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psx:substance/methamphetamine/proposal/dependence/a899d1c6-22f1-403f-9ecb-598a8193bc08

proposal2026-04-21recordapproved

psx:substance/methamphetamine/proposal/dependence/a899d1c6-22f1-403f-9ecb-598a8193bc08

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1Provenance card

the boundary, as counts

Sources

4223 with DOI

27 strong · 12 moderate · 3 weak

Compilations

12026-04-21T01:25:31.457Z

pipeline-v5 · prompt hash not recorded — run predates 2026-09 · 1 other run

Decisions

108last ruled 2026-06-04

0 awaiting a ruling

Issued documents

52026-10-19T20:32:51.245Z

notice · info card · emergency

Searches

210 with no results

queries and counts on the build

Claims checked

8370 supported

70 supported · 13 not

Correspondence

0received

consent field ships in Phase 4

Edges

306

derivations recorded for this entity

Complete over 42 sources, 1 compilation, and 108 decisions.Not here: the private journal (never).Working material — drafts, discards, unsupported claims — is listed below and readable on the working page.Cite: psychedex.org/substances/methamphetamine/archive

2Build

one panel per compilation run

generation run 2026-04-21

85 min completedmodel pipeline-v5plan not recordedrun/58ad24e8…

Selection

results seen106
selected by the model39
consumed as sources42

Verification

claims checked83
supported67
partially supported3
not supported0
inconclusive13
  • record
  • seen / partial
  • working

The model's own caveats

  • taper_silent

Reproduce

inputs
42 source keys (listed under Sources)
plan
not recorded — template version, prompt hash and git SHA are written from 2026-09 onward
model
pipeline-v5
streams
none — agent transcripts are persisted from 2026-09 onward
21 searches — query, source, results, what was kept and why
21 searches for this run
#sourcequeryseenkeptrationale
1WebSearch/DEAmethamphetamine Schedule II DEA legal status US UK Class A Australia103Legal scheduling information
2PubMedmethamphetamine TAAR1 trace amine receptor agonist83Primary structural biology of METH-TAAR1 interaction and TAAR1 functional studies
3PubMedmethamphetamine neurotoxicity dopaminergic serotonergic brain damage oxidative stress53Reviews of molecular mechanisms of METH-induced neurotoxicity
4PubMedmethamphetamine receptor binding affinity dopamine norepinephrine serotonin transporter Ki20Not directly measuring METH binding affinities at primary targets
5WebSearchmethamphetamine history synthesis 1893 Nagayoshi Nagai 1919 Akira Ogata101Historical data not available in PubMed
6PubMedmethamphetamine pharmacokinetics human bioavailability half-life metabolism84Primary PK data directly for methamphetamine in human subjects
7PMCmethamphetamine binding affinity Ki DAT NET SERT—1Primary source for human transporter binding affinities of methamphetamine
8PubChemmethamphetamine by name11Primary chemical identity data for d-methamphetamine (active enantiomer)
9PubMedmethamphetamine tolerance sensitization dopamine receptor downregulation32Documents METH sensitization and lasting vulnerability to relapse psychosis
10OpenAlexmethamphetamine mechanism of action dopamine neurotoxicity101High-citation comprehensive methamphetamine review
11ClinicalTrials.govmethamphetamine treatment use disorder104Active and completed clinical trials for METH use disorder treatment
12StatPearls/NCBI Bookshelfmethamphetamine pharmacology metabolism interactions—3Clinical reference for FDA-approved therapeutic use and drug interaction data
13PubMedmethamphetamine monoamine transporter inhibition dopamine norepinephrine serotonin release substrate72Foundational mechanism papers on amphetamine/METH reverse transport
14WebSearchmethamphetamine UN 1971 Convention Psychotropic Substances Schedule II EU legal91—
15PMC/OpenAlexmethamphetamine dopamine transporter PET imaging abstinent users—1—
16WebSearchmethamphetamine Canada CDSA Schedule I101—
17PubMedmethamphetamine MAOI interaction fatal serotonin toxicity11—
18PubMedmethamphetamine MAO inhibitor monoamine oxidase weak activity21—
19PubMedmethamphetamine controlled dose human subjective effects cardiovascular dose response83—
20PubMedmethamphetamine hemorrhagic stroke intracerebral hemorrhage young adult22—
21PMC/OpenAlexmethamphetamine brain structural abnormalities MRI neuroimaging—1—
83 claims by section — every cited sentence, checked against its source
safety29 · 25 ok
  • Methamphetamine is a significant cause of stroke in adults under 45partially supported

    Methamphetamine is a putative cause of strokes in younger people (below age 45). Review of epidemiology, mechanisms and case reports. jnnp-2017-316071

  • In one emergency department series, methamphetamine was implicated in 72% of agitated patient presentationssupported

    202 agitated ED patients. METH toxicity in 146 (72%), cocaine 14%, psychiatric illness 10%. pmid:9696171

  • Droperidol demonstrated superiority to lorazepam in a randomized comparison for methamphetamine-induced agitationsupported

    Droperidol superior to lorazepam for chemical restraint in METH-induced agitation. pmid:9696171

  • Serotonin syndrome triggered by methamphetamine combined with serotonergic agents requires discontinuation of offending drugs and administration of cyproheptadine or chlorpromazine; benzodiazepines for supportive care.supported

    Treatment: discontinue agent, cyproheptadine, chlorpromazine, or benzodiazepine. pmid:16227063

  • Cardiovascular complications are the second leading cause of death in methamphetamine users:supported

    Cardiovascular complications are the second leading cause of death in methamphetamine abusers. j.hlc.2015.10.019

  • Claim in safety — inconclusiveinconclusiveworking →

  • Pulmonary arterial hypertension (PAH): Documented epidemiological association with hemodynamic severity comparable to idiopathic PAH; reduced carboxylesterase 1 (CES1) activity may contribute to endothelial apoptosis via oxidative stresssupported

