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Licit and illicit drugs
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
All drugs in this group act by increasing concentrations of a neurotransmitter called dopamine. Dopamine is located within certain vital areas of the hind-brain. Dopamine has many different actions, but perhaps the best known involves mediating the sense of pleasure. Some drugs, such as cocaine (Figure 24.6), simply prevent the reuptake of dopamine, allowing it to accumulate in the space between nerve endings (synaptic cleft), while others, such as the amphetamines (khat has nearly the same structure as amphetamine, as does the drug called fenethylline or Captagon in the Middle East), have a similar action to cocaine but, in addition, cause presynaptic neurons to release additional dopamine stored within their endings. The net result is that even more dopamine accumulates within the synapses leading, in turn, to an enhanced dopamine effect. However, like many of the newer antidepressants, cocaine also blocks the reuptake of serotonin (sometimes causing a disorder known as serotonin syndrome) and blocks the reuptake of all catecholamines, especially norepinephrine. It is this last action that explains most of the vascular disease associated with stimulant abuse. Excessive concentrations of catecholamines within the heart cause fibrosis (Figure 24.7) or even micro-infarction of the myocardium (Figure 24.8). This process disrupts the normal electrical flow of the heart, causing an irregular heartbeat (arrhythmia). The result can be fatal.
Qualitative exploration of the experiences of men who use drugs of obtaining psychoactive medicinal products in Jordan
Published in Journal of Ethnicity in Substance Abuse, 2022
Mayyada Wazaify, Nour Alhusein, Jenny Scott
A convenience sample of seventeen participants were interviewed. It is unknown how many were initially approached. The Center typically has about 30 residents at any one time, although not all may have met the inclusion criteria. Average length of stay at the Center prior to interview was 10 days (range 5 − 14 days), suggesting those in an acute withdrawal phase were unlikely to have been included. Interviews lasted between 10 and 44 minutes (median 16 minutes). All were male. There are no female resident facilities at the Addiction Treatment Center. Median age was 27.5 (range 21 to 39 years). All reported dependence on one or more prescription or over the counter medicine. Alprazolam, clonazepam, bromazepam and tramadol were the most commonly used drugs. Most but not all participants used such drugs in combination with illicit drugs (e.g. heroin, Captagon (fenethylline) or hashish) to augment or modify effects.
Psychoactive substances use in Jordan: Descriptive study of data from Anti-narcotic Department (AND), 2014-2018
Published in Journal of Substance Use, 2022
Dima Albals, Alaa Yehya, Mayyada Wazaify
Different psychoactive substances which possess either stimulant or depressant effects can be used in order to get “high.” Central nervous system (CNS) stimulants (e.g., amphetamine and derivatives) are usually prescribed to speed up the activities of the brain by enhancing alertness, concentration and energy (Huang et al., 2006). For this reason, they are prescribed by physicians to treat conditions such as attention deficit hyperactivity disorder (ADHD) and depression. Stimulants also include illicit substances like cocaine and Captagon (Fenethylline). CNS depressants, on the other hand, work by “depressing” or slowing down the normal activity of the brain (Sullivan & Evans, 2014). When taken exactly as prescribed, depressants can be effective treatments for insomnia and different anxiety disorders. Also, painkillers mainly opioids such as morphine and tramadol are usually prescribed to relieve severe types of pain, especially after major surgery (Dodgen & Shea, 2000). Since 2004, Novel Psychoactive Substance (NPS) known as synthetic cannabinoids have been introduced into illegal market worldwide (Seely, Lapoint, Moran, & Fattore, 2012). They have been described as “legal highs” and “research chemicals,” highlighting their “designer” nature, to circumvent the law, especially when bought online. Known by several street names around the world like K2, Spice or synthetic marijuana (in Jordan known as Joker), they are considered attractive for substance users because of easy availability, cheap price besides their potent psychoactive effects (Cottencin, Rolland, & Karila, 2014). Moreover, lack of detection in routine drug screenings is considered the main challenge for tackling these substances (Schifano, Chiappini, Corkery, & Guirguis, 2018).
The association of amfetamines and cathinones with acute coronary syndrome – a systematic review
Published in Clinical Toxicology, 2023
F. M. J. Gresnigt, E. S. Smits, C. den Haan, R. K. Riezebos, E. J. F. Franssen, D. W. de Lange
There is evidence that the use of amfetamines and cathinones is associated with the occurrence of acute coronary syndrome. It is likely that khat chewing is a risk factor for acute coronary syndrome, and the inclusion of khat in the international acute coronary syndrome guidelines should be considered. Amfetamine, metamfetamine, MDMA, fenethylline, 4-fluoroamfetamine, and synthetic cathinones were also reported in association with acute coronary syndrome. However, this evidence is limited, of low quality and with a low number of reported cases. Further prospective studies need to be conducted.