Is Adderall considered a controlled substance. What are the implications of this classification. How does the DEA regulate Adderall. Why is Adderall classified as a Schedule II drug. What are the legal consequences of possessing Adderall without a prescription.

Understanding Adderall: Composition and Medical Uses

Adderall is a prescription medication that combines amphetamine and dextroamphetamine. It’s primarily used to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. The drug works by affecting the central nervous system and neurotransmitters in the brain, helping individuals with ADHD to focus and manage their behavior more effectively.

Available in both immediate and extended-release formulations, Adderall’s effects can vary depending on whether the user has ADHD or not. For those without ADHD, the drug can produce a euphoric high, increased energy, and heightened self-confidence. However, these seemingly positive effects come with significant risks and potential for abuse.

The Controlled Substance Classification: What It Means for Adderall

Adderall is indeed classified as a controlled substance. This designation carries important implications for its regulation, distribution, and legal status. Controlled substances are drugs that have the potential to create physical or mental dependence, and their use and distribution are strictly regulated by the Drug Enforcement Administration (DEA).

The DEA categorizes controlled substances into different schedules based on their potential for abuse and medical use. Where does Adderall fall in this classification system?

• Adderall is a Schedule II controlled substance
• This classification indicates a high potential for abuse
• Schedule II drugs are considered to have a significant risk of psychological or physical dependence

Adderall’s Schedule II Status: Implications and Regulations

As a Schedule II controlled substance, Adderall is subject to strict regulations regarding its prescription and distribution. These regulations are designed to prevent abuse and ensure that the drug is used only for legitimate medical purposes. What are some of the key regulations surrounding Adderall?

1. Prescriptions must be written by a healthcare provider
2. Electronic transmission of prescriptions to pharmacies is allowed
3. Limitations on the amount that can be prescribed in a given time period
4. New prescriptions are required for each refill

These regulations aim to balance the medical benefits of Adderall with the need to prevent its misuse and abuse.

The Risk of Adderall Abuse and Addiction

Despite its controlled status, Adderall abuse remains a significant concern. The drug’s effects on mood and productivity make it attractive for non-medical use, particularly among students and professionals seeking to enhance their performance. Can Adderall be addictive?

Yes, Adderall has a high potential for addiction, especially when used without a prescription or in ways other than prescribed. The risk of dependence is one of the primary reasons for its controlled substance classification.

Signs of Adderall Abuse

• Finishing prescriptions earlier than intended
• Unusual thought patterns
• Unexplained weight loss
• Significant mood changes

Legal Consequences of Unauthorized Adderall Possession

Possessing Adderall without a valid prescription can lead to serious legal consequences. The severity of these consequences can vary depending on factors such as the amount possessed and the jurisdiction. Potential penalties may include fines, probation, or even imprisonment.

Is it legal to share your Adderall prescription with others? No, sharing or selling Adderall is illegal and can result in criminal charges. The controlled substance status of Adderall means that its distribution is strictly regulated, and only licensed pharmacies can dispense it with a valid prescription.

Mitigating Addiction Risk: Extended-Release Formulations

For individuals concerned about the addiction potential of Adderall, there are options to discuss with healthcare providers. One such option is the use of extended-release formulations. How do extended-release versions of Adderall differ from immediate-release?

Extended-release Adderall is designed to release the medication into the bloodstream more slowly over time. This gradual release can potentially lower the risk of addiction by reducing the intense highs and subsequent crashes associated with immediate-release formulations.

The Widespread Availability and Misuse of Adderall

Despite its controlled status, Adderall has become increasingly available due to a rise in prescriptions. This increased availability has unfortunately led to more opportunities for misuse and illegal distribution. Why has Adderall prescription rates increased?

Several factors contribute to the rise in Adderall prescriptions:

• Increased awareness and diagnosis of ADHD
• Broader acceptance of medication as a treatment option
• Pressure for academic and professional performance

This trend has inadvertently created a larger pool of potential sources for illegal Adderall distribution, as some individuals with prescriptions may sell their medication for profit.

Short-term and Long-term Effects of Adderall Misuse

While Adderall can be beneficial when used as prescribed, misuse can lead to a range of negative effects. What are some of the short-term effects of Adderall abuse?

• Nausea and headaches
• Increased anxiety
• Elevated heart rate and blood pressure
• Insomnia

Long-term misuse of Adderall can lead to more severe consequences. What are potential long-term effects of Adderall abuse?

• Cardiovascular problems
• Increased risk of stroke
• Psychological dependence
• Cognitive impairment
• In extreme cases, death

The Comedown Effect

One of the challenges associated with Adderall misuse is the “comedown” effect. As the drug’s effects wear off, users may experience a range of unpleasant symptoms. What does an Adderall comedown feel like?

