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AMPHETAMINES CAPTAGON:

AMPHETAMINES CAPTAGON WALID SARHAN F.R.C.Psych. Consultant Psychiatrists

Is there a problem?:

Is there a problem? The confiscated amounts. The numbed of cases treated. The number of overdose deaths. The female involvement. The number of court cases. The age of Abuse. The HIV and Hepatitis cases.

Substances:

Substances Street drugs. Pharmaceuticals. Volatile Substances. Alcohol. Nicotine. Caffeine

Street drugs:

sarhan Street drugs Hashish. Heroin. Amphetamines. Cocaine. Hallucinogenics.

Slide 5:

AMPHETAMINE CONTENT What are Amphetamines? History How Are Amphetamines Consumed? What are the Effects? Short Term Effects Long Term Effects Addiction Withdrawal Use in the United States Testing for Amphetamines Useful Links

Street shapes:

Street shapes

Street shapes:

Street shapes

Street shapes:

Street shapes

Street shapes:

Street shapes

powder:

powder

Variable shapes:

Variable shapes

12/1/2011 :

12/1/2011 العقبة : احباط تهريب 60 الف حبة كبتاجون

26 يناير 20111:

26 يناير 20111 مكافحة المخدرات" تضبط نصف مليون حبة مخدرة من حبوب الكبتاجون

Slide 19:

WHAT ARE AMPHETAMINES? Amphetamines are powerful stimulants that increase activity in the Central Nervous System (CNS), or speed up the way the human body works. They are classified as a CNS Stimulant. Amphetamines are drugs that induce false feelings of power, strength, self-assertion and enhanced motivation.

Slide 20:

HISTORY of AMPHETAMINES 18 JAN 1887 First amphetamine, phenylisopropylamine was synthesized by a German chemist. 1919 Methamphetamine is first synthesized. 1932 Amphetamines were marketed for the first time as benzedrine in an over-the-counter inhaler to treat congestion. 1937 Amphetamines were made available for prescription in tablet form to treat narcolepsy.

Slide 21:

HISTORY of AMPHETAMINES World War II Amphetamines are widely distributed to soldiers on both sides to enhance performance. This led to addiction problems in post war Japan. 1942 Dextro -amphetamine becomes commonly available throughout the United States. 1950s Amphetamines were widely used to treat depression and cause weight loss. 1960s Methamphetamine use begins to appear around the United States .

Slide 22:

HISTORY of AMPHETAMINES 1970 Amphetamines became illegal after the passage of “United States Drug Abuse Regulation and Control Act of 1970” 1980s – present The smoking of methamphetamine becomes popular throughout the United States despite the dangers involved. Present Amphetamines are classified by the DEA as a Schedule II Controlled Substance. Amphetamines, specifically methamphetamine has been associated with “Raves”, and belongs to the “Club Drugs” family.

STREET NAMES:

Speed STREET NAMES The amphetamines found on the street are almost never pure, and have been known to be mixed with substances such as glucose. Amphetamines are known by several slang terms such as : Crystal Billy Whiz Glass Sulphate Uppers Ups Wake Ups Bennies Dexies Black Beauties Jollies

LOCAL STREET NAMES:

LOCAL STREET NAMES كبتاغون كبت أبو هلالين منشط الدراسة منشط السواقة

news:

news الصفحة الرئيسية » سياسة » شؤون اردنية إحباط تهريب 130 ألف حبة "كبتاغون" في جمرك جابر 2009/06/27 عمان- أحبطت كوادر الجمارك الأردنية العاملة في مركز جمرك جابر عملية تهريب 130 ألف حبة كبتاغون المخدرة كانت بمخبأ سري في إحدى المركبات. ووفق بيان للجمارك الأردنية اليوم السبت فقد تم تسليم المهربين وواسطة النقل للجهات المختصة لاتخاذ الإجراءات القانونية اللازمة بحقهم. --بترا

news:

