Amphetamine Consumption Research Articles

Androgenic Anabolic Steroid, Cocaine and Amphetamine Abuse and Adverse Cardiovascular Effects

Introduction:Anabolic-androgenic steroids (AAS), a synthetic derivate of testosterone, have become a popular drug among athletes and bodybuilders to enhance muscle mass and improve the athletic performance. Many pathological effects such as hepatic and endocrine dysfunction, behavioural changes and cardiovascular complications have been reported.Case Report:Within these ast ones, we find an increase in left ventricular muscle mass, concentric myocardial hypertrophy, left ventricular diastolic dysfunction, arterial hypertension, prothrombotic effects, changes in the concentration of cholesterol levels, particularly a reduction in HDL cholesterol concentration, myocardial infarctions in relation to endothelial dysfunction, vasospasms or thrombosis and sudden cardiac death.Discussion:We report the case of a 32-year-old patient with a history of arterial hypertension, depressive syndrome and consumption of cocaine, amphetamines and AAS who developed severe left ventricular systolic dysfunction and myocardial hypertrophy with signs of heart failure and peripheral arterial embolism.

A continuidade do uso de anfetaminas por motoristas de caminhão no Estado de São Paulo, Brasil, a despeito da proibição de sua produção, prescrição e uso

Amphetamine use by truck drivers for occupational purposes is widely known. The production and consumption of amphetamines was banned by the Brazilian National Health Surveillance Agency (ANVISA) in October 2011. This study analyzes persistent amphetamine use by truck drivers since the ban was implemented. A convenience sample of 427 truck drivers was taken along highways in São Paulo State in 2012. Participants were asked to answer a structured questionnaire and provide a urine sample to screen for recent amphetamine consumption through toxicological analysis. Among the interviewed drivers, 7% had used some illicit drug recently and 2.7% had used amphetamines. Amphetamines are still consumed by truck drivers despite the risks and the recent ban. The authorities should thus monitor the possession and use of amphetamines by drivers in order to effectively enforce the ban.

Pilot Study of the Estimation of Amphetamines Consumption in the Polish City of Poznan

According to the European Monitoring Centre for Drugs and Drug Addiction Annual Report 2011 in many European countries amphetamines or ecstasy is the second most commonly used illicit substance after cannabis. More reliable and objective method based on the ‘sewage epidemiology’ was applied to estimate the level of amphetamines consumption in Poland. Amphetamine, methamphetamine and MDMA (ecstasy) were determined in wastewater samples collected from the main Wastewater Treatment Plant in the Polish city of Poznan (about 687,000 people) using liquid chromatography/tandem mass spectrometry (LC-MS-MS). Back-calculations used in the ‘sewage epidemiology’ approach were applied to estimate the level of consumption of analyzed drugs. Analysis of variance (ANOVA) was applied to check the monthly differences between determinations. Two-year profiles of consumption for amphetamine methamphetamine and ecstasy were calculated. Results from our city indicate that consumption of amphetamines is one order of magnitude lower than in Western Europe. Therefore, there is a different profile of amphetamines consumption. Consumption of amphetamine is several times lower, but the consumption of ecstasy is relatively high. ANOVA analysis confirmed significant differences between monthly loads of determined illicit drugs

Does accumulating exposure to illicit drugs bring forward the age at onset in schizophrenia?

