Methamphetamine is prescribed for obesity, narcolepsy, and attention deficit hyperactivity disorder (1). Methamphetamine is a member of a group of synthetic compounds referred to as amphetamines (2). Amphetamines are referred to as ice and crystal meth on the street. Shabu was its Egyptian name (3). There are four commonly used amphetamines in the US, and methamphetamine is one of them (4). In Iraq, dextroamphetamine is in addition to methamphetamine (5). People who utilize methamphetamine frequently take polydrugs, which needs to be evaluated. Higher rates of dependency and hazardous use are linked to crystalline methamphetamine (6). The primary effects are neurocognitive; these include depression, psychosis, and other neuropsychiatric and cognitive consequences, in addition to a pleasurable and energetic mood (7). Chronic methamphetamine usage causes neurotoxicity in dopaminergic axon terminals, which is linked to decreased dopamine synthesis and decreased expression of the dopamine transporter despite the fact that this causes acute elevations in dopamine and norepinephrine signaling that drive the methamphetamine-associated euphoria (8). One of the key contributing factors to the development and maintenance of drug misuse is distress tolerance (9). When a substance is used repeatedly, tolerance and dependent use develop over weeks or months. A disorder of the regulation of stimulant use, stimulant dependence is caused by the repeated or continuous use of stimulants and is characterized by subjective cravings and strong internal desires to use (i.e., impaired control over use, prioritizing use over other activities, and persistent use despite harm or negative consequences). When stimulants are used consistently for at least a month—that is, nearly every day—for at least a year, signs of dependence typically become apparent (6). Stimulant use disorder is defined by a pattern of usage that results in clinically significant impairment or distress, escalation of the dose used, unsuccessful attempts to reduce, cravings, problems in social or professional settings, and physical or psychological issues (6).

The number of patients included in the current study is 73. The studied sample was analyzed across two groups: group B (the control group) representing individuals with normal mental health (comprising normal, mild, and borderline cases) and group A (the major group) representing individuals diagnosed with major depressive disorder (MMD) encompassing moderate, severe, and extreme depression.

The socio-demographic features shown in Table 1 illustrate that all patients are male. No statistically significant associations were found between the two groups across all variables (p > 0.05 for all comparisons), including educational level (p = 0.686), occupation (p = 0.863), residence (p = 0.839), financial status (p = 0.558), and marital status (p = 0.897). While age exhibited variation in major depressive disorder (MDD) prevalence across different age groups, the overall difference was not statistically significant (p = 0.349).

Patterns of Methamphetamine abuse: Table 2 illustrates significant associations that emerge between various clinical factors and methamphetamine abuse patterns. Patients diagnosed with major depressive disorder (MDD) exhibited notably higher urine methamphetamine concentrations (p = 0.001). Admission status also played a crucial role, with newly admitted and routinely admitted patients displaying significantly elevated levels (p = 0.011 and p = 0.009, respectively). Moreover, longer periods of methamphetamine discontinuation were linked with lower concentrations (p = 0.021, p = 0.020, p = 0.008 for 14–20 days, 21–27 days, and 28 days or more, respectively), while longer durations of methamphetamine use correlated with higher concentrations (p = 0.015 and p = 0.029 for 1–4 years and 5–8 years). Routine reviews every 3 months were associated with lower concentrations (p = 0.009), and individuals testing positive for methamphetamine had significantly higher concentrations (p = 0.044).

Figure 2 shows the duration of methamphetamine discontinuation (days). A duration from 0 to 3 day(s) had 42.5% and that of 28 days or more had 23.3%.

Methamphetamine concentration levels were determined using the Amphetamines II (AMPS2) test. In the sample (73 patients), the methamphetamine concentration levels in urine were from 3 to 92,274 ng/mL, with mean ± SD 10,873.6 ± 18,641.

Psychosocial Variables assessment: Table 3 depicts significant associations with notable effect sizes. Patients diagnosed with major depression disorder (MDD) exhibited higher scores on the General Health Questionnaire (GHQ-30) compared to those without MDD (p = 0.0001, Cohen’s d = 0.015). Additionally, higher urine methamphetamine concentrations were associated with increased loneliness, as measured by the University of California, Los Angeles (UCLA) Loneliness Scale (p = 0.001, Cohen’s d = 0.001). Levels of aggression, assessed using the Modified Overt Aggression Scale (MOAS), were significantly elevated in individuals with higher methamphetamine concentrations (p = 0.0001, Cohen’s d = 1.05). Beck Depression Inventory (BDI-II) scores demonstrated a significant increase with higher methamphetamine concentrations, indicating more severe depression (p = 0.0001, Cohen’s d = 3.24). Patients ranging from moderate to extreme depression levels meet the DSM-5 criteria for MDD.

Figure 3A shows the Beck Depression Inventory-II across group A (MDD) and group B (normal) associated with different methamphetamine urine concentration levels.

Figure 3B shows the University of California, Los Angeles (UCLA) scale across group A (MDD) and group B (normal) associated with different methamphetamine urine concentration levels.

Figure 3C shows the Modified Overt Aggression (MOAS) scale across group A (MDD) and group B (normal) associated with different methamphetamine urine concentration levels.

Laboratory data with methamphetamine: Table 4 shows the laboratory data with methamphetamine. Significant differences were observed in creatinine levels (p = 0.0001, Cohen’s d = 1.74), hemoglobin (Hb) levels (p = 0.031, Cohen’s d = 0.46), and aspartate aminotransferase (SGOT) levels (p = 0.031, Cohen’s d = 1.18) between patients with normal and elevated methamphetamine concentrations.

