DEFINITION

The nonmedical misuse or abuse of, or dependence on, psychostimulants such as:

• Amphetamines were first used as a nasal decongestant and then by the U.S. military to improve alertness in troops. In the 1950s, they gained popularity as weight-loss drugs (e.g., ephedra, ma huang) and became frequently misused medications. They enhance dopamine and norepinephrine activity in the mesocorticolimbic pathway due to effects on monoamine transporters.[1]
• Cocaine is a tropane ester alkaloid found in leaves of the Erythroxylum coca plant that enhances dopamine, norepinephrine, and serotonin activity by blocking presynaptic reuptake. It also activates the corticomesolimbic dopamine reward circuit. [2]Smoked or IV produces effects lasting 15-30 min; snorting and ingested use lasts 1-3 hours.[3]
  • Cocaine base, ("crack," "freebase") which can be smoked because it has a relatively low melting point (98ºC) and vaporizes. It is rarely injected because it is relatively insoluble. Onset of action is within seconds.[3]
  • Cocaine HCl cannot be efficiently smoked because it melts at 195ºC with substantial loss of the active metabolites. Cocaine salt is readily injected or insufflated ("snorted") through the nose; it is highly water soluble with onset of action in 20-30 minutes.[3]
• Methamphetamine is a psychostimulant derived from amphetamines and increases the release and blocks the reuptake of monoamine neurotransmitters. Starting in the late 1980s, use of methamphetamine has evolved to include a wider range of the population and of the country (used to be localized mostly to CA and OR). Street names include crystal meth, crank, ice, chalk, and Tina.[4]
• Synthetic cathinones (AKA "bath salts") are beta-ketone amphetamine analogs that vary in pharmacologic properties. They are reported to increase energy, empathy, and libido (associated with high-risk sexual behavior)[5]. They emerged as a misused substance in Europe in 2009 and spread to the U.S. in 2010.[6]