Whilst cannabis has been associated with an earlier age at onset in schizophrenia, the impact of amphetamine and/or cocaine plus cannabis consumption on age at onset remains unclear. The present study was designed to test the hypothesis that consumption of amphetamine and/or cocaine in addition to cannabis would lead to an earlier age at onset of schizophrenia than that seen for cannabis consumption alone. A secondary objective was to determine what kind of effect additional substance use exerted (e.g. additive, multiplicative). Patients with a diagnosis of schizophrenia were recruited from consecutive admissions to the inpatient and outpatient services of a large psychiatric hospital in Perth, Australia and 167 participants were assessed using the Diagnostic Interview for Psychosis, which included detailed inquiry into illicit drug use in the 12 months prior to the onset of psychiatric symptoms. Participants were categorized into four groups: no illicit substance use (n = 65), cannabis use (n = 68), cannabis plus amphetamine use (n = 25), and cocaine plus cannabis/cocaine plus cannabis plus amphetamine use (n = 9). Analysis of variance was performed to detect trends, and linear regression used to analyze the consumption of each additional substance as a predictor of age at onset. We observed a linear trend for mean age at onset: 23.34 (SD = 6.91) years for no illicit substance use, 22.51 (SD = 5.27) years for cannabis use, 20.84 (SD = 3.48) years for cannabis plus amphetamine use, and 19.56 (SD = 3.54) years for cocaine plus cannabis/cocaine plus cannabis plus amphetamine use; the variation in the means between groups was statistically significant: F(1,163) = 5.66, p = 0.008, Cohen's d = 0.38. For the consumption of each additional substance, age at onset was earlier by 1.2 years: R (2) = 0.034, F(1,165) = 5.72, p = 0.018. Whilst preliminary, these findings suggest that additional consumption of each substance predicted an earlier age at onset by approximately 1 additional year.

Amphetamine-like stimulants hit the headlines

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

Toxicity of amphetamines: an update

Amphetamines represent a class of psychotropic compounds, widely abused for their stimulant, euphoric, anorectic, and, in some cases, emphathogenic, entactogenic, and hallucinogenic properties. These compounds derive from the β-phenylethylamine core structure and are kinetically and dynamically characterized by easily crossing the blood-brain barrier, to resist brain biotransformation and to release monoamine neurotransmitters from nerve endings. Although amphetamines are widely acknowledged as synthetic drugs, of which amphetamine, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) are well-known examples, humans have used natural amphetamines for several millenniums, through the consumption of amphetamines produced in plants, namely cathinone (khat), obtained from the plant Catha edulis and ephedrine, obtained from various plants in the genus Ephedra. More recently, a wave of new amphetamines has emerged in the market, mainly constituted of cathinone derivatives, including mephedrone, methylone, methedrone, and buthylone, among others. Although intoxications by amphetamines continue to be common causes of emergency department and hospital admissions, it is frequent to find the sophism that amphetamine derivatives, namely those appearing more recently, are relatively safe. However, human intoxications by these drugs are increasingly being reported, with similar patterns compared to those previously seen with classical amphetamines. That is not surprising, considering the similar structures and mechanisms of action among the different amphetamines, conferring similar toxicokinetic and toxicological profiles to these compounds. The aim of the present review is to give an insight into the pharmacokinetics, general mechanisms of biological and toxicological actions, and the main target organs for the toxicity of amphetamines. Although there is still scarce knowledge from novel amphetamines to draw mechanistic insights, the long-studied classical amphetamines-amphetamine itself, as well as methamphetamine and MDMA, provide plenty of data that may be useful to predict toxicological outcome to improvident abusers and are for that reason the main focus of this review.

Driving Under the Influence of Amphetamine‐Like Drugs

Scientific opinions differ whether the use of stimulants causes deterioration in driving skills. In 1857 of 8709 cases of driving under the influence of drugs, amphetamine-like drugs (amphetamine, methamphetamine, and methylendioxyamphetamine) were present either alone or together with other licit or illicit drugs. In 338 cases, amphetamines were the only psychoactive substance group in plasma at mean, median, and highest concentrations of 0.18, 0.12, and 1.05 mg/L, respectively. A widespread opinion is that after the consumption of amphetamines, centrally stimulating effects with corresponding consequences on safe driving are expected. In contrast, many cases were observed that rather suggested an influence of centrally sedating substances when considering the psycho-physical conditions. Relations between concentration and effect could not be established. The apparent sedation is probably the consequence of sleep deprivation during an amphetamine binge and the after-effects of the drug.

