Psychedelic or hallucinogenic drugs such as lysergic acid diethylamide LSD ; , 3, 4, 5trimethoxy-b-phenethylamine mescaline ; , trimethoxy-b psilocybin, 3, 4-methylenedioxymethamphetamine MDMA ; , N, N-dimethyltryptamine DMT ; and their relations occur in abundance throughout the natural world, and have been used by humankind for thousands of years. In some cultures they are important tools for spiritual experiences, whereas in others they are labelled as dangerous drugs of misuse. What is less well known about these substances is the role they played in psychiatry for a brief historical interval. This article offers a short overview of this period and questions whether interest in these compounds might be emerging again.
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Adrenaline and noradrenaline operate as messengers of the sympathetic part of the autonomous nervous system, partially across the same post synaptic receptors for the functioning of inner organs like the bronchi, heart, stomach, intestines, etc since neurons play a dominant role in the brain via noradrenaline, the main function of the amphetamines as central stimulators had to originate via noradrenagic synapses.
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West of Edgar Clark counties is Coles County, Illinois. Coles County has the distinction of being one of the Illinois counties that routinely has the largest number of seized methamphetamine laboratories.11 While Edgar and Clark counties are bordered on the east and west by counties with high levels of methamphetamine, and both counties are accessible by major highways, by all accounts the methamphetamine problem in Edgar and Clark counties is generally selfcontained. That is, most of the methamphetamine produced in the county is used there and, conversely, most that is used in the county has been produced there. Unlike reports from California, where methamphetamine distribution networks transport the drug from Mexico or from large U.S. labs to local drug markets, there are at present few indications of methamphetamine distribution networks linking users in Edgar and Clark counties to producers in other parts of the country. Some locals do cross county lines to steal precursors, and some people from surrounding counties do enter Edgar and Clark counties to steal precursors or to cook methamphetamine in portable labs, but primary production and use remain local. Although methamphetamine has probably been in both counties in limited amounts for decades, in recent years the drug has come to be seen as a problem of near crisis proportions, and the local production of methamphetamine appears to be a relatively recent phenomenon. In both counties the first signs of methamphetamine production were seen in 1998 and since then the problem appears to have increased geometrically. Reports from a variety of local sources suggest there is little in the way of a "methamphetamine business" in either county, at least not a highly organized business driven by cash transactions. Rather, methamphetamine production and use appear to primarily rely on bartering and trading services for drugs among acquaintances. For example, a cook will agree to 5.
Drug Name AMBIEN CR TAB 6.25MG Zolpidem Tartrate ; amitriptyline hcl tab 10 mg amitriptyline hcl tab 100 mg amitriptyline hcl tab 150 mg amitriptyline hcl tab 25 mg amitriptyline hcl tab 50 mg amitriptyline hcl tab 75 mg amoxapine tab 100 mg amoxapine tab 150 mg amoxapine tab 25 mg amoxapine tab 50 mg amphetamine-dextroamphetamine tab 10 mg amphetamine-dextroamphetamine tab 12.5 mg amphetamine-dextroamphetamine tab 15 mg amphetamine-dextroamphetamine tab 20 mg amphetamine-dextroamphetamine tab 30 mg amphetamine-dextroamphetamine tab 5 mg amphetamine-dextroamphetamine tab 7.5 mg apap-isometheptene-dichloral cap 325-65-100 mg ARTHROTEC 50 TAB Diclofenac w Misoprostol ; ARTHROTEC 75 TAB Diclofenac w Misoprostol ; bupropion hcl tab 100 mg bupropion hcl tab 75 mg bupropion hcl tab sr 12hr 100 mg bupropion hcl tab sr 12hr 150 mg bupropion hcl tab sr 12hr 200 mg buspirone hcl tab 10 mg buspirone hcl tab 15 mg buspirone hcl tab 30 mg buspirone hcl tab 5 mg buspirone hcl tab 7.5 mg butalbital-acetaminophen tab 50-325 mg butalbital-acetaminophen tab 50-650 mg butalbital-acetaminophen-caff w cod cap 50-325-40-30 mg butalbital-acetaminophen-caffeine cap 50-325-40 mg butalbital-acetaminophen-caffeine cap 50-500-40 mg butalbital-acetaminophen-caffeine elixir 50-325-40 mg 15ml butalbital-acetaminophen-caffeine tab 50-325-40 mg butalbital-acetaminophen-caffeine tab 50-500-40 mg butalbital-acetaminophen-caffeine tab 50-750-40 mg butalbital-aspirin-caff w codeine cap 50-325-40-30 mg butalbital-aspirin-caffeine cap 50-325-40 mg butalbital-aspirin-caffeine tab 50-325-40 mg CAMPRAL TAB 333MG Acamprosate Calcium ; carbamazepine chew tab 100 mg carbamazepine susp 100 mg 5ml carbamazepine tab 200 mg CARBATROL CAP 100MG Carbamazepine ; CARBATROL CAP 200MG Carbamazepine ; CARBATROL CAP 300MG Carbamazepine and aricept.
