psychosis, and violent behavior (SAMSHA, 2020). The highs and lows from these drugs create a binge and crash pattern (NIDA, 2018). Chronic stimulant use can alter brain structures with decreased attention span, confusion, impaired memory, inhibited impulse, and reduced motor skills (SAMSHA, 2020). Stimulant Drugs by Schedules Schedule I Aminorex; methyl-aminorex; methcathinone, animal use only
in the brain, reinforcing drug-taking behaviors, which are desensitized over time. Individuals with cocaine use present with many different symptoms. Physical effects of cocaine include constricted blood vessels, dilated pupils, increased body temperature, tachycardia, tremors, or restlessness (NIDA, 2020b). Methamphetamine is a highly addictive psychostimulant chemically related to amphetamine. In the central nervous system, amphetamines block presynaptic reuptake of catecholamines, such as dopamine and norepinephrine, causing hyperstimulation at selected postsynaptic neurons (Richards & Laurin, 2022). Other non-catecholaminergic central and nervous pathways are hyperstimulated. CNS dopaminergic alterations cause mood, excitation, motor and sensory movements, and appetite changes. Serotonin contributes to mood changes and psychotic and aggressive behavior (Richards & Laurin, 2022). This drug is inexpensive and readily synthesized from cheap chemicals, such as pseudoephedrine, anhydrous ammonia, red phosphorus, and hydrochloric acid (Richards & Laurin, 2022). Snorting or smoking methamphetamine causes excessive tooth and gum disease (meth mouth); snorting methamphetamine causes anosmia and deviated septum; smoking this drug causes lung and airway damage (SAMSHA, 2020). MDMA , commonly known as ecstasy (E or X), is derived from methamphetamine. MDMA is an indirect sympathomimetic that stimulates the release and inhibits the reuptake of epinephrine, norepinephrine, and dopamine. MDMA can cause tachycardia, elevated blood pressure, mydriasis, increased energy, anorexia, and increased concentration (Preda, 2018). Adverse effects can include nausea, diaphoresis, anorexia, tremors, myoclonus, tics, paresthesia, nystagmus, hyperreflexia, hypertension, urinary retention, and ataxia (Preda, 2018). An individual exposed to these stimulants can develop stimulant use disorder within one week (APA, 2013). Individuals demonstrating a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months meet the criteria. ● Psychomotor agitation or retardation ● Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias ● Confusion, seizures, dyskinesias, dystonias, or coma Stimulant intoxication is not a criterion for substance use disorder (APA, 2013). A specific antidote does not exist. Therefore, activated charcoal is warranted in this situation. Otherwise, supportive treatment is prescribed in the case of an overdose.
(3,4-Methylenedioxymethamphetamine) commonly known as MDMA, Cocaine Amphetamines, dextroamphetamine; methamphetamine, methylphenidate; phentermine Clortermine, not currently in use Phendimetrazine, weight loss; benzphetamine, weight loss
Schedule II
Schedule III
Schedule IV Diethylpropion, weight loss; Modafinil Schedule V Pyrovalerone (Preda, 2018)
Cocaine is a naturally occurring alkaloid obtained from the Erythroxylon coca shrub (Holstege et al., 2021). First used by ancient Peruvians, Freud later proposed cocaine to treat depression, asthma, and cachexia (Holstege et al., 2021). Today, cocaine has limited medical use but is widely used as an illicit drug through inhalation (snorting) and other routes. When snorted, the onset of action is within five minutes and typically peaks within 30 minutes. The half-life of cocaine is 30-90 minutes and can be absorbed across any mucosal surface, including respiratory, gastrointestinal, and genitourinary tracts (Holstege et al., 2021). The drug has numerous adverse health effects on all organ systems (Holstege et al., 2021). Cocaine increases dopamine
STIMULANT INTOXICATION
As in other situations, behavioral and psychological changes occur in stimulant intoxication. Auditory hallucinations or paranoid ideations may be prominent (APA, 2013). Signs and symptoms of intoxication develop during or shortly after use, including ● Tachycardia or bradycardia ● Pupillary dilation ● Elevated or lowered blood pressure
● Perspiration or chills ● Nausea or vomiting ● Evidence of weight loss
STIMULANT WITHDRAWAL
The essential feature of stimulant withdrawal is characterized by the development of dysphoria along with ● Fatigue
Bradycardia is often present and can be a withdrawal measure (APA, 2013). Additionally, anhedonia and drug craving can also be present. Withdrawal lasts up to 1-3 weeks. Pharmacotherapeutics utilized in withdrawal include trazodone, benzodiazepines, and neuroleptics as part of a comprehensive treatment plan (Preda, 2018).
● Vivid, unpleasant dreams ● Insomnia or hypersomnia ● Increased appetite ● Psychomotor retardation or agitation
HALLUCINOGEN RELATED DISORDERS
A long history of using hallucinogenic plants exists among humans for ceremonial and religious purposes. However, defining psychoactive drugs that are so diverse in chemical structures is challenging. Hallucinogens are a group of drugs that alter an individual’s awareness of surroundings, emotions, and thoughts. Despite their name, hallucinogens do not consistently
cause hallucinations (Forrest, 2020). These are divided into two categories, including classic hallucinogens and dissociative drugs.
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