Tolerance can be defined as the need for increasing doses of a drug over time to maintain the same effect achieved at previous lower doses. The body becomes tolerant to the effects of meth within minutes.7, 9 Remember, after smoking or injecting meth, the user experiences an intense explosion of dopamine, experienced as a euphoric high. Meth users try to maintain that high by using ever-increasing quantities of meth, or by switching to a faster-acting way of using, such as moving from snorting to injecting. Some abusers go on a binge known as a "meth run," injecting a gram (1,000 mg) of meth every two to three hours until the user runs out of the drug or is too intoxicated to continue.2 This can last for several days or even weeks. To compare, a medicinal dose of legal methamphetamine, Desoxyn, is about five to 15 milligrams (mg) per day. This means a user on a meth run is taking approximately 800 times the therapeutic dose of meth each day.2, 9 (Approximate illegal dose of 1,000 mg times every three hours [eight times a day] divided by an average of 10 mg, the therapeutic dose of meth.)
There are two ways to understand how a person can develop tolerance to meth.9 First, methamphetamine depletes the neurotransmitter norepinephrine from the body. As the brain's supply of norepinephrine dwindles, the user needs more and more meth to maintain a consistent high. This tolerance can happen after only one or two doses of meth. Secondly, ketosis causes tolerance. Ketosis is a by-product of not eating for long periods of time. Not only does this produce very bad breath, but when a person stops eating, it changes the body's metabolism, causing the urine to become more acidic. As we learned in Chapter Three, the more acidic the urine, the more methamphetamine is excreted in the urine. This causes the user to need more and more meth to achieve the same high.
BINGING, TWEAKING, AND CRANK BUGS
Many meth users go on "binge and crash" runs for three to five days and then crash, sleeping for one or two days. During these binges, users often become agitated and feel "wired." Their behavior becomes unpredictable. They may be friendly and calm one moment, then angry and terrified the next, prone to out-of-control rages, delusions, paranoia, and violence. This phase of the meth high is called tweaking. Tweakers become hyperactive, obsessed with details, and intensely focused, and feel compelled to repeat meaningless tasks, such as taking apart and reassembling clocks, stereos, and other types of machinery. The release of high amounts of the body's fight-or-flight chemicals, epinephrine (adrenaline) and norepinephrine, is thought to cause this tweaking effect in a meth user.
Tweakers may also have a strong sensation of bugs crawling beneath their skin, a disorder known medically as formication but more often referred to as "crank bugs." Meth users can pick obsessively at these invisible "bugs," creating unsightly oozing sores and scabs on their faces and bodies.5, 7 11 24
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