The health care system is in some respects very different to any other in the world.
To the word or name by which the goods or services are known and by which they are ordered. There is an old adage: "words talk in Trademarks". How are Trademarks protected? Protection for a Trademark is obtained by registration at the Patents Office or its equivalent in other countries ; . In Ireland and the UK, there is a Common Law right to stop "passing off" based upon goodwill or reputation resulting from use of a Trademark. However, as a result of harmonisation of laws in the EC, registration of Trademarks is becoming of increased importance. What does a Trademark Registration cover? A Trademark is registered in respect of the goods and or services for which it is used or intended to be used. Goods and services are divided into 42 Classes. In most countries, an application for registration can specify goods and or services in more than one Class. Earlier Rights What are "Relative Grounds for refusal"? A Trademark cannot be validly registered if it is identical or confusingly similar to a Trademark already registered or applied for ; in relation to identical or similar goods and or services. In Ireland, the UK, the Scandinavian countries, Spain, Japan, Canada and the USA, an Official search and examination is carried out to identify similar earlier Trademarks; then if one is found, an objection is raised against the later mark. If this objection cannot be overcome, the application for the later mark is refused. In another group of countries including Germany and France, there is no Official search for prior marks, but a third party can oppose the application after it has been published in an Official Bulletin. In the Benelux countries, an Official search is carried out but no objections can be raised by either an Examiner or third parties. In Italy, there is neither search nor opposition, the validity of a Trademark registration is usually tested in Court proceedings. In countries which follow the "Common Law", earlier rights may be derived from a Trademark which is not registered but which has acquired goodwill as a result of use in a similar or related field of goods or services. In E. U. countries, including Ireland, earlier rights may also be claimed in a Trademark which is registered in respect of quite different goods or services, where use of the later mark without due cause is likely to damage the established reputation of the earlier mark and atenolol, for example, dexedrine.
Baskin-Sommers, A. and I. Sommers 2006 ; . "The co-occurrence of substance use and high-risk behaviors." J Adolesc Health 38 5 ; : 609-11. Ellison, J. M. and D. F. Dobies 1984 ; . "Methamphetamine abuse presenting as dysuria following urethral insertion of tablets." Ann Emerg Med 13 3 ; : 198-200. Israel, J. A. and K. Lee 2002 ; . "Amphetamine usage and genital self-mutilation." Addiction 97 9 ; : 1215-8. Nakano, Y., K. Kaneko and Y. Inoue 2003 ; . "A patient with self-inflicted injuries of the cervical vertebrae and spinal cord." Arch Orthop Trauma Surg 123 7 ; : 379-81. Tominaga, G. T., G. Garcia, et al. 2004 ; . "Toll of methamphetamine on the trauma system." Arch Surg 139 8 ; : 844-7. Wada, K., S. B. Greberman, et al. 1999 ; . "HIV and HCV infection among drug users in Japan." Addiction 94 7 ; : 1063-9. Hwang, W., J. Ralph, et al. 2003 ; . "Incomplete Brown-Sequard syndrome after methamphetamine injection into the neck." Neurology 60 12 ; : 2015-6.