Significant differences were found in medication decisions (as detox medications), as shown in Table 5 , associated with methamphetamine urine concentration levels. Olanzapine usage was significantly higher in patients with elevated methamphetamine concentrations (p = 0.004, Cohen’s d = 1.079). Fluoxetine (p = 0.005, Cohen’s d = 1.046) and analgesia use without specific medication (p = 0.001, Cohen’s d = 1.074) were also notably higher in this group. Furthermore, sedative use, specifically benzodiazepine (p = 0.001, Cohen’s d = 1.446), and anticonvulsant use, particularly carbamazepine (p = 0.003, Cohen’s d = 1.041), demonstrated significant differences between the two groups.

In Table 2 – 5 , the p-values were computed at the 0.05 level using Student’s t-test with Cohen’s d value. According to Cohen’s guidelines, the effect size can be interpreted as small (around 0.2), medium (around 0.5), or large (around 0.8).

The occurrence of major depression disorder (MMD) and its association with methamphetamine abuse was highlighted, emphasizing the severity of mental health comorbidities in methamphetamine users and echoing observations by Hashisha et al. (2022) (3). The findings underscore the profound impact of methamphetamine on psychosocial factors, particularly among individuals with varying urine concentration levels of the substance.

The observed gender disparity in rehabilitation facilities, attributed to male-exclusive wards, underscores the need for gender-sensitive treatment approaches. Moreover, the socio-demographic profile of the studied sample, with a prevalence of urban residency and primary to secondary education attainment, resonates with the findings of Al-imam et al. (2023) and Chachan et al. (2022), suggesting a correlation between drug availability and population density (4, 5). However, the discrepancy in illiteracy rates, covering one-third of the sample, deviates from earlier studies, indicating potential unique local factors or variations in educational infrastructure (4, 5). Similarly, marital status trends align with those observed by Chachan et al., suggesting societal or cultural influences on divorce rates (5).

The findings align with global perspectives linking unemployment among young individuals with increased drug consumption, as highlighted in previous research (3, 24). Another study from Erbil declares the comparable consequences published by N. Mahmood et al. (25). Moreover, the significant rise in methamphetamine screening results corroborates data from Curran et al. (2022), emphasizing the widespread prevalence of substance abuse within society (17). Notably, minor cross-reactivity in multidrug screening tests may occur, potentially resulting in false positive amphetamine screening results (20).

Exclusion criteria ensuring the focus on individuals with methamphetamine addiction or abuse without pre-existing mental or medical conditions align with the study’s objective. The prolonged duration of methamphetamine abuse observed in the study cohort raises clinical concerns regarding the chronicity of substance use disorders and the challenges associated with long-term management and intervention, consistent with previous research (13).

Assessments of psychosocial variables reveal severe distress levels among the sample, consistent with prior findings (26) and echoing observations by Hashisha et al. (2022) (3). Moreover, correlations between methamphetamine abuse and scores on psychological scales highlight the global impact of substance abuse on mental wellbeing (15).

The psychological impact of drug addiction, particularly methamphetamine use, extends beyond mere substance dependence, encompassing a spectrum of social and psychological challenges. This study echoes prior research (27). The concerning relationship between methamphetamine concentration levels and psychological distress underscores the heightened vulnerability of individuals with methamphetamine addiction to mood disturbances, emphasizing the importance of comprehensive psychiatric assessment and tailored interventions (28). Additionally, associations between methamphetamine use and aggression align with previous research, emphasizing the need for vigilant monitoring and targeted interventions to mitigate aggression (3, 28).

The utilization of specific medications such as olanzapine, fluoxetine, and carbamazepine in managing methamphetamine addiction emphasizes the diverse treatment approaches influenced by physician preferences and patient responses, consistent with prior research (6, 29).

The prevalence of major depression disorder (MMD) within the cohort of individuals grappling with methamphetamine abuse unveils a striking correlation that echoes global observations. This connection highlights a profound vulnerability to mood disturbances among this demographic group (28). Delving deeper, the study sheds light on how varying levels of methamphetamine concentration in urine intertwine with psychological distress, magnifying the substantial toll methamphetamine abuse exacts on mental wellbeing (28). These revelations not only emphasize the urgency of acknowledging and addressing the intricate relationship between substance abuse and mental health but also underline the need for nuanced interventions tailored to this complexity.

What is particularly intriguing is how these findings resonate with prior research by Hashemzadeh et al. (2021) and Marquez-Arrico et al. (2020), where similar patterns were observed (30, 31). This confluence of evidence adds weight to the argument that major depression disorder (MMD) is not just a concurrent issue but rather an integral facet of the intricate tapestry of challenges faced by those entangled in methamphetamine abuse.

Concentrations above 300 ng/mL, which is the detectable level, demonstrate statistically significant non-inferior levels of psychosocial variables, including loneliness, social isolation, and depression, in comparison to aggressiveness behaviors. Methamphetamine urinary concentration levels increase with a dramatically significant elevation of depression, loneliness, and social isolation and a mild significant elevation of aggressiveness behavior. The multi-screening test could give a false positive. It tends to interact with other medications, particularly antidepressants. This will lead to accused patients and stick a stigma on them—a negative result with a patient who does not have any previous diseases and/or problems but undergoes withdrawal symptoms of drug abuse. Methamphetamine smoking makes people become abusers accidentally. We highly recommended using a urinary methamphetamine test in addition to a screening test and specialist decision.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Research Ethics: The current study has received ethical approval from: The Ethical Committee, Iraqi Board for Medical Specializations. The approval was granted according to number 739 on the 27th of February 2023, The Iraqi Ministry of Health. The approval was granted according to protocol number 2 in 2021, Al-Rusafa Health Directorate, Baghdad. The approval was granted according to number 42397 on the 20th of March 2023. Additionally, this study is a research output of the Iraqi Medical Board thesis, Clinical Pharmacy Department. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

MA: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. NA-H: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – review & editing. HS: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – review & editing.