| AMPHETAMINES
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Amphetamine,
dextroamphetamine, and methamphetamine are collectively
referred to as amphetamines. Their chemical properties
and actions are so similar that even experienced users
have difficulty knowing which drug they have taken.
Amphetamine was first marketed in the 1930s as Benzedrine
in an over-the-counter inhaler to treat nasal congestion.
By 1937, amphetamine was available by prescription in
tablet form and was used in the treatment of the sleeping
disorder narcolepsy and the behavioral syndrome called
minimal brain dysfunction (MBD), which today is called
attention deficit hyperactivity disorder (ADHD). During
World War II, amphetamine was widely used to keep the
fighting men going; both dextroamphetamine (Dexedrine)
and methamphetamine (Methedrine) became readily available.
As use of amphetamines spread, so did their abuse.
Amphetamines became a cure-all for helping truckers
to complete their long routes without falling asleep,
for weight control, for helping athletes to perform
better and train longer, and for treating mild depression.
Intravenous amphetamine abuse spread among a subculture
known as "speed freaks." With experience,
it became evident that the dangers of abuse of these
drugs outweighed most of their therapeutic uses.
Increased control measures were initiated in 1965 with
amendments to the federal food and drug laws to curb
the black market in amphetamines. Many pharmaeutical
amphetamine products were removed from the market and
doctors prescribed those that remained less freely.
In order to meet the ever-increasing black market demand
for amphetamines, clandestine laboratory production
mushroomed, especially methamphetamine laboratories
on the West Coast. Today, most amphetamines distributed
to the black market are produced in clandestine laboratories.
Amphetamines are generally taken orally or injected.
However, the addition of "ice," the slang
name for crystallized methamphetamine hydrochloride,
has promoted smoking as another mode of administration.
Just as "crack" is smokable cocaine, "ice"
is smokable methamphetamine. Both drugs are highly addictive
and toxic.
The effects of amphetamines, especially methamphetamine,
are similar to cocaine, but their onset is slower and
their duration is longer. In general, chronic abuse
produces a psychosis that resembles schizophrenia and
is characterized by paranoia, picking at the skin, preoccupation
with one's own thoughts, and auditory and visual hallucinations.
Violent and erratic behavior is frequently seen among
chronic abusers of amphetamines.
[Abstracted from D.E.A. website q.v.]
| AMPHETAMINES
|
| Effects |
| Euphoria! Feeling of enhanced well
being, increased energy and loss of appetite. Potent
stimulus -- used to compensate for sleep deprivation
(Truck drivers, students, etc.) Both adrenergic
and dopamine-ergic -- increasing "energy"
and enhanced athletic ability! WITHDRAWL OFTEN POSSIBLE
WITHOUT HOSPITALIZATION (if good support system!)
|
| Incidence
of Abuse |
| Very common - especially in trucking
industry and among athletes. Methamphetamine is
increasing in popularity among "recreational"
users .... with number of clandestine labs increasing!
|
| Chemical
Name |
| Dextro-amphetamine and dextro-methamphetamine |
| Forms
and Street Names |
Amphetamine = Speed, Uppers, Pep pills,
Bennies, Wake ups, Eye-openers, Co-pilots, Coast-to-coast,
Cartwheels, A's, Black beauties, Methamphetamine
= Crank, Speed, Met, Crystal met, Crystal Smokable
= "Ice." Methamphetamine is available
on the street in liquid form and many abusers "inject."
|
| Preferred
routes of administration |
| Ingested, snorted, or used I.V. Methamphetamine:
"Crystal Met" or "crank" is
made in simple & ubiquitous clandestine labs.
Smokable form of Met. is called "ice."
Amphetamine: Abused for decades; but has legitimate
uses: for obesity, ADD, premature ejaculation, et.
al. |
| Length
of time detectable after user |
1 to 4 days
Elimination is pH dependent. ACIDIC URINE ENHANCES
EXCRETION!
CAUTION:
1. Acidification will "backfire" on donor
by increasing urinary concentration!
2. Do not acidify urine during intoxication because
this can exacerbate myoglobinuric renal failure
secondary to rhabdomyolysis! [EMERGENCY MEDICINE,
JULY 1995] |
| Metabolite
Actually sought in urine |
Screen is sensitive to both Amphetamine and Methamphetamine
in both D and L isomers!