P-18 - Ethno-botanical preference in drug consumption habits at young romanian populations

Romania is on the fourth place in the EU considering the consumption of ethno-botanical drugs with a psychotropic effect, which was far from safe, in 2009 more than 1300 persons, asked for medical help being seriously poisoned. Material and methods On a festival called “Peninsula Music Festival 2010” we examined the drug usage habit of 256 young participants with a questionnaire. We evaluate correlation with risk factors of preference of ethno-botanical drugs. Results Gender distribution: 59.37% man and 40.63 women. Age distribution: Sample size = 256, Mean age 21.60 years, Standard deviation 4.33. The individuaĺs smoking habit influences the judgement of the dangerousness of smoking. Considering the consumed drugs the great majority of students (similarly to the international situation) tried out ethno-botanical drugs and marijuana. This is followed by the abuse of medicine and amphetamines consumption. The changes of both legal and illegal drug use habits conclude to the fact that the same happens in our country as in the western union countries. Conclusions The frequency of drug trials grows among the youth, the habits of drug use change, cannabis derivatives and ethno-botanical drugs dominate while the proportion of opiate users is decreasing.

Drug use and associated demographic factors of freshman students in a Chilean University

OBJECTIVE: to characterize the student population first enters the Universidad Austral de Chile in terms of drug use and associated factors. METHODS: association study of drug use and demographic variables of 845 students. The self-administered questionnaire contained two main instruments, the detection pattern of alcohol and other drugs (DEP-ADO) and the AUDIT. Partnerships were established using parametricand nonparametric tests. RESULTS: increased consumption of alcohol and marijuana was associated with male gender. The onset of drug and alcohol consumption did not differ significantly according to sex. The frequency of alcohol consumption on faculties has significant differences in men and women. The variables "where you live" and "who lives" was significantly related to consumption of amphetamine and marijuana. CONCLUSION: the main problem of this population is the consumption of alcohol, snuff and Marijuana.

Adolescent amphetamine exposure elicits dose-specific effects on monoaminergic neurotransmission and behaviour in adulthood

Despite the growing non-medical consumption of amphetamine (Amph) during adolescence, its long-term neurobiological and behavioural effects have remained largely unexplored. The present research sought to characterize the behavioural profile and electrophysiological properties of midbrain monoaminergic neurons in adult rodents after Amph exposure during adolescence. Adolescent rats were administered vehicle, 0.5, 1.5, or 5.0 mg/kg.d Amph from postnatal day (PND) 30-50. At adulthood (PND 70), rats were tested in an open-field test (OFT) and elevated plus maze (EPM), paralleled by in-vivo extracellular recordings of serotonin (5-HT), dopamine (DA) and norepinephrine (NE) neurons from the dorsal raphe nucleus, ventral tegmental area, and locus coeruleus, respectively. 5-HT firing in adulthood was increased in rats that had received Amph (1.5 mg/kg.d) during adolescence. At this regimen, DA firing activity was increased, but not NE firing. Conversely, the highest Amph dose regimen (5.0 mg/kg.d) enhanced NE firing, but not DA or 5-HT firing rates. In the OFT, Amph (1.5 mg/kg.d) significantly increased the total distance travelled, while the other doses were ineffective. In the EPM, all three Amph doses increased time spent in the open arms and central platform, as well as the number of stretch-attend postures made. Repeated adolescent exposure to Amph differentially augments monoaminergic neuronal firing in a dose-specific fashion in adulthood, with corresponding alterations in locomotion, risk assessment (stretch-attend postures and central platform occupancy) and risk-taking behaviours (open-arm exploration). Thus, adolescent Amph exposure induces long-lasting neurophysiological alterations that may have implications for drug-seeking behaviour in the future.

Cocaine and other illicit drugs in airborne particulates in urban environments: A reflection of social conduct and population size

Levels of cocaine and other psychoactive substances in atmospheric particulate matter (PM) were determined in urban environments representing distinct social behaviours with regard to drug abuse: night-life, university and residential areas. Three cities (with population >1 million and <0.3 million inhabitants) were selected. Mean daily levels of drugs in PM were 11–336 pg/m 3 for cocaine, 23–34 pg/m 3 for cannabinoids, and 5–90 pg/m 3 for heroin. The highest levels were recorded on weekends, with factors with respect to weekdays of 1–3 for cocaine, 1–2 for cannabinoids and 1.1–1.7 for heroin. Higher levels were detected in the night-life areas, pointing towards consumption and trafficking as major emission sources, and possibly ruling out drug manufacture. The similarities in temporal trends at all sites suggested a city-scale transport of psychoactive substances. Correlations were detected between cocaine and amphetamine consumption ( r 2 = 0.98), and between heroin and cannabinoids ( r 2>0.82).

