Explained: Sonali Phogat may have been given a meth overdose; how can this drug induce a heart attack?

Phogat was declared dead in St Anthony’s Hospital in Anjuna on August 23. She died after a heart attack that was initially thought to have been triggered by blunt injuries, but which is now understood to have been brought on by an overdose of methamphetamine.

The stimulant drug

The United States National Institute on Drug Abuse (NIDA), the lead federal agency supporting scientific research on drug use and addiction, says methamphetamine — meth for short — is a powerful, highly addictive stimulant that affects the central nervous system, and is used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.

Crystal methamphetamine or crystal meth is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine.

Methamphetamine can be smoked, swallowed in the form of a pill or tablet, snorted, and injected after dissolving the powder in water or alcohol. Police have said the accused in the Phogat case, Sangvan and Singh, “intentionally gave the victim an obnoxious chemical substance in a liquid” hours before she died on Tuesday morning.

“Methamphetamine can lead to myocardial infarction (heart attack); it can cause stroke. The drug can affect the heart, the brain, and the kidneys. It can result in the blood pressure shooting up suddenly. So, it is a very dangerous drug if there is an overdose,” Dr Rommel Tickoo, director of internal medicine at Max Super Speciality Hospital, said.

However, Dr Tickoo said, “nobody knows how much can lead to overdose — that will depend on not just the quantity, but how the drug is taken, and how the individual processes it”.

In general, people get a feeling of euphoria after consuming the drug, Dr Tickoo said — and “although these problems occur when there is an overdose, it is a recreational drug that should not be used”.

Effect on the brain

Meth raises the amount of dopamine in the brain. Dopamine, a natural chemical, plays a role in body movement, motivation, and reinforcement of rewarding behaviours. According to NIDA, the ability of the drug to rapidly release high levels of dopamine in reward areas of the brain strongly reinforces drug-taking behaviour, making the user want to repeat the experience.

According to NIDA, even small amounts of meth can result in many of the same health effects as those of other stimulants, such as cocaine or amphetamines. These include increased wakefulness and physical activity; decreased appetite; faster breathing; rapid and/ or irregular heartbeat; and increased blood pressure and body temperature.

Role in heart attack

A senior forensics expert told The Indian Express: “Methamphetamine on its own might not cause the heart attack but it can result in a cardiac arrest if consumed in an excess quantity. The recreational drug can lead to over sedation, which can affect the organs, including the heart.”

The authors of a study on how meth hurts the heart published last year in ‘Circulation: Cardiovascular Quality and Outcomes’, the journal of the American Heart Association, called “urgent attention to this insidious yet rapidly growing form of severe heart failure — methamphetamine-related heart failure, which is taking the lives of young people…”.

“The problem has been made drastically worse in recent years by the increase in purer, more potent methamphetamine throughout our communities,” they said. “Methamphetamine, also known as meth, is an addictive stimulant that can affect the cardiovascular system by triggering blood vessel spasms and life-threatening spikes in blood pressure. It can also increase plaque in the arteries and rewire the heart’s electrical system. Prolonged methamphetamine use has been associated with a severe form of dilated cardiomyopathy, a condition in which the weakened heart muscle becomes enlarged and cannot pump adequate blood.”

A 2005 technical report of the National Drug and Alcohol Research Centre at the University of New South Wales-Australia concluded that sporadic, low-dose use of methamphetamine may not induce cardiac complications in the healthy.

But when given in higher doses — the threshold of this “toxic” dosage is unclear, and also depends on the individual’s response — may lead to narrowing and spasms in the blood vessels, rapid heart rate (tachycardia), high blood pressure, and death of cardiac muscles.

In the long run, it can result in early development of coronary artery disease (blockage of arteries to the heart), formation of fibrous tissue in the heart, and enlargement of the heart muscles, making it difficult to pump blood to all parts of the body (dilated cardiomyopathy). The risk of these effects on the heart increases in those who take meth along with other drugs, especially psycho-stimulant drugs, the report said. (‘Cardiotoxicity associated with methamphetamine use and signs of cardiovascular pathology among methamphetamine users’: Sharlene Kaye and Rebecca McKetin, NDARC, UNSW-A)