Dependance: Stimulants

Question 1

Signs and symptoms

Answer 1

Increased alertness, endurance and confidence

• Risky behaviour
• Unpleasant ‘crash’ period (dysphoria [i.e. dissatisfaction with life] and lethargy)

Side effects:
- Cocaine – n.b. no dependence (but can become ‘habit’):
- Acute – arrhythmia, intense anxiety, hypertension → CVA impulsivity, impaired judgement
- Chronic – nasal septum necrosis, foetal damage, panic & anxiety, delusions, psychosis

I.E. “Cocaine-induced Delusional Disorder” – believes performance in excess of ability

• Amphetamines – n.b. very regular use associated with dependence:

· Acute – tachycardia, arrhythmia, hyperpyrexia, irritability, post-use depression

· Quasi-psychotic state with visual, auditory and tactile hallucinations

• Ecstasy – n.b. tolerance but no dependence:

· Acute – increased sweating, nausea, vomiting, diminished potency despite increased libido

· Death associated with dehydration & hyperthermia (some chronic liver & cognitive disease)

-Cocaine withdrawal – occurs in 2 stages:
(1) Crash phase – from 3 hours – S/S: depression, exhaustion, agitation, irritability
(2) Withdrawal – S/S: cravings, irritability, anergia, poor concentration, insomnia, slowed movements

· Lasts 1-10 weeks

Question 2

Investigations / Management

Answer 2

Investigations:

o Urine drug screen – cocaine in urine for up to 5-7 days

· Management:

o Harm reduction (see Opiates)

o Short-term withdrawal symptom relief as an inpatient with BDZ