Introduction

Amphetamine (b-phenylisopropylamine) and other phenethylamine derivatives have been widely abused for many years; this contrasts with their relatively limited value as therapeutic agents. Amphetamine was first marketed as an over-the-counter nasal decongestant in the United States in 1932, but following reports of abuse and toxicity it later became a controlled drug.

Street amphetamine sulfate is an off-white powder with an average purity of usually no more than 5 per cent. The rest may be made up of other less potent stimulants (such as caffeine or ephedrine) or inert chemicals (such as glucose, vitamin C, chalk, or talc). Formulations are sold as powder or tablets, and may be ingested, snorted, smoked, or injected intravenously; the usual daily adult dose of amphetamine is 5 to 15 mg. Commonly used terms are whiz, uppers, speed, sulfate, and sulf. A crystalline smokable form of methamphetamine ('ice'), an amphetamine derivative with marked central stimulant effects, is rapidly absorbed from the lungs, resulting in almost immediate clinical effects which might last for up to 15 h.

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) and other mood-enhancing amphetamine derivatives (3,4-methylenedioxyethamphetamine (MDEA, eve) and 3,4-methylenedioxyamphetamine (MDA, adam)) were widely abused in the United States in the mid-1980s. Their pharmacological profile can explain their widespread use as 'dance drugs' across Europe and Australia in the early 1990s; it has been suggested that as many as half a million people abuse MDMA every week in the United Kingdom. The stimulant and mood-enhancing properties of MDMA make it an ideal adjunct to so-called 'rave' dancing, where it facilitates heavy and prolonged exertion. Ecstasy is usually taken orally. It is generally sold in tablet form, or less commonly enclosed in capsules of varying colors; the usual street doses are 30 to 150 mg.

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