Stimulant Abuse: Pharmacology, Cocaine, Methamphetamine (and Treatment)

[Chip (OP)]

source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056348/

Stimulant use and abuse: a primary care issue

Recent history

Stimulants, including cocaine and amphetamines, are among the most widely used and abused illegal substances in the United States. Coca chewing has a long history of indigenous use in South America 1. Widespread use of cocaine followed its isolation from coca in 1859 and a medical publication purporting its benefits in 1884. Its subsequent incorporation into patent medicines and popular beverages, e.g., Vin Mariani and Coca-Cola contributed to its profligate use 2. Rising social and medical problems raised concern in many circles and restrictions were gradually applied until the Harrison Act (1914) banned all OTC inclusion of cocaine 3. In the US, a popularity wave of cocaine began in the 1970’s followed by the crack wave of the 1980’s 4. These waves have left paths of adverse consequences, including association with the HIV epidemic, in the latter decades of the 20th century.

The first of the synthetic stimulants, amphetamine (isolated in 1887), was first popularized in the 1930’s with an OTC nasal decongestant (Bezedrine inhaler) containing the amphetamine phenylisopropylamine and the following the discoveries of clinical applications for fatigue, narcolepsy and depression 5. High availability, and popularity, led to misuse and OTC use was banned in 1957. Prescription misuse followed WWII (with common military usage) and illicit diversion of medications. Methamphetamine (isolated in 1919) use peaked during the late 1960’s creating a “speed scene.” The passage of the Controlled Substances Act in 1971 led to a dramatic decline in prescribed amphetamine and the popularity of amphetamines and methamphetamine declined for a time 6. The 1990’s brought a reemergence of methamphetamine, particularly to the western US, concurrent to mounting small scale production, aka “meth labs,” first in California and subsequently spreading nationwide 7. New forms of methamphetamine, e.g., “crank” and “ice,” have had their popularity waves as well. The popularity of amphetamines is reciprocal with cultural representations throughout the 1940’s – 1990’s, e.g., in literature, movies and music 8, 9.

Table 1

Medical complications of stimulant use

Organ system	Acute complications	Chronic complications
Central nervous system	Hallucinations, esp. tactile	Psychotic symptoms
	Dyskinesia	Cerebrovascular disease/stroke
	Seizures	Movement disorders, e.g., dystonic reactions, akathisia, choreoathetosis, tardive dyskinesia
Cardiovascular system	Tachycardia	Myocarditis
	Hypertension	Cardiomyopathy
	Myocardial infarction	Myocardial fibrosis
	Arrhythmias	Myocardial infarction
Pulmonary	Cough, shortness of breath, wheezing	Interstitial pneumonitis
	Pulmonary edema, hemorrhage	Bronchiolitis obliterans
	Pneumothorax
Renal		Renal ischemia
		Renal failure
Gastrointestinal	Reduced gastric motility	Gastric ulceration and perforation
		Intestinal infarction
		Ischemic colitis
Liver		Viral hepatitis secondary to contaminated syringe use
Endocrine	Reduced prolactin	Inc, normal or dec. prolactin
	Increased epinephrine, CRH, ACTH, cortisol and luteinizing hormones	Normal testosterone, cortisol, LH, thyroid hormones
Musculoskeletal	Movement disorders (see CNS)	Rhabdomyolysis
Head and neck	Rhinitis	Rhinitis
		Perforated nasal septum
		Nasal and gingival ulceration
		Sinusitis
		Dental decay and periodontal disease
		Xerostomia
		Corneal ulcers
Immune system		Vasculitis sysndromes
Sexual function		Erectile dysfunction
		Irregular menses
Reproductive	Vaginal bleeding	FDA category C
	Abruption placenta	Placenta previa
	Premature rupture of membranes	Low birth weight
General/other	Dehydration	Weight loss
		Nutritional deficits

see the source link for the full study