Przemyslaw Zuratynski1, 2, Dawid Pietrzak3, Sylwia Jaltuszewska4, Kamil Krzyzanowski1, Rafal Szczepanski1, Marlena Robakowska5, *Daniel Slezak1
Patient abusing amphetamine and its derivatives in terms of emergency medicine – assessment of differential diagnosis and treatment
Pacjent nadużywający amfetaminy oraz jej pochodnych w aspekcie medycyny ratunkowej – ocena diagnostyki różnicowej oraz sposobu leczenia
1Department of Emergency Medicine, Faculty of Health, Medical University of Gdansk, Poland
2Independent Public Multi-Specialist Health Care Unit of the Ministry of Interior and Administration in Bydgoszcz, Poland
3Dr. Antoni Jurasz University Hospital No. 1 in Bydgoszcz, Poland
4Institute of Health Sciences, Medical Rescue Department, Pomeranian Academy in Slupsk, Poland
5Department of Public Health and Social Medicine, Faculty of Health, Medical University of Gdansk, Poland
Na rynku narkotykowym istnieje wiele związków chemicznych, które są bardzo niebezpieczne dla zdrowia, a nawet życia zażywających. Powstające nowe produkty, często jako mieszanki i wzmocnione stężenia, zachęcają do spróbowania. Jedną z takich substancji jest amfetamina i jej pochodne. Amfetamina jako środek leczniczy – benzydyna, została wprowadzona w 1932 roku przez firmę Smith, Kline & French. Wykorzystywana była do leczenia stanów zapalnych błony śluzowej nosa i astmy oskrzelowej, dodatkowo do leczenia narkolepsji. W czasie II wojny światowej jej właściwości były wykorzystywane jako środek stymulujący przez żołnierzy amerykańskich. W latach 60. XX wieku amfetamina była stosowana jako specyfik wspomagający odchudzanie. Jak podają źródła, w 2000 roku na rynku europejskim sprzedano ponad 30 mln tabletek amfetaminy.
There are many dangerous chemicals on the drug market that are very dangerous to the health and even life of the users. New products, often in blends and reinforced concentrations, encourage people to try them. One such substance is amphetamine and its derivatives. Amphetamine as a therapeutic agent – benzidine – was introduced in 1932 by Smith, Kline and French. It was used to treat inflammation of the nasal mucosa and bronchial asthma, in addition to treating narcolepsy. During World War II its properties were used as a stimulant by American soldiers. In the sixties of the twentieth century amphetamine was used as an aid to weight loss. According to sources, more than 30 million tablets were sold on the European market in 2000.
There are many dangerous chemicals on the drug market that are very dangerous to the health and even life of the users. New products, often in blends and reinforced concentrations, encourage people to try them. One such substance is amphetamine and its derivatives. The law clearly states that we are not allowed to carry drugs with us. Even the smallest amount can cause a court to pass judgment. The punishment that will be imposed depends on the amount and type of drugs that you possess, the defendant’s previous criminal record and the defendant’s lifestyle to date. Courts usually pronounce a sentence of up to 1.5 years’ imprisonment with a conditional sentence of up to 5 years, it all depends on the defendant and how he behaves at the trial, the greater the repentance the milder the sentence. In order to approximate the consequences of the abuse of amphetamine in terms of emergency medicine, it is necessary to start by characterising the structure and use of this drug.
Amphetamine and its derivatives
Amphetamine (chemical designation: (±)-2-amino-1-phenylpropane; chemical formula: C9H13N; molar mass: 135.21 g/mol) is a prototype of psychostimulating drugs, which are characterized by sympathicomimetic effects and strong effects on the central nervous system (CNS). It was first synthesized in 1887 by Romanian chemist Lazar Edeleanu. The properties of amphetamine were first described in 1927. In the list of psychotropic substances, besides the international name, amphetamine has another name – psychedrin. Amphetamine reaches its maximum concentration in the blood about 2 to 3 hours after consumption, and the half-life is 7 to 14 hours. It increases when the pH is less than 6.7 and then it can reach up to 34 hours. Amphetamine in its pure state is a colourless liquid, which dissolves poorly in water, but well in acids. It is commonly found as a salt. Illegally produced amphetamine sulfate is in the form of white, yellow or brown powder, depending on the type of contamination and production technology. Sometimes it has an unpleasant solvent smell (1-4).
