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“If addiction is judged by how long a dumb animal will sit pressing a lever to get a "fix" of something, to its own detriment, then I would conclude that net news is far more addictive than cocaine” Rob Stampfli

2011

Fact Sheet on CNS Stimulants

Physiological Complication in Psychopharmacology

Missy Beckwith

Fact Sheet on CNS Stimulants.

What are Central Nervous System (CNS) Stimulants ?

Central nervous system (CNS) stimulants are medicines that speed up physical and

mental processes. (1) This includes the two most frequently-used drugs on the planet,

caffeine and nicotine. (2) Amphetamines, methamphetamine, cocaine and methylphenidate

(Ritalin) are all stimulants. (6) As the name suggests, stimulants increase alertness, attention,

and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulants historically

were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a

variety of other ailments. But as their potential for abuse and addiction became apparent, the

medical use of stimulants began to wane. Now, stimulants are prescribed to treat only a few

health conditions, including ADHD, narcolepsy, and occasionally depression—in those who

have not responded to other treatments. (3)

All stimulant drugs cause an increase in general behavioral activity. When taken short-term (one

or two weeks), stimulant drugs cause states of euphoria, optimism, and general feelings of well-

being. Initial feelings of anorexia are frequent, a quality that leads to their use/abuse in weight

loss products. Insomnia is also frequent. These responses indicate that the part of the brain which

controls these functions, the hypothalamus, is strongly affected by these drugs and that the

dopamine transmitter system is primarily involved in many of these effects.

Other effects are:

decreased feelings of depression

increased thoughts and associations

increased talkativeness

increased blood pressure

anxiety

irritability

decreased fatigue (2)

What are names of prescription, OTC, common and illicit CNS

Stimulants?

Examples include cocaine, methamphetamine, amphetamines, methylphenidate (Ritalin),

nicotine, caffeine, and MDMA (3,4-methylenedioxymethamphetamine), better known as

“Ecstasy” (12) caffeine, nicotine, over the counter cold medicines, chocolate, diet pills, like

ephedrine, or ma huang, and the class of drugs known as amphetamines- both legally prescribed

and illegal. (18)

Cocaine comes in two forms. Powder cocaine is a hydrochloride salt, made from the leaf of the

coca plant. “Crack” is a smokeable form of cocaine that is processed with ammonia or baking

soda and water, and heated to remove the hydrochloride. (12) Khat is a flowering evergreen

shrub that is abused for its stimulant-like effect. Khat has two active ingredients, cathine

and cathinone. (17) Synthetic stimulants that are marketed as “bath salts” are often found in a

number of retail products. These synthetic stimulants are chemicals. The chemicals are synthetic

derivatives of cathinone, a central nervous system

stimulant, which is an active chemical found naturally in the khat plant. Mephedrone and MDPV

(3-4 methylenedioxypyrovalerone) are two of the designer cathinones most commonly found in

these “bath salt” products. Many of these products are sold over the Internet, in convenience

stores, and in “head shops.”(17)

What are street names for various CNS Stimulants?

Cocaine is generally sold on the street as a fine, white, crystalline powder, known as

“coke,” “C,“ “snow,” “flake,“

“blow,” “bump,“ “candy,“

“Charlie,” “rock,” Soda Cot,

and “toot.” “Crack,” the street

name for the smokeable form of

cocaine, got its name from the

crackling sound made when

it’s smoked. A “speedball” is cocaine or crack combined with heroin, or crack and heroin

smoked together.

Methamphetamine is commonly known as “speed,” “meth,” “chalk,” and “tina.” Ice, Crystal,

Crank, Tweak, Uppers, Black Beauties, Glass, Bikers Coffee, Methlies Quick, Poor Man's

Cocaine, Chicken Feed, Shabu, Crystal Meth, Stove Top, Trash, Go-Fast, Yaba, and Yellow

Bam, “glass,” “fire,” and “go fast.” (15)

Street names for amphetamines include “speed,” “bennies,” “black beauties,” “crosses,”

“hearts,” “LA turnaround,” “truck drivers,” and “uppers.”

Khat : Abyssinian Tea, African Salad, Catha, Chat, Kat, and Oat. (17)

"Bath Salt": Bilss, Blue Silk, Cloud Nine, Drone, Energy-1, Ivory Wave, Lunar Wave, Meow

Meow, Ocean Burst, Pure Ivory, Purple Wave, Red Dove, Snow Leopard, Stardust, Vanilla Sky,

White Dove, White Knight, White Lightening. (17)

Street names for methylphenidate include “rits,” “vitamin R,” and “west coast.” (12)

Stimulants

Type Conditions They Treat Street Names

• Dextroamphetamine (Dexedrine and Adderall) • Methylphenidate (Ritalin and Concerta)

• ADHD • Narcolepsy (sleep disorder) • Depression

Skippy, the smart drug, vitamin r, bennies, black beauties, roses, hearts, speed, or uppers

What are the therapeutic uses of prescription Stimulants?

Stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their

attention. (10) Methamphetamine hydrochloride has been marketed as a prescription drug for

quite some time. The primary use of the drug is for the treatment of Attention Deficit Disorder

(ADD) with Hyperactivity and for the treatment of Exogenous Obesity. (13) Some

psychostimulants have been found to have uses that are not typical for other drugs in the same

class. Although bupropion is a phenylalkylamine, the structural dissimilarity with amphetamine

is significant enough to produce considerably different physiologic effects. Bupropion is an

example of a weak psychostimulant that has found use as an antidepressant (Wellbutrin®) and is

also marketed as a smoking cessation aid (Zyban®). (14) Methamphetamine was originally used in

nasal decongestants and bronchial inhalers (the levo isomer of methamphetamine is still utilized for

these indications). Later it was available in tablets and injectable formulations and used for weight

control, depression, and to increase alertness and prevent sleep. A broad segment of society used

methamphetamine products for stimulant effects. Today there is only one product, Desoxyn®, currently

marketed in 5 mg tablets. Desoxyn® has very limited use in the treatment of obesity, and attention

deficit hyperactivity disorder. IMS Health® reports that 14,000 total prescriptions for methamphetamine

were dispensed in the U.S. in 2009. (16)

What are the Neurological (Brain) Effects of Stimulant Abuse?

The effects of amphetamines and methamphetamine are similar to cocaine, but their onset

is slower and their duration is longer. In contrast to cocaine, which is quickly removed from the

brain and is almost completely metabolized, methamphetamine remains in the central nervous

system longer, and a larger percentage of the drug remains unchanged in the body, producing

prolonged stimulant effects. Chronic abuse produces a psychosis that resembles schizophrenia

and is characterized by: Paranoia, picking at the skin, preoccupation with one’s own thoughts,

and auditory and visual hallucinations. Violent and erratic behavior is frequently seen among

chronic abusers of

amphetamines and

methamphetamine.(17) Short

term effects of stimulants

exert their effects on the brain

by disrupting or modifying

the normal communication that occurs among brain neurons and brain circuits. Cocaine and MA

have both been shown to specifically disrupt the dopamine neurotransmitter system. This

disruption is accomplished by over stimulating the receptors on the postsynaptic neuron, either

by increasing the amount of dopamine in the synapse through excessive presynaptic release or by

inhibiting dopamine's pattern of reuptake or chemical breakdown .(4) Stimulants help to increase

chemicals found in the brains neurotransmitters. The chemicals cause the brain to become more

active, which results in more alertness, energy, and attention. The user may have a feeling of

euphoria; chasing this feeling can lead to addiction. (9)

The use of cocaine and MA increases the amount of available dopamine in the brain, which leads

to mood elevation (e.g., feelings of elation or euphoria) and increased motor activity. With

cocaine, the effects are short-lived; with MA the duration of effect is much longer. As the

stimulant level in the brain decreases, the dopamine levels subside to normal, and the pleasurable

feelings dwindle away.(4) Other neurological effects, including strokes, seizures, headaches, and

coma; and gastrointestinal complications, abdominal pain and nausea. In rare instances, sudden

death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are

often a result of cardiac arrest or seizures followed by respiratory arrest.

Khat can induce manic behavior with: Grandiose delusions, paranoia, nightmares,

hallucinations, and hyperactivity (17)

In addition research has also revealed a potentially dangerous interaction between cocaine and

alcohol. This mixture is the most common two-drug combination that results in drug-related

death. (5)

What are the Physiological Effects from Stimulant Abuse?

The short-term physiological effects of cocaine use include constricted blood vessels;

dilated pupils; and increased body temperature, heart rate, and blood pressure. Large amounts of

cocaine may intensify the user's high but can also lead to bizarre, erratic, and violent behavior.

Some cocaine users report feelings of restlessness, irritability, anxiety, panic, and paranoia.

Users may also experience tremors, vertigo, and muscle twitches. (5) The immediate

psychological effects of stimulant administration include a heightened sense of well-being,

euphoria, excitement, heightened alertness, and increases in motor activity. Stimulants also

reduce food intake. (4) Long-term abuse of stimulants changes the way the brain functions and

may lead to severe mental disorders and memory loss. Research also suggests that stimulants

impair the ability of specific brain circuits to change in response to experiences. This new

evidence may help explain some of the behavioral and cognitive deficits that are often seen in

people who are addicted to stimulants. (8) Khat causes an immediate increase in blood pressure

and heart rate. Khat can also cause a brown staining of the teeth, insomnia, and gastric disorders.