    94.4% of METH-PAH patients had CES1 variant (rs115629050). Reduced CES1 promotes endothelial apoptosis. ajplung.00453.2016

  • Yen et al. documented 7 consecutive cases of stroke following methamphetamine inhalation (mean age 32 years): 5 hemorrhagic (lobar, caudate, and putaminal intracerebral hemorrhage) and 2 ischemic, all occurring within 3 days of drug usesupported

    7 patients with stroke following methamphetamine inhalation. Mean age 32 years. 5 hemorrhagic, 2 ischemic strokes. Strokes occurred within 3 days after drug use. Lobar, caudate or putaminal intracerebral hemorrhage. pmid:8137834

  • Chronic methamphetamine use produces persistent reductions in striatal dopamine transporter density (23–25% in caudate and putamen by PET), gray-matter deficits in cingulate and limbic cortex (11.3%), hippocampal volume reduction (7.8%), and white-matter hypertrophy (7.0%)supported

    PET showed DAT density reductions of 23-25% in caudate/putamen of abstinent METH users after ~3 years abstinence vs controls. pmid:9763484

  • Chronic methamphetamine use produces persistent reductions in striatal dopamine transporter density (23–25% in caudate and putamen by PET), gray-matter deficits in cingulate and limbic cortex (11.3%), hippocampal volume reduction (7.8%), and white-matter hypertrophy (7.0%)supported

    MRI showed 11.3% gray-matter deficit in cingulate/limbic/paralimbic cortex, 7.8% smaller hippocampal volumes, 7.0% white-matter hypertrophy in chronic MA users vs controls. pmid:15229250

  • Pflügner et al. documented adverse neonatal outcomes in 102 neonates born to methamphetamine-using mothers at a single center in Germany.supported

    102 neonates from mothers with antenatal METH consumption admitted to University Hospital Leipzig 2004-2015. Documents neonatal outcomes from prenatal METH exposure. s-0043-121991

  • Claim in safety — inconclusiveinconclusiveworking →

  • Sato demonstrated that chronic methamphetamine use produces a lasting vulnerability: even after prolonged abstinence, administration of small methamphetamine doses — or non-drug stressors including sleep deprivation and psychological stress — reliably triggered acute psychotic recurrence indistinguishable from the initial episodesupported

    Chronic MAP abuse produces a lasting vulnerability to paranoid delusional psychosis with hallucinations similar to schizophrenia. Reuse of MAP, alcohol, and nonspecific stressors can trigger acute recurrence. pmid:1632581

  • Sato demonstrated that chronic methamphetamine use produces a lasting vulnerability: even after prolonged abstinence, administration of small methamphetamine doses — or non-drug stressors including sleep deprivation and psychological stress — reliably triggered acute psychotic recurrence indistinguishable from the initial episodepartially supported

    16/21 experienced relapse with small METH doses. Haloperidol (3 mg/day) prevented acute provocation. pmid:6860719

  • Haloperidol (3 mg/day) prevented provocation in experimental challenge paradigms, confirming the dopaminergic mechanism.supported

    Haloperidol (3 mg/day) prevented acute provocation. Suggests dopaminergic supersensitivity mechanism. pmid:6860719

  • Persistent psychosis is associated with more severe cognitive impairment in methamphetamine users, suggesting that psychosis vulnerability may serve as a clinical marker for underlying neurotoxic damage.supported

    Persistent psychosis indicates more severe cognitive impairment. j.drugalcdep.2014.12.035

  • Claim in safety — inconclusiveinconclusiveworking →

  • Neuroimaging confirms persistent DAT reductions of 23–25% after years of abstinence — a finding that reflects structural terminal loss rather than reversible pharmacological tolerancesupported

    PET showed DAT density reductions of 23-25% in caudate/putamen of abstinent METH users after ~3 years abstinence vs controls. Raises possibility of increased risk for parkinsonism. pmid:9763484

  • The evidence base for pharmacological treatment of methamphetamine withdrawal remains poorsupported

    Insufficient knowledge regarding the withdrawal syndrome of methamphetamine and appropriate management may contribute to low treatment attendance. j.1465-3362.2010.00240.x

  • Mirtazapine, naltrexone, and bupropion show potential efficacy signals across acute and protracted withdrawal phasessupported

    Potential efficacy for MA withdrawal noted for mirtazapine, naltrexone, bupropion and repetitive transcranial magnetic stimulation during acute, early protracted and late protracted withdrawal phases. add.16093

  • No FDA-approved medication exists for methamphetamine use disordersupported

    No established pharmacotherapy for AMPH/MA dependence. s40263-020-00711-x

  • No FDA-approved medication exists for methamphetamine use disordersupported

    No established pharmacotherapy for METH dependence. dar.12048

  • Claim in safety — inconclusiveinconclusiveworking →

  • Mechanisms include fatal hypertensive crisis from massive norepinephrine accumulation, serotonin toxicity from combined monoamine release and degradation blockade, and secondary intracranial hemorrhagesupported

    Fatalities reported for MAOIs + methamphetamine. Hypertensive urgency/emergency and intracranial hemorrhage documented. Serotonin toxicity suspected with MAOI + methamphetamine. s40263-025-01256-7

  • The additive serotonergic burden creates risk for serotonin syndrome — a potentially fatal condition presenting as hyperthermia, rigidity, clonus, and autonomic instabilitysupported

    Serotonin syndrome typically occurs within hours of addition of new serotonergic agent or abuse of stimulants such as MDMA or methamphetamine. pmid:16227063

  • Concurrent MAOI use: Fatal hypertensive crisis, serotonin toxicity, and intracranial hemorrhage are documented consequencessupported

    Fatalities reported for MAOIs + methamphetamine. Hypertensive urgency/emergency and intracranial hemorrhage documented. Serotonin toxicity suspected with MAOI + methamphetamine. s40263-025-01256-7

