D-methamphetamine is now widely associated with Mexican polydrug trafficking organizations that clandestinely manufacture the drug using the ephedrine or pseudoephedrine method. The drug is a powerful central nervous system stimulant with physical and psychological effects similar to those of cocaine. Its street names include speed, crank, ice, meth, and go-fast. Low-intensity abusers swallow and snort it. Binge and high-intensity abusers are psychologically addicted and prefer to smoke or inject the drug to achieve a faster and stronger high. The binge pattern has seven stages in its cycle: rush, high, binge, tweaking, crash, normal, and withdrawal. The high-intensity abuse pattern usually does not include a condition of normalcy or withdrawal. Tweaking is the most dangerous stage for abusers, medical personnel, and law enforcement personnel. A tweaker has probably not slept in 3-15 days and as a result will be extremely irritable and paranoid. A tweaker needs no provocation to behave or react violently, but confrontation increases the chances of a violent reaction. Tweakers who are using alcohol have intensified negative feelings and associated dangers. Photographs, tables, figure, and 26 references