• Extreme fatigue
• Irritability
• Depression
• Difficulty concentrating

These comedown effects can contribute to the cycle of addiction, as users may be tempted to take more of the drug to avoid these negative feelings.

Adderall in the Context of Other Controlled Substances

To better understand Adderall’s status as a controlled substance, it’s helpful to compare it to other drugs in the same category. How does Adderall compare to other Schedule II substances?

Other Schedule II controlled substances include:

• Opioid painkillers like oxycodone and fentanyl
• Cocaine
• Methamphetamine

Like Adderall, these substances are considered to have legitimate medical uses but also carry a high risk of abuse and dependence. The inclusion of Adderall in this category underscores the seriousness with which the DEA views its potential for misuse.

Alternatives to Adderall for ADHD Treatment

Given the risks associated with Adderall, some individuals and healthcare providers may seek alternative treatments for ADHD. What are some alternatives to Adderall for managing ADHD symptoms?

• Non-stimulant medications like atomoxetine or guanfacine
• Behavioral therapy and cognitive-behavioral therapy
• Mindfulness and meditation practices
• Dietary changes and nutritional supplements
• Exercise and physical activity routines

These alternatives may be particularly beneficial for individuals with a history of substance abuse or those concerned about the potential for addiction to stimulant medications like Adderall.

The Role of Healthcare Providers in Adderall Prescription and Monitoring

Healthcare providers play a crucial role in the responsible prescription and monitoring of Adderall use. What responsibilities do doctors have when prescribing Adderall?

• Conducting thorough evaluations to ensure accurate diagnosis
• Educating patients about the risks and proper use of the medication
• Monitoring patients for signs of abuse or dependence
• Adjusting dosages as needed to minimize risks while maximizing benefits
• Considering alternative treatments when appropriate

Regular follow-ups and open communication between patients and healthcare providers are essential for the safe and effective use of Adderall.

The Impact of Adderall’s Controlled Substance Status on Research and Development

The classification of Adderall as a controlled substance affects not only its distribution and use but also research and development efforts. How does Adderall’s status impact scientific research?

Researchers studying Adderall or developing similar medications face additional regulatory hurdles and scrutiny. This can potentially slow down the development of new treatments for ADHD and related conditions. However, these regulations also ensure that new medications undergo rigorous testing for safety and efficacy before reaching the market.

Public Health Implications of Adderall’s Controlled Substance Status

The controlled substance classification of Adderall has broader implications for public health policy and education. How does this status affect public health approaches to Adderall?

• Increased awareness campaigns about the risks of stimulant abuse
• Development of prevention programs targeting high-risk groups
• Enhanced monitoring of prescription patterns to identify potential misuse
• Improved training for healthcare providers on responsible prescribing practices

These public health initiatives aim to balance the legitimate medical use of Adderall with efforts to prevent its misuse and abuse.

The Future of Adderall and Controlled Substance Regulations

As our understanding of ADHD and the effects of stimulant medications evolves, so too may the regulations surrounding Adderall and similar drugs. What potential changes might we see in the future regarding Adderall’s controlled substance status?

• Development of new formulations with lower abuse potential
• Refinement of prescribing guidelines to further reduce the risk of misuse
• Increased use of digital technologies to monitor and control medication use
• Potential reclassification based on new research findings

These potential developments highlight the ongoing need for balance between providing effective treatment options and protecting public health and safety.

Is Adderall Considered A Controlled Substance? What Does That Mean?

Is Adderall a controlled substance? This is a common question a lot of people have, and below is more information about Adderall in general, what’s meant by the term controlled substance, and an answer to “is Adderall a controlled substance.”

Adderall is a prescription stimulant that’s a combination of two substances: amphetamine and dextroamphetamine. It’s available in an immediate and extended-release formulation, and its primary function is to help people who have attention deficit hyperactivity disorder or ADHD. It’s also sometimes prescribed to people with narcolepsy.

When a person with ADHD takes Adderall, it has somewhat of a calming effect on them, and this is largely because of how it affects the central nervous system and neurotransmitters in the brain. It can help someone with ADHD concentrate and focus more effectively, and it can also help them manage their behaviors. 

While Adderall is available by prescription, it’s also very commonly abused in the U. S. When someone doesn’t have ADHD, and they take it, the result is different. A person without ADHD who takes Adderall will find that they feel a type of high with it, although the effects can depend on how much is taken. Signs of being high on Adderall can include euphoria, a sense of excitement or energy, self-confidence, and optimism.

