Abstract
Methamphetamine (MA) use continues to increase on a global scale. Patients using MA utilize emergency department and hospital resources at a higher rate than other patients due to serious associated medical conditions, including blunt and penetrating trauma, stroke, myocardial infarction, cardiomyopathy, and rhabdomyolysis. Mental health resources are also utilized at a high rate stemming from MA-associated agitation, aggression, psychosis, self-harm, and suicidal ideation. Patients presenting with MA toxicity frequently require a combined team effort of clinicians, nurses, psychiatric workers, and social services prior to final disposition. The phenomenon of “Methamphetamine Washout Syndrome” (MAWS) has been used to describe a period of MA-induced hypersomnolence greater than eight hours at our institution. During this period the patient cannot easily be awakened or interviewed, and they continue to occupy a hospital bed. The etiology of MAWS was initially thought to simply be a result of catecholamine depletion followed by a period of synthesis and restoration. In this report, we investigate this theory and other potential causes of MAWS such as MA neurotoxicity from microglial activation and cytokine release, mitochondrial dysfunction, energy supply disruption, and apoptosis. The effect of MA on sleep is also detailed, and potential treatment options to optimize patient outcome and decrease length of stay are discussed.