AMPHETAMINES

OFFICIAL NAMES: Amphetamine (Adderall), laevoamphetamine (Benzedrine), dextroamphetamine (Dexedrine), methamphetamine (Methedrine)

STREET NAMES: Black dex, bens, bennies, benz, black and white, blackbirds, black bombers, black Cadillacs, black mollies, blacks, blue boys, blue mollies, brain pills, brain ticklers, brownies, browns, bumblebees, chicken powder, co-pilot, coasts-to-coasts, crisscross, cross tops, dex, dexies, diamonds, diet pills, dominoes, double cross, drivers, eye openers, fives, footballs, forwards, french blues, go, greenies, head drugs, hearts, horse heads, ice, jelly baby, jugs, leapers, lid poppers, lid proppers, lightning, MAP, minibennies, morning shot, nugget, oranges, peaches, pep pills, pink hearts, pixies, rhythm, rippers, road dope, rosa, roses, snap, snow pallets, sparkle plenty, sparklers, speed, spivias, splash, splivins, sweeties, sweets, tens, thrusters, truck drivers, turnabout, uppers, uppies, wake ups, West Coast turnarounds, whiffledust

DRUG CLASSIFICATIONS: Schedule II, stimulant

OVERVIEW

Amphetamine was first synthesized in 1886 by a German chemist, though it was not used for medical purposes until the early 1930s. Amphetamine dilates the small sacs of the lungs, providing relief to patients with breathing disorders. In 1931, the pharmaceutical company Smith, Kline, and French introduced the Benzedrine Inhaler to relieve the discomfort of nasal congestion due to colds, hay fever, and asthma. Soon after, the sulfate form of amphetamine was also aggressively marketed. Amphetamine was promoted as a sort of "wonder drug" without knowledge of its potentially addictive properties.

Because users complained of sleeplessness, druggists started compounding tablets for the treatment of a sleeping disorder known as narcolepsy in 1935. Amphetamine then became popular because it delayed fatigue. "Pep pills" soon became available over-the-counter. Truckers were quick to use the pills to keep awake during long-haul deliveries. The first reports of college students using amphetamines to beat fatigue while studying surfaced in 1936. Businessmen and their secretaries also began using amphetamines to induce increased alertness.

By 1937 amphetamine was being used to treat a condition known as minimal brain dysfunction, a disorder later renamed attention deficit hyperactivity disorder (ADHD). The use of amphetamine for that disorder continues into the twenty-first century.

During World War II, soldiers on both sides of the war used amphetamines to maintain alertness and increase stamina. Historians speculate that overuse produced states of uncontrolled aggression that may have contributed to "berserker" charges by soldiers on both sides during many battles. Historians have said that from 1942 until his suicide, Hitler received daily methamphetamine (MAP), a kind of amphetamine, injections from his doctor. Many historians believe that the amphetamine abuse corrupted Hitler's judgement, undermined his health, and probably influenced the course of the war.

Unfortunately, as the use of amphetamine spread, so did its abuse. The first major epidemic of modern times occurred in Japan after the end of World War II. Much of the country was devastated during the war, and the Japanese had to work long hours to rebuild their country. Japanese men who had been soldiers recalled how amphetamine kept them going during the war and sought to acquire the drug. As a result of that demand, inventories of amphetamines were released for sale without prescription. This led to a national epidemic that only ended in the mid-1950s after the Japanese government restricted access to amphetamines and passed stricter laws against illegal amphetamine use.

Major epidemics of amphetamine abuse and dependence occurred in the 1950s, 1960s, and again in the 1990s in the United States and western Europe, particularly in Denmark, Finland, Sweden, and the United Kingdom. In the United States during the 1950s, the availability of over-the-counter amphetamine "diet" pills fueled the epidemic. Amphetamines were even given to race horses during that time since it was believed the drug made them run faster.