This all might sound great, but there are many risks of abusing Adderall. There are short-term effects of Adderall use that aren’t desirable and can include nausea, headache, anxiety, and rising heart rate and blood pressure. There’s also the risk of addiction, and when people come down from the Adderall high, they tend to feel sluggish, depressed or unwell. 

There are also severe side effects of Adderall which may include cardiac problems, stroke, and even death. 

Adderall use and availability have become pretty widespread because of the steep increase in the number of prescriptions written for it each year, and that’s allowed more people to have access to it without a prescription.

However, is Adderall a controlled substance? Yes, and below is more information about what exactly that means.

There are two primary categories of drugs, which are prescription and over-the-counter. With over-the-counter drugs, anyone can buy them, but with prescription drugs, a doctor or healthcare provider has to prescribe the drug. Within the category of prescription drugs are controlled and non-controlled substances.

Things that are used to treat chronic conditions such as blood pressure medicines and diabetes medicines, as well as things like antibiotics, are non-controlled. On the other hand, if a drug has the potential to create a physical or mental dependence, it’s considered controlled. This means the Drug Enforcement Administration regulates these drugs and then breaks them down into further categories based on what the likelihood is that the substance will cause dependence.

Adderall is a controlled substance, as are narcotic pain medications.
Adderall is actually a Schedule II controlled substance in the U. S., and this means that it has a high potential for abuse. This should serve as a warning for people because the DEA is saying as a controlled substance, Adderall is pretty likely to lead to psychological or physical dependence that could be severe.

When someone is purchasing a controlled substance like Adderall, they need not only the prescription itself, but there are also other regulations. For example, the prescription has to be written by the health care provider, and it can be sent over to the pharmacy electronically. You are also limited to certain amounts of the drug in certain periods of time, and you have to get a new prescription every time you get it filled. 

Adderall is a controlled substance because as with other stimulants, the risk of dependence is high. 

Despite the fact that Adderall is a controlled substance, people still take it illegally without a prescription, and many people with a prescription sell it at a high markup. It’s a desirable drug because it provides such a boost in mood and productivity for many people.  

If you are worried about the risk of addiction with Adderall, there are options you can discuss with your doctor. One option is using the extended-release version of the drug because it’s released into the bloodstream more slowly, which can lower the addiction potential.

Some of the signs that you may be abusing Adderall include finishing your prescription sooner than you’re supposed to, unusual thinking, weight loss and changes in mood. 

If you are caught with a controlled substance like Adderall without a legitimate prescription, there can be legal consequences. These consequences can depend but can include a fine, or being held in prison. States vary in how they enforce controlled substances law, but the Controlled Substances Act is a federal law.

Adderall is a controlled substance, and what this means is that even with a prescription you should be aware of the risk of abuse and addiction. Also, if you don’t have a prescription and you use this drug, you may be putting yourself at risk for legal problems.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.

Dextroamphetamine-Amphetamine – StatPearls – NCBI Bookshelf

Continuing Education Activity

Dextroamphetamine/amphetamine belongs to a class of drugs known as central nervous system stimulants. The Drug Enforcement Administration/Food and Drug Administration classifies these medications as schedule II drugs with high potential for abuse in the United States. Immediate-release and sustained-release amphetamine medications are FDA-approved to treat ADHD and narcolepsy in both adult and pediatric populations. Non-FDA-approved clinical uses for dextroamphetamine/amphetamine include cerebrovascular accidents. This activity will highlight the mechanism of action, adverse event profile, approved and off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions of dextroamphetamine/amphetamine, pertinent for interprofessional team members using these medications for their intended indications.

Objectives:

• Identify the mechanism of action of dextroamphetamine/amphetamine.

• Review the approved and off-label indications for dextroamphetamine/amphetamine.

• Summarize the contraindications and adverse events associated with dextroamphetamine/amphetamine therapy.

• Explain the importance of interprofessional communication in improving care coordination among the interprofessional team when initiating dextroamphetamine/amphetamine therapy.

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Indications

Dextroamphetamine/amphetamine belongs to a class of drugs known as central nervous system stimulants. The Drug Enforcement Administration/Food and Drug Administration (DEA/FDA) classifies these medications as schedule II drugs with high potential for abuse in the United States. Based on the published data by the American Psychiatric Association, 3% to 7% of school-aged children and 4% of adults in the United States have a diagnosis of attention-deficit/hyperactivity disorder (ADHD). Immediate-release amphetamine medication and sustained-release amphetamine medication are used to treat ADHD and narcolepsy in both the adult and pediatric populations.[1][2]

Non-FDA-approved clinical uses for dextroamphetamine/amphetamine:

Cerebrovascular Accident

• FDA approval: Adult, no; Pediatric, no

• Recommendation: Adult, Class III (et al.)

