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Q: Can you tell me a little bit about crank addicts. What are the symptoms of crank abuse?

Dr. Keti:

Methamphetamine abuse has been around for years. Methamphetamine is known as crank, speed, ice or crystal. It can be snorted, smoked, injected or taken orally. Methamphetamine abuse is a big problem in Hawaii and the West Coast in particular. MDMA is a combination of mescaline and methamphetamine, also called ecstasy on the street.

The symptoms of methamphetamine user include: increased alertness, a sense of expanded mood or euphoria, oftentimes paranoia, especially in high dose acute use - tachycardia, hypertension with the risk of seizures and also cardiac arrhythmias.
Usually this patient is a patient who presents with tachycardia, a little bit hypertensive, quite agitated, paranoid and their pupils are dilated but usually not as fixed as what we see in anticholinergic intoxications. They can get high, paranoid, psychotic, end up jumping out of a window. End up in the intensive care unit with multiple fractures - but then they can go through a period of time after the use where there is a crash of depression, mood instability. In fact they can be even quite suicidal in the post-use period. This is a typical type of scenario for either the crank or the cocaine addict.

Many drugs of abuse, though not all, have a withdrawal syndrome that's upsetting and painful. Maternal use of heroin, methadone, methamphetamine, or phencyclidine may produce a neonatal withdrawal syndrome characterized by increased muscle tone, tremors, and a high-pitched cry. In some (few only presently) cases of acute usage of crank, speed, ice or crystal, vascular lesion as in classic polyarteritis nodosa (PAN), were studied. PAN is a necrotizing inflammation of small and medium-sized muscular arteries. Nonspecific signs and symptoms are the hallmarks of classic PAN. Fever, weight loss, and malaise are present in over one-half of cases. Patients usually present with vague symptoms such as weakness, malaise, headache, abdominal pain, and myalgias. The prognosis of untreated classic PAN as well as that of microscopic polyangiitis is extremely poor. The usual clinical course is characterized either by fulminant deterioration or by relentless progression associated with intermittent acute flare-ups. Death usually results from renal failure; from gastrointestinal complications, particularly bowel infarcts and perforation; and from cardiovascular causes.

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