In the 1960s, public health authorities noted the first epidemic of intravenous drug use centered around the Haight-Asbury district of San Francisco, California. Individuals, soon to be known as "speed freaks," had learned how to melt amphetamine down and inject the liquefied substance into their veins.

The new drug counterculture of the early 1960s prompted increased control measures. Countries throughout the world passed new laws and regulations in the 1960s and 1970s. In the United States, Congress passed the Controlled Substance Act (CSA) of 1970. The CSA included amendments to the federal food and drug laws that put strict controls on the production, import, and prescription of amphetamines. Many amphetamine forms, particularly diet pills, were removed from the over-the-counter market though they remain available by prescription.

As a result of those laws and regulations, and similar laws in other nations, a black market for amphetamines emerged in many countries. In the 1990s, illicit amphetamine production was increasingly reported in the western United States and eastern Europe, particularly in Poland and Hungary.

CHEMICAL/ORGANIC COMPOSITION

All amphetamines are synthetic, or manufactured, substances derived from alpha-methyl-beta-phenyl-ethylamine, a colorless liquid consisting of carbon, hydrogen, and nitrogen. In terms of their chemical structures, amphetamines are related to two natural substances known to boost energy within the human body. Those substances are ephedrine and adrenaline. Ephedrine is a natural stimulant found in plants of the genus Ephedra. It is the active ingredient in the Chinese herbal drug ma huang. Adrenaline is the body's "fight or flight" hormone.

According to the U.S. Department of Justice's Drug Enforcement Administration (DEA), amphetamine, dextroamphetamine, laevoamphetamine, and methamphetamine (MAP) are all referred to as amphetamines because their chemical properties and actions are "so similar" that "even experienced users have difficulty knowing which drug they have taken." Consequently, it doesn't matter what an amphetamine pill or capsule is called. The only difference between amphetamine and dextroamphetamine, for instance, is a few molecules of dextrose, a type of sugar.

The composition of amphetamine or dexamphetamine pills or capsules actually is a combination of the various types of amphetamine "salts." For instance, the

5 mg amphetamine tablet known as Adderall contains 1.25 mg of dextroamphetamine saccharate, 1.25 mg of amphetamine aspartate, 1.25 mg of dextroamphetamine sulfate, and 1.25 mg of amphetamine sulfate.

Methamphetamine is composed of the above named forms of amphetamine with the addition of ephedrine or pseudoephedrine. Many users consider MAP to have more of a "kick," which is why many who abuse amphetamines prefer methamphetamine. The legal form of methamphetamine is the prescription pill Methedrine. Most illegal forms of MAP come from illegal laboratories. MAP is relatively easy to manufacture and does not require sophisticated equipment. Illicit production has occurred in home kitchens, trailers, recreational vehicles, and rural cabins. It is often converted to its water-soluble form, a salt-like substance. However, MAP manufacturing can be dangerous. Combined in the wrong ways, the chemicals used in the process can explode. Illegal "chemists" and innocent victims have been maimed and killed by explosions and resulting fires.

In an attempt to limit the illegal manufacture of MAP in the latter part of the twentieth century, many governments, including the U.S. government, passed laws limiting the sale of ephedrine. Those laws were ineffective because the illicit drug makers learned how to use a chemical called pseudoephedrine to make methamphetamine. Pseudoephedrine is an ingredient found in many over-the-counter medicines used for colds, allergies, and the flu. Since it is readily available, the illegal drug makers have been able to continue to manufacture illicit MAP.

INGESTION METHODS

Prescription amphetamines come in tablet or capsule form. The most common way amphetamines are ingested is by swallowing amphetamine pills or capsules. However, drug abusers also crack open the capsules for the amphetamine powder or grind the tablets into a powder. That powder can then be inhaled or "snorted." Mixed with tobacco or marijuana, it can be smoked. The "ice" form of methamphetamine looks like shaved glass slivers or rock salt and can be smoked in a glass pipe.