Amphetamine has many hallucinogenic compound derivatives, i.e.:
– methamphetamine – an organic chemical compound called stimulant, which is based on the β-phenylethylamine skeleton. It is a white, odorless powder with a bitter taste, easily dissolved in water. It is most often found in the form of an unpurified, white and yellowish egg-smelling powder or as a high-purity methamphetamine hydrochloride – characteristic transparent crystals,
– 2,4,5-trimethoxy-amphetamine (TMA) – first synthesized in 1933. TMA is equivalent to naturally occurring mescaline in cacti (Peyotl and San Pedro). TMA may be present in 1 of 6 groups of substances (TMA, TMA-2, TMA-3, TMA-4, TMA-5 and TMA-6),
– methyl-2,5-dimethoxyaamphetamine (DOM) – first synthesized in 1963,
– paramoxyamphetamine (PAM) – first synthesized in 1963,
– 3,4-methylenedioxyamphetamine (ecstasy) – an organic chemical compound which resembles the structure of amphetamine. The half-life of MDMA is about 7 to 10 hours and its maximum serum concentration after consumption reaches about 2 to 3 hours (3, 4).
Amphetamine as a therapeutic agent – benzidine – was introduced in 1932 by Smith, Kline and French. It was used to treat inflammation of the nasal mucosa and bronchial asthma, in addition to treating narcolepsy. During World War II its properties were used as a stimulant by American soldiers. In the sixties of the twentieth century amphetamine was used as an aid to weight loss. According to the sources, in 2000, over 30 million tablets were sold on the European market (5).
Availability and performance of amphetamine and its derivatives
Amphetamine is a drug that is highly addictive mentally and physically weak. Psychoderine affects the body in such a way that it tolerates everything and everyone. The drug is most often used in an oral form dissolved in liquid because it is well absorbed from the digestive tract. Another method of taking amphetamine is to take it through the nose or by intravenous injection. “The ideal dose”, the drug is 1 g but there are often cases where the dose is increased up to 7 g per day. Amphetamine is a favorite drug of young people, because it helps to concentrate on the activity, gives a relaxing effect and above all it is cheap. This drug has small side effects compared to other drugs available on the illegal market.
Unfortunately, Poland is among the leading countries importing and exporting amphetamine and its derivatives.
Methamphetamine has a much stronger effect on the CNS, causing euphoric effects similar to those of cocaine but with a longer duration. There is a variety of methamphetamine, which you take by burning it in a special pipe. Pure methamphetamine is taken by injecting it intravenously and sometimes it is taken through the nose or orally. After injection or burning, the effect of euphoria occurs within 5 to 15 seconds, after oral or nasal use, the happiness effect has to wait from 15 to 20 minutes and is usually weaker. The consequences of taking methamphetamine are much more serious than those of amphetamine alone. Dependence on this drug is rapid and very serious. A person who takes methamphetamine over time will take more and more doses because he or she is not satisfied, starts neglecting daily activities and only thinks about taking another dose of the drug, and often falls asleep for up to 48 hours after taking it! When he wakes up, he feels depressed and wonders what to do to take another dose of “booster”. Such behaviour often leads to mental and physical problems, such as chest pain, hypertension, subcutaneous micro-inflows and arrhythmia. A human being rolls down to the social bottom. Rapid withdrawal can cause as severe effects as its frequent use, such as headaches, drowsiness, intestinal spasms and depression. Quitting is very difficult and requires the help of doctors and psychologists. Methamphetamine is much more dangerous because it is often used as a cocaine substitute and is much cheaper.