Sewage epidemiology — A real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium. The consumption of cocaine (COC), amphetamine (AMP), methylenedioxymethamphetamine (MDMA), methamphetamine (METH), methadone (MTD) and heroin (HER) was evaluated based on measured concentrations of the parent compound and/or metabolites in daily 24-hour composite influent wastewater samples. The inevitable back-calculations used in the sewage epidemiology approach were adapted to newly available information regarding the stability of the compounds in wastewater and the excretion pattern of illicit drugs. For COC, three different back-calculation approaches were evaluated. In addition, for the first time, efforts were made to calculate the number of inhabitants living in the catchment area of the WWTP in a real-time and dynamic way, based on concentrations of nitrogen, phosphorus and oxygen in the wastewater samples. Clear variations in the amount of inhabitants in the catchment area of the WWTP were observed. For COC, AMP and MDMA a significant higher weekend use was observed while for HER and MTD no significant daily variations could be found. METH consumption was negligible. Generally, the sewage epidemiology calculations were in agreement with official statistics. This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations. Therefore, efforts should be made to further optimize this approach in the future.

Effect of 3,4-methylenedioxyamphetamine on dendritic spine dynamics in rat neocortical neurons — Involvement of heat shock protein 27

Along with chronic neurotoxic effects, the long-term consumption of amphetamines has been associated to psychiatric symptoms and memory disturbances. Dendritic spine dynamics have been discussed as a possible morphological correlate. However, the underlying mechanisms are still elusive. 3,4-Methylenedioxyamphetamine (MDA), a major drug of abuse and a main metabolite after 3,4-methylenedioxymethamphetamine (MDMA) intake, provokes a loss of dendritic spine-like protrusions in primary cultures of rat cortical neurons. 3,4-Methylenedioxyamphetamine also induced a rapid activation of the p38 mitogen activated protein kinase (p38 MAPK) pathway and phosphorylation of heat shock protein 27 (hsp27) indicative for its decreased chaperone activity. Concurrent pharmacological inhibition of the p38 MAPK by SB203580 abolished hsp27 phosphorylation and diminished the loss of dendritic spine-like protrusions. Moreover, upon MDA treatment dendritic spine-like protrusions were stabilized in neurons constitutively expressing hsp27. In parallel experiments we observed a robust activation of the heat shock transcription factor 1 (HSF-1) and a subsequent increase of hsp27 and hsp70. The regulation of small heat shock proteins corroborates the existence of a neuronal stress response after MDA treatment. Pharmacological targeting of small heat shock protein phosphorylation may provide a new strategy to preserve spine integrity after amphetamine exposure.

Amphetamines induce tissue factor and impair tissue factor pathway inhibitor: role of dopamine receptor type 4

Amphetamine intake is associated with acute vascular syndromes. Since these events are caused by arterial thrombosis and this in turn is triggered by tissue factor (TF), this study examines whether amphetamines regulate TF in human endothelial cells. Amphetamine (10(-7)-10(-4) mol/L) enhanced thrombin- and tumour necrosis factor (TNF)-alpha-induced as well as basal TF expression (P = 0.029, 0.0003, and 0.003 at maximal concentration), and TNF-alpha-induced plasminogen activator inhibitor (PAI)-1 expression (P = 0.003), whereas tissue factor pathway inhibitor expression was impaired (P = 0.008). Similarly, 3,4-methylenedioxymethamphetamine (10(-7)-10(-4) mol/L) enhanced TF expression (P = 0.046). These effects were paralleled by an increased TF activity (P = 0.002); moreover, clotting time of human plasma was accelerated by supernatant from amphetamine-treated cells (P = 0.03). Amphetamine enhanced TF mRNA expression via phosphorylation of the mitogen-activated protein kinases (MAPKs) extracellular signal-regulated kinase (ERK) and p38 (P = 0.03 and 0.033), but not c-Jun NH(2)-terminal kinase (JNK; P = 0.81). The effect of amphetamine on TF expression was abrogated by the dopamine D4 receptor antagonists L-745,870 and L-750,667, but not D2 or D3 receptor antagonists; furthermore, L-745,870 blunted the amphetamine-induced activation of ERK and p38, but not JNK. Amphetamines induce endothelial TF expression via stimulation of dopamine D4 receptor and activation of the MAPKs p38 and ERK. These effects occur at clinically relevant amphetamine concentrations and may account for the increased incidence of acute vascular syndromes after amphetamine consumption.

