Type Substance AKA

By Gopyraj Sundararajah Examples of the Amphetamines

Amphetamine (phenylisopropanlamine: alpha- methylphenlyethylamine) Methamphetamine (methlyamphetamine) 3,4-methylenedioxymethamphetamine (MDMA or ecstasy) 3,4-Methylenedioxyamphetamine (MDA) 3,4-methylenedioxy-N-ethylamphetamine (MDEA, MDE) 3,4-methylenedioxy-alpha-ethyl-N- methylphenethylamine (MBDB) Pseudoephedrine

What Do They Do?

Stimulant – It stimulates the central nervous system (nerves and brain) by increasing the amount of certain chemicals in the body

Appetite suppressant – This increases heart rate and blood pressure and decreases appetite, among other effects Clinical Use

Treat narcolepsy

Attention deficit disorder with hyperactivity (ADHD)

Other purposes? Methamphetamine Slang

Speed Whiz Crystal meth Ice Shabu Pure Base Rock Crank P The nickname "P" is unique to New Zealand. How Is It Taken Snorted (especially powdered 'speed')

Smoked ('P', a common variant, is often smoked through a glass pipe)

Injected

Eaten (in pill form)

Inserted anally (shelving) Common Effects

Energy and alertness

Talkativeness, increased confidence, excitement

Difficulty sleeping, Reduced appetite

Feelings of power and invincibility

Aggression, paranoia, irritability

Increased heart rate, breathing and blood pressure

Sweating, dry mouth, dilated pupils

Increased Use Commonly Results In Compounding paranoia

Psychosis

Extreme mood swings

http://www.hollywoodgrind.com/tag/methamphetamine/ Increased Use Commonly Results In

Tweaking

Violence – Serious assault – Homicide

Downer

Origin

Amphetamine has to be synthesized

Synthesized in 1887 by Lazăr Edeleanu, a chemist in Germany

He was looking for compounds related to ephedrine, a drug found in a Chinese herb

Methamphetamine, much more potent and easier to make than Amphetamine, was first synthesized in 1919 in Japan The Discovery

No pharmacological use until 1927

Gordon Alles Psychopharmacologist Use and Abuse

1933 or 1934 Smith, Kline and French

Inhaler - Benzedrine

Decongestant Highs and Lows

World War II

72 million tablets were issued to British forces

Hitler is said to have been on daily injections.

FDA banned Benzedrine inhalers

Limited amphetamines to prescription use in 1965

A schedule II drug under the Controlled Substances Act in 1971

USAF

A U.S. Air Force F-16CJ patrols the northern "no-fly" zone over Iraq. Pilots on such long patrols often take amphetamine "go pills" to stay alert.

Amphetamines are believed to have played a role in the deaths of four Canadian soldiers in Afghanistan involved in a friendly fire incident (2003). Articles Related to P Usage on NZ Herald This May?

• Saturday May 30, 2009 • P labs give home owners toxic shock • Mothers lament lack of aid for addicts • Customs cuts will assist P smugglers - Labour • Border security gaps real problem in fight against P, say pharmacists • Frontline addiction services: P addicts curable if society will make the commitment • Denis O'Reilly: Let's cut the hype and look at the realities of methamphetamine • Pharmacists urged to join P-pill ban • Making cold pills prescription better than ban - Goff • PM moves to ban P-makers' vital cold pills • Should the Government ban pseudoephedrine in NZ? • Govt considering way to deal with 'P' problem, says Key • Public face masked criminal's private life • Saturday May 23, 2009 • The night Dad was bashed to death • The war on P: Phoebe's story • Government to make treatment of P addicts a priority • The war on P: Graphic view of addiction's ravages • Still scarred by a stranger's addiction • Overwhelmed by paranoia, moods • Jackie's story: P has destroyed my life • Editorial : Lawmakers need to step up in P fight • The war on P: Angie's poem • Paul Holmes on Millie's drug addiction, celebrity friends and his hero • Drug education in schools panned • Drinking ads see help calls skyrocket • Students sign up for random drug tests • Families hit by P struggling to find treatment • Auckland trial uses Ritalin to wean users away from P • 'The horror stories are true - it's terrible' • Quiet revolution in dealing with young offenders • Millie Elder pleads not guilty to drugs charges • Hearing for ex-journalist drug accused • Chemist faces life term for supplying P-makers • Drug kingpins in for a hostile time • Police gaining greater powers to fight drug trade • Law tweak to nab drug dealers • Customs faces huge tracking task • Beatles, Ali help in fight against P • Doubts raised on pill-shopper watchdog

Saturday May 16, 2009 • P - drug tide swamping police, courts • Police stumble on huge jail-based P ring • Waging war on P

Friday May 8, 2009 • Two jailed for 30 years for supplying drugs • Evacuation as police deal with P-lab • P-addict jailed for violent attack • Man arrested for P at alcohol check point • Millie Elder faces new drug charges

47 articles Is it a Problem in New Zealand?

