hyperactivity disorder). It is still legally produced in the U.S., sold under the trade name Desoxyn (Abbott. PDR 2001) with indications for ADHD and for short-term therapy in exogenous obesity.

During World War II, amphetamines were widely used as stimulants to keep the fighting men going (during the Viet Nam war, American soldiers used more amphetamines than the rest of the world did during WWII). And after World War II, when military surplus became available to the public, methamphetamine abuse became epidemic.

In the United States in the 1950s, legally manufactured tablets of both dextroamphetamine (Dexedrine) and methamphetamine (Methedrine) became readily available and were used non medically by college students, truck drivers, and athletes. As use of amphetamines spread, so did their abuse. Amphetamines became a cure-all for such things as weight control to treating mild depression.

In the 1960s, the route and degree of abuse changed dramatically with the increased availability of injectable methamphetamine. The 1970 Controlled Substances Act severely restricted the legal production of injectable methamphetamine, causing its use to decrease greatly. It is at present a Schedule II stimulant finding limited use for narcolepsy, attention-deficit disorder, and for a limited time, as an appetite suppressant for obesity.

In the 1980s, the smokable form of methamphetamine, "ice," became available. Like crack cocaine, it is smoked in glass pipes, emitting no odor, with effects lasting for 12 hours or more.

In the mid-80s, methamphetamine was introduced into the fringe circle of use in the Philippines. In less than two decades, it has broken out of the urban subcultures and gained access access into the rural communities with devastating impact.

In the US, its use has undergone a resurgence, a 2004 study reporting that it has already surpassed cocaine use.

General info
In the U.S., from 2000 to 2004, methamphetamine use rose as other drug use fell. Worldwide, according to an UNODC report, use of amphetamine reached 30 million (0.7% of the population age 15 to 64 years old). In the Philippines, as in Thailand, Japan, Korea and Taiwan, methamphetamine is the drug of choice; Asia accounting for 60% of meth users.

Collectively, amphetamine, methamphetamine and Ecstasy are grouped as ATS, amphetamine-type stimulants. Synthetic drugs, production estimates are based on seizures, and of these, 80% were amphetamine and methamphetamine. Of the 12,000 clandestine ATS labs dismantled in 2002, most were producing methamphetamines.

Shabu, a powerfully addictive meth stimulant, easily accessible and affordable, is the drug of choice of over 90% of Filipino drug users.

Usually, a "fix" is used every 3 hours.

A single "pingi" or 0.1 gm costs P100. One mongo-sized "gram" costs P1,000-2,000. (In contrast, 1997 methamphetamine prices in the U.S. ranged from $3,500 TO $30,000 per pound, $400 TO $2,800 per ounce, and $37 per gram in the Seattle area to $300 per gram in the New York.

A mandatory "surprise" testing in one precinct found 69% positive for drug use.

The preferred manner of use is smoking, compared to snorting, injecting, or oral ingestion i.e., dissolved in a drink. There are geographic variations in usage: In Hawaii, 96% of users smoke it; in San Francisco 57% of users prefer injection, 27% snort, 11% smoke.

It is easily produced in make-shift laboratories and the by-products are toxic and hazardous.

The National Drug Law Enforcement and Prevention Center gives a conservative estimate of at least 250,000 drug abusers, possibly over half a million. Another conservative estimate puts the number of addicts at one million.

A survey of youths aged 15-30 conducted by the SWS (Social Weather Stations) in 1996 which included youth participation in illegal activities showed a 7% with drug use and 6% with drug pushing. In 2012, a US State Department cited a UN report that disclosed 2.1 % of Filipinos aged 16 to 64 were using shabu. With shabu as the drug of choice among 90% of users, the mathematics is gut-wrenching.

Methamphetamine is inexpensive and easy to make, Its illicit manufacture can be accomplished in a variety of ways, but is produced most commonly using the ephedrine/pseudoephedrine reduction method. Large-scale production of methamphetamine using this method is dependent on ready access to bulk quantities of ephedrine and pseudoephedrine.

Street meth is never pure, usually cut with a miscellany of substances, including talc or heroin.

How meth works
Methamphetamine stimulates release of excessive amounts of the neurotransmitter dopamine. Dopamine is produced in the nerve cells of the ventral tegmental area and is concerned with pleasure regulation in the brain. Upon entering the nerve cell, meth stimulates the release of dopamine, which then binds to specialized receptors of other nerve cells creating the typical "rush."

