Study of Methamphetamine Use in Patients Referred to Emergency Ward of a General Hospital at North of Iran in 2017

Document Type : Original Article


1 Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

2 Professor, Department of Psychiatry, School of Medicine AND Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran

3 Department of Emergency Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

4 Department of Health, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran


Background: Acute use of methamphetamine affects the sympathetic system and causes symptoms like tachycardia, hypertension (HTN), tachypnea, peripheral blood vessels constriction, hyperthermia, and mydriasis that can lead to many medical complications. Thus, this study aimed to evaluate the use of methamphetamine, clinical symptoms, and admission causes in patients referred to emergency ward of Imam Khomeini General Hospital in Sari, Iran.
Methods:In this cross-sectional study, 3263 patients were enrolled in the census. The population was patients referred to emergency ward of Imam Khomeini Hospital in Sari, in 2017. Clinical signs and symptoms, test results, primary and definite diagnosis, and patients' status during discharge or referral were extracted from medical records. Statistical analysis was performed using SPSS software.
Findings: A total of 3263 people were enrolled in the study. The prevalence of positive methamphetamine test in patients referred to the emergency department was 1.2%, which was significantly higher in men
(P = 0.017). The mean age was 39.9 ± 17.2 years. Methamphetamine users were more likely to be traumatized than the general population. There was a statistically significant difference in seizure (P = 0.003), chest pain
(P < 0.001), tachycardia (P < 0.001), palpitation (P < 0.001), HTN (P = 0.002), tachypnea (P = 0.001), visual hallucinations (P = 0.001), auditory hallucinations (P = 0.001), paranoia (P = 0.001), grandiosity
(P = 0.035), talkativeness (P = 0.001), suicidal ideation (P < 0.001), homicidal ideation (P = 0.001), violence (P < 0.001), and disorientation (P < 0.001) in positive methamphetamine test group.

Conclusion: Methamphetamine use is more frequent in young men in the second and third decades of life. The most common clinical symptoms in these patients were HTN, chest pain, palpitations, tachycardia, seizure, aggression, anxiety, delusions, and hallucinations