Some hardcore drug abusers liquify the powder and the "ice" forms of MAP and inject the solution directly into their bloodstreams. When injected, the "high" or "rush" occurs almost immediately, increasing the danger of addiction to amphetamines, which experts compare to that of heroin or cocaine. An additional concern is the tendency for drug users to reuse and share syringes, dramatically increasing the risks of blood poisoning and contracting HIV/AIDS, hepatitis, or other diseases.

THERAPEUTIC USE

Amphetamines, in prescription form, have been found to be helpful in treating narcolepsy, a condition in which a person suffers from excessive or sudden, recurrent daytime sleepiness. However, narcolepsy is a fairly rare disease.

They have also sometimes been found useful for the treatment of ADHD, a condition that interferes with the learning ability of affected individuals. Millions of children have been diagnosed as having ADHD. Many of those children and increasing numbers of adults are treated with amphetamine-like drugs such as Ritalin and Cylert. The generic name for those amphetamine-like drugs is methylphenidate. Some children with ADHD do not respond to the various forms of methylphenidate and are placed on amphetamines instead.

Amphetamines have also been used and often misused for the treatment of obesity. Medical studies show that dieters who use prescription amphetamines usually do quite well at losing weight initially. However, when those dieters are taken off of amphetamines almost all regain their lost weight and become even heavier over a five-year period. Although the use of amphetamines for weight loss was popular in the 1950s and again in the 1980s and part of the 1990s, most medical doctors do not prescribe amphetamines for weight loss. Nonamphetamine weight-loss drugs are used instead. It remains uncertain as to whether those drugs will be any more effective over the long term in helping people keep off excess weight.

A 2001 study demonstrated a potential new therapeutic role for dextroamphetamine. The study indicated that it may help some stroke survivors recover faster from the stroke-caused speech disorder known as aphasia. Officially, however, amphetamine has been approved only for the treatment of narcolepsy, attention deficit hyperactivity disorder (ADHD), and obesity.

USAGE TRENDS

The use and abuse of amphetamine-like stimulants is a growing global problem, according to the World Health Organization (WHO). The United Nations estimated that in the year 2000, 29 million people around the world abused various types of amphetamine stimulants in the previous decade. That figure was larger than the number of people consuming cocaine and opiates combined. According to the 1999 National Household Survey on Drug Abuse, 9.4 million Americans had tried the MAP form of amphetamine during their lifetimes.

Scope and severity

No specific total amphetamine-use statistics are available. However, according to the year 2000 report of the Drug Abuse Warning Network, there was a 35% increase from 1999 to 2000 in the number of hospital emergency department (ED) cases in which amphetamines were mentioned. DAWN is a national surveillance system that collects data on drug-related emergency department visits.

Age, ethnic, and gender trends

There are few studies revealing age, ethnic, and gender trends in amphetamine abuse. According to a 1998 article in Journal of Psychology, the demographic characteristics of amphetamine/methamphetamine abusers changed in the mid-1990s compared to a period only five years previously. Young Caucasian white men who are unemployed and single have been especially likely to be amphetamine users, according to researcher John B. Murray. However, "more married, widowed, and divorced people" and fewer Caucasians were reported in outpatient and inpatient populations studied in 1994–1995 compared to a previous 1989–1994 study.

MENTAL EFFECTS

Amphetamines stimulate the central nervous system (CNS), producing feelings of euphoria, providing relief from fatigue, and increasing alertness. CNS stimulation provoked by amphetamines can also intensify emotions, increase aggression, and alter self-esteem.

As a prescription drug for the treatment of ADHD, amphetamines have been shown to increase performance accuracy, improve short-term memory, improve reaction time, aid in mathematical computation, increase problem-solving abilities in games, and help individuals concentrate.

Unfortunately, chronic amphetamine use can result in a psychological addiction, the belief that a person needs the drug in order to function. Psychological dependence can develop quickly, especially in people who already have clinical depression.