  • History of drug-induced psychosis: Sensitization produces lasting vulnerability to psychotic recurrencesupported

    Chronic MAP abuse produces a lasting vulnerability to paranoid delusional psychosis with hallucinations similar to schizophrenia. pmid:1632581

  • Concurrent serotonergic medications: SSRIs, SNRIs, tramadol — serotonin syndrome risksupported

    Serotonin syndrome typically occurs within hours of addition of new serotonergic agent or abuse of stimulants such as MDMA or methamphetamine. pmid:16227063

  • Pregnancy: Prenatal exposure associated with adverse neonatal outcomessupported

    102 neonates from mothers with antenatal METH consumption admitted to University Hospital Leipzig 2004-2015. Documents neonatal outcomes from prenatal METH exposure. s-0043-121991

neuroscience14 · 12 ok
  • Microglial activation: Sustained neuroinflammatory response amplifies ongoing neurodegenerative processessupported

    Methamphetamine neurotoxicity includes... activated astroglial and microglial cells. Mechanisms:... microglial activation. s0074-7742(09)88005-7

  • Haloperidol (3 mg/day) prevented provocation in experimental challenge studies, implicating dopaminergic supersensitivity as the mechanism.supported

    Haloperidol (3 mg/day) prevented acute provocation. Suggests dopaminergic supersensitivity mechanism. pmid:6860719

  • Rothman et al. proposed a dual-deficit model in which methamphetamine withdrawal involves simultaneous depletion of both dopaminergic and serotonergic neurotransmissionsupported

    Dual-deficit model of stimulant withdrawal: DA dysfunction underlies anhedonia and psychomotor disturbances; 5-HT dysfunction leads to depressed mood and lack of impulse control. pmid:12105089

  • Claim in neuroscience — inconclusiveinconclusiveworking →

  • Low doses enhance executive function — particularly attention and working memory — selectively in individuals with depressed baseline performance, consistent with an inverted-U dose-response relationship between prefrontal dopamine levels and cognitive performance.supported

    30 mg IV METH improved attention/information processing speed and working memory (choice reaction time, 1-back, 2-back) in METH-dependent individuals displaying poorer cognitive performance at baseline. Those with high baseline performance showed similar or decreased performance. j.pnpbp.2010.11.034

  • Oxidative stress: Excess cytosolic dopamine undergoes auto-oxidation generating reactive oxygen species (ROS), compounded by mitochondrial dysfunctionsupported

    Oxidative stress, excitotoxicity and mitochondrial dysfunction play major roles in METH neurotoxicity, producing monoaminergic depletions. pmid:16796384

  • Oxidative stress: Excess cytosolic dopamine undergoes auto-oxidation generating reactive oxygen species (ROS), compounded by mitochondrial dysfunctionsupported

    Mechanisms: oxidative stress, transcription factor activation, DNA damage, excitotoxicity, blood-brain barrier breakdown, microglial activation. s0074-7742(09)88005-7

  • McCann et al. used PET with [¹¹C]WIN-35,428 to demonstrate DAT density reductions of 23–25% in the caudate nucleus and putamen of abstinent methamphetamine users, persisting after approximately 3 years of abstinencesupported

    PET showed DAT density reductions of 23-25% in caudate/putamen of abstinent METH users after ~3 years abstinence vs controls. pmid:9763484

  • Thompson et al. reported MRI-based structural findings in 22 chronic methamphetamine users versus matched controls: 11.3% gray-matter deficit in cingulate, limbic, and paralimbic cortex; 7.8% smaller hippocampal volumes (significantly correlated with memory task performance); and 7.0% white-matter hypertrophy, the latter possibly reflecting adaptive gliosis.supported

    MRI showed 11.3% gray-matter deficit in cingulate/limbic/paralimbic cortex, 7.8% smaller hippocampal volumes, 7.0% white-matter hypertrophy in chronic MA users vs controls. Hippocampal deficits correlated with memory performance. pmid:15229250

  • Claim in neuroscience — inconclusiveinconclusiveworking →

  • Even after years of abstinence, administration of small methamphetamine doses — or exposure to non-drug stressors — reliably triggered acute psychotic episodes identical to the initial drug-induced psychosissupported

    Chronic MAP abuse produces a lasting vulnerability to paranoid delusional psychosis with hallucinations similar to schizophrenia. Reuse of MAP, alcohol, and nonspecific stressors can trigger acute recurrence. pmid:1632581

  • TAAR1 therapeutic potential: Selective TAAR1 agonists may reduce methamphetamine self-administration without the adverse effects of dopamine antagonists. The structural basis for TAAR1-methamphetamine recognition is now characterized, but clinical translation to human addiction treatment remains untested.supported

    TAAR1 is an established METH target relevant to drug addiction and neurological disorders. Cryo-EM structures of human TAAR1 bound to methamphetamine. s41586-023-06775-1

  • β2AR-TAAR1 interaction: Wang et al. identified β2AR as mechanistically distinct from TAAR1 in mediating methamphetamine's effects on NAc circuitry. Whether combined TAAR1 agonism and β2AR antagonism offers synergistic therapeutic benefit is unknown.supported

    Cryo-EM study demonstrating β2-adrenergic receptor as a novel METH target via Gs-mediated cAMP signaling, structurally distinct from TAAR1. Beta2AR inhibition via zenidolol elevates GluA1-Ser831 phosphorylation in NAc D2-MSNs. j.celrep.2025.116337

  • Reversibility of DAT loss: McCann et al. showed 23–25% DAT reductions persisting after 3 years of abstinence. Whether further recovery occurs over decades, and whether this deficit translates to clinically increased Parkinson's disease risk, remains unresolved.supported

