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The health concerns for most amphetamine-like substances, including methamphetamine, are largely the same. Each has its own risk and toxicity profile. Street methamphetamine provides the additional risks of black market, unregulated medications; potential contaminants or adulteration; the potential of neurotoxicity and a higher risk of compulsive use associated with snorting, smoking, or injecting.

Frequency: unknown, rare, uncommon, common, very common, typical.
Certainty: unknown, little direct evidence, some evidence, case reports only, medium / link established, high / clear causation.

• Agitation, Inability to Concentrate: In some users, increasing with dose, amphetamine causes agitation, restlessness, and inability to concentrate or focus.
  
  Frequency: uncommon, increasing with dose.
  Certainty: clear causation.
• Cardiovascular Stress: Increased heart rate and blood pressure. Tachycardia (fast heart) and palpitations are common at high doses.
  
  Frequency: very common.
  Certainty: clear causation.
• Heart Attack & Hypertensive Crisis: With higher doses and for vulnerable individuals, Cardiovascular Stress can precipitate severe hypertensive crises and Heart Attacks.
  
  Frequency: uncommon.
  Certainty: clear causation.
• Stroke: Increases risk of stroke as dose increases.
  
  Frequency: unknown.
  Certainty: medium. [Kaku 1990, Lambrecht 1993]
• Overheating: High doses can cause overheating (hyperthermia) which can be dangerous in certain environments or for vulnerable people.
  
  Frequency: common.
  Certainty: clear causation.
• Poor Sleep Quality: Mild sleep disruptions are very common and include difficulty falling asleep and poor sleep quality.
  
  Frequency: typical.
  Certainty: clear causation.
• Sleep Deprivation: Repeated dosing can lead to lack of sleep for days on end, resulting in cognitive impairment, poor judgement, confusion, hallucinations, and paranoia.
  
  Frequency: typical with repeated dosing.
  Certainty: clear causation.
• Bad Driving: Lack of sleep can lead to impaired judgement and poor driving.
  
  Frequency: common with sleep deprivation.
  Certainty: link established.
• Poor Diet: Reduced appetite and reduced enjoyment of eating can lead to poor diet which, over time, can lead to poor general health, oral health and skin tone, and increased physical and mental stress.
  
  Frequency: common with chronic use.
  Certainty: clear causation.
• Stress & Oxidative Damage: Methamphetamine causes stress to the body and mind and causes an increase in oxidative stress in blood and tissues. At very high doses and frequencies of use, organ damage and premature aging may occur.
  
  Frequency: common.
  Certainty: some evidence.
• Damage to Teeth and Gums #: Jaw tension can lead to teeth grinding (bruxia/bruxism) and permanent wear and cracking. Long-term use of amphetamines can result in tooth rot (dental caries) and loss of teeth. [Shaner 2002] Regular amphetamine use can lead to gingivitis (inflammation of the gums). This may be the result of prolonged dry mouth which can cause the gums to become inflamed, worsening oral health. [Hasan 2004].
  
  Frequency: common.
  Certainty: link established.
• Paranoia: Using recreational (higher) doses of amphetamines more than once per day or for several days in a row can cause mild to moderate paranoid ideation in some users. The paranoid thinking can cause lasting problems and the paranoia can sometimes last for days or weeks after use ceases. Regular amphetamine use (and lack of sleep) can cause paranoid, delusional thinking and sometimes auditory and visual hallucinations (usually barely audible or on the periphery of vision). Chronic, high dose use may lead to long term mental health problems. [Nurse's PDR 2005]
  
  Frequency: uncommon.
  Certainty: some evidence [self reports].
• Risky Sex: Euphoria, altered mental state, and altered sense of control at recreational doses can lead to risky sexual behavior. [ Self Reports ]
  
  Frequency: unknown.
  Certainty: some evidence [self reports].
• Dry Mucus Membranes: Dried mucus membranes can lead to bloody noses, painful sinus dryness, and increased likelihood of sinus infections.
  
  Frequency: common.
  Certainty: link established.
• Dry Skin, Picking at the Skin: Regular amphetamine use is associated with a drying of the skin and increased itchyness. Obsessively picking or pulling at the skin (sometimes until it bleeds) is reported in many people after higher dose, frequent use of methamphetamine.
  
  Frequency: unknown.
  Certainty: some evidence [self reports].
• Neurotoxicity (Methamphetamine): At high doses, methamphetamine causes damage to dopamine and serotonin neurons in the brain [Seiden 1976, Thompson 2004]. Long term use may lead to noticeable neurological and behavioral problems. This effect is well documented with methamphetamine in mice and now largely confirmed in humans; behavioral/clinical effects of this damage is not well documented in humans [Hanson 2004].
  
  Frequency: unknown.
  Certainty: link established in rodents, exact nature unclear in humans.
• Neurotoxicity (D/L-Amphetamine): Neurotoxicity with D/L amphetamine (most of what is prescribed as medications) is not as well documented, but at very high doses and frequencies, neurotoxicity does occur in mice and rats. [Jonsson 1982]
  
  Frequency: unknown.
  Certainty: unknown.
• Rhabdomyolysis and Kidney Damage: Breakdown of muscle fibers usually caused by overheating and overstimulation. High-dose use can result in rhabdomyolysis, causing large amounts of proteins to be released into the blood. Urine becomes dark as the rhabdomyolysis increases and the kidneys can suffer mild to severe damage. [Chan 1994, Lan 1998].
  