news إحباط تهريب كبتاغون وحشيش خبرني- أحبطت إدارة مكافحة المخدرات بالتنسيق مع القوات المسلحة الثلاثاء محاولة تهريب32 كيلوغراما من الحشيش وأكثر من أربعمائة ألف حبة كبتاجون. وقال الناطق الإعلامي باسم مديرية الأمن العام الرائد محمد الخطيب أن معلومات وردت لإدارة مكافحة المخدرات، أشارت إلى أن مجموعة من الأشخاص تنوي تهريب كمية من المخدرات الى داخل المملكة، حيث تم تشكيل فريق متخصص لمتابعة هذه المعلومات والتحري عن هوية هؤلاء الأشخاص، وتم التعرف عليهم ورصد تحركاتهم وكشف مخططهم. وأضاف الخطيب أنه تم تنفيذ خطة محكمة لضبط جميع المتورطين والمواد المخدرة وإيداعهم للجهات المختصة.

news:

news خبرني - احبطت الاجهزة الامنية في مركز اصلاح وتأهيل قفقفا الثلاثاء محاولة تهريب كمية من الحبوب المخدرة الى داخل المركز . و قال الرائد الخطيب : ان احد الزوار حاول ادخال كمية من الحبوب المخدرة والبالغة (1400) حبة تقريبا الى احد النزلاء بواسطة وضعها داخل امتعة كان ينوي تسليمها للنزيل من خلال الامانات الموضوعة داخل مراكز الاصلاح لخدمة النزلاء من قبل ذويهم . وأضاف الرائد الخطيب أن مثل هذه المحاولات لا تعود إلا بالضرر على النزلاء أنفسهم مشيرا أن مديرية الأمن العام ستوالي اتخاذ إجراءاتها المشددة حيال مثل هؤلاء الأشخاص ضعاف النفوس الذين يحاولون إدخال مثل هذه الممنوعات والتي تؤثر سلبا على النزلاء، مؤكدا على قدرة العاملين في هذه المراكز على كشف أية محاولة تهريب لأي مواد ممنوعة إلى داخل مراكز الإصلاح وذلك باستخدام أجهزة علمية متطورة وحديثة

CAPTAGON:

CAPTAGON Fenetylline (CAPTAGON) is included in a list of compounds to be considered by a World Health Organization (WHO) Expert Committee in April 1985 for possible international scheduling under the Convention on Psychotropic Substances

CAPTAGON:

CAPTAGON over 23 years, this central stimulant has been used therapeutically in hyperkinetic children and other indications in place of amphetamines and other central stimulants with higher risk levels

CAPTAGON:

CAPTAGON More illegal amphetamines are being seized in the Gulf than in the US, China and Britain combined,” said the 303-page report released last week. “Captagon pills — a mixture of the stimulants fenethylline and caffeine — change hands for only a few riyals on the streets of Jeddah, Manama and Doha.”

CAPTAGON:

CAPTAGON Saudi Customs forms have a strongly worded disclaimer warning that drug traffickers are given the death penalty, but Saudi Arabia is the No. 1 abuser of stimulants in the region despite this ominous message to smugglers, according to a new report released by the United Nations Office on Drugs and Crime (UNODC).

CAPTAGON:

CAPTAGON The UNODC report reveals how young Saudis and Arabs fall prey to drugs and addiction. The report documents how Captagon seizures mushroomed from 291 kgs in 2000 to 12.3 tons in 2006.

CAPTAGON:

CAPTAGON Omani officials have also confiscated two tons of illegal stimulants recently, while smaller shipments were seized in Bahrain, Qatar, the UAE and Kuwait.

CAPTAGON:

CAPTAGON DUBAI, United Arab Emirates - 11 Dec 2009. In reportedly one of the UAE’s biggest drug hauls, authorities raided a warehouse and seized 4.2 million Captagon pills. One arrest was made and several other suspects remain at large.

CAPTAGON:

CAPTAGON DOHA, Qatar - 25 June 2009. In June 2009, Qatar disbanded an international drug trafficking network and seized four million pills of Captagon, reportedly the biggest-ever drugs haul in the country.

