Amphetamines Toxicity - An Overview

Introduction:

Amphetamines belong to a group of drugs called central nervous system stimulants used for conditions like narcolepsy, attention deficit hyperactivity disorder (ADHD), and obesity. The toxicity of amphetamines occurs when they are abused or used as recreational drugs. The most commonly abused amphetamine drugs are methamphetamine (METH) and its derivative, 3,4-methylenedioxymethamphetamine (MDMA). Their mechanism of action is an increase in the neurotransmission of dopamine, serotonin, and norepinephrine. These neurotransmitters through the serotonin and dopamine transporters enter into the neurons and displace the storage vesicles. There is a greater affinity of MDMA for serotonin transporters. Amphetamine toxicity produces clinical effects which are significant and often end up in emergencies.

What Is the Cause of Amphetamine Toxicity?

Amphetamine toxicity occurs when the drug is used for recreational purposes (drugs taken occasionally for enjoyment). METH is available in various forms and can be used as smoked, inhaled, injected, or consumed orally. But the most common way of abuse is by smoking METH. When METH is either smoked or injected it produces a “flash” or “rush” phenomenon which can lead to a drug addiction causing serious health problems. The etiology of abuse is not clear but it can be due to the tolerance effect wherein more and more amounts of the drug is required to produce the same level of action. It can happen due to a decrease in the number of receptors postsynaptically and a decrease in neurotransmitter storage presynaptically. There is always a higher possibility of addiction with the overuse of this drug. It is called by street names such as speed, ice, uppers, and crank.

What Are the Signs And Symptoms of Amphetamine Toxicity?

Amphetamine makes the individual feel more energized and confident and makes thinking clear. Since it is a strong central nervous system stimulant, its stimulating effect can be addicting both physically and psychologically. The overall health is severely affected due to addiction to the stimulating effects. Long-term abuse of this drug can damage neurons and can cause seizures, stroke, dysrhythmias, and psychosis. The overdose can be of two types. It can either be acute or chronic.

Acute Overdose: It is a short-term overdose which happens when it is consumed in a higher dose by accident or on purpose. It can result in death.

Chronic Overdose: It is a long-term overdose and happens when people take it regularly over a few years. Other symptoms include:

• Heart attack.

• Chest pain.

• Agitation, irritability, and other behavioral changes.

• Increase in body temperature (hyperthermia).

• Kidney failure.

• Seizures and tremors.

• Stroke.

• Coma or loss of consciousness.

• Breathing difficulties.

• Sweating.

• Fainting, nausea, and vomiting.

• Delirium.

• Psychosis, hallucinations, and delusions.

• Dehydration and urine retention.

• Rapid speech.

• Doing persistent and repetitive tasks.

• Compulsive behavior like cleaning house and skin picking.

• Restlessness.

What Is the Treatment for Amphetamine Toxicity?

• The treatment starts with preventing the intoxicated people from causing harm to themselves and others because they would be hostile and rude since they are feeling paranoid from the drug toxication.

• Physical and chemical restraining would be required to prevent harm to self and the people surrounding them. Medical emergencies need to be identified and treated first to avoid mortality. Life-threatening emergencies such as seizures, airway obstruction, trauma, accident, and cardiac dysrhythmias also needs to be addressed.

• The treatment can be supportive therapy by putting the patient under sedation and observation if the patient does not experience any life-threatening emergencies. The drugs used for sedation and to prevent an episode of seizure are benzodiazepines.

• In some cases, activated charcoal is given orally to a conscious patient to reduce the absorption of amphetamine in the digestive tract.

• Lots of fluid is given to treat dehydration and to eliminate any potential electrolyte imbalance.

• Emergency Test: A patient arriving at an emergency room for the reason of amphetamine toxicity is run through some tests like a CT scan to check for bleeding and an electrocardiogram (ECG) to assess the condition of the heart. Chest X-ray is taken if a patient has difficulty in breathing.

• General tests like blood and urine tests are taken. Toxicology screening is done to determine the drug levels in the body.

• Life-Saving Treatment: When patients acutely overdose on very high amounts of amphetamine, the patients require some treatment techniques to save them from death. Those techniques are monitoring oxygen and clearing the airway obstruction if any to allow the patient to breathe easily and maintain a patent airway. Since the body temperature of the patient is high, rapid cooling of the body is done.

What Is the Prognosis of Amphetamine Toxicity?

• Complete recovery from the drug overdose is possible but how healthy the patient has recovered depends on the amount of drug being taken and how fast they were treated.

• The success and quality of recovery are better with faster access to medical treatment. Even with augmented medical treatment, psychosis, and paranoia can be present for 10-12 months. But insomnia and memory loss can be permanent.

• The changes to skin and tooth loss are permanent. The patient can replace the tooth for cosmetic purposes.

• If there is any incidence of heart attack or stroke, it could cause permanent paralysis or disability.

• A stroke or cardiac attack might have occurred due to very high body hyperthermia and high blood pressure. Since the drug is abused intravenously through injections, there is a possibility of infection to the heart, lungs, kidneys, brain, liver, and spine. This infection can leave permanent damage to the organs even with appropriate treatment.

• If the overdose is very severe, it can lead to death, but death due to amphetamine toxicity is rare.

Conclusion

An overdose of drugs denotes a tendency of substance abuse, which can happen again in the future and lead to addiction. Those patients can be enrolled in individual or group sessions for counseling. Proper education and awareness regarding the consequences of drug abuse should be given to people recovering from addiction.