Amphetamine-like stimulants hit the headlines

Abstract

Drug abuse is a worldwide health issue and a global cause ofpremature mortality and morbidity. A substantial proportionof young adults have used an illicit drug at some time intheir lives. In 2011, the UN Office on Drugs and Crimereported that 149–271 million people aged 15–64 wereestimated to have used an illicit drug at least once in 2009.Of these, between 14 million and 56 million were estimatedto have used an amphetamine-type stimulant (correspond-ing to 0.3–1.3 % of the population) (UNODC, World DrugReport 2011). Therefore, I am very happy to see a very nicewell-written and well comprehensive review entitled‘‘Toxicity of Amphetamine: An Update’’ contributed byCarvalho et al. (2012).Stimulants, including amphetamine derivatives, areamong the most widely abused illegal substances. Over thelast five decades, their popularity has paralleled with cul-tural literary, cinematographic and musical movements. Infact, there are indicators that both consumption and manu-facture of amphetamines have increased. Data from surveysof college students also show that illicit use of stimulants isstill growing (Ciccarone 2011).The detrimental health consequences of stimulant abuseare accompanied by relevant economic and societal costs.Mental disorders, road-traffic accidents, suicides and vio-lence seem to be increased in amphetamine users. However,causal associations remain unclear due to several con-founding variables and poor quantification of risk. Accord-ing to a survey in 2006, one in three of all drug-relatedemergency visits in the United States involved cocaine.Methamphetamineand amphetamine were associated with 5and 2 % of these visits, respectively, representing a totalnumber of 107,575 visits. MDMA alone accounted for16,749 visits (Substance Abuse and Mental Health ServicesAdministration 2008).Acute clinical features include intoxication and over-dose. Chronic use is associated with psychological andbehavioral disturbances. Cognitive impairment and psy-chotic symptoms such as paranoia, delusions and halluci-nations may persist for years following abstinence fromuse. Bloodborne bacterial and viral infections are alsoworrisome due to risks of unsafe injection (Schep et al.2011; Degenhardt and Hall 2012).The high prevalence of stimulant abuse and its harmfulconsequences make the screening, diagnosis and treatmentof persons with stimulant abuse a top concern for primarycare providers. Having a working knowledge of use pat-terns, clinical features and target-organ effects is thereforeessential.The review ‘‘Toxicity of amphetamines: an update’’,published in the current issue of Archives of Toxicology(Carvalho et al. 2012), addresses the pharmacokinetics;toxicity mechanisms; target-organ toxicity; individual pre-disposition (genetic polymorphisms); and relevant druginteractions of the classical amphetamines: amphetamineitself, as well as methamphetamine and 3,4-methylene-dioxymethamphetamine (MDMA, ecstasy). All issues cov-ered are of utmost importance for increased awareness ofdanger and for management and treatment of the intoxicatedpatients.Recently, a new class of ‘‘designer drugs’’ has emergedon the drug market, known as ‘‘legal highs’’ or ‘‘herbalhighs’’ ‘‘bath salt’’. They include a wide range of products,from natural plant-originated substances to synthetic