Illicit drugs in the environment: Emerging contaminants and indicators of drug abuse

Illicit drugs in the environment: Emerging contaminants and indicators of drug abuse

Determination of ketamine and amphetamines in hair by LC/MS/MS

A liquid chromatography-tandem mass spectrometry method was developed for the determination of ketamine (with its metabolite norketamine) and some amphetamines (amphetamine, methamphetamine, methylenedioxyamphetamine, and 3,4-methylenedioxymethamphetamine). This method was developed to determine these compounds in hair and is able to simultaneously quantify all of them in human hair. Hair samples (20 mg) were washed and pulverized, and an extraction with formic acid (0.01%) and ultrasonication for 4 h was used. Deuterated analogs of the analytes were used as internal standards for quantification. Linearity from 0.5 to 25 ng/mg was obtained for both ketamine (and norketamine) and amphetamines with correlation coefficients exceeding 0.99. The limit of detection and the limit of quantification obtained were 0.1 and 0.5 ng/mg, respectively, for ketamine and amphetamines. A total of 25 hair samples from known drug abusers (relating to designer drug consumption or consumption of amphetamines) were examined by this validated method. The results show that the proposed method is suitable for testing these drugs in a single sample of hair. In addition, it is simpler and faster than analysis by conventional methods such as gas chromatography-mass spectrometry, which usually require a more laborious extraction procedure and, in most of cases, an additional derivatization process.

Consumo de anfetaminas, para mejorar rendimiento académico, en estudiantes de la Universidad de Manizales, 2008

Objetivo: Identificar la frecuencia del uso no medicado de anfetaminas y otras sustancias,para mejorar rendimiento académico, en estudiantes de la Universidad deManizales (Manizales, Caldas, Colombia).Materiales y métodos: Se realizó un estudio de corte transversal. La población fue de3616 estudiantes de todas las facultades de la Universidad de Manizales, con una muestrarepresentativa de 309 estudiantes. Se empleó una encuesta anónima, que permitió identificarel consumo de anfetaminas, otras sustancias relacionadas y factores asociados.Resultados: La edad promedio fue de 20,46 años, estrato medio. La muestra másnumerosa fue de las facultades de Medicina (17,5%) y Derecho (16,8%). 32,8% informóel consumo de drogas como marihuana (68,9%), popper (26,9%), éxtasis (22,6%).14,6% manifiestó consumir anfetaminas para mejorar rendimiento académico, otrassustancias son marihuana y cocaína, consumos asociados a época de parciales; esteconsumo resultó ser dependiente de la Facultad (Medicina 42,3%, Economía 16,7%)y semestre cursado (9° semestre 44%, 5° semestre 24,1%); 71% que consumió metilfenidatomanifestó obtener resultados favorables. Como factores asociados a esteconsumo se encuentró el consumo de alcohol y el consumo de drogas en general.Conclusiones: El consumo de anfetaminas en esta universidad es alarmante, particularmenteen las facultades de Medicina (42,3%) y Economía 16,7%. Para prevenir el abuso yconsumo de sustancias para mejorar rendimiento académico, es necesaria una intervenciónintegral, que contemple tanto aspectos personales del estudiante como de la institución.