Fulde GW, Forster SL. The impact of amphetaminetype stimulants on emergency services. Curr Opin
Psychiatry 2015; 28(4): 275-9.
2. Barr AM, Panenka WJ, MacEwan GW, Thornton
AE, Lang DJ, Honer WG, et al. The need for speed:
An update on methamphetamine addiction. J
Psychiatry Neurosci 2006; 31(5): 301-13.
3. Narconon. History of Meth [Online]. [cited 2007];
Available from: URL:
4. Alam Mehrjerdi Z. Crystal in Iran:
methamphetamine or heroin kerack. DARU J Pharm
Sci 2013; 21(1): 22.
5. Scott JC, Woods SP, Matt GE, Meyer RA, Heaton
RK, Atkinson JH, et al. Neurocognitive effects of
methamphetamine: A critical review and metaanalysis. Neuropsychol Rev 2007; 17(3): 275-97.
6. Drug Control Headquarters. Drug Control in 2008:
Annual report and rapid situation assessment.
Tehran, Iran: Drug Control Headquarters; 2009.
7. Nikkhah K, Sasannejad P, Ardom M, Kiani R.
Recognition of special form of amphetamine
acquaintance in iran and presentation of 4 cases with
Methamphetamine Use in Patients Referred to Emergency Hadinezhad et al.
24 Addict Health, Winter 2019; Vol 11, No 1, 05 January
neurovascular complication. Med J Mashad Univ
Med Sci 2009; 52(4): 249-52. [In Persian].
8. Siahjani L, Oraki M, Zare H. Length of
methamphetamine abuse and sustained attention
disorders among methamphetamine abusers. Research
on Addiction 2013; 7(27): 53-66. [In Persian].
9. Vocci FJ, Appel NM. Approaches to the
development of medications for the treatment of
methamphetamine dependence. Addiction 2007;
102(Suppl 1): 96-106.
10. Angoorani H, Narenjiha H, Tayyebi B, Ghassabian
A, Ahmadi G, Assari S. Amphetamine use and its
associated factors in body builders: A study from
Tehran, Iran. Arch Med Sci 2012; 8(2): 362-7.
11. Lashkaripour K, Torbati E. Methamphetamine
dependency. Int J High Risk Behav Addict 2012;
1(1): 7-8.
12. Chiang WK. Amphetamines. In: Flomenbaum NE,
Goldfrank LR, Hoffman RS, HowlandMA, Lewin
NA, Nelson LS, editors. Goldfrank's toxicologic
emergencies. 8th ed. New York, NY: McGraw-Hill;
2006. p. 1118-32.
13. Casaletto KB, Obermeit L, Morgan EE, Weber E,
Franklin DR, Grant I, et al. Depression and executive
dysfunction contribute to a metamemory deficit
among individuals with methamphetamine use
disorders. Addict Behav 2015; 40: 45-50.
14. Mihu MR, Roman-Sosa J, Varshney AK, Eugenin
EA, Shah BP, Ham LH, et al. Methamphetamine
alters the antimicrobial efficacy of phagocytic cells
during methicillin-resistant Staphylococcus aureus
skin infection. MBio 2015; 6(6): e01622-15.
15. Harro J. Neuropsychiatric adverse effects of
amphetamine and methamphetamine. Int Rev
Neurobiol 2015; 120: 179-204.
16. Zarrabi H, Khalkhali M, Hamidi A, Ahmadi R,
Zavarmousavi M. Clinical features, course and
treatment of methamphetamine-induced psychosis
in psychiatric inpatients. BMC Psychiatry 2016;
16: 44.
17. Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda
KE, Giraudon I, et al. Acute recreational drug and
new psychoactive substance toxicity in Europe: 12
months data collection from the European Drug
Emergencies Network (Euro-DEN). Clin Toxicol
(Phila) 2015; 53(9): 893-900.
18. Liakoni E, Dolder PC, Rentsch K, Liechti ME.
Acute health problems due to recreational drug use
in patients presenting to an urban emergency
department in Switzerland. Swiss Med Wkly 2015;
145: w14166.
19. Hendrickson RG, Cloutier R, McConnell KJ.
Methamphetamine-related emergency department
utilization and cost. Acad Emerg Med 2008; 15(1):
20. Pasic J, Russo JE, Ries RK, Roy-Byrne PP.
Methamphetamine users in the psychiatric
emergency services: a case-control study. Am J Drug
Alcohol Abuse 2007; 33(5): 675-86.
21. Hirabayashi N, Wada K, Kimura T, Hirabayashi E,
Mishima S, Yukioka T, et al. Prevalence of
substance abuse among patients with physical
diseases seen in an emergency room in Japan. Am J
Addict 2004; 13(4): 398-404.
22. Mattson ME. Emergency Department Visits
Involving Methamphetamine: 2007 to 2011. The
CBHSQ Report. Rockville, MD: Substance Abuse
and Mental Health Services Administration (US);
23. Richards JR, Hamidi S, Grant CD, Wang CG, Tabish
N, Turnipseed SD, et al. Methamphetamine use and
emergency department utilization: 20 years later. J
Addict 2017; 2017: 4050932.
24. McKetin R, Degenhardt L, Shanahan M, Baker AL,
Lee NK, Lubman DI. Health service utilisation
attributable to methamphetamine use in Australia:
Patterns, predictors and national impact. Drug
Alcohol Rev 2018; 37(2): 196-204.
25. Khanjani N, Mousavi M, Dehghanian A, Jahani Y,
Soori H. The role of drug and alcohol use and the
risk of motor vehicle crashes in Shiraz, Iran, 2014: A
case-crossover study. Traffic Inj Prev 2017; 18(6):
26. Behnoush B, Taghadosinejad F, Arefi M, Shahabi
M, Jamalian M, Kazemifar A M. Prevalence and
complications of drug-induced seizures in Baharloo
Hospital, Tehran, Iran. Iran J Toxicol 2012; 6(16):
588-93. [In Persian].
27. Goudarzi F, Ansari H, Gholamzadeh S, Zarenezhad
M, Maleki M, Jafarizadeh F, et al. Evaluation of the
frequency, clinical signs and prognosis of drug
abuse in poisoning cases referred to Shiraz
Shoushtari Hospital from September 2008 to
September 2010. Sci J Forensic Med 2016; 22(1):
7-14. [In Persian].
28. Zarghami M, Khoshboresh Astaneh A. Substance
use among patients in Zare Hospital psychiatric
emergency ward [MD Thesis]. Sari, Iran:
Mazandaran University of Medical Sciences; 2014.
[In Persian].