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The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer.—U.S. Drug Enforcement Administration (DEA) fact sheet

ABOVE: Drug Enforcement Administration, US Department of Justice. “Drug Fact Sheet: Amphetamines,” undated, retrieved January 5, 2013: www.justice.gov/dea/druginfo/drug_data_sheets/Amphetamines.pdf.
dictionary illustration of phrenology brain Mark Strozier

Like sterioids for the brain, amphetamines can make people better at whatever they do, until the effects wear off. Are the benefits worth the side-effects?

Amphetamines in FOCUS:
Brain-Performance, Stay-Awake and Anorectic (Lose-Desire-to-Eat) Drugs

These powerful stimulants do more than increase alertness, concentration and mental productivity, amphetamines decrease fatigue and produce a short-term mood elevation, even in those who are not depressed. Like steroids for the brain, amphetamines can make people perform better at whatever they do, until the effects wear off. The next day without the drug, amphetamine users often complain that they feel tired, “stupid,” or depressed.

Drug Enforcement Administration, Department Of Justice: Schedule II Controlled Substance

What are Amphetamines?

All the following are collectively called “amphetamines”:

All amphetamines (amphetamine, dextroamphetamine and methamphetamine) have essentially the same chemical properties and their actions are so alike that even experienced users may not feel a difference between them, according to a 2005 report by the Drug Enforcement Agency (DEA).

ABOVE: Drug Enforcement Administration, US Department of Justice. “Amphetamines,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed.

Using amphetamines once is sufficient to induce some of these symptoms:

Short-Term Effects:

  • Enhanced mood and body movement
  • Increased wakefulness, physical activity
  • Increased respiration
  • Euphoria
  • Insomnia
  • Increased heart rate
  • Increased blood pressure
  • Reduced appetite
  • Cardiovascular collapse, death
  • Dilated pupils

Long-Term Effects:

  • Damage to brain cells containing serotonin
  • Over time, reduced level of dopamine resulting in Parkinson's-like symptoms
  • Weight loss
  • Confusion
  • Tremors
  • Convulsion
  • Paranoia
  • Hallucinations
  • Damage to nerve cells, causing strokes
  • Cardiovascular collapse, death

Effects from Withdrawal:

  • Irritability
  • Anxiety
  • Paranoia
  • Aggressiveness
  • Fatigue and long periods of sleep
  • Depression

Behaviors resulting from amphetamine intoxication such as withdrawal from others, experiencing hallucinations, paranoia, delirium perhaps occurring with violence and stereotyped behaviors such as repeatedly assembling and dissembling electronic equipment may resemble symptoms of schizophrenia. But a skilled clinician should be able to make the proper diagnosis.

ABOVE: Psychology Today's Diagnosis Dictionary: Amphetamines; last reviewed by Fiery Cushman on Jan. 10, 2005; captured from www.psychologytoday.com on Jan. 8, 2008.

History of Amphetamines

First marketed as Benzedrine in an asthma inhaler, amphetamines became very popular as “uppers” and diet pills by the mid-1900s. Military commanders, truck drivers and students turned to amphetamines for similar reasons: They can keep you fighting long after your body would otherwise surrender to sleep.

As use of amphetamines spread, so did their abuse. In 1965, federal drug laws were initiated to curb the black market in amphetamines and now all amphetamines are considered potential drugs for abuse under the Controlled Substances Act. Production levels in the United States are regulated by the DEA, which sets quotas (or limits) on the amount that may be manufactured each year, in an effort to control illegal uses.

How Amphetamines Work

When we are stressed or under threat, the central nervous system prepares us for physical action by creating particular physiological changes. Amphetamines prompt the brain to initiate this 'fight or flight' response. These changes include:

  • The release of adrenalin and other stress hormones
  • Increased heart rate and blood pressure
  • Redirected blood flow into the muscles and away from the gut

In small doses amphetamines can banish tiredness and make the user feel alert and refreshed. However, this drug-induced burst of energy and focus comes at a price: a “speed crash” always follows the high and may leave the person feeling nauseous, irritable, depressed and extremely exhausted.

Used For

  • Attention deficit disorder
  • Narcolepsy
  • Depression
  • Obesity

Common Side Effects

  • Nervousness
  • Insomnia
  • Loss of appetite
  • Addiction

Less Common Side Effects

  • High blood pressure
  • Rapid pulse rate
  • Tolerance (continued need to raise the dose)
  • Feelings of suspicion and paranoia

FDA Warning: Links Between ADHD Drugs and Priapism and Sexual Dysfunction

In a recent drug-safety announcement, the FDA announced that drugs containing methylphenidate must including warnings about the risk of priapism. (Methylphenidate drugs include: Concerta, Daytrana, Focalin, Metadate, Methylin, Quillivant, and Ritalin.) It's a serious problem: priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

The FDA included an even stronger warning about atomoxetine (Strattera): “Priapism appears to be more common in patients taking atomoxetine than in patients taking methylphenidate products. Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine.”