Association between Prenatal Tobacco Exposure and Outcome of Neonates Born to Opioid-Maintained Mothers

Background: Prenatal nicotine exposure is associated with increased neonatal mortality, low birth weight, and smaller head circumference. Opioid-dependent pregnant women show a particularly high prevalence of tobacco smoking and are at greater risk for additional adverse events. However, little is known about the impact of tobacco smoking on opioid-maintained pregnant women and neonatal outcomes. Patients and Methods: This study examined the effect of cigarette smoking on 139 opioid-maintained pregnant women and their neonates. Forty-five percent of the participants were maintained on slow-release oral morphine (SROM), 39% received methadone maintenance, and 16% received buprenorphine. Participants were divided into two groups: (1) women who reported a low cigarette consumption of ≤10 cigarettes/day (56.8%) and (2) those reporting heavy consumption of ≥20 cigarettes/day (43.2%). Neonatal outcome measures were assessed, and a standardized Finnegan score was applied to determine the neonatal abstinence syndrome (NAS). Results: Fifty-two percent of the newborns did not require treatment for NAS (54% of neonates born to methadone-maintained mothers, 30% born to SROM-maintained mothers, and 95% born to buprenorphine-maintained mothers; p < 0.001). Heavy cigarette consumption was associated with significantly lower neonatal birth weight (p < 0.001), smaller birth length (p = 0.017) as well as with the severity of NAS (p = 0.03). With regard to concomitant consumption of opioids (p = 0.54), cocaine (p = 0.25), amphetamines (p = 0.90) or benzodiazepines (p = 0.09), no significant differences between heavy or low nicotine consumption were noted. Conclusion: Heavy tobacco smoking in opioid-maintained pregnant women is associated with adverse medical and developmental consequences for the newborn. Future treatment programs for this target group should focus on an individualized approach to opioid maintenance therapy in addition to offering specially tailored counseling for smoking cessation.

S64-02 Addiction services in Cyprus: Results of the EU twinning project evaluation

In April 2007 a European twinning project started between Cyprus and Germany, in order to assist Cyprus as a new Candidate Country in the implementation and harmonisation with the European Community's legislation, by evaluating the governmental drug services in Cyprus and their coordination and promoting the improvement and introduction of new drug treatment services. A field investigation studied parameters as population in need, treatment demand and coverage, as well as high risk patterns and their trend over the last years, showing an individual place of Cyprus in the international drug ranking, with the highest prevalence of cannabis and second highest on ecstasy abuse and one of the smallest in opiates and amphetamine consumption. Nevertheless heroin remains the primary drug of abuse in persons seeking treatment, although Cyprus was until 2008 the only country of the European Union without a substitution treatment. Furthermore this project studies in detail the current availability of the governmental drug facilities, their structure and coordination as well as the legal framework in which they operate, showing a still adapting drug care system, trying to keep up with the increasing special needs of the Cypriot population, but offering the presuppositions for an efficient and good functioning drug care system in the future.

Naltrexone for the Treatment of Amphetamine Dependence: A Randomized, Placebo-Controlled Trial

Currently there is no approved pharmacotherapy for amphetamine dependence. Recent human laboratory studies have demonstrated that naltrexone modulates some of the reinforcing effects of amphetamine. The aim of this study was to investigate the efficacy of naltrexone in comparison with placebo in reducing relapse to amphetamine use in amphetamine-dependent patients. Eighty patients who met DSM-IV criteria for amphetamine dependence were randomized to 12 weeks of double-blind naltrexone (50 mg) or placebo treatment. Patients visited the clinic twice weekly to receive medication and relapse prevention therapy and leave urine samples, which were analyzed for drug toxicology and for assessing adherence to medication via detection of naltrexone's metabolite (6-beta-naltrexol). The main outcome measure was abstinence from amphetamine use, as indicated by the total number of negative amphetamine urine samples during 12 weeks of treatment. All missing urine samples were defined for the analysis as positive for amphetamine. Overall, 55 patients (68.8%) completed the trial. The intention-to-treat analysis showed that the naltrexone group had a significantly higher number of amphetamine-negative urine samples compared with the placebo group. Survival analyses showed that the treatment groups differed in rate of continuous abstinence, in both the intention-to-treat and completer samples, in favor of naltrexone treatment. There was a significant reduction in craving levels and self-reported consumption of amphetamine in the naltrexone group compared with the placebo group. Treatment with naltrexone was well tolerated in this sample. This trial demonstrated the efficacy of naltrexone in reducing amphetamine use in amphetamine-dependent individuals.