AMPHETAMINES

What are amphetamines?

Amphetamines are a class of compounds that stimulate the central and peripheral nervous systems.  The structure of amphetamines is similar to dopamine, serotonin and other cell-produced amines and may explain their actions.  Amphetamines are becoming increasingly abused in the United States and Europe.  Synthetic amphetamine compounds commonly are produced in clandestine laboratories and vary in potency.  Other potentials for amphetamine abuse include prescription medicines and various over-the-counter diet pills. 

Amphetamines may be taken orally, by inhalation, or by injection.  Symptoms occur approximately one hour after oral ingestion.  Symptoms show up within a few minutes upon inhalation or injection of the drug.  Peak blood concentrations occur in 5 minutes with injection of the drug, 30 minutes with inhalation, and 2 to 3 hours after ingestion. 

Use of amphetamines causes a general outflow of cell-produced amines from nerve synaptic terminals, resulting in increased neurotransmitter release into the synapse.  This causes physiological adaptation to the drug and an accompanying psychological tolerance that can lead to escalating use of the drug.   Increased chronic use can cause a depletion of biogenic amine stores and a washout of the drug, which can cause the user to want more of the drug.   

Abuse of amphetamines leads to a state of increased wakefulness and decreased fatigue.  Higher dopamine levels in the central nervous system may be cause movement difficulties, schizophrenia, and euphoria.  Serotonergic signals may play a part in the hallucinogenic as well as anorexic aspects of these drugs. 

Use of amphetamines can cause problems with the central nervous system, such as disorientation, headache, agitation, symptoms of stroke; cardiovascular problems, such as chest pain, palpitations, and coronary spasms; gastrointestinal problems, such as, dry mouth, nausea, vomiting, and diarrhea; genitourinary problems; skin/cutaneous problems, such as painful rashes, needle marks, phlebitis, cellulites, and infected deep ulcerations; and eye problems (mydriasis).  Habitual use produces toxic psychosis much like paranoid schizophrenia.  Delusions, hallucinations, and strange violent behavior are also common.  Acute overdose may produce hallucinations, hypertension, hyperthermia, psychosis, seizures, tachycardia, stroke, and possible death.  Other effects of amphetamine use and abuse may include hyperthermia and seizure activity.  Altered neural functions may occur, such as those involving complex behavioral learning patternings, particularly important for understanding effects of amphetamine use during pregnancy.     

Short-Term Effects of Amphetamine Abuse

The short-term effects of methamphetamine abuse can include:

·        Increased attention and decreased fatigue

·        Increased activity

·        Decreased appetite

·        Euphoria and rush

·        Increased respiration

·        Hyperthermia

·        Convulsions

Long-Term Effects of Amphetamine Abuse 

The long-term effects of methamphetamine abuse can include:

·        Dependence and addiction psychosis

·        Hyperthermia

·        Liver damage

·        Weight loss

·        Cardiovascular problems

·        Stroke

·        Acute lead poisoning

·        Skin abscesses

·        Damaged blood vessels

·        Prenatal complications

·        Congenital deformities

Treatments for Amphetamine Abusers 

            Sedation and observation are commonly used to treat patients with amphetamine intoxication who do not exhibit life-threatening symptoms.  Measures establishing the resuscitation of fluids or starting vigorous cooling measures are generally required for patients with complications.  Gastrointestinal decontamination with activated charcoal is often performed on patients exhibiting symptoms caused by acute oral ingestion of the drug.  Some patients are catheterized in order to monitor their urine output, especially if diuretics have been administered to control pulmonary edema.  A calm and soothing environment without physical restraint is required to treat patients exhibiting agitation or persisting seizures.  Significant cardiac dysrhythmias are treated with the appropriate methods.  A specialist in medical toxicology may be consulted to help manage certain cases.  Patients demonstrating focal neural deficits or who have had CT brain scans may need neurological consultations.  Patients showing significant cardiac injury may need cardiological consultation.  Admission is appropriate for the monitoring and treatment of unstable vital signs, chest pain, respiratory distress, pulmonary edema, neurological complications, or toxic psychosis.  Patients may need to be referred to outpatient detoxification centers for managing behaviors.  Patients with stable vital signs who exhibit paranoid psychosis can be transferred to psychiatric hospitals for observation and treatment. 

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