New Zealand has among highest drug abuse rates in world Thursday Sep 25, 2003

P - drug tide swamping police, courts Saturday May 16, 2009

"a massive and extraordinary effect on crime“

“At least 80 per cent of recent High Court trials were connected to the drug, he said”

Auckland's top prosecutor, Crown Solicitor Simon Moore New Zealand Drug Foundation 55 percent of frequent methamphetamine users Negative impact: Health, Friendship, Social life

21 percent of frequent users reported suicidal thoughts

13 percent made 'suicide attempts' after using methamphetamine

31 percent had injected in the previous six months

73 percent had 'binged' in the previous six months, using the drug continuously for more than 48 hours

52 percent said methamphetamine was "very easy" to get

17 percent said they could source methamphetamine in less than 20 minutes. Recent Trends In Illegal Drug Use In New Zealand 2006-2008

Findings from the 2006, 2007 and 2008 Illicit Drug Monitoring System (IDMS)

By C.Wilkins, R. Griffiths, P. Sweetsur Recent Trends

General population who had ever tried methamphetamines in 2006 – 9.0%

Proportion of the population who had used methamphetamines in the previous 12 months in 2006 – 3.4%

Current Availability of Methamphetamine by Combined Frequent Drug Users Reliability of Supply of Methamphetamine in Past Six Months by Combined Frequent drug users Lifetime Prevalence and Prevalence in The Past 12 Months of Amphetamine Use Lifetime Prevalence and Prevalence in the Past 12 Months of Crystal Methamphetamine Use Lifetime Prevalence and Prevalence in The Past 12 Months of Ecstasy Use Proportion of Clients Testing Positive For Problematic Drug Use by Drug Type LabPlus Finding

Number of Amphetamines Tested

1000 800 2006-2007 600 2007-2008 400 2008-2009

Test Number 200 0

ul t v r J ep c Jun Aug S O No Dec Jan Feb Mar Ap May Month LabPlus Finding

Amphetamines Type Substances

14.0 12.0 10.0 2006-2007 8.0 2007-2008 6.0 4.0 2008-2009 2.0

Percentage positive Percentage 0.0

ul p t v r J c Jun Aug Se O No Dec Jan Feb Mar Ap May Month Screening for Amphetamines

The primary screening: Immunoassays

Sample Type: Urine

Difficult to produce specific immunoassay antibodies

Monoclonal and polyclonal antibodies are used in immunoassay Types of Immunoassays

Highly selective for either amphetamine or methamphetamine

Detect both amphetamine and methamphetamine To varying extent but that also exhibit higher levels of cross- reactivity to the hydroxy amine compounds found in many over- the-counter (OTC) drugs.

Assays that consist of dual assays for amphetamine and methamphetamine With low levels of cross-reactivity to OTC drugs. How to Pick The Right Assays

Influenced by the intended use of the testing

Laboratories performing workplace drug testing desire immunoassays specific for only those compounds

On the other hand, laboratories affiliated with an emergency department (ED) desire immunoassays directed toward the broad spectrum of amphetamines LabPlus

LabPlus perform both Work Place Drug Testing and Clinical Work

CEDIA Amphetamine/Ecstasy assay

Immunoassay cut-off of 300 ng/mL AS/NZS 4308 cut-off 300 ng/mL

Other labs? CEDIA Amphetamine/Ecstasy Assay CEDIA Amphetamine Assay Workplace Drug Testing

Screening using immunoassay

Confirmation can be carried out for workplace drug testing – Amphetamine – Methamphetamine –MDMA –MDA

Using AS/NZS 4308:2008 Cut off level of 150 ng/mL Clinical Work

Screening using immunoassay

Most immunoassay positive will get secondary screen

Characterization Screening Procedure using GC-MS Amphetamine Phentermine Methamphetatmine Ephedrine/Pseudoephedrine Methylenedioxyamphetamine (MDA) Methylenedioxymethamphetamine (MDMA) Benzylpiperazine (BZP) Immunoassay vs GCMS

Immunoassay vs GCMS

160 26% 140 120 68% 33% 100 Immunoas s ay 80 43% 60 GCMS 40 20 Number of positives 0 300-310 311-320 321-330 331-350 Amphetamine CEDIA value (ng/mL) Issue With Immunoassay?

What is giving the “false” positive immunoassay results? Phenylethylamine - maybe

Is the cut-off for immunoassay should be adjusted?

What does the clinician want? Remember

Amphetamine abuse is a real problem in NZ

Lab data shows drop in amphetamine positive results in recent year

Amphetamine immunoassay results might not be what your clinician wants