PHYSIOLOGICAL EFFECTS

Increased pulse rate and increased blood pressure are normal with amphetamine use. But even short-term use can cause adverse physical effects, including intoxication, irregular heartbeats (tachycardia), and excessive body warmth, a dangerous and sometimes deadly condition known as hyperthermia.

Prolonged abuse of amphetamine can lead to tolerance, making it necessary to take higher doses of the drug to get the effect or high originally experienced. Taking greater quantities of the drug increases the chance of an overdose. An overdose can increase blood sugar, cause an irregular heartbeat, and cause circulatory collapse. In other words, an overdose can kill. Fatal overdose reactions are usually preceded by convulsions, then coma. Death may occur due to burst blood vessels in the brain, heart attacks, or very high fever.

Chronic use can lead to dangerous changes within the body which cause cravings for the drug, agitation, decreased energy, increased appetite, insomnia, and a craving for sleep. Once the drug taking is temporarily stopped, abusers have been known to drop into deep sleeps that last up to 48 hours. Drivers of cars and trucks coming down from an amphetamine high have been known to fall asleep behind the wheel and cause deadly crashes.

Harmful side effects

Side effects include delayed and impaired judgment, sleep onset, reduced appetite, weight loss, tics, stomachache, headache, and jitteriness. Convulsions and coma may occur. Individuals who ingest amphetamine by dissolving the tablets in water and injecting the mixture risk complications due to the insoluble fillers used in the tablets. When injected, those materials block small blood vessels and can cause serious damage to the lungs and retina of the eye.

Chronic amphetamine users can demonstrate compulsive behavior and talk excessively and disjointedly. Affected individuals can become exhausted and lose insight into their actions, often insulting or otherwise alienating friends and family without obvious cause. High-dose amphetamine consumption causes abusers to become paranoid, or unrealistically suspicious of everyone, and experience hallucinations. Most high-dose amphetamine abusers become psychotic, or mentally deranged, within a week after continuous use. They experience delusions of being persecuted and auditory and visual hallucinations. Chronic amphetamine abuse is also associated with violence, criminal assault, homicides, suicides, and traffic accidents.

Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. The infants may experience symptoms of drug withdrawal. Mothers taking the drug should refrain from nursing, since amphetamine is excreted in human milk. A number of studies using rodents as test animals indicate that women should not take amphetamines when pregnant.

Long-term health effects

Since amphetamines increase blood pressure, the chances for a stroke increases in users. Abusers of amphetamine may also be prone to degenerative disorders of the nervous system such as Parkinson's disease. Research published in the March 2001 issue of American Journal of Psychiatry indicates that MAP abuse leads to long-lasting changes in the human brain that are linked to impaired coordination and memory.

Medical studies indicate that five to 15% of the amphetamine users who become psychotic fail to recover completely even after physical withdrawal symptoms pass. Psychiatrists in Japan did a study demonstrating that amphetamine psychosis can persist for several years.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

Amphetamines are frequently combined with other drugs to prolong the "rush" or "high" or to add a psychedelic, or hallucinogenic, component to the experience. Despite the number of years that amphetamines have been abused, there are relatively few studies about their abuse potential and effects, and apparently there are no studies about the effects of amphetamine when combined with other drugs of abuse.

It is known that amphetamines may counter the sedative effect of antihistamines and other sedating agents. Amphetamines raise blood pressure, so abusers who take prescription anti-hypertension pills do not get the full benefit from those anti-hypertensives.

Amphetamines do not mix well with a class of antidepressant medication known as MAO inhibitors. Mixing the two types of drugs can cause headaches, increase blood pressure, and even result in death.

TREATMENT AND REHABILITATION

Withdrawal can be unpleasant, and feelings of cravings and depression can return long after the withdrawal period. During the withdrawal period, individuals may experience abdominal pain, increased fatigue, fever, infection, loss of appetite, diarrhea, shortness of breath, nausea, vomiting, dizziness, emotional upset, insomnia, nervousness, and weight loss. Amphetamine withdrawal brings on intense cravings for the drug, which often leads to relapse. Intense craving is experienced by 87% of all amphetamine abusers who attempt to abstain from the drug.