Chronic abuse of Khat can cause physical exhaustion.(17)

What are Signs and Symptoms of CNS Stimulant Dependence?

Stimulants are substances that induce a number of characteristic symptoms. CNS effects

include alertness with increased vigilance, a sense of well-being, and euphoria. Many users

experience insomnia and anorexia, and some may develop psychotic symptoms. Stimulants have

peripheral cardiovascular activity, including increased blood pressure and heart rate. They

encompass a broad category of substances, including those prescribed for medical conditions;

those manufactured for illicit substance abuse; and those found in over-the-counter (OTC)

decongestants, herbal extracts, caffeinated beverages, and cigarettes. (7) Signs and symptoms of

use and dependence on these drugs include:

Euphoria

Decreased appetite

Rapid speech

Irritability

Restlessness

Depression as the drug wears off

Nasal congestion and damage to the mucous membrane of the nose in users who snort

drugs

Insomnia

Weight loss

Increased heart rate, blood pressure and temperature

Paranoia (6)

What are the Withdrawal Effects from Stimulant Abuse?

In general, symptoms of withdrawal may include irritability, headaches, nausea,

vomiting, and mood swings. The severity of withdrawal symptoms varies, depending on the

specific drug. For instance, individuals who are addicted to caffeine may experience symptoms

of fatigue or headaches when they stop drinking coffee. In contrast, individuals who abuse

methamphetamines experience much more severe withdrawal symptoms that may even be life

threatening. Examples of these symptoms include intense cravings for the drug, psychotic

reactions, anxiety, moderate to severe depression, intense hunger, irritability, fatigue, mental

confusion, and insomnia.

Withdrawal symptoms associated in general with discontinuing stimulant use include fatigue,

depression, and disturbance of sleep patterns. Repeated abuse of some stimulants (sometimes

within a short period) can lead to feelings of hostility or paranoia, even psychosis. Further, taking

high doses of a stimulant may result in dangerously high body temperature and an irregular

heartbeat. There is also the potential for cardiovascular failure or seizures. (3)

What are the Health Risks of Stimulant Abuse?

The general acute effects of stimulants have been well documented. Among a range of

physiological responses, stimulants are known to raise both systolic and diastolic blood pressure,

increase heart rate, increase respiration rate, increase body temperature, cause pupillary dilation,

heighten alertness, and increase motor activity.

Acute effects from excessive doses include dangerously rapid and erratic heartbeat, cerebral

hemorrhaging, seizures/convulsions, respiratory failure, stroke, heart failure, brain damage,

coma, and death. (4)

Although the effects of chronic stimulant abuse in humans has not

been well documented, some of the chronic effects include organ

toxicity, compromised health (e.g., underfed, malnourished, poor

hygiene), dental problems, and dermatitis. (4)

References(1) http://www.healthline.com/galecontent/central-nervous-system-stimulants

(2) www.castaliapub.com/drugsandclients/pdf/CNS_Stimulants.pdf · PDF file

(3) http://www.drugabuse.gov/ResearchReports/Prescription/prescription4.html

(4) http://www.addictioninfo.org/articles/672/1/How-Stimulants-Affect-the-Brain-and-

Behavior/Page1.html

(5) http://www.nida.nih.gov/ResearchReports/Cocaine/effects.html#how

(6) http://www.cpcwa.org/InformationAndResources/cdsigns.html

(7) http://emedicine.medscape.com/article/289007-overview

(8) http://www.wellness.com/reference/conditions/cns-stimulants/symptoms-and-causes

(9) http://www.thecabinchiangmai.com/site/prescription-addiction/cns-stimulant-medications-

addiction-other-health-effects/

(10) http://www.drugabuse.gov/Infofacts/PainMed.html

(11) http://teens.drugabuse.gov/peerx/pdf/PEERx_Toolkit_FactSheets_Stimulants.pdf

(12) http://teens.drugabuse.gov/facts/facts_stim1.php

(13) http://health.utah.gov/meth/html/Healthconcerns/TherapeuticUse.html

(14) http://findarticles.com/p/articles/mi_qa3890/is_200504/ai_n13636397/

(15) http://www.justice.gov/dea/concern/meth.html#3

(16) http://www.deadiversion.usdoj.gov/drugs_concern/meth.htm

(17) http://www.justice.gov/dea/pubs/drugs_of_abuse.pdf

(18) http://www.healthandgoodness.com/article/the-affect-of-stimulants-on-your-health.html