Currently, most methamphetamine in the United States is produced by transnational criminal organizations (TCOs) in Mexico. This methamphetamine is highly pure, potent, and low in price. The drug can be easily made in small clandestine laboratories, with relatively inexpensive over-the-counter ingredients such as pseudoephedrine, a common ingredient in cold medications.
To curb production of methamphetamine, Congress passed the Combat Methamphetamine Epidemic Act in 2005, which requires that pharmacies and other retail stores keep logs of purchases of products containing pseudoephedrine and limits the amount of those products an individual can purchase per day. Restrictions on the chemicals used to make methamphetamine in the United States have dramatically reduced domestic production of the drug. In 2010, there were 15,256 domestic methamphetamine laboratory incidents—a figure that has fallen over 80 percent to 3,036 in 2017. Data on drug seizures indicate that most domestic production of methamphetamine is now conducted in small laboratories that make two ounces or less of the drug-using common household items.
Mexico has also tightened its restrictions on pseudoephedrine and other methamphetamine precursor chemicals. But manufacturers adapt to these restrictions via small- or large-scale “smurfing” operations: obtaining pseudoephedrine from multiple sources, below the legal thresholds, using multiple false identifications. Manufacturers in Mexico are also increasingly using a different production process (called P2P which stands for pseudoephedrine’s precursor chemical, phenyl-2-propanone) to make methamphetamine that does not require pseudoephedrine.
When methamphetamine is smuggled into the United States in powder or liquid form, domestic conversion laboratories transform it into Buy crystal meth online amphetamine. These laboratories do not require a significant amount of equipment, so they can be small in size and thus easily concealed, which presents challenges to law enforcement agencies. Methamphetamine pressed into a pill form intended to resemble ecstasy has also recently emerged, potentially in an effort to make methamphetamine more appealing to people who haven’t tried it before. As with other illicit drugs like heroin and cocaine, methamphetamine is also sometimes laced with fentanyl.
Methamphetamine production is also an environmental concern; it involves many easily obtained chemicals that are hazardous, such as acetone, anhydrous ammonia (fertilizer), ether, red phosphorus, and lithium. Toxicity from these chemicals can remain in the environment around a methamphetamine production lab long after the lab has been shut down, causing a wide range of damaging effects to health. Because of these dangers, the U.S. The Environmental Protection Agency has provided guidance on cleanup and remediation of methamphetamine labs.
Ketamine has been found to be a rapid-acting antidepressant in depression. It also may be effective in decreasing suicidal ideation, although based on lower-quality evidence. The antidepressant effects of ketamine were first shown in small studies in 2000 and 2006. They have since been demonstrated and characterized in subsequent studies. A single low, sub-anesthetic dose of ketamine given via intravenous infusion may produce antidepressant effects within four hours in people with depression. These antidepressant effects may persist for up to several weeks following a single infusion. This is in contrast to conventional antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), which generally require at least several weeks for their benefits to occur and become maximal. Moreover, based on the available preliminary evidence, the magnitude of the antidepressant effects of ketamine appears to be more than double that of conventional antidepressants. On the basis of these findings, ketamine has been described as the single most important advance in the treatment of depression in over 50 years. It has sparked interest in NMDA receptor antagonists for depression and has shifted the direction of antidepressant research and development.
Ketamine has not been approved for use as an antidepressant, but its enantiomer, ketamine, was developed as a nasal spray for treatment-resistant depression and was approved for this indication in the United States in March 2019. The effectiveness of ketamine is limited, however, with significant effectiveness for treatment-resistant depression seen in only two of five clinical trials. Although there is evidence to support the effectiveness of ketamine and ketamine in treating depression, there is a lack of consensus on dosing and the effects and safety of long-term therapy. Ketamine can produce euphoria and dissociative hallucinogen effects at higher doses, and thus has abuse potential. Moreover, ketamine has been associated with cognitive deficits, urotoxicity, hepatotoxicity, and other complications in some individuals with long-term use. These undesirable effects may serve to limit the use of ketamine and ketamine for depression.