Current research has demonstrated that there are no medical treatments effective for treating amphetamine abuse. This means that other drugs cannot be substituted to assist in the weaning process. However, thousands of individuals have successfully gone through withdrawal and continue to abstain from amphetamine use despite the long and uncomfortable process. Twelve-step programs are helpful for many substance abusers in recovery.

Besides intense amphetamine cravings, other unpleasant withdrawal side affects include agitation, anxiety, vivid or unpleasant dreams, decreased energy, increased appetite, lethargy, and increased sleep. People in withdrawal lose interest in the pleasure of other activities. Their physical movements are slowed, and clinical depression is prevalent. Although symptoms may lessen after just four or five days, some symptoms can continue for weeks or even months.

While medical literature indicates that other drugs have limited benefits during the recovery process, the psychological/behavioral literature on addiction rehabilitation reveals that although relapse rates are high, rehabilitation is possible. Addiction experts say that amphetamine withdrawal and treatment is a time-consuming process, and behavioral and emotional support is essential for success. Organizations such Phoenix House, Freedom House, and SAFE (Substance Abuse Family Education) run withdrawal treatment and rehabilitation programs for teens that last for as long as a year at live-in residence centers.

PERSONAL AND SOCIAL CONSEQUENCES

Authorities point out that few people are capable of questioning the value of a drug that makes them feel good and is considered to have beneficial effects. However, occasional experimentation can easily become compulsive drug use and abuse. Abusers frequently do not recognize the effects amphetamines have on their failures and also often do not see how that "upper" has negative effects on their relationships with others.

Early onset of drug abuse is associated with early sexual activity, crime, and educational failure. Young amphetamine users risk exploitation by adults and are more likely to become involved in criminal or violent behavior and prostitution—having to resort to sex for survival. Consequently, they are also more likely to become infected with HIV or other sexually transmitted diseases and by tuberculosis or other bacterial, fungal, or viral infections. Chronic amphetamine abusers are also more at risk for mental and emotional disorders including anxiety, phobias, and depression. They are at higher risk of suicide.

Amphetamines have the potential to produce "unprovoked, random, and often senseless violence," according to the World Health Organization (WHO). They are likely to demonstrate paranoia, antisocial behavior, become overly verbally and physically aggressive, and start fights over literally nothing.

The social consequences of amphetamine abuse include higher rates of accidents, violence, and crime. This is a worldwide phenomenon, says WHO. According to the National Institute on Drug Abuse (NIDA), drug abuse cost American society $97.7 billion during1992. That estimate included costs for substance abuse treatment and prevention, related health care, reduced job productivity, lost earnings, and other costs to society such as crime and social welfare. How much of that is due to amphetamine misuse is unknown, but the study estimated that the costs were borne almost equally by governments (46%) and by those who abuse drugs and members of their families (44%). More than half of the estimated costs of drug abuse were associated with drug-related crime.

LEGAL CONSEQUENCES

Individuals who buy, sell, or transport illegal amphetamines, or those who buy, sell, or otherwise traffic in the equipment to manufacture illegal amphetamines risk hefty fines and imprisonment. In the United States, the consequences of illegal possession, sale, or even freely sharing amphetamines without a medical doctor's prescription can be severe under terms of the Controlled Substance Act (CSA) of 1970.

A first offense of simple possession of amphetamine without a doctor's prescription can result in imprisonment for not more than one year and a fine of $1,000 or both. A second offense can result in imprisonment for up to two years and a fine of $2,500. A third illegal possession offense can result in up to three years of prison time and a fine of $5,000.