• Strength of evidence: Adult, Category B

Research by Walker-Batson et al. in 1995 and Crisostomo et al. in 1988 shows that amphetamine use in patients with ischemic stroke improved motor function compared with patients undergoing physical therapy alone. However, another study showed conflicting results, as the mean scores on the Fugl-Meyer motor scale were not significant for the amphetamine group compared with the placebo group.  

Amphetamine/dextroamphetamine is used off-label by college students for memory enhancement, test-taking ability, and study marathons.

FDA-approved clinical uses for dextroamphetamine/amphetamine:

Attention Deficit Disorder with Hyperactivity

Dextroamphetamine/amphetamine is FDA-approved for adult and pediatric (ages 3 to 16 years) populations. Amphetamines, along with other remedial measures such as psychological, educational, and social, are prescribed to manage patients with symptoms like distractibility, short attention span, hyperactivity, and impulsivity.

In the pediatric population, the immediate-release tablet is recommended for patients three years of age or older, and the extended-release capsule can be prescribed to patients six years or older.

• Adult, Category B Class IIb (Class ll; have a high potential for abuse and dependence, an accepted medical use, and the potential for severe addiction)

• Pediatric, Category B, Class IIb 

Narcolepsy

Dextroamphetamine/amphetamine is FDA-approval for adult and pediatric patients who are six years of age or older.

• Adult, Category B, Class IIb

• Pediatric, Category B, Class IIb 

Amphetamines are Pregnancy Category C (prior to 2015) (Category C; Animal reproduction studies have shown an adverse effect on the fetus, but no adequate and well-controlled studies in humans. Potential benefits may warrant use in women who are pregnant.)

The American Academy of Pediatrics rates amphetamines as drugs of abuse for which there are reports of adverse effects on the infant during breastfeeding.

Consider potential risks and benefits before prescribing amphetamines during pregnancy and breastfeeding. Use during pregnancy only if the potential maternal benefit outweighs the potential fetal risk.

Reports exist of increased risk of premature delivery and low birth weight in infants born to mothers with amphetamine dependence as amphetamine crosses the placenta. Reported cases show biliary atresia in infants who were exposed to amphetamine in utero during the second and third trimesters.

Amphetamine should not be prescribed to nursing women as it is excreted in human breast milk. Physicians should consider an alternative medication or advise the patient to discontinue breastfeeding. The result of a study on a nursing mother with the diagnosis of narcolepsy who was receiving a daily dose of 20 mg amphetamine was significant for an elevated level of amphetamine in breast milk compared to maternal plasma. Studies showed amphetamines were 3 and 7 times higher in breast milk than maternal plasma on the 10th and 42nd days after delivery, respectively. Measurable amounts of amphetamine were also present in the urine of the infant.

Mechanism of Action

Amphetamines are non-catecholamines, sympathomimetic amines with central nervous system (CNS) stimulant activity. Amphetamines increase dopamine and norepinephrine in the synaptic space by promoting the release of catecholamines from the presynaptic nerve terminals.  They also block norepinephrine and dopamine reuptake into the presynaptic neuron by competitive inhibition. Released norepinephrine affecting both alpha-adrenergic receptor sites and beta-adrenergic receptor sites.[3]

Stimulation of beta-adrenergic receptor sites by these medications increases heart rate, stroke volume, and skeletal muscle blood flow.[4][5] 

Alpha-adrenergic stimulation causes vasoconstriction and an increase in total peripheral resistance, leading to elevations of both systolic and diastolic blood pressures, a weak bronchodilator, and respiratory stimulant action.

However, the mechanism of amphetamine’s mental and behavioral effects in children is not clearly understood.

Both immediate-release tablets and extended-release capsules contain both enantiomer, d-amphetamine, and l-amphetamine salts in the ratio of 3:1. The bioavailable average half-lives are similar for both the sustained-release capsule and immediate-release tablet.

Duration of action

Half-life Elimination

• Children 6 to 12 years: D-enantiomer: 9 hours; L-enantiomer: 11 hours

• Adolescents 13 to 17 years: D-enantiomer: 11 hours; L-enantiomer: 13 to 14 hours

• Adults: D-enantiomer: 10 hours; L-enantiomer: 13 hours

Time to Peak

Administration

Dextroamphetamine/amphetamine administration is via the oral route. Prescriptions can be as a tablet (immediate-release) or capsule (extended-release).

Dosage Forms

• Extended-release capsule: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg

• Tablet: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg

Extended-release capsules should be swallowed whole (without chewing), or the entire capsule may be sprinkled on food and consumed immediately. Do not divide the dose of a single capsule.

Patients should avoid afternoon or late evening doses due to insomnia caused by dextroamphetamine/amphetamine.