The safety warning also raised concerns about links between priapism and amphetamine drugs, which include Adderall, Dexedrine, ProCentra and Vyvanse.

ABOVE: U.S. FDA Drug Safety Communication: FDA warns of rare risk of long-lasting erections in males taking methylphenidate ADHD medications and has approved label changes. (12/17/2013).

Required “Black Box” Warning Label

The Food and Drug Administration (FDA) requires the following “black box” warning on all amphetamines, which means that medical studies indicate the drugs carry a significant risk of serious, or even life-threatening, adverse effects.

WARNING

AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NONTHERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.

MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.

ABOVE: FDA black box warning label means that medical studies indicate the drug carries a significant risk of serious or even life-threatening adverse effects. The bold warning label appears on the manufacturer's wholesale packaging and is the strongest alert the FDA can require of drug-makers.

If It Doesn't Work

The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.

Abrupt cessation of amphetamine drugs can cause extreme fatigue and severe, even suicidal, depression in adult patients.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

If It Does Work

"In the treatment of ADHD for children and young adults, [amphetamine] is now prescribed frequently, often as a first-line drug. This is, in my opinion, a very serious mistake," states Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. "[Amphetamine] is now abused throughout college campuses, where it is bought, sold, stolen, borrowed, snorted and injected. It is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first."

What are the Risks?

Dependence, Tolerance and Withdrawal

It is possible to build up a tolerance to amphetamines, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on amphetamines just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.

Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of "binge crash" characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.

Amphetamine-Induced Psychosis

Induction of schizophrenic-like states in children on prescribed doses of stimulant medications, including Adderall, have been observed, though not as well documented as with amphetamine abusers, according to The Journal of the American Board of Family Medicine in an article entitled, "Adderall-Induced Psychosis in an Adolescent."

Amphetamine-Induced Anxiety Disorder

The onset of amphetamine-induced anxiety disorder can occur during amphetamine use or withdrawal, according to best-selling psychiatry text, Kaplan and Sadock's Synopsis of Psychiatry citing American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

"Amphetamine, as with cocaine, can induce symptoms similar to those seen in obsessive disorder, panic disorder, and phobic disorders," states Synopsis of Psychiatry.

Amphetamine-Induced Sexual Dysfunction

Referring again to American Psychiatric Association's Manual of Mental Disorders, Synopsis of Psychiatry states: "High doses and long-term use of amphetamines are associated with erectile disorder and other sexual dysfunctions."

meth mouth: pus-streaked gums and blackened and broken rotting teeth is attributed to heavy methamphetamine use Photo taken by Dozenist

ABOVE: Pus-streaked gums with blackened and rotting and broken teeth are attributed to heavy methamphetamine use. Despite its street name “meth mouth,” similarly accelerated tooth disease can be caused by the abuse of other stimulants with similar actions, such as amphetamines, cocaine and methylphenidate. NEWSWEEK, Aug. 8, 2005: www.slate.com/~.

Abuse

Abuse of amphetamines has many serious potential side effects, including psychotic behavior, depression, anxiety, fatigue, paranoia, aggression, violent behavior, confusion, insomnia, auditory hallucinations, mood disturbances and delusions.

Violent and erratic behavior is frequently seen among chronic abusers of amphetamines, especially methamphetamine.

According to the DEA the effects of amphetamines are similar to cocaine but the onset is slower and the duration is longer. Chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one’s own thoughts, and auditory and visual hallucinations. These psychotic symptoms can persist for months and even years after use of these drugs has ceased, and may be related to their neurotoxic effects.

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  • SOURCES:
  • Drug Enforcement Administration, US Department of Justice. “Stimulants,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed.
  • Drug Enforcement Administration, US Department of Justice. “Drug Fact Sheet: Amphetamines,” undated, retrieved January 5, 2013: www.justice.gov/dea/druginfo/drug_data_sheets/Amphetamines.pdf.
  • National Institute of Mental Health. Medications. Bethesda, MD: National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services; NIH Publication No. 02-3929, 2007 ed. www.nimh.nih.gov/health/publications/medications/medications.pdf.
  • Gorman, Jack M. The Essential Guide to Psychiatric Drugs. New York, NY: St. Martin's Press, 1992.
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What do Amphetamines Include?