Distribution, which includes selling or giving away more than 100 grams of amphetamine is illegal under CSA section 841. It is an offense punishable by prison terms of a minimum of five years and up to 40 years with fines of up to $2 million. If death or injury results from illegal distribution, the penalties become imprisonment for a minimum of 20 years to more than life and a fine of $2 million. A person convicted of selling amphetamines to someone under 21 years of age is subject to twice the maximum punishment.

Legal history

Before 1970, amphetamines were subject to numerous and sometimes confusing laws regulating their manufacture and distribution. In 1970, the U.S. Congress passed the Comprehensive Drug Abuse Prevention and Control Act, which has been the legal foundation of the U.S. government's fight against the abuse of amphetamines and other drugs since its passage. The Controlled Substances Act (CSA) is title II of that legislation. The CSA placed all drug substances that had been regulated under existing federal laws into one of five schedules based on the substance's medicinal value, harmfulness, and potential for abuse and addiction. Schedule I is reserved for the most dangerous drugs that have no recognized medical use. Amphetamines fall under Schedule II, dangerous drugs with useful and legitimate medical uses that also have a high potential for abuse and addiction.

See also Designer drugs; Ecstasy (MDMA); Methamphetamine; Methylphenidate

RESOURCES

Books

Bayer, Linda. Amphetamines and Other Uppers. Broomall, PA., Chelsea House Publishers, 2000.

Cobb, Alice B. Speed and Your Brain: The Incredibly Disgusting Story. New York: Rosen Publishing group, 2000.

Kuhn, Cynthia. Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstacy. New York: W.W. Norton & Company, Inc., 1998.

Littell, Mary Ann. Speed and Methamphetamine Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, Inc., 1999.

Pellowski, Michael J. Amphetamine Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, Inc., 2001.

Periodicals

"All They Need is the Love Clinic: A Dallas Program Helps Kids to Say No to Sex and Drugs." Christianity Today 45, no. 15 (December 3, 2001): 62-65.

Gilbert, Laura. "Just Say Know: The Truth About Drugs." Teen Magazine 45, no. 7 (July 2001): 90.

"Kicking Drugs: A Recovery Diary: Stacia Litchfield Had It All-Including A Hardcore Drug Addiction That Drove Her To Trade Sex For A High. Now, After A Grueling Three Years In Rehab, She's Emerged-Clean And Ready For A New Life." Teen People 4, no. 16 (August 1, 2001): 138+.

Other

"Confessions of a Teenage Drug Addict." May 2001. <http://www.thailandlife.com/drugs/index.html>.

Stocker, Steven. "Overall Teen Drug Use Stays Level, Use of MDMA and Steroids Increases." NIDA Notes 15, no. 1 (March2000). <www.nida.gov>.

Organizations

American Council for Drug Education (ACDE), 204 Monroe Street, Rockville, MD, USA, 20852, (301) 294-0600, [email protected].

Narcotic Educational Foundation of America (NEFA), 28245 Avenue Crocker, Suite 230, Santa Clarita, CA, USA, 91355-1201, (661) 775-6968, [email protected], <http://www.cnoa.org/NEFA.htm>.

National Clearinghouse for Alcohol & Drug Information (NCADI), P.O. Box 2345, Rockville, MD, USA, 20852, (800) 729-6686, [email protected], <http://www.samhsa.gov/centers/clearinghouse/clearinghouses.html>.

National Families in Action, 2957 Clairmont Road, Suite 150, Atlanta, GA, USA, 30329, (404) 248-9676, [email protected], <http://www.emory.edu/NFIA/>.

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Dept. of Health and Human Services, 5600 Fishers Lane, Rockville, MD, USA, 20857, (301)443-6239, (800) 622-Help, [email protected], <http://www.samhsa.gov/centers/clearinghouse/clearinghouses.html>.

University of Kentucky Center for Prevention Research, 1151 Red Mile Rd. Ste.1-A, Lexington, KY, USA, 40504, (606) 257-5588, <http://www.uky.edu/RGS/PreventionResearch/welcome.html>.

Maury M. Breecher, PhD, MPH