Crystal methamphetamine is a very potent psychostimulant substance that causes overstimulation of the centres of the brain that control emotions, cognitive functions and pleasure. This overstimulation affects the sympathetic division of the central nervous system by releasing dopamine, serotonin and norepinephrine, causing overstimulation of the respective brain receptors, which in turn results in its empathogenic, hallucinogenic and euphoric properties.

It can be smoked, injected (slammed), inserted rectally (booty bump), snorted or ingested orally, in some cases wrapped in a piece of paper to prolong digestion (bombing). Its street names include meth, speed, ice, Tina, crystal, tweak, crank, and glass.


  • Initially causes higher heart rate, blood pressure and temperature, excessive sweating, rapid shallow breathing, and pupils’ dilation.
  • Highly increases sexual desire and causes a strong sense of euphoria, especially when the substance is smoked or injected.
  • People who use crystal methamphetamine report feeling more confident, losing their appetite and not needing to sleep.
  • Increases energy, curiosity, and alertness and decreases anxiety.
  • People who consume large amounts may experience hypertension, chest pains, heart failure, arrhythmia, difficulty in breathing, high body temperature, paranoia, severe stomach pain, coma, unresponsiveness, intracranial haemorrhage, seizures and ischemic stroke.
  • During the comedown, when the substance effect starts wearing off, people may report experiencing increased anxiety and depression as well as tiredness and headaches.

Long-term use consequences and medication treatment

The prolonged use of crystal methamphetamine leads to tolerance, which, in turn, may lead to higher doses and frequency of use. Furthermore, crystal methamphetamine remains in the brain for a long period of time. Among long-term consequences, we may find:

  • dental decay
  • weight loss
  • skin picking, scabs, or repeated infections
  • agitation, mood swings, insomnia
  • psychosis, paranoia, delusions, and hallucinations
  • persistent neuropsychological issues, including alterations in executive function, episodic memory, psychomotor functions and information processing

Dependence on crystal methamphetamine is hard to treat, as there is no medication that can help with abstinence, and no approved relapse treatment medication. Several substances have been proposed in order to help with individual symptoms, including Modafinil, Bupropion, Naltrexone, Mirtazapine and cannabidiol (CBD).

It has to be noted that crystal methamphetamine does not cause serious physical dependence. However, it does cause strong psychological dependence. Its withdrawal symptoms include depression, irritability, anhedonia (being unable to experience pleasure), attention deficit etc. The absence of physical symptoms of withdrawal may not let people using crystal methamphetamine realise they are becoming dependent. Therefore, they might end up consuming more in order to self-medicate the dependence symptoms. This, in turn, can lead to serious problems and even more severe unwanted effects.

Mixing with prescribed medication and other substances

  • Certain antidepressants, when combined with crystal methamphetamine use, may cause high blood pressure, increased body temperature, and serotonin toxicity.
  • The use of crystal methamphetamine can decrease the effectiveness of medications for psychosis and blood pressure.
  • Mixing methamphetamine with other substances, including ecstasy, cocaine, poppers and erectile dysfunction drugs is very dangerous and may cause blood pressure dysregulation, heart attack or stroke.
  • Erectile dysfunction drugs are commonly used in combination with methamphetamine in order to bypass the “crystal dick” effect, that is, chronic erectile dysfunction even in the presence of sexual arousal that crystal methamphetamine causes.

Harm reduction


Having a nutritious meal before partying and playing protects from the exhaustion that will follow. Additionally, high fat food protects from the harmful effects of oral uptake of crystal methamphetamine.

Sexual health

If condoms are used, keep in mind that crystal methamphetamine makes its recipient quite tireless and with very intense sexual desire. Thus, condoms are best changed after 30 minutes of sexual intercourse, or they might break. Additionally, water-based lubricants are preferable, as other lubricant constitutions may corrode the latex of the condoms and make them break more easily.

Take a break

Taking breaks during the chemsex sessions to hydrate by drinking water or juices, having a snack and avoiding to exhaust our body is also recommended. Sugar, caffeine and alcohol should be avoided, while electrolytes seem helpful. Crystal methamphetamine makes people not feel hungry, thirsty or tired, but that does not mean that the bodily needs are not still there. In fact, they may be even greater due to the strain caused by the substances’ effects and the sexual activities that take place. For the same reasons, having a shower during a break from partying may be refreshing, while it also helps keep the body clean.