The temperature of 20 to 25 degrees C (68 to 77 degrees F) is the preferred temperature to store the medication.

FDA Dosage for Management of Attention Deficit Hyperactivity Disorder

Pediatric

Younger than 3 years

Dextroamphetamine/amphetamine is not recommended for children younger than 3 years of age.

Three to 5 years

An immediate-release tablet is used for children 3 to 5 years of age. Clinicians should evaluate the potential for misuse by the patient or parents before prescribing the short-acting tablets. 

• An initial dose of 2.5 mg of an immediate-release tablet once daily in the morning. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.

• Increase daily dose by 2.5 mg at weekly intervals until reaching the optimal response.

• The dosage range is 2.5 to 40 mg per day, given in 1 to 3 divided doses.

Six years and older

Both immediate-release tablets and extended-release capsules are appropriate for children 6 years of age and older.

Immediate-release tablet:

• An initial dose of 5 mg once or twice daily. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.

• Increase daily dose by 5 mg weekly until obtaining an optimal response.

• The dosage range is 5 to 40 mg per day in 1 to 3 divided doses.

Extended-release capsule:

• An initial dose of 5 to 10 mg once daily in the morning.

• Increase daily dose by 5 to 10 mg weekly until obtaining an optimal response.

• The maximum daily dose is 30 mg.

Adolescents 

Both immediate-release tablets and extended-release capsules are appropriate for this age.

Immediate release:

• An initial dose of 5 mg once or twice daily. The first dose should be upon awakening. Subsequent doses of immediate-release tablets may be at intervals of 4 to 6 hours.

• Increase daily dose by 5 mg weekly until obtaining an optimal response.

• The dosage ranges from 5 to 40 mg per day in 1 to 3 divided doses.

Extended-release capsule:

• An initial dose of 10 mg once daily in the morning.

• Increase to 20 mg daily after one week if needed. There is no adequate evidence that higher doses afford additional benefits.

Adult

Immediate release tablet:

• An initial dose of 5 mg once or twice daily

• Increase daily dose by 5 mg weekly until obtaining an optimal response

• Usually, dosage range from 5 to 40 mg per day in 1 to 3 divided doses. Subsequent doses may be at 4 to 6 hours intervals

Extended-release capsule:

• An initial dose of 20 mg once daily in the morning;

• Based on the available evidence, higher doses (up to 60 mg per day) do not provide additional benefits.

FDA Dosage for management of Narcolepsy

Pediatric (6 years or older)

• An initial dose of 5 mg immediate-release tablet daily.

• Increase daily dose by 5 mg weekly until obtaining an optimal response.

• Usually, the dosage ranges from 5 to 60 mg per day in 1 to 3 divided doses.

Adult 

• An initial dose of 10 mg immediate-release tablet once daily in the morning.

• Increase daily dose by 10 mg weekly until obtaining an optimal response.

• Usual dosage range: 5 to 60 mg per day in 1 to 3 divided doses

There are no specific dosage adjustments provided in the manufacturer’s labeling for patients with renal or hepatic impairment and geriatric population, but dextroamphetamine/amphetamine should be used with caution and start at the low end of the dosage range.

Adverse Effects

Common

• Cardiovascular: Increased systolic arterial pressure

• Neurologic: Headache, insomnia

• Endocrine metabolic: Weight loss

• Gastrointestinal (GI): Dry mouth, decrease in appetite, weight loss, abdominal pain, nausea, diarrhea

• Psychiatric: Feeling nervous, mood swings

Serious

• Cardiovascular: Cardiomyopathy, myocardial infarction, peripheral vascular disease, Raynaud disease, sudden cardiac death

• Neurologic: Cerebrovascular accident, seizure

• Dermatologic: Stevens-Johnson syndrome, toxic epidermal necrolysis

• Immunologic: Hypersensitivity reaction

• Psychiatric: Psychotic disorder such as new or worsening psychotic or manic symptoms, behavior changes, or emotional lability

Contraindications

• Advanced arteriosclerosis 

• Symptomatic cardiovascular disease

• Agitated states 

• Concomitant use or use within 14 days of MAOI administration, including linezolid or IV methylene blue, may result in hypertensive crisis.

• Glaucoma 

• History of drug abuse 

• Hypersensitivity or idiosyncrasy to amphetamine or other product components 

• Hyperthyroidism 

• Moderate to severe hypertension 

Caution is necessary when prescribing stimulants for ADHD to patients with comorbid conditions such as pre-existing psychosis and bipolar illness because they may worsen behavior disturbances and thought disorders that might occur in these patients. Detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression screening, should be considered in these patients to evaluate the risk of bipolar disorder.