GC/MS differentiates Amp and Met...... Isomers are
a separate assay. Federal regs call for confirmation
assays including "Amp," "Met,"
and isomers of "Met." |
| Confounding
drugs (or factors): |
SPECIAL PROBLEM #1:
High Ephedrine levels can cause false positives
for Methamph. Because of problem #1 (see cascade
above): POSITIVE METHAMPHETAMINE REQUIRES BOTH 500
"Met" AND AT LEAST 200 "Amp."
SPECIAL PROBLEM #2:
ISOMERS! Both Amp and Met have L (legal) and D (drug)
isomers. Because of problem #2, If donor claims
Seligiline or Vick's Inhaler use or asserts use
when "prompted," Stereoisomer assay must
be performed by lab!
[Vick's Inhaler and Seligiline = L-Methamphetamine!]
POSITIVE METHAMPHETAMINE REQUIRES AT LEAST 20% D-Methamphetamine!
THE ISOMER PROBLEM:
The clever "Ice" or "Speed"
user may be sniffing Vick's to confound test!
The innocent Vick's user should have ZERO -- or
VERY LITTLE D-Methamphetamine He is NOT INNOCENT
(POSITIVE) if D-met is over 20%.
FALSE POSITIVES:
Remember that Vick's Inhaler AND the Anti-Parkinsonism
drug, Seligiline, are both L-methamphetamine and
will cause positives on both the screening and
GC/MS study! ISOMERS must be ordered!!!
FINAL REMINDER:
The "DESIGNER DRUGS" (Amphetamine derivatives)
"Ecstacy - Eve: MDMA, MDA, & MDE, etc.
...plus Ephedrine ("Mini Thins") &
many others are all frequently abused but NOT
DETECTED with current testing methods! [They do
NOT metabolize to pure Amp or Met.] See Section
on "Designer Drugs" |
| Screening
Cut-off: |
| 1000 ng/ml
|
| Confirmation
GC/MS Cut-off: |
| 500 ng/ml (for both) |
| LEGAL
(PRESCRIPTION) FORMS: |
Amphetamine: Adderal, Amphogel,
Biphetamine, Dexedrine, Dextrostat, Dextroamphetamine
(generic) Methamphetamine: Desoxyn
Other drugs which metabolize to amphetamine and/or
methamphetamine:
| DRUG |
METABOLITES |
MEDICAL USES |
| benzphetamine (U.S.: Didrex®) |
d-amphetamine
d-methamphetamine |
Anorectic. |
| clobenzorex (Mex.: Asenlix®, Fr.: Dinintel®,
Spain: Finedal®) |
d- and l- amphetamine |
Anorectic. |
| famprofazone (Geodowin®) |
d- and l- amphetamine
d- and l- methamphetamine |
Sold as an analgesic and antipyretic in
Europe and, until mid-1990, Korea. |
| fencamfamine (Altimine®, Envitrol®,
Phencamine®) |
d- and l- amphetamine
d- and l- methamphetamine |
Antidepressant. |
| fenethylline (Ger.: Captagon®) |
d- and l- amphetamine |
A Schedule I drug in the United States.
Used elsewhere to treat attention deficit
disorder, narcolepsy, and depression. |
| fenproporex (Ger.: Appetizugler®, Mex.:
Fenisec®, Spain: Antiobes Retard®,
Dicel® Falagan®, Grasmin®, Tegisec®) |
d- and l- amphetamine |
Anorectic. |
| mefenorex(Arg.: Doracil®, Fr.: Incital®,
Ger.: Rondimen®, Spain, Switz.: Pondinil®) |
d-amphetamine |
Anorectic. |
| mesocarb(Europe: Sydnocarb®) |
amphetamine |
|
| prenylamine(Segontin®) |
d- and l- amphetamine |
Coronary vasodilator |
| selegiline(deprenyl, Spain: Plurimen®,
U.S.: Elderpryl®) |
l-amphetamine
l-methamphetamine |
Parkinson's Disease. |
From MRO Update: Feb. 1998
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