Cocaine is in another area. This topic primarily addresses stimulant and methamphetamine abuse, emphasizing the lack of approved medications for dependence or withdrawal management. While ADHD stimulants generally don’t cause severe withdrawals, combining stimulants with depressants like alcohol, heroin, or benzodiazepines can result in serious adverse reactions. Given the widespread prescription and abuse of stimulants, the discussion will explore associated risks, challenges, and potential treatment strategies.
Structures of Stimulants
The phenylethylamine structure is the backbone of epinephrine, norepinephrine, and dopamine as well as a variety of abused substances including all amphetamines, “bath salts”, the 2C series, and most “designer” drugs. In general, phenylethylamines increase norepinephrine, dopamine, and serotonin.
Common Substances
- Amphetamines (Adderall): Amphetamine is a central nervous (CNS) system stimulant that functions by increasing the amounts of dopamine, norepinephrine, and serotonin (to a lesser extent) in the synaptic cleft through a variety of mechanisms. (-NIH)
- Cocaine: A powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
- Crystal Methamphetamine: a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine –DrugAbuse. Meth, or methamphetamine, is a powerfully addictive stimulant that is both long-lasting and toxic to the brain. Its chemistry is similar to speed (amphetamine), but meth has far more dangerous effects on the body’s central nervous system. –abovetheinfluence.
- Methamphetamine (Desoxyn): is a stimulant drug usually used as a white, bitter-tasting powder or a pill –DrugAbuse.
- Methylphenidate (Ritalin, Concerta): blocks the reuptake of two neurotransmitters, norepinephrine (NE) and dopamine, by presynaptic neurons. (-NIH)
Other: Caffeine, tea, and energy drinks primarily act on adenosine receptors, promoting wakefulness with less risk of abuse due to minimal dopamine involvement. In contrast, designer drugs like MDMA provide stimulant effects by acting on different pathways, including dopamine, which increases their abuse potential.
| Fluid Sizes/Tablet | Caffeine Amount |
|---|---|
| Coca Cola 12oz. | 34mg |
| Excedrin tablet | 65mg |
| Midol tablet | 60mg |
| Mountain Dew 12oz. | 55mg |
| Red Bull 8.3oz. | 80mg |
| Starbucks 12oz. | 260mg |
| Vivarin (caffeine tablets) | 200mg |
Various Signs and Symptoms
Amphetamines: increase heart rate and body temp, less appetite, energy, aggressiveness, invincibility -> (later when you calm down” anxiety, depression, and agitation.
- High Doses: teeth grinding, paranoia, brain damage, Parkinson-like/neurotoxicity symptoms, Tourette’s, a great release of dopamine, glucose, and norepinephrine -> constrict peripheral.
Methamphetamine (ice is the smokable form of meth): S/E: hallucinations, formication, up to several days of non-sleep, brain damage, aggression, paranoia, and Parkinson’s disease. Crystal Meth usually lasts 8-24; much longer than cocaine. Meth users tend to be during the day, while cocaine users are in the evenings with multiple doses.
Cocaine: euphoria 30-60 minutes -> overtime, REDUCES DA x220 %, moderate-severe depression, anxiety, psychotics symptoms, heart damage, and lung damage if smoked. Reduce the SZ threshold. Causes death to neurons in the brain causes plaque buildup in arteries. Possible death r/t HA, CVA, respiratory failure. LETHAL Combinations:
- Cocaine + ETOH: increased the half-life of cocaine by 5x and is more toxic to the body with cardiac deaths 18-25x over cocaine use alone
- Cocaine + heroin (speedball): increase respiratory depression effects of heroin and all opioids, leading to an increased risk of death
Some Quick Notes
Methamphetamine, though often associated with the 1960s and 1970s, remains a highly addictive and powerful drug with significant influence. The stimulant class, including meth, is particularly problematic due to its addictive nature and the lengths people and dealers will go to obtain it.
Drug testing poses challenges, as illegal stimulants can produce false positives for prescribed ADHD medications due to chemical similarities. While urine screens are quick and cost-effective, but their results can be questionable, especially without the resources or additional staff to perform such tasks. Additionally, “pressed pills” may contain multiple substances, complicating assessments. Ultimately, identifying meth use requires considering the broader context and looking for obvious signs of addiction.
Methamphetamine use is profoundly tragic because its effects often go unnoticed at first, making it harder to detect and address early. In community mental health, inadequate resources for reliable prescription drug testing further complicate the issue. Without access to precise and comprehensive testing methods, such as accurate urine and hair analysis, results can be inconclusive, leading to unfair consequences for patients. This underscores the importance of proper tools and protocols to differentiate drug classes and ensure fair treatment. The hidden nature of meth use only adds to its devastating impact, as the harm may remain unnoticed until it’s too late. Notice how the lady below had about 6-7 years to have noticeable changes:
What Happens if the Rx Testing is Reliable and Patient Test Positive for Meth?
If Rx testing reliably shows a positive result for meth, it’s unlikely to be due to prescribed ADHD medication, as such tests typically account for these drugs. A positive result often suggests misuse, such as using meth itself, taking unknown substances, someone else’s medication, or pressed pills. While this shouldn’t immediately disqualify patients, they should be warned about the consequences of such behaviors, which could impact their ADHD treatment. Switching to long-acting ADHD medications might be considered in some cases.
Effective communication is critical in psychiatric care. Sharing drug screen results with patients—highlighting any discrepancies—can encourage accountability and discourage risky behaviors. Patients are more likely to modify their actions when they know they are being monitored and held responsible.
What About Treatment?
Methamphetamine and cocaine addiction is similar, in which there are no FDA-approved treatments for these disorders. The primary focus is managing mood stability and addressing cravings, which often cause psychological symptoms like agitation, fatigue, depression, and anxiety. Treating coexisting conditions, such as ADHD, is crucial to prevent relapse. Providers are urged to focus on stability, sobriety, and maintaining mutual respect with patients, avoiding overly rigid demands or unclear expectations, especially if the patient is making honest efforts to improve.
Additional Resources & Information
5 Manifestations of Methamphetamine Poisoning by Psychiatric Times
