The fact that cocaine is seldom taken orally may be attributed to the reduced systemic bioavailability with this route of administration (Coe et al., 2018). Sudden death and serious cardiovascular adverse events may occur with misuse of amphetamines. Before prescribing amphetamine sulfate, assess each patient’s risk for abuse, misuse, and addiction. Patients whose depression persists for more than a brief period after amphetamines are stopped may respond to antidepressants. Tolerance develops slowly, but amounts several 100-fold greater than the amount originally used may eventually be ingested or injected. Tachycardia and increased alertness diminish, but hallucinations and delusions may occur.
Route of Administration
- The mechanisms underlying neurotoxicity remain speculative, however; and some evidence suggests marked species differences in vulnerability to stimulant-induced neurotoxicity (see 65 for a review).
- Healthcare service providers need to learn the medical signs, symptoms, and consequences of stimulant use to understand how best to medically manage patients with stimulant use disorders.
- Cocaine is used recreationally as a party drug most often due to the increase in energy and euphoria that it provides.
Blood pressure, heart rate, and other vital signs should be how long do amphetamines stay in urine taken immediately upon presentation. The physical examination should include assessments for hyperthermia, evidence of end-organ damage (eg, neurological deficits, respiratory compromise, or new cardiac murmurs), and skin ulcerations or abscesses. Such questions underscore the need to determine which animal paradigms best simulate relevant therapeutic exposure at different periods of the human lifespan.
Treatment for Adderall Addiction
Many clandestine laboratories are operated by untrained individuals who get instructions from unpublished handwritten sources or through the Internet. As with cocaine, most of the contaminants are intentional fillers used to dilute or cut the product. Some examples of fillers are lactose, lidocaine, procaine, caffeine, quinine, and sodium bicarbonate (Cole et al., 2010). Common medical complications of stimulant use disorders are cardiovascular conditions, respiratory problems, cerebrovascular events, muscular and renal dysfunction, gastrointestinal problems, infections including HIV/AIDS, and hepatitis C. The steep increase in the diagnosis of ADHD during the 1990’s in the United States led to a parallel increase in production and societal exposure to legally distributed amphetamine.
Long-Term Effects Of Amphetamine Use And Abuse
Opportunities for wound assessment and care should be a standard part of outreach, prevention, and harm-reduction services for people who use drugs. Potentially serious manifestations of chronic stimulant use may also be somewhat sensitive to the environment in which the person resides. Lethal doses of stimulants produce a predictable sequence of events culminating in generalized convulsions and death.
Other side effects of amphetamine
The psychosis is consistent with the Dopamine Hypothesis of Schizophrenia, which will be discussed later in Unit 4. Since cocaine is a psychostimulant, withdrawal signs will proceed in the opposite direction and feature depression, lethargy, dysphoria, sleep disturbance, and increased appetite. The primary withdrawal signs are drug craving, mental depression, and suicidality, which can persist for 1-2 weeks following the last use of the drug. Withdrawal signs are intensified if the polysubstance use combines abuse of cocaine with other addictive drugs. Emergency department personnel should stabilize the patient medically and assess potential danger to self and others before trying to take a history.
Quick Facts: Cocaine
The sensitization process in stimulant use disorder is elaborated on in the “Stimulant-Induced Psychosis” section in this chapter. Withdrawal syndromes should be thought of as a direct effect of a withdrawal from excessive dopaminergic activity throughout the body. A binge terminates with acute withdrawal, often called a “crash” (Lerner & Klein, 2019).
Common psychological complications of stimulant use disorders include psychosis, depression, hypervigilance, and anxiety. Resale of prescribed amphetamines constitutes one source of illicit stimulants available for abuse. In addition, licit dextroamphetamine is a substrate for manufacture of illicit methamphetamine, which can then be smoked or injected. One of the easiest ways to make methamphetamine is by addition of a single methyl group to the amino group on the middle carbon atom of amphetamine. Conversely, smoked methamphetamine thermally degrades to yield amphetamine by N-demethylation 23, 77. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
- If not connected to the treatment system, people who use cocaine or MA will likely return repeatedly to the ED and other hospital departments for care of more and more serious health and mental health problems.
- The primary withdrawal signs are drug craving, mental depression, and suicidality, which can persist for 1-2 weeks following the last use of the drug.
- The psychosis is consistent with the Dopamine Hypothesis of Schizophrenia, which will be discussed later in Unit 4.
The effects of psychostimulants on height have also generated controversy and concern, but until recently, consensus from studies examining growth changes during stimulant treatment was lacking. Recent reports have added some clarity to the issue, and the NIH National Toxicology Program concluded that there was concern for neurobehavioral developmental toxicity from amphetamines 23. Misuse and abuse of CNS stimulants, including amphetamine sulfate, can result in overdose and death, and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection. Although the difference in drug dosage from animal to human use varies by drug, the larger concern for pharmacokinetic differences, overall, is between small and large animals, as well as between children and adults. Small mammals have proportionally faster metabolisms than larger mammals (von Bertalanffy, 1957), thus indicating that mice would need higher doses of drug for the same effect in larger species, such as humans.
- It remains possible, however, that high doses of modafinil, especially if given via a rapid route of administration, could be addictive.
- Rhabdomyolysis (a breakdown of muscle tissue that can release protein into the blood and damage kidneys) can occur with severe amphetamine toxicity and is often preceded by psychomotor agitation, hyperthermia, and seizures (Spiller et al., 2013).
- Symptoms begin 2 to 4 days after a person stops use and may persist for 2 to 4 weeks (Lerner & Klein, 2019).
- Benzedrine was also administered in pill form and was used to treat maladies, including sea sickness, narcolepsy, and Parkinson’s disease (Davies et al., 1939).
- Because no standard set of substances is tested in a urine substance screen, medical personnel should make certain that assays for suspected substances are included.
Quick Facts: Methamphetamine
Despite these issues, a general pattern emerges from the human and animal studies on caffeine. As found with the other stimulants reviewed herein, dose seems to be the primary determinant of caffeine’s effects. In general, lower doses of caffeine lead to positive effects, whereas higher doses produce disruptive effects. The conditioned response to shock in humans (Galvanic skin response latency) was found to be potentiated in those administered roughly 325 mg (5 grains) of caffeine before five separate training sessions (Switzer, 1935b).
Psychostimulants,1 broadly construed, include drugs of abuse, such as cocaine and methamphetamine, as well as therapeutic drugs such as mixed amphetamine salts (Benzedrine, Adderall, Vyvanse), methylphenidate (Ritalin, Concerta, Focalin), and modafinil (Provigil, Sparlon2). Psychostimulants are also used nonmedically, with caffeine, coca leaves, and khat being examples of stimulants consumed today primarily for quality-of-life purposes. Casual use of stimulants for wakefulness or performance enhancement dates back centuries. For example, evidence for use of khat (which contains cathinone, a moderate amphetamine-like stimulant), popular in parts of the Middle East and Africa, dates back to at least the 11th century (Al-Motarreb et al., 2002). Today, khat is a social mainstay in several countries (e.g., Yemen), and chewing khat leaves remains legal in many nations, including Israel (Siegel-Itzkovich, 2009).