Ephedrine drug abuse

In a summary of the human abuse literature on anorectic phenylethylamines, Griffiths et al. (1979) found there was a good correlation between the results of self-administration studies in animals and information about the subjective effects and abuse in man. Specifically, amphetamine, diethyl-propion, and phenmetrazine have been associated with numerous clinical case reports involving abuse, and these three compounds as well as benz-phetamine and /-ephedrine have shown similar subjective effects in drug abuser populations (Griffiths et al. 1979). In addition, fenfluramine was associated with low incidence of abuse in humans and did not maintain self-injection responding in animals. Chlorphentermine was similarly associated with low incidence of abuse in man, but did not maintain selfinjection uniformly in animals (Griffiths et al. 1979). 

Drug abuse and dependence Prolonged abuse of ephedrine can lead to symptoms of paranoid schizophrenia. Patients exhibit such signs as tachycardia, poor nutrition and hygiene, fever, cold sweat, and dilated pupils. Some measure of tolerance develops, but addiction does not occur. 

In a new development following the emergence of methcathinone abuse in Southern Africa, an attempt to divert 100 kg of ephedrine, an immediate precursor of methcathinone, was uncovered in South Africa when the substance was ordered for delivery to Zimbabwe. The shipment was stopped prior to the identification of the suspects or the laboratory involved. It is therefore unclear whether the illicit drug laboratory was located in Zimbabwe or whether the substance was to have been smuggled back into South Africa to laboratories already existing in that country. 

It is a synthetic compound with structural similarity to ephedrine and is available in racemic and dextro isomers. It increases the systolic and diastolic blood pressure. Amphetamine is a potent CNS stimulant and causes alertness, insomnia, increased concentration, euphoria or dysphoria and increased work capacity. Amphetamine produces wakefulness and improved physical performance. It contracts the sphincter of the bladder and relaxes the bronchial smooth muscle in large doses. Amphetamines are drugs of abuse and can produce behavioural abnormalities and can precipitate psychosis. It can produce psychological but no physical dependence. 

Stimulant drugs commonly abused in the USA include methamphetamine ("crank," "crystal"), methylenedioxymethamphetamine (MDMA, "ecstasy"), and cocaine ("crack") as well as pharmaceuticals such as pseudoephedrine (Sudafed) and ephedrine (as such and in the herbal agent Ma-huang) (see Chapter 32). Caffeine is often added to dietary supplements sold as "metabolic enhancers" or "fat-burners" and is also sometimes combined with pseudoephedrine in underground pills sold as amphetamine substitutes. 

In the 1990s, methcathinone—called by various street names such as cat, goob, Jeff, speed, bathtub speed, mulka, gaggers, the C, wild cat, Cadillac express, and ephedrine—appeared as a drug of abuse on the black market. Methcathinone, a synthetic form of cathinone, is an even more potent stimulant than its natural counterpart and is illegal in the United States. 

Dextromethorphan is sold alone or, when mixed with other drugs such as phenylpropanolamine or ephedrine, is marketed as ecstasy, after the widely abused street drag. Of course, this formulation is not the same compound as ecstasy. It has also been used to deceive persons who are seeking to buy narcotics such as heroin. The greatest amount of dextromethorphan abuse so far has occurred with the over-the-counter cough formulas. Reportedly, dextromethorphan is also being sold on the Internet in pill and capsule forms as well as the powder. 

The cardiovascular effects, subjective effects, and abuse potential of single intranasal doses of ephedrine 5 and 10 mg have been compared with oral doses of (—)ephe-drine 50 mg in 16 healthy Caucasian men with no drug/ alcohol/nicotine abuse or dependence (5). Intranasal ephedrine caused an increase in blood pressure but associated orthostatic hypotension. 

Cardiac dysrhythmias have been attributed to ephedrine both in therapeutic doses (8) and when used as a drug of abuse (6). 

Ephedra was also sold in combination with many other herbs in obscure combinations. Labels frequently listed 10 or 15 different herbs, but, analysis usually disclosed only the ephedra alkaloids and caffeine as present in sufficient quantities to be physiologically active. After several well-publicized accidental deaths, products clearly intended for abuse, such as herbal ecstasy, and other look-alike drugs (products usually containing ephedrine or phenylpropanolamine designed to look like illicit methamphetamine, but in concentrations higher than recommended by industry or the FDA) were withdrawn from the market. Labels on these products were frequently misleading. For example, one might suppose that a product called Ephedrine 60 contained 60 mg of ephedrine when, in fact, the actual ephedrine content was 25 mg. 

Amphetamine and methamphetamine (Figure 34-19) are CNS stimulant drugs that have limited legitimate pharmacological use. ° They are used to treat narcolepsy, obesity, and attention-deficit hyperactivity disorders. However, they produce an initial euphoria and have a high abuse potential. Other sympathomimetic amines that also have high potential for abuse include the designer amphetamines, ephedrine, pseudoephedrine, phenylpropanolamine, and methylphenidate (Ritalin). 

Reports of ephedra-related stroke on file with the FDA have not yet been published in the peer reviewed literature. In some of the FDA cases, massive doses of ephedrine were consumed (as with products intended for abuse, such as "herbal ecstasy," now withdrawn from the market). In other cases, toxicology testing was not performed, and it is not known with any certainty whether ephedrine was even taken. In still other cases, the drug identified was not ephedrine Many adverse events attributed to ephedrine have actually been due to ephedrine enantiomers, pseudoephedrine (Loizou et al., 1982 Stoessl et al., 1985) and phenylpropanolamine (Johnson et al., 1983 Glick et al., 1987 Lake et al.,... 

Kargin, 1996) and stroke (Stoessl et al., 1985 Yin, 1990 Bruno et al., 1993 Anonymous, 1996a,b Waluga et al., 1998) are fairly common complications of ephedrine abuse, although rarely, if ever, are these seen when the drug is taken in recommended doses. 

Nakahara Y, Kikura R. Hair analysis for drugs of abuse. XIX. Determination of ephedrine and its homologs in rat hair and human hair. J Chromatogr B Biomed Sci Appl 1997 700 83-91. 

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