1. 1 Amphetamines The Use and Abuse of Designer Drugs Megan Trimble Doctor of Pharmacy candidate March 2006

2. 2 What are Amphetamines? The term “amphetamines” refers to a class of drugs. World War II –Stimulants for soldiers and prisoners (1) http://images.google.com/imgres?imgurl=http://www.modafinil.com/article/modsold.jpg&imgrefurl=http://www.modafinil.com/a rticle/soldiers.html. Accessed 29 April 2006.

3. 3 Amphetamine-like Drugs Most commonly abused by college students: –Methamphetamine Results in CNS excitation –In other words, it “revs up” your brain –Chemical responsible for these effects: Dopamine –MDMA Serotonin, not dopamine, is the chemical responsible for the effects felt from using MDMA “Designer” amphetamines (1)

4. 4 “Designer Drugs” What is Methamphetamine? –Street names: “meth” “speed” “chalk” “ice” “crystal” “glass” (1,2) What is MDMA? –Street names: “ecstasy” “E” “Adam” “XTC” “M&M” (1) http://www.teens.drugabuse.gov/facts/facts_xtc1.asp. Accessed April 6, 2006.

5. 5 Amphetamines Forms Methamphetamine –Crystalline powder White, odorless Tastes bitter This form is referred to as “speed” or “meth” –Smoked form Referred to as “ice” “crystal” “glass” (2) –Injection (needle use) (3) MDMA –Tablets Colorful and branded Prevalent at “rave” and club scenes (1) http://www.michigan.gov/images/ravdrug_8430_7.jpg Accessed March 29http://www.michigan.gov/images/ravdrug_8430_7.jpg Accessed March 29, 2006

6. 6 Why Do People Use Amphetamines? Methamphetamine –Increased energy & alertness –Improve mood A false feeling of being happier –Decrease appetite (1) MDMA –Euphoria –Heightened awareness –Inner peace –Ease of socializing (3)

7. 7 Methamphetamine is one of the most widely used and abused drugs, in college age students, today Graph: Amphetamine use/abuse vs. Methamphetamine (2) http://www.nida.nih.gov/ResearchReports/Methamph/methamph2.html#what. Accessed April 6, 2006.

8. 8 Mild Effects of Amphetamines Cognitive effects –Initial “rush” or energy high –Confusion –Poor concentration –Memory problem (especially MDMA) Systemic effects –Restlessness –Movement delays –Sleep disturbances –Thirst –Nausea/vomiting –Chills/Sweating involuntarily –Agitation –Aggression (1,2,4)

9. 9 Severe Effects of Amphetamines (Including Overdosing) Convulsions/seizures Increase heart rate High blood pressure Panic Attacks HallucinationsUnconsciousness Damaged blood vessels (1, 2, 4)

10. 10 Life Threatening Effects of Amphetamines (from abuse) Hyperthermia Hyponatremia (Large free water intake due to physical activity causes a drop in sodium levels) (1) Kidney failure Intracerebral hemorrhage Heart failure Muscle breakdown Fetal death (1,5,6) http://www.drugabuse.gov/pubs/teaching/teaching4/Teaching3.html. Accessed April 6, 2006.

11. 11 Chronic Amphetamine Abuse The use of amphetamines such as “meth” and “ecstasy” can lead to abuse dependence or death –Tolerance develops –“Speed run” Defining the term: The more of this drug you consume, the higher you want get and the harder it is to do so. The user takes increasing amounts without sleeping which can result in being beyond high, for days at a time Many side effects are still seen/experienced many years after being drug free (1)

12. 12 Post-Abuse Effects Repeating the same tasks over and over again Clenching/grinding of teeth Loss of memory Permanent brain damage –Long term psychosis effect –Increased risk of developing Schizophrenia later in life (1) MDMA use results in brain damage that can be evident 6-7 years later –Can occur even if you only use MDMA for a couple of days in your life (7)

13. 13 Amphetamine Pharmacology Stimulant (methamphetamine and MDMA) Hallucinogenic (MDMA) Release of neurotransmitters in brain –Dopamine –Norepinephrine –Serotonin Dopamine and norepinephrine are primarily altered/effected in the brain Serotonin is released with use of higher doses of MDMA (ecstasy) The extent to which these chemicals effect the brain is dependent on how much abuse is taking place; permanent brain damage can occur as a result (1)

14. 14 What is Dopamine? In the brain, dopamine is a significant role player in regulating and controlling your pleasure level. Dopamine is produced (made) in nerve cells. (2) Dopamine is released from the end of specific nerves in your brain, in an excessive amount, when methamphetamine is used and abused. http://www.nida.nih.gov/ResearchReports/Methamph/methamph3.html#short. Accessed April 6, 2006

15. 15 What is Serotonin? Serotonin is involved in brain regulation –Mood, emotions, sleep –Appetite, aggression, perceptions (6) Body craves more serotonin Body craves more serotonin in order to compensate for the excess released from the brain (5) http://www.drugabuse.gov/pubs/teaching/teaching4/teaching.htm Accessed April 6,2006.

