Disorders relating to the use of amphetamine and cocaine

Nicho/as Seivewright

Introduction Clnnical..features

Areamphetamineandcocaine .addictive?

Classification

Diagnosis

Epidemiology

Aetiology

Course .andprognosis Course

Other.drug..use

Prognosis

Complications

Treatment √čvidence

Management

Prevention

Chapter. References Introduction

Amphetamine and cocaine are classed as stimulant drugs, although the distinction between stimulants and depressants can be criticized on the grounds that the same drug may have both actions in turnA) This does indeed occur with amphetamine and cocaine, but the initial desired effects are increased energy and activity, along with elevation in mood. These effects appear to be mainly due to the enhanced central transmission of dopamine and noradrenaline (norepinephrine), with a similar enhancement of serotonin playing a less certain role.

Pharmaceutical preparations of amphetamine were previously widely used for the treatment of depression and obesity, and until the 1970s most misuse of the drug related to such medications. In the period since then of increasing recreational drug use, the powder preparation of 'street' amphetamine (commonly known as 'speed' or 'whizz') has largely displaced the pharmaceutical forms to become one of the most common drugs of misuse in many countries. The powder is typically very impure and constitutes a racemic mixture of D- and L-isomers, with the L-form being relatively inactive. In some countries a more potent street preparation of methylamphetamine is encountered, known as 'ice'. The various forms of the drug may be misused by swallowing (either on its own or in a drink), snorting, or injecting.

The coca shrub is indigenous to several countries in South America, where it is traditional to chew the leaf. Use of the derived cocaine powder has spread to the United States and elsewhere, again most notably since the 1970s. The powder may be injected, sometimes along with heroin, by polydrug users, but probably the best-known usage is by snorting, the image of which became associated with successful executive lifestyles. Cocaine has become more dangerous as usage has gradually transferred in many countries to the 'crack' form, which is made from cocaine hydrochloride powder in a simple chemical process, and is more potent in its effects and withdrawal effects. Very rapid increases in blood levels of the drug can be achieved by smoking crack, and this is the usual route, although it is injected by committed intravenous drug users.

Of the two drugs, cocaine has generally been much more investigated than amphetamine in terms of epidemiology, effects, and treatment approaches, while there has been a particular interest in the links between amphetamine use and a psychosis resembling schizophrenia.

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