Amphetamine Type Substance AKA Amphetamines 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) Ephedrine 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 1000 800 600 Number of Amphetamines Tested 400 Test Number 200 0 Jun Jul Aug Sep Oct Nov Dec Month Jan Feb Mar 2006-2007 Apr 2007-2008 2008-2009 May LabPlus Finding 14.0 12.0 10.0 8.0 Amphetamines Type Substances 6.0 4.0 Percentage2.0 positive 0.0 Jun Jul Aug Sep Oct Nov Dec Month Jan Feb Mar 2006-2007 Apr 2007-2008 2008-2009 May 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.