    PET showed DAT density reductions of 23-25% in caudate/putamen of abstinent METH users after ~3 years abstinence vs controls. Raises possibility of increased risk for parkinsonism. pmid:9763484

pharmacology12 · 12 ok
  • As a lipophilic amine, it enters presynaptic terminals via DAT, NET, and SERT and drives non-exocytotic efflux of dopamine, norepinephrine, and serotonin through transporter reversalsupported

    Methamphetamine caused efflux at concentrations similar to those inhibiting transport (substrate-type releaser). Cocaine, mazindol, citalopram, nisoxetine failed to stimulate efflux despite inhibiting uptake. pmid:7700252

  • As a lipophilic amine, it enters presynaptic terminals via DAT, NET, and SERT and drives non-exocytotic efflux of dopamine, norepinephrine, and serotonin through transporter reversalsupported

    Amphetamine acts at the vesicular level where it redistributes dopamine to the cytosol, promoting reverse transport and dopamine release from synaptic vesicles. pmid:7751968

  • The selectivity profile — NET (Ki ≈ 110 nM) > DAT (Ki ≈ 460 nM) >> SERT (Ki ≈ 31,740 nM) — produces a predominantly dopaminergic and noradrenergic pharmacological signature, distinguishing methamphetamine from serotonin-preferring releasers such as mdma.supported

    Methamphetamine Ki values: human DAT 0.46 ± 0.06 μM (460 nM); human NET 0.11 ± 0.01 μM (110 nM); human SERT 31.74 ± 2.40 μM (31,740 nM). Methamphetamine and amphetamine are most potent at NET and much less potent at SERT. pmid:16515684

  • This cytosolic pool becomes available for DAT-mediated reverse transport, amplifying extracellular dopamine concentrations beyond what DAT reversal alone would producesupported

    Amphetamine acts at the vesicular level where it redistributes dopamine to the cytosol, promoting reverse transport and dopamine release from synaptic vesicles. pmid:7751968

  • This cytosolic pool becomes available for DAT-mediated reverse transport, amplifying extracellular dopamine concentrations beyond what DAT reversal alone would producesupported

    METH-induced efflux 50-60% in DAT+VMAT2 vs 20% when VMAT2 blocked during loading. pmid:15102929

  • Wilhelm et al. demonstrated that the EC₅₀ for [³H]dopamine release from DAT/VMAT2 co-expressing HEK-293 cells is 33.8 μM with intact VMAT2 function and 3.2 μM when VMAT2 is independently blocked, illustrating the quantitative contribution of VMAT2-mediated vesicular redistribution.supported

    Methamphetamine EC50 for DAT-mediated [3H]DA release: 33.8 μM (hDAT+hVMAT2 cotransfected cells without VMAT2 blockade) or 3.2 μM with VMAT2 blocked by DHTB. pmid:15102929

  • Additional molecular targets include trace amine-associated receptor 1 (TAAR1), a Gs-coupled GPCR where methamphetamine acts as an agonist, and β2-adrenergic receptors, activated through Gs-mediated cAMP signaling with a structural binding mode distinct from TAAR1supported

    TAAR1 is an established METH target relevant to drug addiction and neurological disorders. Cryo-EM structures of human TAAR1 bound to methamphetamine and β-PEA. s41586-023-06775-1

  • Additional molecular targets include trace amine-associated receptor 1 (TAAR1), a Gs-coupled GPCR where methamphetamine acts as an agonist, and β2-adrenergic receptors, activated through Gs-mediated cAMP signaling with a structural binding mode distinct from TAAR1supported

    Cryo-EM study demonstrating β2-adrenergic receptor as a novel METH target via Gs-mediated cAMP signaling, structurally distinct from TAAR1. j.celrep.2025.116337

  • Methamphetamine also weakly inhibits monoamine oxidase A (Ki = 17.2 μM) — approximately 3-fold weaker than amphetamine (Ki = 5.3 μM) and orders of magnitude weaker than clinical MAO inhibitorssupported

    Methamphetamine Ki for MAO-A inhibition = 17.2 μM. Ranking: amphetamine (5.3 μM) > methamphetamine (17.2 μM) >> phentermine (196 μM). Weak MAO-A inhibition confirmed. pmid:25455893

  • Methamphetamine demonstrates high bioavailability across routes: 90.3 ± 10.4% smoked and 67.2 ± 3.1% oralsupported

    Bioavailability of smoked methamphetamine was 90.3 +/- 10.4%. Oral bioavailability calculated as 67.2 +/- 3.1%. pmid:8104133

  • The elimination half-life is 11.1 hours (smoked, geometric mean) to 12.2 hours (intravenous), supporting the prolonged duration of subjective effectssupported

    Plasma half-life 11.1 hr smoked, 12.2 hr IV. pmid:8104133

  • Approximately 37–45% of a dose is excreted unchanged in urine, with 62% of an oral dose eliminated renally within 24 hourspartially supported

    37-45% excreted in urine as methamphetamine, 7% as amphetamine. pmid:8104133

clinical-evidence7 · 6 ok
  • The evidence base for methamphetamine withdrawal treatment remains poorsupported

    Insufficient knowledge regarding the withdrawal syndrome of methamphetamine and appropriate management may contribute to low treatment attendance. j.1465-3362.2010.00240.x

  • Li and Shoptaw reviewed available evidence across acute and protracted withdrawal phases, identifying potential efficacy signals for mirtazapine, naltrexone, bupropion, and repetitive transcranial magnetic stimulation (rTMS).supported

    Potential efficacy for MA withdrawal noted for mirtazapine, naltrexone, bupropion and repetitive transcranial magnetic stimulation during acute, early protracted and late protracted withdrawal phases. add.16093

  • An active randomized controlled trial (NCT01309470) is evaluating lisdexamfetamine — an agonist substitution approach — for acute methamphetamine withdrawal in inpatient settingssupported

    Protocol for RCT of lisdexamfetamine (LDX) as agonist therapy for acute METH withdrawal. bmjopen-2025-107242