BRAND NAME GENERIC NAME
Adderall amphetamine plus dextroamphetamine
[instant release]
Adderall XR amphetamine plus dextroamphetamine
[extended release]
Benzedrine amphetamine
[instant release]
Biphetamine amphetamine plus dextroamphetamine
Desoxyn methamphetamine
[instant release]
Dexedrine dextroamphetamine
[instant release]
Dexedrine SR dextroamphetamine
[extended release]
Dexedrine Spansule dextroamphetamine
[extended release]
Dextrostat dextroamphetamine
[instant release]
ProCentra dextroamphetamine
[immediate release, bubblegum flavor]
Vyvanse dextroamphetamine
with lysine (lisdexamfetamine)
[extended release]
  • ALTERNATE NAMES:
  • amphetamine = amfetamine = dl-amphetamine
  • dextroamphetamine = dexamfetamine
    = dexamphetamine = d-amphetamine
  • methamphetamine = d-methamphetamine

NY Times: Children's A.D.D. Drugs Don't Work Long-Term

The NY Times, in an op-ed article by L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development:

“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects...

“Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted [because the drugs are habit-forming] to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”

ABOVE: L. Alan Sroufe, “Ritalin Gone Wrong: Children's A.D.D. Drugs Don't Work Long-Term,” New York Times, pg SR1, NY ed, 1/28/2012.

Amphetamines May Cause 60% Increase in Risk of Parkinson's Disease

Users of amphetamines, like Adderall, may be nearly 60 percent more likely to develop Parkinson's disease than those who don't take the drugs, suggests a 31-year study, presented at the American Academy of Neurology's 63rd Annual Meeting.

The study involved 66,348 volunteers in California. The average age at the start of the study was 36. By 1995, according to the researchers, 1,154 of the amphetamine-users had been diagnosed with Parkinson's disease.

The study's author stated: “If further studies confirm these findings, the potential risk of developing Parkinson's disease from these types of amphetamines would need to be considered by doctors before prescribing these drugs as well as be incorporated into amphetamine abuse programs, including illicit use.”

Amphetamines are now often prescribed to increase wakefulness and focus for people with attention deficit hyperactivity disorder, narcolepsy, and traumatic brain injuries. But when this study was conducted, between 1964 and 1973, amphetamines (Dexedrine and Benzedrine) were commonly used for weight-loss. Adderall is a blend of four amphetamines that includes Dexedrine and Benzedrine.

ABOVE: PR Newswire, “Using Amphetamines May Increase Risk of Parkinson's Disease,” St. Paul, Minn., 2/22/2011. (The study was supported by Kaiser Permanente Northern California.) www.prnewswire.com/news-releases/using-amphetamines-may-increase-risk-of-parkinsons-disease-116660444.html

How much do the “neuro-enhancing” drugs really help? And there's the question of what we mean by “smarter.”

The psycho-stimulants help students bear down on their work, but with odd effects. One college student says he spends “too much time researching a paper rather than actually writing it.” Another student looked back at papers he'd written while on Adderall and found them verbose: “I'd produce two pages on something that could be said in a couple of sentences.”

Could enhancing one kind of thinking exact a toll on others?

All these questions need proper scientific answers, but for now much of the discussion is taking place furtively, among an increasing number of Americans who are performing daily experiments on their own brains (or their children's brains).

ABOVE: Diller, L.H. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill; Bantam Doubleday Dell Pub. Group, Inc. (1998); citing Feidler, N.L., et al., "The effects of stimulant drugs on curiosity behaviors of hyperactive boys," Journal of Abnormal Child Psychology, 11:193-206 (1983). Talbot, M. "Brain Gain: The underground world of 'neuroenhancing' drugs," The New Yorker, 4/2009.

ProCentra: Liquid “Dexedrine”

ProCentra is a new name for what used to be a popular diet drug, Dexedrine. Now sold for children in bubblegum-flavored liquid and advertised as “easier to swallow.” [More]

Vyvanse is a “Pro-Drug”

Although Vyvanse is referred to as “pro-drug” of dextroamphetamine, it is still an amphetamine, meaning that it is easily abused and can cause insomnia, agitation, anxiety and sometimes psychotic symptoms like seeing things or becoming paranoid. The difference between Vyvanse and Adderall is that Vyvanse will work only if it is swallowed so that drug abusers will not be able to snort it or inject it. It is hoped this will limit abuse of Vyvanse. [More]

How Safe is Ritalin?

Many think methylphenidate (Ritalin) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it is highly addictive. [More]

20 Deaths Linked to Adderall XR

The deaths were not associated with overdose, misuse or abuse of Adderall XR, Canadian regulators said. [More]

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