Amphetamines

Amphetamine Misuse and Dependence

Amphetamines come under the category of drugs known as stimulants.

As the name indicates they exert a stimulating effect on the central nervous system elevating the mood.

Amphetamines used for medical purposes include;

• D-amphetamine - D-amphetamine is a more potent form of amphetamine. Dexedrine is used to treat ADHD and narcolepsy. It is sold illegally under the names dexies, uppers and kiddie-speed

• L-amphetamine - has more effects on the body than the central nervous system. It is commonly used in combination with D-amphetamine.

• Mixed amphetamine salts - Adderall is the generic name of a 3 to 1 combination of D- and L- amphetamine respectively. It is commonly used to treat ADHD. Adderall is known as beans, bennies, and pep pills in the street.

• Methamphetamine - is used medically to treat ADHD but is highly regulated due to its addictive potential. Meth, crystal, glass, chalk, and ice are street names methamphetamine is known by.

Other stimulants often abused by addicts include 3,4-methylenedioxymethamphetamine (MMDA/ ecstasy), pseudoephedrine (a nasal decongestant, and low potent stimulant), methylphenidate (Ritalin - low potency), and cocaine.

How Amphetamines Work

Amphetamines are used in medical practice to treat Attention Deficit Hyperactive Disorder, narcolepsy, and even obesity at times. Amphetamines increase the levels of the neurotransmitters dopamine and noradrenaline in the central nervous system, by inhibiting the reuptake of said neurotransmitters. Increased levels of dopamine and noradrenaline are responsible for the stimulant effects.

It is this stimulant effect and euphoria that is desired by most illegal users of amphetamines. Adderall use is also observed in students and highly stressed professionals who seek extra focus, alertness, increased energy, and concentration to make their lives easier.

Short term side effects

• Lower doses of side effects can cause increased heart rate, increased blood pressure, increased body temperature, insomnia, nervousness, excessive talkativeness, dry mouth, and loss of appetite.

• Higher doses can lead to overdosing which can be fatal. Tremors, seizures, headache, restlessness, vomiting, diarrhea, hallucinations, paranoia, even cardiovascular events such as a stroke or a heart attack can occur in high doses.

Long term use

• Development of addiction- which can lead to devastating effects on relationships, work-life, and family.

• Psychological problems such as depression, anxiety, dual diagnosis, suicidal tendencies, paranoia, and aggressive behaviour.

• Amphetamine induced psychosis

• Impaired cognitive function, memory loss, and learning difficulties.

• Paranoid psychosis including persecutory delusions, auditory and visual hallucinations, hostility, and aggressive behaviour is also observed.

Addiction

Developing an addiction is the result of several factors including an unstable family environment, drug use in the family, drug use by peers, lower economic status, social isolation and interpersonal difficulties, and history of trauma and psychiatric problem at a younger age.

Addiction to amphetamines can be identified when there’s a difficulty to control drug use despite knowledge of its negative consequences and severe dependence on the drug leading to severe unpleasant withdrawal symptoms upon discontinuation.

Other signs of addiction;

• Withdrawal effect consisting of low mood and decreased energy is observed upon cessation of the drug. Depression can be severe in some heavy users, accompanied by tremors, anxiety, fatigue, nightmares, increased craving, and suicidal tendencies.

• Dependence on amphetamines can develop quickly, it is observed by alternating high and low moods.

• Neglecting personal hygiene.

• Tooth decay, skin sores

• Having financial difficulties due to drug-related expenses and reflecting social, recreational, and work-related activities.

Prevention and Treatment of Amphetamine Abuse

It is important to seek medical help before things go out of hand. Medical professionals are trained to manage the symptoms associated with overdoses and withdrawal symptoms.

• Restriction of drug use in schools and family environments.

• Careful prescription of drugs by medical professionals.

• Support and care by family members.

• Detoxification.

• Managing withdrawal symptoms with benzodiazepines.

Antidepressives to manage depressive withdrawal symptoms.

References

1. Harrison, P. Shorter Oxford textbook of psychiatry (6th ed., pp. 477-479).

2. https://doi.org/10.1016/B978-0-12-800212-4.00002-9

3. American Addiction Centers. 2020. What's An Amphetamine? Addiction: Signs, Symptoms, And Treatment. [online] Available at: <https://americanaddictioncenters.org/amphetamine> [Accessed 29 September 2020].