  • The British Association for Psychopharmacology (BAP) 2026 consensus guidelines include methamphetamine/amphetamine dependence in their pharmacological management recommendations, confirming the absence of established pharmacotherapy while providing current clinical guidance for management.supported

    BAP consensus guidelines covering pharmacological management of dependence on multiple substances including amphetamine and methamphetamine. International expert panel. 02698811251399593

  • Systematic reviews confirm this therapeutic gap despite decades of clinical investigation.supported

    No established pharmacotherapy for AMPH/MA dependence. Comprehensive assessment of research literature on pharmacotherapy. s40263-020-00711-x

  • Systematic reviews confirm this therapeutic gap despite decades of clinical investigation.supported

    No established pharmacotherapy for METH dependence. dar.12048

  • Claim in clinical-evidence — inconclusiveinconclusiveworking →

summary6 · 5 ok
  • Methamphetamine ((2S)-N-methyl-1-phenylpropan-2-amine) is a potent substituted amphetamine and monoamine releasing agent with an oral bioavailability of 67.2% and an elimination half-life of 10–12 hourssupported

    Oral bioavailability calculated as 67.2 +/- 3.1%. Plasma half-life 11.1 hr smoked, 12.2 hr IV. pmid:8104133

  • Claim in summary — inconclusiveinconclusiveworking →

  • Methamphetamine enters presynaptic terminals as a substrate at DAT (Ki ≈ 460 nM), NET (Ki ≈ 110 nM), and SERT (Ki ≈ 31,740 nM), driving non-exocytotic monoamine efflux through reverse transportsupported

    Methamphetamine Ki values: human DAT 0.46 ± 0.06 μM (460 nM); human NET 0.11 ± 0.01 μM (110 nM); human SERT 31.74 ± 2.40 μM (31,740 nM). pmid:16515684

  • It simultaneously disrupts vesicular dopamine storage via VMAT2, redistributing cytosolic dopamine for DAT-mediated effluxsupported

    Amphetamine acts at the vesicular level where it redistributes dopamine to the cytosol, promoting reverse transport and dopamine release from synaptic vesicles. pmid:7751968

  • Cardiovascular toxicity — hypertension, cardiomyopathy, pulmonary arterial hypertension, stroke — constitutes the primary organ-system risksupported

    Cardiovascular complications are the second leading cause of death in methamphetamine abusers. Includes hypertension, aortic dissection, acute coronary syndromes, pulmonary arterial hypertension and cardiomyopathy. j.hlc.2015.10.019

  • Neurotoxicity produces persistent dopamine transporter reductions of 23–25% in the striatum after years of abstinencesupported

    PET showed DAT density reductions of 23-25% in caudate/putamen of abstinent METH users after ~3 years abstinence vs controls. pmid:9763484

receptor-pharmacology5 · 4 ok
  • Ligand binding assays at human recombinant transporters established the following selectivity profile for d-methamphetamine:supported

    Methamphetamine Ki values: human DAT 0.46 ± 0.06 μM (460 nM); human NET 0.11 ± 0.01 μM (110 nM); human SERT 31.74 ± 2.40 μM (31,740 nM). pmid:16515684

  • Wilhelm et al. characterized methamphetamine's dual action at DAT and VMAT2 in HEK-293 cells co-expressing both transporterssupported

    Methamphetamine EC50 for DAT-mediated [3H]DA release: 33.8 μM (hDAT+hVMAT2 cotransfected cells without VMAT2 blockade) or 3.2 μM with VMAT2 blocked by DHTB. pmid:15102929

  • Claim in receptor-pharmacology — inconclusiveinconclusiveworking →

  • TAAR1 activation opposes dopaminergic reward signaling: functional TAAR1 mediates aversive effects of methamphetamine and suppresses voluntary intake, while mice lacking functional TAAR1 exhibit binge-level methamphetamine consumption and increased excitability of dorsal raphe serotonin neuronssupported

    TAAR1 function suppresses MA reward sensitivity and binge-level intake. Mice lacking functional TAAR1 show binge-level MA consumption. s41386-025-02063-w

  • Wang et al. demonstrated via cryo-EM and mutagenesis that methamphetamine activates β2-adrenergic receptors (β2AR) through Gs-mediated cAMP signaling, with a structural binding mode distinct from TAAR1supported

    Cryo-EM study demonstrating β2-adrenergic receptor as a novel METH target via Gs-mediated cAMP signaling, structurally distinct from TAAR1. j.celrep.2025.116337

chemistry3 · 2 ok
  • Claim in chemistry — inconclusiveinconclusiveworking →

  • L-methamphetamine achieves complete (approximately 100%) oral bioavailability without producing significant psychoactive effects and is used in some over-the-counter nasal decongestants (e.g., Vicks VapoInhaler).supported

    R-methamphetamine: complete bioavailability and pharmacologic inactivity for all oral doses 1-10 mg. Linear pharmacokinetics observed. ftd.0b013e3181db82f2

  • The compound is highly lipophilic, reflected in a large volume of distribution (3.2–3.7 L/kg), which enables rapid passage across the blood-brain barrier.supported

    Volume of distribution 3.24 L/kg smoked, 3.73 L/kg IV. pmid:8104133

comparative-pharmacology3 · 2 ok
  • Amphetamine is the more potent MAO-A inhibitor (Ki = 5.3 μM vs 17.2 μM), though both are weak inhibitors relative to clinical MAOIs.supported

    Methamphetamine Ki for MAO-A inhibition = 17.2 μM. Ranking: amphetamine (5.3 μM) > methamphetamine (17.2 μM) >> phentermine (196 μM). Weak MAO-A inhibition confirmed. pmid:25455893

  • Methamphetamine is 200–500-fold less potent at SERT relative to NET, whereas MDMA's SERT/DAT selectivity ratio is inverted.supported