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The biomolecules present in blood and cells are varied in their structure and chemical reactivity. Many small molecules, proteins and enzymes have the potential to react with platinum complexes.53 The sulfur containing molecules can therefore easily coordinate to the metal, with sulfur as the binding site to give other forms of metal complexes, which leads not only to the inactivity of the drug but also its toxicity in the body system. The sulfur containing tripeptide glutamylcysteinylglycine, glutathione GSH ; , is one such example and is the most prevalent sulfur containing molecule in cells. This intracellular non-protein thiol is found to have a concentration of up to mM.54 It is known to be one of the primary defenses against toxins and oxidants present in the cell. It can deactivate electrophilic drugs including chemotherapeutic agents, and is known to scavenge for heavy metals in the body. Thus although cellular DNA is considered to be the therapeutical target of platinum drugs, a large part of the platinum reacts with cysteine groups of proteins instead, which are also constituents of GSH.55 These reactions may induce toxic side effects that occur in cancer chemotherapy. More importantly, the reaction with these sulfur containing proteins are associated with cellular resistance against platinum drugs.56 A lot of studies have been done to this effect. Hall and co-workers and
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Botulism IVIG BabyBIG is indicated for the treatment of infant botulism caused by toxin type A or B. not expect a lot of use here at Children's Hospital. The cost of a single injection therapy is $22, 900, however, it is anticipated to save weeks of ICU costs. Although the manufacturer does not allow us to stock the product in our pharmacy, they will provide the drug within 24 hours if we have a patient needing it. Due to the high cost, a neurology consult is required prior to its use. Advate This new factor VIII drug is considered the product of choice for newly diagnosed hemophilia A patients. Advate is free of human plasma-derived proteins, and therefore, there is no risk of transmission for human-associated infectious agents. NovoSeven This recombinant factor VIIa product is now on formulary for the treatment of bleeding in patients with hemophilia A or B and with inhibitors to factor VIII or IX. There has also been recent interest, through anecdotes and case reports, in using this product for uncontrolled hemorrhage in surgical patients. Due to its cost, the P&T Committee has selected to restrict NovoSeven to patients on the Hem-Onc service. In the setting of surgical hemorrhage, approval from the Medical Director at the Blood Bank is required prior to use. Aripiprazole Abilify is used in children with a primary psychotic disorder or autism. Its benefits compared with other atypical antipsychotic agents are an absence of both weight gain and QTc prolongation. Unfortunately, the pediatric dosing information is limited as published literature on use in children is lacking. ADHD Drugs Streamlined Due to therapeutic duplication and risk for mix-ups in particular, long acting methylphenidate products ; , P&T Committee recommended to remove Metadate CD and dextroamphetamine from formulary.
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The pharmaceutical composition of the present invention may be prepared in accordance with the methods, and in the formulations, described above and
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The ministry of health and long-term care is gratefully acknowledged for its generous funding of the management of dysphagia in acute stroke pilot project.