The most popular drug of recent times was the Ecstasy pill. Taking it causes short-term euphoria, increased perception, excitement, talkativeness, a sense of strength and a high dose of energy. When someone takes too much, you may notice short lasting side effects such as: visual and sensory hallucinations, increased pulse and pressure, pupil dilatation. You can also see increased sweating, rapid temperature changes and chest pains. After MDMA you can also see long-term effects such as insomnia, anxiety loss, self-aggression and aggression against others, delusions, psychosis and sometimes even death. When someone overdoses ecstasy, insomnia, irritability, hyperactivity, hallucination, sudden pressure surges, convulsions and sometimes death are observed (6).
Amphetamine and derivative poisoning
Easy accessibility, stressful situations and widespread use are leading to increased levels of drug and drug poisoning. These situations are most common among young people, especially students and young learners.
Methamphetamine has a stimulating effect on the sympathetic part of the autonomic sympathetic system. It causes dilatation of the pupils, narrowing of blood vessels, increase in blood pressure, increase in the frequency of myocardial contractions, increase in body temperature, disruption of bronchial smooth muscles and acceleration of breathing.
A person who has taken methamphetamine has a strong euphoria, is polite and sexually aroused. After taking the drug, nausea, vomiting, jaws, limb muscle tremors or dry skin may occur, and unusual behaviours such as excessive irritability or aggressiveness and panic attacks may also occur.
Acute methamphetamine intoxification leads to strong psychomotor excitation, a significant increase in body temperature, i.e. hyperthermia, and tachycardia. In addition, hallucinations, delusions, panic attacks, fortifications, photophobia and tension headaches can be observed. Hyperthermia in such a state may threaten dehydration or even death. During such poisoning, kidney failure and rhabdomyolysis may occur in the body. Cerebral haemorrhage, ischaemic stroke, myocardial infarction and pulmonary hypertension in such a situation usually lead to death.
A person who has abused the drug may develop a range of conditions such as sight or hearing impairment, arrhythmia or, in more serious cases, myocardial infarction and amphetamine psychosis during amphetamine poisoning. When taken intravenously, the drug can cause cyanosis, clots, blockages and subarachnoid hemorrhages. After taking too much amphetamine, cardiovascular problems such as tachycardia, i.e. accelerated heart rate, chest pain, cardiovascular collapse, vasospasm or even stroke occur. On the part of the nervous system in such people we can encounter symptoms such as agitation, convulsions, anxiety, hyperthermia. Additional symptoms from the autonomic system are dilated pupils, excessive sweating, nausea, or an accelerated rate of tachypnoe breathing.
A person who abuses ecstasy shows behaviors such as high emotional tension, depersonalization, anxiety that can turn into panic, hallucination and even depression. After taking MDMA, you may notice pupil dilatation, agitation, strange behavior that is generally not observed and sometimes even a lack of motor coordination. After an overdose of the drug, malignant neuroleptic syndrome can occur, which is characterized by a drop in blood pressure, a sudden rise in body temperature, convulsions and coma, which can lead to death. Ecstasy causes ventricular fibrillation and is particularly dangerous for people with heart disease. In many people, after taking too high a dose of the agent, there is a jawbone and gnashing of teeth which can cause teeth to crumble (7, 8).
Addiction to amphetamine and related compounds
Amphetamine has strong addictive potential. Feelings after taking it such as euphoria, joy, satisfaction or self-confidence encourage to reach for the next dose. Ailments after taking the drug reinforce mental hunger. A person who is addicted to the drug has abstinence symptoms such as feeling unwell, fatigue, apathy, gastric disorders, irritability, anxiety, chills, falls into a vicious circle of addiction. The drug is highly addictive mentally and less physically. After the so-called amphetamine sequence, prolonged sleep, apathy, headaches and even suicidal thoughts can occur.
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