    Methamphetamine Ki values: human NET 0.11 ± 0.01 μM (110 nM); human SERT 31.74 ± 2.40 μM (31,740 nM). Methamphetamine and amphetamine are most potent at NET and much less potent at SERT. pmid:16515684

  • Claim in comparative-pharmacology — inconclusiveinconclusiveworking →

pharmacokinetic-detail3 · 2 ok
  • Claim in pharmacokinetic-detail — inconclusiveinconclusiveworking →

  • Data: Cook et al. 1993; urinary excretion: StatPearls.supported

    37-45% excreted in urine as methamphetamine, 7% as amphetamine. pmid:8104133

  • Carboxylesterase 1 (CES1) participates in methamphetamine metabolism; loss-of-function CES1 variants may increase the risk of methamphetamine-associated pulmonary arterial hypertension through impaired metabolism and endothelial oxidative stresssupported

    CYP2D6 and carboxylesterase 1 (CES1) involved in METH metabolism. 94.4% of METH-PAH patients had CES1 variant (rs115629050). Reduced CES1 promotes endothelial apoptosis. ajplung.00453.2016

history1 · 0 ok
  • Claim in history — inconclusiveinconclusiveworking →

Other runs

  1. brief run2026-09-27completed4 minrun/3a0f22f4…

3Sources

42 consumed · sorted by year · feeds = sections resting on it

Sources 1 to 30
yearsourcetierstatusfeeds
2026Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for PsychopharmacologySinclair JM, Kalk NJ, Kaar SJ, et al. · Journal of psychopharmacologydoi:10.1177/02698811251399593strongconsumed1 section
2026Safety and Efficacy of Monoamine Oxidase Inhibitors in Patients Who Use Psychoactive SubstancesRached G, Campana A, Fiani D, et al. · CNS Drugsdoi:10.1007/s40263-025-01256-7strongconsumed1 section
2025Absence of TAAR1 function increases methamphetamine-induced excitability of dorsal raphe serotonin neurons and drives binge-level methamphetamine intakeRios SM, Mootz JRK, Phillips TJ, Ingram SL · Neuropsychopharmacologydoi:10.1038/s41386-025-02063-wstrongconsumed1 section
2025Study protocol for a randomised controlled trial to determine the efficacy of lisdexamfetamine for the treatment of acute methamphetamine withdrawal in inpatient settingsAcheson LS, Siefried KJ, Lintzeris N, et al. · BMJ opendoi:10.1136/bmjopen-2025-107242strongconsumed1 section
2025β2AR as a target in methamphetamine addiction: Divergent mechanisms from TAAR1Wang Y, Zhang L, Li J, et al. · Cell Reportsdoi:10.1016/j.celrep.2025.116337strongconsumed3 sections
2024Methamphetamine — StatPearlsNCBI Bookshelfurl:38af06ec12cd64f7weakconsumedcited only
2024Psychosis in acute methamphetamine intoxication is usually self-limiting and can be managed in the emergency department: A retrospective seriesHumphreys M, Martin C, Theodoros T, Andronis D, Isoardi K · Emergency medicine Australasiadoi:10.1111/1742-6723.14287moderateconsumed1 section
2023Clinical management of psychostimulant withdrawal: review of the evidenceLi MJ, Shoptaw SJ · Addictiondoi:10.1111/add.16093strongconsumed2 sections
2023Methamphetamine-associated pulmonary arterial hypertension: data from the national biological sample and data repository for pulmonary arterial hypertensionCharoenpong P, Dhillon N, Murnane K, et al. · BMJ Open Respiratory Researchdoi:10.1136/bmjresp-2023-001917moderateconsumed1 section
2023Recognition of methamphetamine and other amines by trace amine receptor TAAR1Liu H, Zheng Y, Wang Y, et al. · Naturedoi:10.1038/s41586-023-06775-1strongconsumed3 sections
2023Sexual orientation differences among men in a randomized clinical trial of extended-release naltrexone and bupropion for methamphetamine use disorderKidd JD, Smiley SL, Coffin PO, et al. · Drug and alcohol dependencedoi:10.1016/j.drugalcdep.2023.110899strongconsumed2 sections
2020Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic ReviewSiefried KJ, Acheson LS, Lintzeris N, Ezard N · CNS drugsdoi:10.1007/s40263-020-00711-xstrongconsumed2 sections
2019Effects of stimulant drug use on the dopaminergic system: A systematic review and meta-analysis of in vivo neuroimaging studiesProebstl L, Kamp F, Manz K, et al. · European psychiatrydoi:10.1016/j.eurpsy.2019.03.003strongconsumed1 section
2018Methamphetamine Consumption During Pregnancy and its Effects on NeonatesPflügner A, Thome U, Bernhard MK, et al. · Klinische Padiatriedoi:10.1055/s-0043-121991moderateconsumed1 section
2017Reduced carboxylesterase 1 is associated with endothelial injury in methamphetamine-induced pulmonary arterial hypertensionOrcholski ME, Khurshudyan A, Shamskhou EA, et al. · American journal of physiology. Lung cellular and molecular physiologydoi:10.1152/ajplung.00453.2016moderateconsumed2 sections
2017Stroke and methamphetamine use in young adults: a reviewLappin JM, Darke S, Farrell M · Journal of neurology, neurosurgery, and psychiatrydoi:10.1136/jnnp-2017-316071strongconsumed1 section
2016The Cardiac Complications of MethamphetaminesParatz ED, Cunningham NJ, MacIsaac AI · Heart, Lung and Circulationdoi:10.1016/j.hlc.2015.10.019strongconsumed2 sections
2015Persistence of psychotic symptoms as an indicator of cognitive impairment in methamphetamine usersChen CK, Lin SK, Chen YC, et al. · Drug and alcohol dependencedoi:10.1016/j.drugalcdep.2014.12.035moderateconsumed1 section