  Frequency: rare.
  Certainty: some direct evidence.
• Dangerous to combine with other stimulants: Amphetamines used with MDMA appear to cause damage to the dopamine neurons in the brain [Reneman 2002]. Amphetamines combined with other stimulants can substantially increase the risk of dangerous hyperthermia (overheating), rhabdomyolysis (breakdown of muscles), and other related health problems.
  
  Frequency: uncommon.
  Certainty: clear causation.
• Death: Usually resuling from cardiac arrest, stroke, or hyperthermia. Acute renal failure associated with rhabdomyolysis, acidosis, and ischemic renal failure also is associated with methamphetamine fatalities. Disseminated Intravascular Coagulation also reported. [Lan 1998].
  
  Frequency: rare.
  Certainty: clear causation.

• Reduced Appetite: Although still prescribed to aid in weight loss, the recognized cardiovascular risks of using amphetamines now make their prescription for weight loss far less common than in the past. The prevalence of "weight loss only" non-prescription use of amphetamines is impossible to gauge.
  
  Frequency: typical.
  Certainty: clear causation.
• Attention Deficit Disorder: Amphetamines are widely prescribed for use in treating moderate to severe cases of Attention Deficit Disorder (ADD) in both children and adults. Attention-improving doses tend to be low doses (3-20 mg of amphetamine or methamphetamine oral), although dosages are higher for tolerated individuals.
  
  Frequency: effective for some.
  Certainty: link established.
• Attention / Wakefulness: In low doses and used infrequently, amphetamine increases wakefulness and attentiveness in users. It is used by truckers, the military, and others who need to stay awake for long periods of time. Wakefulness can be important for safety when operating machinery.
  
  Frequency: typical.
  Certainty: link established.
• Dry Mucus Membranes: Dried mucus membranes can reduce allergy and cold symptoms.
  
  Frequency: common. Certainty: link established.

• Do not take amphetamines if you are using, or have used an MAO Inhibitor within the last 2 weeks.
• MAOIs include harmine & harmaline, as well as many antidepressants.
• Check with a doctor if you're unsure whether your medication contains MAOIs.
• When combined with MAOIs, amphetamines can cause "serotonin syndrome" with fever, hypertension, and arrhythmias.
• Regular or frequent amphetamine use can lead to dependence.
• Regular amphetamine users experience tolerance and require increased dosages to achieve the same level of effects.

• Hasan AA, Ciancio S. Relationship between amphetamine ingestion and gingival enlargement. Pediatr Dent. 2004 Sep-Oct;26(5):396-400.
• Shaner JW. Caries associated with methamphetamine abuse. J Mich Dent Assoc. 2002 Sep;84(9):42-7.
• Nurse's PDR 2005
• Hanson GR, Rau KS, Fleckenstein AE.The methamphetamine experience: a NIDA partnership. Neuropharmacology. 2004;47 Suppl 1:92-100.
• Itzhak Y, Achat-Mendes C. Methamphetamine and MDMA (ecstasy) neurotoxicity: 'of mice and men'. IUBMB Life. 2004 May;56(5):249-55.
• Thompson PM, Hayashi KM, Simon SL, Geaga JA, Hong MS, Sui Y, Lee JY, Toga AW, Ling W, London ED. Structural abnormalities in the brains of human subjects who use methamphetamine. J Neurosci. 2004 Jun 30;24(26):6028-36.
• Seiden LS, Fischman MW, Schuster CR. Long-term methamphetamine induced changes in brain catecholamines in tolerant rhesus monkeys. Drug Alcohol Depend 1976;1(3):215Ð9.
• Jonsson G, Nwanze E.Selective (+)-amphetamine neurotoxicity on striatal dopamine nerve terminals in the mouse. Br J Pharmacol. 1982 Oct;77(2):335-45.
• Lan KC, Lin YF, Yu FC, Lin CS, Chu P. Clinical manifestations and prognostic features of acute methamphetamine intoxication. J Formos Med Assoc. 1998 Aug;97(8):528-33.
• Chan P, Chen JH, Lee MH, Deng JF. Fatal and nonfatal methamphetamine intoxication in the intensive care unit. J Toxicol Clin Toxicol. 1994;32(2):147-55.
• Kaku DA, Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Ann Intern Med. 1990 Dec 1;113(11):821-7.
• Lambrecht GL, Malbrain ML, Chew SL, Baeck E, Verbraeken H.Intranasal caffeine and amphetamine causing stroke. Acta Neurol Belg. 1993;93(3):146-9.
• Richards JR, Johnson EB, Stark RW, Derlet RW.Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med. 1999 Nov;17(7):681-5.
• Kendrick WC, Hull AR, Knochel JP. Rhabdomyolysis and shock after intravenous amphetamine administration. Ann Intern Med. 1977 Apr;86(4):381-7.

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LINKS
Amphetamine Toxicity, emedicine.com