ORIGINAL ARTICLE Health Conditions in Methamphetamine-Dependent Adults 3 Years After Treatment Larissa J. Mooney, MD, Suzette Glasner-Edwards, PhD, Patricia Marinelli-Casey, PhD, Maureen Hillhouse, PhD, Alfonso Ang, PhD, Jeremy Hunter, MA, William Haning, MD, Paula Colescott, MD, Walter Ling, MD, and Richard Rawson, PhD Objectives: Medical conditions in methamphetamine (MA) users have not been well characterized. Using both self-report and phys- ical examination data, the aims of this study were to (1) describe the frequency of medical conditions in a sample of MA users 3 years posttreatment; (2) evaluate the association between medical condi- tions and MA use frequency; and (3) examine the relationship of route of administration with medical outcomes. Methods: MA-dependent adults (N = 301) who participated in the Methamphetamine Treatment Project were interviewed and exam- ined 3 years after treatment. Medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and Life Experiences Timeline. Current and lifetime medical con- ditions, electrocardiogram characteristics, and physical examination abnormalities were assessed. Results: Among the most frequently reported lifetime conditions were wounds and burns (40.5%, N = 122) and severe dental problems (33%, N = 99), and a significant proportion of the sample evidenced prolonged corrected QT interval (19.6%, N = 43). Al- though health conditions were not associated with MA use fre- quency during follow-up, intravenous MA use was significantly associated with missing teeth (odds ratio = 2.4; 95% confidence interval, 1.2– 4.7) and hepatitis C antibodies (odds ratio = 13.1; confidence interval, 5.6 –30.1). Conclusion: In this sample of MA users, dental problems and corrected QT prolongation were observed at elevated rates. Al- though posttreatment MA use frequency was not associated with a majority of medical outcomes, intravenous MA use exacerbated risk for dental pathology and hepatitis C. Longer term follow-up research is needed to elucidate health trajectories of MA users. Key Words: medical, health, methamphetamine, intravenous, treatment (J Addict Med 2009;3: 155–163) M ethamphetamine (MA) is a potent and highly addictive stimulant, the effects of which are longer lasting and more harmful to the central nervous system as compared with those of amphetamine. 1 According to the most recent Na- tional Survey on Drug Use and Health, 10.4 million Ameri- cans aged 12 years and older report lifetime use of MA, representing 4.3% of the population. 2 Despite significant health risks associated with use, current literature on MA- related medical illness, influenced primarily by case reports and autopsy series, is limited in scope relative to cocaine and other drugs of abuse. Acute and chronic medical conditions affecting multiple organ systems have been documented in MA users, most notably the cardiovascular and central nervous systems. 3,4 MA intoxication is responsible for increasing inci- dences of hospital visits, and the rate at which MA is cited as a factor in emergency department presentations across the nation is rising steadily. 5 Although the majority of fatalities related to MA intoxication involve accidents or violence, life-threatening medical consequences related to MA use have been reported, including myocardial infarction, aortic dissection, arrhythmias, pulmonary edema, seizures, and stroke. 6–8 Some of the deleterious health-related effects of MA use may be accounted for, at least in part, by its cellular mechanisms of action. As a central and peripheral nervous system stimulant, MA facilitates the release of newly synthe- sized norepinephrine and dopamine from nerve terminals and, to some extent, blocks their synaptic reuptake. 9 The resulting catecholamine surge mediates many of the acute symptoms and physiological changes associated with MA intoxication, including elevated heart rate and blood pressure. Excess circulating norepinephrine may contribute to organ pathology by causing vasoconstriction and ischemia. Like- wise, the oxidation of accumulated intra- and extracellular catecholamines may lead to the formation of reactive oxygen species and subsequent cellular toxicity. 3,4 From the UCLA Integrated Substance Abuse Programs (L.J.M., S.G.-E., P.M.-C., M.H., J.H., W.L., R.R.), Los Angeles, CA; University of California School of Medicine (A.A.), Los Angeles, CA; and University of Hawaii School of Medicine (W.H., P.C.), Honolulu, HI. Received for publication August 1, 2008; accepted February 17, 2009. Send correspondence and reprint requests to Larissa J. Mooney, MD, UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, 1640 S. Sepulveda Boulevard., Suite 200, Los Angeles, CA 90025. e-mail: lmooney@mednet.ucla.edu. Supported by the Methamphetamine Abuse Treatment—Special Studies (MAT-SS) contract 270-01-7089 and grants numbers TI 11440-01, TI 11427-01, TI 11425-01, TI 11443-01, TI 11484-01, TI 11441-01, TI 11410-01, and TI 11411-01, provided by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Admin- istration (SAMHSA), US Department of Heath and Human Services. The opinions expressed in this publication are solely those of the authors and do not reflect the opinions of the government. Copyright © 2009 American Society of Addiction Medicine ISSN: 1921-0629/09/0303-0155 J Addict Med • Volume 3, Number 3, September 2009 155