Cardiovascular Events (US black box warning) 

Sudden death is one of the main concerns associated with CNS stimulant treatment. Misuse or even usual doses of amphetamine in children and adolescents with structural cardiac abnormalities or other serious heart problems may cause sudden death and serious cardiovascular adverse events. Avoid prescribing amphetamine to patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems that could increase the risk of sudden death.

Evaluating cardiovascular status in patients before the initiation of stimulant medication is highly recommended. A careful history and physical exam, including all the possible risk factors such as a family history of sudden death or ventricular arrhythmia, should undergo assessment for the presence of cardiac disease. Additional cardiac evaluation with electrocardiogram and echocardiogram should take place if finding suggests cardiac disease. 

Abuse/Misuse/Diversion (US black box warning) 

Amphetamines are DEA Schedule II controlled substances with a high potential for misuse and dependence. Avoid administration for extended periods as it may lead to drug dependence. Particular attention should focus on the possibility of subjects obtaining amphetamines for non-therapeutic use. The drug should not be distributed to others, and healthcare professionals should prescribe or dispense the medication sparingly.

Assess the risk of abuse before prescribing, and monitor for signs of misuse and dependence while on therapy. Clinicians should exercise caution with this drug in patients with a history of ethanol or drug use disorder.

Documentation strongly suggests the interaction with concurrent use of amphetamine and monoamine oxidase inhibitor drugs is contraindicated as it may result in a hypertensive crisis.

Although available documentation is poor, pharmacologic considerations lead physicians to suspect the interaction of amphetamine and thiazide diuretics. The interaction may be life-threatening as it may result in increased exposure to amphetamine.

Concurrent use of amphetamine and serotonergic agents that inhibit CYP2D6 may increase amphetamine exposure and increase the risk of serotonin syndrome.

Concurrent use of ascorbic acid and amphetamines may cause decreased amphetamine efficacy in patients. [6][7][8]

Monitoring

•  Monitor improvement in mental and behavioral symptoms of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD). Reevaluate the patient for the long-term usefulness of the drug by temporarily withdrawing therapy.

• Monitor decreased frequency of narcoleptic attacks.

• Evaluate cardiovascular status before and during treatment. Conduct a further evaluation of any patient who develops any symptoms indicative of a cardiac condition, including exertional chest pain, palpitations, near syncope, or syncope during treatment with stimulants.

• Evaluate ADHD patients for bipolar disorder risk factors before starting the treatment.

• Monitor pediatric patients with new-onset or worsening aggressive behavior after starting the treatment

• Monitor growth in pediatric patients during treatment.

• Evaluate for any sign of peripheral vasculopathy such as Raynaud phenomenon, tics, and Tourette syndrome before and during treatment.

Toxicity

Methamphetamine abuse became an epidemic during the last decade and is one of the main concerns. Increased rates of depression, suicidal ideation, and attempts are seen more in the methamphetamine-abusing adolescent patient population. Twenty to 25 mg/kg is reportedly the lethal dose in the adult population, but the dose-response is variable between the patients. Chronic amphetamine abusers may develop tolerance to up to 15,000 mg/day without lethal results.[9][10][11]

The mechanism of toxicity is primarily related to excessive extracellular dopamine, norepinephrine, and serotonin. The primary clinical syndrome involves prominent neurological and cardiovascular effects, but secondary complications can involve renal, muscle, pulmonary, and GI effects.

Hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, seizures, and altered mental status are some of the most common signs and symptoms of amphetamine intoxication. Diagnosis can be confirmed by detecting amphetamine in stomach contents or vomitus or by positive urine toxicology for illicit drugs. False-positive amphetamine screen can present following trazodone overdose or bupropion overdose.

There is no antidote for amphetamine toxicity; however, activated charcoal is an emergency treatment. In patients who can drink safely, the recommendation to administer activated charcoal, 1 to 2 g/kg up to 100 g by mouth if the ingestion occurred within the previous hour.

Amphetamine-related toxicity requires management by controlling life-threatening central nervous system and cardiovascular signs in a quiet environment. Hospital supportive care includes monitoring the airway, breathing, and circulation. Agitation and seizures are controllable with benzodiazepines, phenothiazines, pentobarbital, and propofol. A beta-blocker such as propranolol can help to manage cardiac tachyarrhythmias. Consider intravenous nitroprusside (start at 0.5 to 1 mcg/kg per minute and titrate as needed) for severe hypertension. Intravenous fluid should be given as it counters hyperthermia, assists in maintaining renal function, and helps promote the elimination of amphetamine and its analogs.