Psychobabble , bupropion wellbutrin ; has a chemical structure similar to amphetamine, and works primarily through dopamine effects and
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Professor Olaf H. Drummer, Ph.D. BAppSc MRACI ARCPA Victorian Institute of Forensic Medicine & Department of Forensic Medicine Monash University, Southbank, Victoria, Australia INTRODUCTION The contribution of drugs other than alcohol on road trauma is still under some debate. Drugs frequently detected in crash victims and impaired drivers include amphetamines, cocaine and other CNS stimulants, benzodiazepines, cannabis, and opiate-like drugs such as heroin, morphine and methadone. All of these drugs are capable of causing relevant impairment of driving skills, but there is still uncertainty as to how such drug use translates to an increased crash risk 1-6 ; . This presentation reviews the studies that have investigated illicit drug use and their impact on crash risk and provides a summary of the Victorian law that provides police powers to detect drivers using alcohol and or drugs. MEASURING CRASH RISK Crash risk has been studied using one or a combination of the following: a ; case control designs by matching drug use in crashes with a control group or linkage studies of drug use through prescriptions; b ; responsibility studies by examining the effect of drug use on the proportion culpable; and c ; by use of surveys. CASE CONTROL STUDIES Epidemiological studies provide a powerful method to study the affect of drugs use and crash risk, however, the results have not always been consistent. A number of studies have shown that the use of minor tranquilizers, such as benzodiazepines, increase crash risk. A 5-fold higher risk of a serious road accident was seen with hospital admissions from road crashes in people who used these drugs in the past 3 months 7 ; . A similar study showed the odds ratio was elevated for those persons taking benzodiazepines, particularly within a few weeks of the first prescription 8 ; . However, a nested case-control design of over 200, 000 drivers using driver's license files, police reports of injurious crashes, and health insurance records showed an increased risk of motor vehicle crash involvement in the elderly population using long acting benzodiazepines 9 ; . This contrasted with another study that found the relative risk of injurious crash involvement for current users of any psychoactive drug was significantly elevated and was primarily due to benzodiazepines and sedating antidepressants 10 ; . In contrast, another study showed no increase in accident risk with the use of benzodiazepines and sedatives 11 ; . A related case-control study on injured persons involved in road crashes showed that use of anti-depressants and opioid analgesics by older drivers was associated with increased risk of collisions, but not with benzodiazepines or sedating antihistamines 12.
Salmonella is one of the most important sources of food-borne illness in humans, mainly due to the complexity of Salmonellosis epidemiology Zancan et al. 2000 ; . Broiler meat is a high risk product, according to Berchieri 2000 ; , and production systems and processing facilitate the presence of Salmonella in the final product. There are several methods to verify the contamination of Salmonella in samples Read et al. 1994 ; . The bacterial analysis of excreta is a sensitive test Aho, 1992 ; , and present better results as compared to the methods using cloacal swabs and antibody research in avian serum. Other advantages are that it does not cause stress, and is more representative of bird contamination Giessen et al. 1991 ; . The absence of Salmonella in the 63 excreta samples from broiler flocks produced in the state of Cear implies that management and hygiene are good in these farms. These results are in agreement with Moreira 2002 ; , who did not find Salmonella in day old broiler chicks reared by poultry companies in the same region. However, Gama 2001 ; found Salmonella enteritidis contamination in commercial layer chicks, and Zancan et al. 2000 ; verified 44.45% of Salmonella contamination in the transport boxes of commercial layer chicks. On the other hand, all carcass categories fresh, refrigerated, and frozen ; presented some kind of contamination, as shown in Table 1. Salmonella panama was isolated in 14.3% of the fresh carcasses. In refrigerated carcasses, there was a high level of contamination 16.7% ; with Salmonella enteritidis and Salmonella newport. The lower rate of contamination occurred in frozen carcasses 5.26% ; with the isolation of Salmonella enteritidis. The total and
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THE CONTROL OF IDD IN ZIMBABWE Charles Todd Senior Lecturer, University of Zimbabwe Medical School Judith Mutamba National IDD Control Coordinator, Ministry of Health and Child Welfare Zimbabwe is a landlocked sub-Saharan African country situated between the Zambezi and Limpopo rivers see map, Figure 1 ; . It thus south of the Equator and entirely within the Tropic of Capricorn. Zimbabwe's neighbors are Zambia to the north, Mozambique to the east, South Africa to the south and Botswana to the west. Most of the country is on the Central African plateau at altitudes of 900 meters or more above sea level. Granite, schists and igneous rocks make up more than 70% of the country's area. The total surface area of Zimbabwe is 390, 757 km2, and population around 11.5 million. Around one third of the population live in urban areas. Greatest population densities apart from cities ; are found in the east and north, and lowest in the west. The country is divided into 8 provinces plus the two main cities. Zimbabwe is classified as a lower middle income country 1994 per capita GDP was US$438 ; . It has a well developed infrastructural network of roads and railways. The principle sources of national, for example, smoking drugs.