Don’t overdo it

Taking smaller doses at longer time intervals may help to keep track of the substance’s effects and protect from overdose.

Dental hygiene

In order to avoid dental problems, teeth brushing (in the cases of sessions that last for days), using sugar free chewing gum and hydrating will protect the teeth from the harmful effects of crystal methamphetamine.

The Comedown

Comedown, that is, the symptoms caused when crystal methamphetamine effect wears off, may be quite overwhelming but they are temporary most of the time.

Some harm reduction recommendations regarding crystal methamphetamine comedown are:

  • Consuming nutritious food, including high quality protein, and a lot of liquids (juices, tea, water) is of great importance for the body to recoverCalcium and magnesium food supplements may also help with anxiety and irritability. Additionally, multivitamin supplements are also important for the body to recover.
  • Having a lot of sleep and being in a quiet and safe environment is also very helpful, especially regarding the recovery from the psychological impact of the come down. Lack of sleep for over 24 hours may cause severe cognitive deficits as well as hallucinations (e.g. insects crawling over the body) and psychosis.
  • Communication with trusted, non-judgmental friends, family members etc. is important, especially if one has a difficult time recovering and needs to share their feelings with other people – sharing itself may be healing. For the same reason, contact with people and being in environments that are anticipated to cause irritation or anxiety is best avoided. Maintaining a social network not involved in chemsex is useful, in order to be supported and have quality time not connected with substance use, which may help to keep control over it.
  • If the comedown is particularly overwhelming, reduction of the substance amount used or even taking some distance from chemsex involvement for some time altogether may be a good idea. Overwhelming comedowns are often a sign of dependence.

In cases when symptoms are not receding or they are difficult to control, it is important to seek support from a properly trained professional or affirmative community based service.

Skin care

It is also important to take care of skin damage caused by scratching, picking the skin and/or injecting by using proper equipment (e.g. antibiotic ointments) so that the skin can heal properly and infections are avoided.

Concerning psychosis

Crystal methamphetamine induced psychosis is quite common. Its symptoms closely resemble paranoid schizophrenia, including paranoid ideation, ideas of being followed or surveilled, acoustic and tactile hallucinations and confusion. According to David Stuart1, “common symptoms of crystal methamphetamine include:

  • Feeling like people are listening under the door/outside the house.
  • Feeling like our phone/PC/electrical items are bugged or hacked.
  • Being hyper alert to possible hidden cameras.
  • Feeling at the centre of a plot devised by a gang or a cult, or people we recently partied with.
  • Feeling like someone has deliberately infected us with HIV/hepatitis C (or something else).
  • Feeling convinced that someone has deliberately drugged us without consent.
  • Feeling like we are being ‘gaslighted’ (people trying to convince us we are insane, or imagining things).
  • Hearing whispers, or cruel persecutory voices.
  • Seeing floating presences in the periphery of vision.
  • Feeling like insects are under our skin – or a compulsive need to pick at the skin, pick at spots.
  • Being hyper-conscious of strange symptoms our body is displaying (joint pain, oddly coloured skin or blemishes, something in our urine or faeces.
  • The belief that we can hear the electricity in the walls, or radio signals.
  • Being hyper-aware of insects or micro-bacteria in nooks, crannies, fabrics.
  • An awareness of incredible coincidences that no one else can see or interpret.
  • A feeling of being judged by everyone for being high/having gay sex/wanking/having HIV/being effeminate/being unsexy/not fitting in/for having particular fantasies or fetishes/for watching porn (or particular porn).
  • Feeling that something urgent or dangerous is at play, feeling unsafe.
  • The feeling of being followed, either electronically or in real life.
  • An obsession with solving (or finding evidence for) any of the above.

Crystal methamphetamine psychosis is more probable in cases of dependence, regular use, or overdose, as well as lack of sleep. Although its symptoms may be very frightening, in most cases they will cease if we cease substance use and invest time in proper self-care (e.g. sleep, nutrition, relaxation). There are also cases, however, where the symptoms may remain for several days to weeks or relapse even with very small doses of substance use. In such cases, abstinence could be recommended, as well as seeking support from a properly trained mental health professional and community services. During a chemsex party, if such symptoms manifest, it is a good idea to take a break and seek the company of a trusted partner or partners. Chemsex partners are advised to be kind and calm and help their peers feel safe and relaxed. Trying to persuade them that “everything is in their mind” is a bad idea.

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