In cases of severe agitation, clinicians should consider aggressive treatment to avoid malignant hypertension, rhabdomyolysis, hyperthermia, and seizures. Evidence supports using large doses of benzodiazepines to treat amphetamine-overdose-related psychosis and agitation. In cases where agitation, delirium, and movement disorders are unresponsive to benzodiazepines, second-line therapies include antipsychotics such as ziprasidone or haloperidol, central alpha-adrenoreceptor agonists such as dexmedetomidine, or propofol can be administered. Neuromuscular paralysis, intubation, and active cooling measures may be necessary in severe cases. In patients with tachycardia, obtain ECG, and consider telemetry. Use intravenous fluid and sedation to control cardiac symptoms. In cases of severe hypertension, consider intravenous nitroprusside. Starting 0.9% normal saline and monitoring creatine kinase (CK), electrolytes, and creatinine is the best way to manage rhabdomyolysis.

There are case reports regarding the Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, which is triggered by amphetamine overdose. In one case, a patient presented to the emergency department after ingesting 30 amphetamine salt tablets with symptoms of chest pain and shortness of breath. At the time of presentation, cardiac enzymes were elevated, the electrocardiogram was unremarkable, and ejection fraction (EF) was 25% to 30% with severe hypokinesis. However, 24 hours later, symptoms were resolved, and a repeated echocardiogram performed three days later showed an EF of 60% with no regional wall motion abnormalities.

Enhancing Healthcare Team Outcomes

All interprofessional healthcare team members should know the potential complications with amphetamine-like agents. This team includes clinicians, specialists, mid-level practitioners, nurses, and pharmacists. These agents should not be prescribed liberally, and even when prescribed, the patient must have close monitoring to ensure that there is no misuse of the medication.

A careful history, physical exam, and cardiovascular evaluation should take place before initiating stimulant medication because serious cardiac problems can increase the risk of sudden death. Evaluate and monitor the risk of abuse and dependence before prescribing amphetamines and during therapy. Physicians should avoid prescribing the immediate-release (short-acting) type if there is a suspicion of potential for misuse in the patient or the parents. The prescribing physician should advise the patient to report symptoms of tachycardia, hypertension, angina, peripheral vasculopathy, or Raynaud phenomenon. Also, patients should receive education regarding the most common adverse effect of the medication. Most amphetamine-related toxicity is safely manageable with supportive care, including monitoring airway, breathing, and circulation and controlling agitation with benzodiazepines.

With interprofessional care coordination and open communication among the interprofessional team members, patients are more likely to experience therapeutic benefits and avoid adverse events and toxicity when prescribed amphetamine-like agents. [Level 5]

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References

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Chen LY, Crum RM, Strain EC, Alexander GC, Kaufmann C, Mojtabai R. Prescriptions, nonmedical use, and emergency department visits involving prescription stimulants. J Clin Psychiatry. 2016 Mar;77(3):e297-304. [PMC free article: PMC5903919] [PubMed: 26890573]

2.

Lakhan SE, Kirchgessner A. Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav. 2012 Sep;2(5):661-77. [PMC free article: PMC3489818] [PubMed: 23139911]

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Preuss CV, Kalava A, King KC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 21, 2022. Prescription of Controlled Substances: Benefits and Risks. [PubMed: 30726003]

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Gnanavel S. Lisdexamfetamine and Secondary Raynaud’s Phenomenon. Prim Care Companion CNS Disord. 2018 Sep 13;20(5) [PubMed: 30256542]

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Disclosure: Nazila Sharbaf Shoar declares no relevant financial relationships with ineligible companies.

Disclosure: Raman Marwaha declares no relevant financial relationships with ineligible companies.

Disclosure: Mohammed Molla declares no relevant financial relationships with ineligible companies.

Adderall and its psychoactive properties

What if a person does not want to be treated or undergo rehabilitation?

This is a very common situation, and a special approach is needed for such a person. The reason why a person does not want to be treated or undergo rehabilitation is that a person does not believe in the effectiveness of treatment or rehabilitation, believing that this is a waste of time. Such people either try unsuccessfully to quit drugs on their own, or they have undergone ineffective treatment or rehabilitation. The best way to solve this problem is to involve a rehabilitation center specialist as a consultant. Sometimes it may take a long conversation and persuasion, it’s normal to take the time to convince a person to stop using drugs and seek help, and this is not in vain.

In order to gain freedom from drugs, one must want to become free, and the specialists of our clinic can help the drug addict understand this simple truth. Thus, even in the most, at first glance, hopeless case, you can still try to convince a person and send him to rehabilitation of his own free will. Our specialists and consultants are experienced and will help in such cases.

Why do people use drugs?