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Health Risks of Problematic to Dependent Amphetamine Use

Amphetamines are synthetic stimulant drugs that affect the Central and Peripheral Nervous Systems. Amphetamines consist of a structure called phenylethylamine. Phenylethylamine is similar to catecholaminergic, dopaminergic, and serotonergic agonists (biogenic amines).

These compounds elevate mood and energy while suppressing appetite.

Amphetamines such as Adderall are prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy.

Amphetamines provide symptomatic relief in Parkinson's disease. However, in many regions of the world including the United States, Europe, and Australasia, amphetamine abuse has become a menacing problem.

Misuse of amphetamines results in serious effects such as agitation, seizures, psychosis, and life-threatening cardiac arrhythmias. Extended misuse can quickly lead to dependence and addiction.

According to reports published by the United Nations Office on Drugs and Crime (UNODC), amphetamine-type stimulants now rank as the world's second most widely abused drug class following cannabis. Amphetamine-type stimulants refer to a group of drugs whose principal members include amphetamine and methamphetamine.

Ephedrine, pseudoephedrine, methylphenidate, and MDMA or Ecstasy fall into this group. Ecstacy is a compound infamous for its hallucinogenic properties. Synthetic amphetamine compounds, varying in purity and potency, are manufactured illegally in clandestine laboratories.

They can be a mix of drugs, binding agents, caffeine, sugar, or other psychoactive substances. They vary in appearance and can come as powder, tablets, crystals, and capsules. Some of these drugs are abused as performance enhancement substances.

Amphetamines can be injected, snorted, smoked, or swallowed. Oral use is associated with a lag time of around 1 hour, while inhaled and intravenous methods produce effects within a few minutes. Peak concentrations in the blood occur 5 minutes after intravenous injection, 30 minutes following nasal or intra-muscular use, and 2-3 hours post-ingestion.

The use of amphetamines appears to vary with sex, gender, and race. Single white men aged 20-35 years who are typically unemployed constitute the largest demographic, although the practice is becoming increasingly common among women and other ethnic groups.

The Effects of Amphetamines

The effects and the duration of psycho-activity depend on several factors including,

• Amount and strength of the dose.

• Chemical substituents on the amphetamine molecule and type of amphetamine used.

• Combination with other drugs.

• The physical make-up, overall health, and well-being of the user.

• Response to the drug (someone who used amphetamines for the first time may have a different reaction to someone who is a frequent user)

Immediate effects of amphetamines include :

• Increased heart rate and respiratory rate

• A burst of energy - the user becomes restless, talkative, and euphoric

• Hallucinations

• Elevated blood pressure and dilation of pupils

• Dry mouth and sweating

• Loss of appetite and increased libido

• Nosebleeds and damage to the nasal passage due to snorting.

Methamphetamines lack the stimulant properties of pure amphetamine, but still offers the euphoric and hallucinogenic aspects.

These actions are similar to those of cocaine. However, the duration of amphetamine action lasts up to 10 to 12 hours. In contrast, cocaine lasts for a shorter period - 10-20 minutes. Methamphetamines can be detected in blood around 4-10 hours after use and in urine for around 2-5 days.

Injecting amphetamines and sharing needles runs the risk of contracting infections such as Hepatitis C, Hepatitis B, HIV/AIDS, tetanus, and bacterial endocarditis.

Long term effects of amphetamines

In the central nervous system, amphetamines act by causing a general efflux of biogenic amines (indirect sympathomimetics) while inhibiting their reuptake.

The net effect is an increase of neurotransmitter release into the synapse. The increase in neurotransmitters results in physiological adaptation through receptor downregulation. The subsequent physiological tolerance and accompanying psychological tolerance lead to escalating use of the drug and increased toxicity.

Long term use can deplete biogenic amine stores and a paradoxical reverse effect of the drug. In the cardiovascular system, long term amphetamine use can result in myonecrosis and dilated cardiomyopathy.

Serious health and lifestyle problems ensue, including;

• Extreme weight loss and malnutrition. The exact mechanism through which amphetamines suppress appetite is yet to be determined. Low appetite can lead to unhealthy eating habits and then to malnutrition, furthering the damage to the brain and other organs.