Effects
Short-term effects
The effects are similar to cocaine but last longer- 4 to 16 hours.
• Heightened attention and energy
• Excessive talking
• Euphoria, decreased fatigue
• Increased activity, increased sexuality
• Decreased appetite
• Increased respiration
• Hyperthermia, occasionally leading to convulsions and lethal levels.

Long-term effects
• Dependence
• Anxiety, confusion, and insomnia
• Addiction psychosis
• Paranoia
• Hallucinations, visual and auditory
• Mood disturbances
• Repetitive motor activity
• Stroke
• Weight loss
• Violent behavior, homicidal or suicidal thoughts
• 'Crank bugs' - Formication (sensation of insects creeping on the skin) causing users to pick at themselves causing ulcerations on the hand and arms.
• Disturbed sleep patters; decreased sleep needs
• Disinterest in usual social interactions, sex, food
• Cardiovascular: Inflammation of the heart lining
• Stereotypy behavior - performing routine acts over and over again.

Meth mouth
An oral-dental problem unique to meth abusers wherein normal white teeth can change in a few months into twisted grayish-brown stubs that eventually fall out.

Toxicity
Signs and symptoms of toxicity include arrhythmias, excessive sweating, hypertension, hyperthermia, insomnia, irritability, mydriasis (dilation of pupils), psychosis, seizure, rapid heart rate and tremors.

The stimulant effects from methamphetamine can last for hours, instead of the minutes from 'crack' cocaine. Often, the meth user stays awake for days. After injecting or smoking, the immediate rush or high is called a "swap," short-lived, minutes long. Snorting (within 3 to 5 minutes) and ingestion (within 15-20 minutes) causes a euphoria, a 'high' rather than an intense 'rush" within 15-20 minutes. As the high wears off, the user enters a stage called "tweaking" where he or she becomes prone to violence, delusions and paranoia. Some try to buffer through this stage by the use of cocaine or heroin. Like heroin and cocaine, methamphetamine can be snorted, smoked or injected. Tweaking may be mistaken as a cocky and noisy drunkenness.

The crash happens after the tweaking. To the binge-abuser, with the depletion of body epinephrine, the body "crashes" into a sleep, seemingly, a "lifeless" state that may last 1-3 days, during which time the abuse poses no threat to anyone. After the crash, in-between binge, the abuser is in a normal stage.

Although there are no acute physical withdrawal syndrome on discontinuation of chronic use, a patient may experience a subtle creeping in of fatigue, lethargy, anxiety, paranoia, aggression, or an intense craving for the drug and even a suicidal state. Re-use or re-indulgence of methamphetamine will break this train of symptomatology. It is believed that prolonged exposure can cause damage to the dopamine-producing brain cells, with more profound damage on serotonin-containing cells and concerns as to whether this can contribute to the psychosis seen in long-term users.

Meth rehab success rate is low; 93 percent in traditional treatment programs return to abuse.

Hypersexual Behavior and AIDS Concerns
Meth induces hypersexual behavior, and especially with anal intercourse, HIV / viral transmission concerns are raised and unprotected receptive users are put in greater risk. Adding to the risk is the anal insertion of meth and consequent damage to the rectal lining that increases the likelihood of HIV transmission.

Sources / Suppliers
• China-based syndicates overseeing drug-trafficking operations. Production materials smuggled from mainland China by drug syndicates using Hongkong and Taiwan as transhipment points.
• In the Philippines, there have been reports of increasing Muslim-based operations.

Clearance & Detection Times
• The usual dose of amphetamine is 5 to 10 mg—much higher in tolerant subjects. It has a half lifethat varies between 10 and 30 hours.

After smoking 22 mg of methamphetamine hydrochloride, it remains detectable in the blood for 48 hours, at a cutoff detection level of 3 ng/mL. At 22 mg smoking dose, methamphetamine as base ("Ice"), remains detectable in the urine (detection level 300 ng/mL) for 60 hours. After a controlled administration of 10 mg of methamphetamine, the final detection time in urine after a single dose at the lime of quantification (LOQ), 2.5 ng/mL) was 87.2 ± 52 (extreme values 46-144) hours. (5)

Today, "Shabu" poses a problem as serious, as frightening, as formidable, as any present day issue confronting the Filipino society. How can a country and a system mired in corruption fare against the commerce of drug trade so empowered by its bottomless coffers and consequent political clout? Many powerful nations have succumbed; the fanfares of their drug wars drug muffled, their policies inevitably compromised, shifting from prevention into containment.

Sadly, I think the Filipino society confronts an impossible task. The problem is past prevention. Is containment still possible? 
                                                                                                                                                                ca 2004