The reasons are very diverse, these are both genetic and personal factors. It is naive to think that addiction is just an addiction to a particular substance. Drug addiction is a disease based on a special state of mind, and the disease is bio-psycho-socio-spiritual. The worst thing is that drug addicts realize too late that they are not just “indulging” in drugs, but can no longer live without them. Sometimes addiction develops after six months, and even a year, more often after 2-3 months, but often a person becomes addicted after the first injection. The end always comes down to this: either isolation (prison, psychiatric hospital) or death.

Need to be tough or accommodating with an addict family member?

You must strictly follow the rules, which are the same for everyone. It is necessary that he knows your attitude to a particular situation and your actions. By force or persuasion, you will not force him to stop using, he must want it himself. Most often, in order for an addict to want to quit, enough time must pass, he must reach his “bottom”, that is, see all the “charms” of drug addiction and its consequences, and only after that he wants to stop using and begin addiction treatment.

How to treat drug addiction?

There are usually three stages in the treatment of drug addiction:

1. Elimination of physiological dependence on drugs, relief of withdrawal symptoms (the so-called “withdrawal”) – detoxification.
2. Treatment aimed at overcoming psychological dependence.
3. Social rehabilitation of a former drug addict.

Why should an addict undergo rehabilitation at a center and not at home?

During rehabilitation, a drug addict is still subject to a momentary impulse that can occur at any time during treatment, if during this, sometimes a short, period of time, there is no specialist nearby, everything can end in a breakdown and drug use. A simple conversation with our chemical addiction counselors can save a person and enable them to complete their rehabilitation program. Neither the parents, nor the friends of the addict, nor even the advice of a narcologist will help at this moment. It is very important that a person undergo rehabilitation in a clinic, as in this case you can observe all the changes in his behavior, help to cope with difficulties throughout the difficult path of getting rid of addiction, and ultimately lead a person to a state where he becomes stronger. own addiction and learn to live without drugs.

In addition, being in our rehabilitation centers limits a person’s social circle, which has a positive effect on treatment. It is impossible to bring drugs into the center, as this is controlled in our rehabilitation centers. Being in the center, the addict is fully focused on the passage of rehabilitation, and nothing distracts him.

What is addiction?

Addiction is an obsessive need for something, an obsession. Currently, there are many different addictions. But they are all divided into chemical and non-chemical. There are many non-chemical types of addictions, for example: gambling, Internet addiction, human addiction, food addiction and others. Chemical addictions include drug addiction and alcoholism. Addiction is a disease listed in the medical reference book of diseases. Self-treatment, as a rule, does not give results. And as in the treatment of any other serious disease, the help of qualified specialists is needed here.

What are spices, salts?

Various smoking mixtures are called spices. As a rule, this is a common pharmacy herb, for example, chamomile with a chemical applied to it. This is a very dangerous and terrible drug. The formula of a chemical is constantly changing, its impact on the human body is unpredictable. Spice, like salts, are synthetic drugs. The salts got their name because of the way they spread. Initially, this dangerous drug was presented to drug users as bath salts. It has become widespread among chemically addicted people due to its negligible price and legal (originally) sale. The use of salts and spices is instantly addictive. After the first use, a person is not able to give up the drug. The chemical composition is unpredictable and has a devastating effect on the addict’s body. Even one use can be fatal.

How can you tell if a child has started using drugs?

Family members often turn a blind eye to the fact that negative changes are taking place in the lives of loved ones. I don’t want to admit that trouble has come to the house, the psyche protects from this pain, and the parents of a drug-using child do not immediately understand that a problem has appeared in the family.

There are many signs that a child has started using drugs. Changes in behavior, lying, secrecy, “incomprehensible” acquaintances, academic failure, frequent phone calls so that no one can hear, aggression, sudden mood swings – all this indicates that it is time for parents to pay attention to their child. The eyes also betray the drug user. Pupils can be greatly dilated or, conversely, “on a dot”, depending on the type of substance that the person has used. Further signs are more obvious: money and things begin to disappear from the house, the child does not spend the night at home, and when he returns, he looks exhausted, and sleeps for a long time, weight loss.

The sooner the problem of addiction is detected, the less negative consequences will occur in life. Be more attentive to your loved ones.

Do drugs greatly change personality?

The use of narcotic substances contributes to the fact that at the first stage the spiritual growth of a person gradually slows down until it stops completely. Intellectual abilities in connection with the strongest destructive effect of drugs on the human brain deteriorate noticeably, provoking, moreover, the development of psychological diseases. The emotional palette becomes poorer over time, a person experiences strong feelings only in connection with the use. This in combination leads to the fact that the person who uses drugs degrades.

Is it possible to recover from drug addiction on your own?

An illness characterized by dependence is defined by the World Health Organization as a progressive, chronic, fatal disease. Obviously, without the help of specialists, it is impossible to recover!

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