The assays can be performed manually and can be also mounted on fully automated analyses. Diverse sample such as urine, saliva, blood, serum, or hair can be used in the assays. Here are some of the most requested assays: Cannabinoids, Opiates, Methadon, Cocaine metabolites, Benzodiazepines, Amphetamines and
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1. Powders are best collected using vials or plastic bags without holes! ; . If the items are pre-packaged ex. small plastic bags of Cocaine or Methamphetamine ready for distribution ; , then the small plastic bags should be placed in a larger plastic bag or other sealable container. Each container should be marked for identification i.e. initials, date, etc.
Nephrology, Instituto Salud Publica, Puerto Ordaz, 2Nephrology, Hospital Universitario Caracas, Caracas, Venezuela Introduction: The progressive increase in the incidence and prevalence of chronic kidney disease CKD ; and its associated high co-morbidity has become a serious public health problem. Delayed referral less than 6 months before initiation of dialysis ; to a nephrology unit is recurrent, resulting in a markedly reduced survival and increased complications. Conversely, early referral allows identification of CKD at its initial stages and the appropriate intervention to prevent or ameliorate disease progression. The aim of the present studies was to evaluate the impact of the presence of a nephrologist in an ambulatory care center on the pattern of referrals to a specialized care and the initiation of treatment compared to previous referrals occurring mainly at advanced stages of CKD and bactroban.
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Alexander M. Goberman, Ph.D, CCC-SLP , Department of Communication Disorders, Bowling Green State University, 200 Health Center Building, Bowling Green, OH 43403, U.S.A., e-mail: goberma bgnet.bgsu.
Opening Statement by Sponsor: SEN. TRUDI SCHMIDT opened the hearing on SB 287. The bill addresses the pseudoephedrine problem. The first two sections address the restriction regarding the access of pseudoephedrine products. The last sections deal with the meth watch program. An amendment put the meth watch program under the Department of Justice. Therefore, there is no fiscal note at this time. The important part of the bill is to restrict the access of pseudoephedrine so that it can only be purchased from a pharmacist. People will not need a prescription, but it will only be available behind a pharmacy counter. This has proven to be very effective in cutting down the methamphetamine clandestine labs operation by approximately 70-80%. States are realizing that this is the only way to stop these "mom and pop" labs. Proponents' Testimony: Mike McGrath, Attorney General, Montana, spoke in support of SB 287. He felt that this is the most significant thing that can be done to stop clandestine meth labs. Pseudoephedrine is the one necessary ingredient to make meth. If that product is restricted, it will stop most of the "mom and pop" meth labs. He spoke about the problems that meth creates. It fills the prisons, creates problems in the health care community, social service agencies, schools, and it creates tremendous family and community disruption. Mr. McGrath stressed two more points. Some people are concerned that the product will be behind the counter. Claritin D is a composite product and would be covered under this bill. One tablet of Claritin D contains 120 mg. of pseudo and 5 grams of an antihistamine. He resisted taking out the composite products. He encouraged the Committee to keep these products available only at a pharmacy. There are exceptions in the bill for people who live in rural communities. Gel caps and liquid pseudoephedrine is available and these types cannot be used to make meth. Access for people who need this product will not be hindered. The bill was amended in the Senate and addressed the meth-watch program. Section 10 has a provision that says if there is no funding, the program would be voided. That is not necessary any longer because funding has not been requested. He had an and biaxin.
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Patient satisfaction is an integral aspect of our practice. With the need to establish patient rapport relatively quickly, it is important that we work to have a better understanding of patient satisfaction and the intricacies of what is needed to fairly assess it.