2014Inhibition of monoamine oxidase (MAO) by alpha-ethylphenethylamine and N,alpha-diethylphenethylamine, two compounds related to dietary supplementsSantillo MF · Food and chemical toxicologypmid:25455893strongconsumed2 sections
2014Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literatureCourtney KE, Ray LA · Drug and alcohol dependencedoi:10.1016/j.drugalcdep.2014.08.003strongconsumed4 sections
2013Pharmacotherapy of amphetamine-type stimulant dependence: an updateBrensilver M, Heinzerling KG, Shoptaw S · Drug and alcohol reviewdoi:10.1111/dar.12048strongconsumed2 sections
2011Acute, low-dose methamphetamine administration improves attention/information processing speed and working memory in methamphetamine-dependent individuals displaying poorer cognitive performance at baselineMahoney JJ, Jackson BJ, Kalechstein AD, De La Garza R, Newton TF · Progress in neuro-psychopharmacology & biological psychiatrydoi:10.1016/j.pnpbp.2010.11.034strongconsumed1 section
2011Putting the call out for more research: the poor evidence base for treating methamphetamine withdrawalPennay AE, Lee NK · Drug and alcohol reviewdoi:10.1111/j.1465-3362.2010.00240.xmoderateconsumed2 sections
2010Estimating the intake of abused methamphetamines using experimenter-administered deuterium labeled R-methamphetamine: selection of the R-methamphetamine doseLi L, Lopez JC, Galloway GP, Baggott MJ, Everhart T, Mendelson J · Therapeutic drug monitoringdoi:10.1097/ftd.0b013e3181db82f2strongconsumedcited only
2009Molecular bases of methamphetamine-induced neurodegenerationCadet JL, Krasnova IN · International review of neurobiologydoi:10.1016/s0074-7742(09)88005-7strongconsumedcited only
2007Neurotoxicity of substituted amphetamines: molecular and cellular mechanismsCadet JL, Krasnova IN, Jayanthi S, Lyles J · Neurotoxicity researchpmid:17449459strongconsumedcited only
2006Causes and consequences of methamphetamine and MDMA toxicityQuinton MS, Yamamoto BK · The AAPS journalpmid:16796384strongconsumed1 section
2006Human pharmacology of the methamphetamine stereoisomersMendelson J, Uemura N, Harris D, Nath RP, Fernandez E, Jacob P, Everhart ET, Jones RT · Clinical pharmacology and therapeuticspmid:17015058strongconsumed2 sections
2005Toxin-induced hyperthermic syndromesRusyniak DE, Sprague JE · Medical clinics of North Americapmid:16227063moderateconsumed1 section
2004Effects of methamphetamine and lobeline on vesicular monoamine and dopamine transporter-mediated dopamine release in a cotransfected model systemWilhelm CJ, Johnson RA, Lysko PG, Eshleman AJ, Janowsky A · Journal of pharmacology and experimental therapeuticspmid:15102929strongconsumed2 sections
Show all 42 sources — 12 more
Sources 31 to 42
yearsourcetierstatusfeeds
2004Structural abnormalities in the brains of human subjects who use methamphetamineThompson PM, Hayashi KM, Simon SL, Geaga JA, Hong MS, Sui Y, Lee JY, Toga AW, Ling W, London ED · Journal of Neurosciencepmid:15229250moderateconsumed2 sections
2002Appetite suppressants as agonist substitution therapies for stimulant dependenceRothman RB, Blough BE, Baumann MH · Annals of the New York Academy of Sciencespmid:12105089moderateconsumed1 section
1998Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidolRichards JR, Derlet RW, Duncan DR · Journal of Emergency Medicinepmid:9696171strongconsumed1 section
1998Reduced striatal dopamine transporter density in abstinent methamphetamine and methcathinone users: evidence from positron emission tomography studies with [11C]WIN-35,428McCann UD, Wong DF, Yokoi F, Villemagne V, Dannals RF, Ricaurte GA · Journal of Neurosciencepmid:9763484moderateconsumed3 sections
1995Amphetamine redistributes dopamine from synaptic vesicles to the cytosol and promotes reverse transportSulzer D, Chen TK, Lau YY, Kristensen H, Rayport S, Ewing A · Journal of Neurosciencepmid:7751968strongconsumed2 sections
1995Biogenic amine flux mediated by cloned transporters stably expressed in cultured cell lines: amphetamine specificity for inhibition and effluxWall SC, Gu H, Rudnick G · Molecular pharmacologypmid:7700252strongconsumed1 section
1994Stroke associated with methamphetamine inhalationYen DJ, Wang SJ, Ju TH, Chen CC, Liao KK, Fuh JL, Hu HH · European neurologypmid:8137834weakconsumed1 section
1993Pharmacokinetics of methamphetamine self-administered to human subjects by smoking S-(+)-methamphetamine hydrochlorideCook CE, Jeffcoat AR, Hill JM, Pugh DE, Patetta PK, Sadler BM, White WR, Perez-Reyes M · Drug metabolism and dispositionpmid:8104133strongconsumed4 sections
1992A lasting vulnerability to psychosis in patients with previous methamphetamine psychosisSato M · Annals of the New York Academy of Sciencespmid:1632581moderateconsumed2 sections
1986Enduring changes in brain and behavior produced by chronic amphetamine administration: a review and evaluation of animal models of amphetamine psychosisRobinson TE, Becker JB · Brain researchpmid:3527341strongconsumedcited only
1983Acute exacerbation of paranoid psychotic state after long-term abstinence in patients with previous methamphetamine psychosisSato M, Chen CC, Akiyama K, Otsuki S · Biological psychiatrypmid:6860719moderateconsumed2 sections
1971UN 1971 Convention on Psychotropic Substances - methamphetamine Schedule IIUnited Nations Office on Drugs and Crime (UNODC)url:4e5a80f71daccf68weakconsumedcited only