16. 16 Serotonin http://www.drugabuse.gov/ResearchReports/MDMA/MDMA3.html#effects. Accessed April 29, 2006.

17. 17 Routes of Administration (Ways to use amphetamines) Methamphemines –Oral (ingested) –Parenteral (injected) –Inhalation (snorting) –Smoked and resmoked (1,2) MDMA –Oral Tablet Capsule Pill (1,7)

18. 18 Duration of Time Using amphetamine-like drugs effect the body for a long period of time –Methamphetamine 24 hours + Repetitive use due to tolerance –Accumulation occurs and the duration of effect on the body is prolonged (1)

19. 19 Elimination from Body Renal Elimination (Kidneys) –Amphetamines 30 % –Methamphetamines 40-50% –MDMA 65% Hepatic Elimination (liver) (1)

20. 20 Risks of “Designer Drugs” Lead poisoning (methamphetamine abusers) (2) –Contamination from making and using on the street Fetal Complications due to use and abuse during pregnancy –Deformities –Death

21. 21 Risks from Injection Using and sharing needles increases the risk of contracting severe and life threatening diseases –HIV –Hepatitis B and C The risk of HIV is not only increased by injection but also from the enhanced sexual feelings that arise from using these drugs –Amphetamine use can increase your libido or alter your perception in engaging in sexual activity –Rough sex is common with use which can lead to tears and abrasions resulting in bleeding (2)

22. 22 Summary Why do people use and abuse amphetamine- like drugs (“designer drugs)? –Stress release –Ease of communication with peers Feelings of fitting in/socializing –Elevates mood –Decreases anxiety due to school, work and personal relations Acceptance –Unwanted withdrawal symptoms (don’t want to feel bad)

23. 23 Summary Amphetamine-like substances such as “meth” and “ecstasy” are highly abusive drugs among college students today. These highly addictive drugs may seem appealing due to their short term, feel good, highs. But the high is just that – short term. The after effects not only cause tremendous emotional instability but also cause negative, physical effects as well. Amphetamines harm your entire body; the brain, heart, liver, kidneys and blood vessels are among the many systems of your body that deteriorate and shut down, leading to a possible cause of death. Not only can death occur, but the risks of acquiring HIV, hepatitis, and other serious diseases are significantly increased.

24. 24 References (1) Goldfrank’s Toxicologic Emergencies. 7th ed. c2002. The McGraw-Hill Companies, Inc. “Chapter 68 Amphetamines” March 26th 2006 [Date accessed]. Available from STAT!Ref [database on the Internet] (2) “Methamphetamine Abuse and Addiction.” [about 6 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (2) “Methamphetamine Abuse and Addiction.” [about 6 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (3) “Infofacts:Methamphetamine.” [about 4 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (3) “Infofacts:Methamphetamine.” [about 4 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (4) “MDMA Abuse and Addiction.” [about 3 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (4) “MDMA Abuse and Addiction.” [about 3 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed]

25. 25 References Continued (5) “The Neurobiology of Ecstasy (MDMA).” [about 5 screens] National Institute On Drug Abuse. [internet website] c2005. National Institure of Health. [inassociation with] 6 April 2006 [date accessed] (5) “The Neurobiology of Ecstasy (MDMA).” [about 5 screens] National Institute On Drug Abuse. [internet website] c2005. National Institure of Health. [inassociation with] 6 April 2006 [date accessed] (6) “Infofacts:MDMA(Ecstasy).” [about 2 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (6) “Infofacts:MDMA(Ecstasy).” [about 2 screens] National Institute On Drug Abuse. [internet website] c2005. National Institute of Health. [in association with] 6 April 2006 [date accessed] (7) “Ecstasy.” [about 2 screens] National Institute On Drug Abuse For Teens. [internet website] c2003. National Institute of Health. [in association with] 6 April 2006 [date accessed] (7) “Ecstasy.” [about 2 screens] National Institute On Drug Abuse For Teens. [internet website] c2003. National Institute of Health. [in association with] 6 April 2006 [date accessed]