Methamphetamine is a Schedule II drug, meaning that it has a very limited medical use and is available only through highly restricted prescription procedures. The drug was first prescribed for people suffering from narcolepsy and obesity, and its use was also recorded among soldiers on both sides during World War II. While meth recipes were previously available only on the black market for thousands of dollars, they now are accessible free of charge on the Internet. Meth use produces an increase in energy and alertness and a decrease in appetite. Users can obtain 10 to 15 doses from a single gram of methamphetamine, which can be smoked in much the same way as crack cocaine. Some smoke, snort or inject the drug, while others dissolve and drink it or wrap it in paper and swallow it. Much homemade meth tends to be only about 1 percent pure and includes ingredients such as lye and strips of lithium from batteries. Addicts frequently try to lessen the effects of coming down off the drug.
Address requests for reprints to: Chair, Clinical Practice and Economics Committee, AGA Institute National Office, c o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: 301 ; 654-5920. The Medical Position Statements MPS ; developed under the aegis of the American Gastroenterological Association AGA ; Institute and its Clinical Practice and Economics Committee CPEC ; were approved by the AGA Institute Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized placebo-controlled trials; however, when this is not possible the use of experts' consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA Institute stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient's current medical situation.
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Sc hedule Schedule I Definition High potential for abuse no medical use Sched ule II Narcotic and non-narcotic substances i.e., barbiturates and amphetamines ; with high potential for abuse addiction as well as medical efficacy Sched ule III Narcotic preparations and nonnarcotic substances with less potential for abuse addiction than Sch edu le I & II Sched ule IV Non-narcotic drugs that have a lower potential for abuse than Sched ule III Schedule V Drugs that m ay contain narcotics and have a low potential for abuse and are not habit forming Source: Texas Department of H e Drugs a nd Medical D e v tdh ate.tx bfds dm d co ntrol sub st s che d l and United States Drug Enforcement Agency at : usd oj.gov dea pu bs s che duling l Robitussin AC, Phenergan VC Valium, D arvocet-N Vico din hydroc odo ne w ith acetaminophen ; , Lortab, Tylenol w Codeine, Phenteramine Drug Exam ple Marijuana, Heroin, Illicit Cocaine i.e., `crack' ; Ritalin, Morphine, Cocaine, OxyContin, Dexedrine, Seconal.
When To Start COC COC can be started immediately if she has been using her hormonal method consistently and correctly, or if it is reasonably certain she is not pregnant. There is no need to wait for her next menstrual cycle. If her previous method was an injectable, she should start COC when the repeat injection would have been given.
Table 2: Characteristics of included studies on treatment for zmphetamine withdrawal" is the summary of the main characteristics of included studies given by the author of each study. Only 2 studies Jittiwutikan et al, 1997; Srisurapanont et al, 1999b ; met the criteria for considering studies. Both of them compared amineptine and placebo in the treatment of amphetamine withdrawal. Lorazepam was occasionally used during the treatment. The total number of participants in the two included studies was 73. All of them were adults with amphetamine withdrawal DSM-IV ; . The outcomes of interest in both studies were: 1. Discontinuation rate in both studies 2. Average score in global state, as measured by Clinical Global Impression or CGI Guy, 1976 ; in both studies 3. Average score in withdrawal symptoms, as measured by Amphe5amine Withdrawal Questionnaire or AWQ Srisurapanont et al, 1999a ; in one study Srisurapanont et al, 1999b ; 4. Average score in craving, as measure by craving score of Questionnaire for Evaluating Cocaine Craving and Related Responses or QECCRR Voris et al, 1991 ; in one study Jittiwutikan et al, 1997.
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Reported by: State Behavioral Risk Factor Surveillance System coordinators. Office of Disease Prevention and Health Promotion, US Dept of Health and Human Svcs. Epidemiology and Statistics Br, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC!
