Health and psychosocial consequences associated with long-term prescription of dexamphetamine to Amphetamine Misusers in Wolverhampton 1985–1998

Abstract

In December 1998 a retrospective case-note study was carried out on twenty patients treated with dexamphetamine between 1984 and 1998 in Wolverhampton, which was one of the larger centres for dexamphetamine prescription in the UK. Demographic features, drug use at initial contact, subsequent management and outcomes, including health and social circumstances, were assessed. Patients who had stopped attending for at least six months were compared with those retained in treatment. A new analytic method to detect amphetamine stereoisomers indicative of concurrent illicit drug use in urine was utilized.Retention in dexamphetamine treatment was associated with reduction in both injecting and illicit amphetamine use and an improvement in employment status. Treatment retention was also associated with older age, longer history of drug use, stable relationships and fewer prison sentences during treatment. However, illicit use of other drugs continued, as did criminal activity.As no limits were placed on duration of treatment, some patients received a prescription for fourteen years without ill effect. Psychotic symptoms, which were due to use of illicit amphetamine or misuse of prescribed medication, developed in five out of twenty patients. One patient suffered a possible myocardial infarction. This study provides some evidence, from a selected sample, that prescription of dexamphetamine may improve outcome in amphetamine users and does not inevitably lead to physical and psychiatric complications. Mental illness is a relative contraindication, although those who have become psychotic through chaotic use may benefit if prescription stabilizes substance use and lifestyle.