• Dry mouth and dental problems. Methamphetamine, in particular, can cause severe dental disease. Unhealthy eating and decreased secretion of saliva are implicated factors. Multiple dental caries and severe infections result, leading to the loss of teeth.

• Methamphetamine misuse can lead to skin damage. The patient hallucinates that "something is crawling under the skin”, causing them to scratch their skin incessantly and pick at sores. There is delayed healing of wounds due to poor circulation.

• Reduced immunity resulting in regular infections.

• Multiple drug dependence, since the user relies on other drugs such as sedatives to balance the effects.

• Mood swings, panic attacks, anxiety, dual diagnosis, and depression.

• Hallucinations and paranoia - resembling paranoid schizophrenia. Chronic abuse, especially in high doses, is known to cause "amphetamine psychosis". The symptoms of amphetamine psychosis include visual and auditory hallucinations, delusions of persecution, delusions of reference with concurrent clear consciousness and profound agitation. While a vast majority of these patients make a full recovery following long-term cessation of the substance, 5 to 15% of users fail to recover completely. Moreover, psychosis is prone to be re-established, even at a small dose.

• Aggression and bizarre violent behavior.

• Increased risk of stroke, heart failure, and fatal arrhythmias. The sympathomimetic action of amphetamines causes an increase in blood pressure. High blood pressure can damage blood vessels and the heart. Dilated cardiomyopathy can result in life-threatening arrhythmias. Studies suggest that long-term amphetamine abuse ages the cardio vasculature and likely the whole organism in general.

• Reduced performance and troubling concentrating leading to professional, academic, financial, and relationship issues.

Amphetamine Overdose

Overdose commonly occurs when amphetamines are taken in combination with other drugs, including over the counter and prescription medications.

Substances typically taken in combination with amphetamines are benzodiazepines (including sleeping pills), antidepressants, cannabis, opiates (such as heroin), and alcohol.

Patients with amphetamine overdose present to emergency departments with symptoms such as,

• breathing difficulties

• seizures

• chest pain and palpitations

• reduced/absent urine output

• chills or fever

• extreme agitation

Treatment for Amphetamine Misuse

Treatment options for amphetamine abuse patients comprise detoxification, individual counselling, and group therapy.

Patients require an integrated and well-supervised treatment regimen as it is dangerous to go cold-turkey or self-detox due to the extremely uncomfortable withdrawal symptoms, which may also trigger a relapse.

These symptoms vary according to individuals and are usually managed using benzodiazepines. Symptoms include;

• fatigue, aches, and pains

• anxiety, depression, paranoia

• confusion and irritability

• extreme hunger

• sleep problems and nightmares

• nausea, convulsions

The past decade has seen amphetamine abuse increasingly invade its way into the mainstream culture in several countries. Drug abuse, especially amphetamine misuse poses a dire threat to the health, the social, and economic fabric of families and communities.

Even though the problem is relatively new in many countries, it is rapidly growing and difficult to nip in the bud. Despite its widening geographical spread, awareness of this issue is limited. The responses are neither consistent nor integrated. In any case, the present situation warrants prompt attention.

A vital step in the prevention of amphetamine dependence (addiction) is educating patients on the toxic effects of amphetamines. It is crucial to stress that amphetamines are not a safe alternative to cocaine use.

References

1- Who.int. 2020. WHO | Amphetamine-Type Stimulants. [online] Available at: <https://www.who.int/substance_abuse/facts/ATS/en/> [Accessed 18 December 2020].

2- Emedicine.medscape.com. 2020. Amphetamine Toxicity: Practice Essentials, Pathophysiology, Etiology. [online] Available at: <https://emedicine.medscape.com/article/812518-overview#a2> [Accessed 18 December 2020].

3- Betterhealth.vic.gov.au. 2020. Amphetamines. [online] Available at: <https://www.betterhealth.vic.gov.au/health/healthyliving/amphetamines> [Accessed 18 December 2020].

4- United Nations: Office on Drugs and Crime. 2020. ATS: Second Most Commonly Abused Drug Type Worldwide. [online] Available at: <https://www.unodc.org/unodc/en/frontpage/2011/September/ats-second-most-used-drug-type-in-the-world.html> [Accessed 18 December 2020].

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