72 tap pharmaceutical products inc consolidated statements of shareholders' equity years ended december 31, 2003 , 2002 and 2001 dollars in thousands, except share amounts ; common stock additional paid-in capital accumulated other comprehensive income loss ; retained earnings total shareholders' equity shares amount see notes to consolidated financial statements.
Which of the following statements is characteristic for tardive dyskinesia? A ; recent phenothiazine therapy is usually found in the history B ; the intramuscular injection of benztropine rapidly relieves the symptoms C ; grimacing is typical D ; intentional tremor is diagnostic for the condition E ; the administration of phenothiazine may precipitate the attack PSY-3.268. Grandious delusions may occur in which of the following conditions? A ; schizophrenia B ; frontal lobe tumor C ; manic syndrome D ; compulsive neurosis E ; amphetamine intoxication PSY-3.269. Characteristic symptoms of acute manic psychosis include: A ; lack of insight B ; flight of ideas C ; confabulation D ; distractibility E ; depression in the family history PSY-3.270. Characteristic symptoms of depression include: A ; diminished concentration B ; hallucinations C ; hypochondriasis D ; delusions of persecution E ; weight loss ANSWER KEY PSY-3 ; 1.T 2.T 3.T.
Methamphetamine produces rapid changes in fundamental brain function as a result of direct damage to neural tissue. PET scan research conducted at UCLA, Johns Hopkins and Brookhaven Laboratories all demonstrates the profound neurotoxicity of methamphetamine. The reversibility of the nerve damage resulting from methamphetamine is in question. Monkey studies at UCLA suggest that there is recovery from the methamphetamine damage, but only following a period of months or years. Other researchers have found that the changes associated with methamphetamine use do not appear to recover with time.
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Matched a sub-group of patients prescribed dexamphetamine with patients not receiving a prescription n 12 matched pairs ; . They found significantly greater treatment retention in the dexamphetamine group; however, greater reductions in the amount and frequency of reported illicit amphetamine use did not reach statistical significance possibly due to the small sample size. The first published randomized controlled trial was conducted by Shearer et al. [41] in Sydney, Australia, and this compared 21 long-term dependent amphetamine users receiving 60 mg dexamphetamine daily to a control group of 20 similar users, both groups receiving standard drug counselling. Although this feasibility study was limited by small sample size, both groups were found to respond positively to intervention with reduced injecting, reduced methamphetamine-positive urine samples and reduced severity of dependence. The only statistically significant between-group difference was in the uptake of counselling, which was greater in the treatment group. Between-group differences, while failing to reach statistical significance, were in the direction of treatment benefit. A definitive RCT was considered feasible and warranted. White [42] reported on the 4-year experience of a large cohort of 148 amphetamine users in Cornwall, England, prescribed up to 90 mg dexamphetamine elixir daily mean dose 45.2 mg ; . The most notable outcome was a rapid 50% reduction in injecting behaviour achieved over an average of 2 months in treatment. White noted a high treatment dropout rate of 34%, a finding also reported by Charnaud & Griffiths. Safety and feasibility issues The selection of an appropriate agonist involves weighing risks against benefits of cessation of hazardous drug use. The development of psychotic symptoms is the most serious potential adverse consequence of dexamphetamine replacement therapy. Screening and monitoring for psychotic symptoms is integral to any prescribing programme. Exclusion of patients with a history of schizophrenia or bipolar affective disorder has been recommended [43]. Screening may be complicated by non-disclosure, as well as the common experience among amphetamine users of drug-induced transient psychotic symptoms and brief psychotic episodes. A history of drug-induced psychotic episodes may also make an individual more vulnerable to future amphetamine-induced psychotic episodes [44]. None of the studies described so far have reported first psychotic episodes among patients, leading several investigators to conclude that the risk of psychotic symptoms developing was small with low-dose, orally administered dexamphetamine. McBride et al. [39], noted three episodes of psychosis among 63 patients.
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