4Docket

one filing per activity — decisions, correspondence, reports

  1. 0012026-04-21revisionRevision 1

    Initial LLM generation (v5 pipeline, wiki)

    psx:substance/methamphetamine/version/1
  2. 0022026-04-21proposaldose_tier · threshold
  3. 0032026-04-21proposaldose_tier · light
  4. 0042026-04-21proposaldose_tier · common
  5. 0052026-04-21proposaldose_tier · strong
  6. 0062026-04-21proposaldose_tier · heavy
  7. 0072026-04-21proposaltimeline · oral · onset
  8. 0082026-04-21proposaltimeline · oral · come_up
  9. 0092026-04-21proposaltimeline · oral · peak
  10. 0102026-04-21proposaltimeline · oral · plateau
  11. 0112026-04-21proposaltimeline · oral · resolution
  12. 0122026-04-21proposaltimeline · oral · afterglow
  13. 0132026-04-21proposaltimeline · smoked · onset
  14. 0142026-04-21proposaltimeline · smoked · come_up
  15. 0152026-04-21proposaltimeline · smoked · peak
  16. 0162026-04-21proposaltimeline · smoked · resolution
  17. 0172026-04-21proposaltimeline · smoked · afterglow
  18. 0182026-04-21proposaltimeline · insufflated · onset
  19. 0192026-04-21proposaltimeline · insufflated · come_up
  20. 0202026-04-21proposaltimeline · insufflated · peak
  21. 0212026-04-21proposaltimeline · insufflated · resolution
  22. 0222026-04-21proposaltimeline · insufflated · afterglow
  23. 0232026-04-21proposaltoxicity
  24. 0242026-04-21proposaldependence · full
  25. 0252026-04-21proposalwithdrawal
  26. 0262026-04-21proposaltolerance
  27. 0272026-04-21proposaldosage · oral
  28. 0282026-04-21proposaldosage · smoked
  29. 0292026-04-21proposaldosage · insufflated
  30. 0302026-04-21proposalduration · oral · onset
  31. 0312026-04-21proposalduration · oral · come_up
  32. 0322026-04-21proposalduration · oral · peak
  33. 0332026-04-21proposalduration · oral · offset
  34. 0342026-04-21proposalduration · oral · total
  35. 0352026-04-21proposalduration · oral · aftereffects
  36. 0362026-04-21proposalduration · smoked · onset
  37. 0372026-04-21proposalduration · smoked · come_up
  38. 0382026-04-21proposalduration · smoked · peak
  39. 0392026-04-21proposalduration · smoked · offset
  40. 0402026-04-21proposalduration · smoked · total
  41. 0412026-04-21proposalduration · smoked · aftereffects
  42. 0422026-04-21proposalduration · insufflated · onset
  43. 0432026-04-21proposalduration · insufflated · come_up
  44. 0442026-04-21proposalduration · insufflated · peak
  45. 0452026-04-21proposalduration · insufflated · total
  46. 0462026-04-21proposalduration · insufflated · aftereffects
  47. 0472026-06-04proposal60 value proposals approved together

    one review action inferred from a shared reviewer and instant — the graph records one activity per proposal

    60 items in this filing

    • duration · insufflated · offset
    • contraindication · cardiovascular
    • contraindication · cardiovascular
    • contraindication · metabolic
    • contraindication · psychiatric
    • contraindication · other
    • contraindication · cardiovascular
    • contraindication · neurological
    • contraindication · pregnancy_breastfeeding
    • contraindication · psychiatric
    • dose_tier · threshold
    • dose_tier · light
    • dose_tier · common
    • dose_tier · strong
    • dose_tier · heavy
    • timeline · oral · onset
    • timeline · oral · come_up
    • timeline · oral · peak
    • timeline · oral · plateau
    • timeline · oral · resolution
    • timeline · oral · afterglow
    • timeline · smoked · onset
    • timeline · smoked · come_up
    • timeline · smoked · peak
    • timeline · smoked · resolution
    • timeline · smoked · afterglow
    • timeline · insufflated · onset
    • timeline · insufflated · come_up
    • timeline · insufflated · peak
    • timeline · insufflated · resolution
    • timeline · insufflated · afterglow
    • toxicity
    • dependence · full
    • withdrawal
    • tolerance
    • dosage · oral
    • dosage · smoked
    • dosage · insufflated
    • duration · oral · onset
    • duration · oral · come_up
    • duration · oral · peak
    • duration · oral · offset
    • duration · oral · total
    • duration · oral · aftereffects
    • duration · smoked · onset
    • duration · smoked · come_up
    • duration · smoked · peak
    • duration · smoked · offset
    • duration · smoked · total
    • duration · smoked · aftereffects
    • duration · insufflated · onset
    • duration · insufflated · come_up
    • duration · insufflated · peak
    • duration · insufflated · total
    • duration · insufflated · aftereffects
    • contraindication · other
    • contraindication · cardiovascular
    • contraindication · neurological
    • contraindication · psychiatric
    psx:substance/methamphetamine/proposal/dosage/81a57b26-5b77-4020-8f0a-90b5af18a19a
  48. 0482026-06-04publicationPublication — backfill
  49. 0492026-09-27revisionr1.a1

    brief-overview retired 2026-09-30 (founder): Description reads the essential summary for every substance.

    psx:substance/methamphetamine/version/2

5Issued documents

what the notice, info card and emergency page said, by hash

Issued documents
documentcontent hashissuedfrom versionsuperseded
info_card3274f128ed1b087f099c0b81…2026-10-19 20:32Revision 1current
noticeae6ecef67396a473d4bff26d…2026-10-19 20:32Revision 1current
emergency58d3299a8754d788e3d74c0e…2026-09-04 04:31Revision 1current
info_card4393bd25923022593b7a1d05…2026-09-04 04:31Revision 1superseded2026-10-19
notice1106ec0b75687f4a241652e9…2026-09-04 04:31Revision 1superseded2026-10-19