CAPTAGON:

CAPTAGON RIYADH, Saudi Arabia - 10 Jan 2010. Saudi Arabian authorities reported the seizure of more than 8 million Captagon pills with an estimated street value of $77.9 million. Six men - three Saudis and three foreigners.

CAPTAGON:

CAPTAGON AMMAN, Jordan - 13 Feb 2009. Anti-narcotics police foiled a plot to smuggle a record poly-drug consignment which included 119 kg of heroin, 39 kg of hashish and 2 kg of methamphetamine.

CAPTAGON:

CAPTAGON Captagon, or “amphetamine,” has become the Arabian Peninsula’s favorite drug. In 2008 the Middle East accounted for 73 percent of global seizures, according to the report First Published: February 26, 2010-CAIRO

Trends in the world drug markets Amphetamine-type stimulants market2009:

Trends in the world drug markets Amphetamine-type stimulants market 2009 Trafficking in fake Captagon (amphetamine)in the Near and Middle East dominates global amphetamine seizures The Near and Middle East accounted for nearly two thirds of all amphetamine seized,

Amphetamines: Mechanism of Action:

Amphetamines: Mechanism of Action CNS effects are caused by release of NE and DA from presynaptic storage sites in the nerve terminals, increasing the amounts available at the postsynaptic receptor .

Amphetamines: Pharmacological Effects:

Amphetamines: Pharmacological Effects Response intensity and duration varies with type of drug, dose & route of administration Low dose: typical psychomotor stimulation Moderate dose: tremors, insomnia, agitation, increased respiration Continuous high doses: repetitive activity, aggression, delusions, anorexia Detectable in urine for 48 hours

Therapeutic uses:

Therapeutic uses : uses are limited due to the physical and psychological dependence which can develop and the tolerance to the euphoric and anorectic effects; there is less tolerance to the convulsive effects. ADHD: Dextroamphetamine and methylphenenidate (Ritalin) paradoxically alleviate the hyperkinesis and short attention span in these individuals. Atomoxetine ( strattera ) is a non-stimulant used for ADHD in children & adults, this drug blocks the reuptake of NE. Narcolepsy: This rare sleep disorder involves overwhelming, irresistible urges to sleep during the day despite adequate night time sleep there may be associated episodes of cataplexy or even paralysis.

HOW ARE AMPHETAMINES CONSUMED?:

Amphetamines are generally a white or off-white powder that can be ingested in one of three ways: Orally – In a pill form Snorted – This can cause severe damage to the interior and exterior of the nose. Intravenously - The amphetamine can be injected into either the blood stream or the muscle tissue HOW ARE AMPHETAMINES CONSUMED?

Pharmacokinetics::

Pharmacokinetics: Amphetamine is completely absorbed from the GI tract, metabolized in the liver and excreted in the urine. Acidification of the urine promotes excretion. The duration of action is 4-6 hours (much longer than cocaine).

SHORT TERM SIDE EFFECTS:

SHORT TERM SIDE EFFECTS Dilated Pupils Increased Blood Pressure Increased Heart Rate Decreased Appetite Dry Mouth Headache Dizziness/Nausea Tremors Irregular Heartbeat Loss of Coordination Collapse Loss of Consciousness

Amphetamines Intoxication:

47 Amphetamines Intoxication In contrast to opiates, these drugs created an excitatory condition characterized by elevated heart rate. They also illicit extreme feelings of euphoria. These drugs have some of the highest incidences of abuse. Ecstasy (MDMA), LSD (lysergic Acid) Crystal Meth ( methamphetamine) all fall under this umbrella.

Amphetamine Dependence:

Amphetamine Dependence Produce stimulation and euphoria Effects are dose related Small amounts cause mental alertness, wakefulness and increased energy Large amounts can cause psychoses Tolerance develops

LONG TERM SIDE EFFECTS:

In addition to those listed below amphetamine use can cause the users to have long term problems with high blood pressure, irregular heartbeats, and severe sleeping disorders. LONG TERM SIDE EFFECTS Malnutrition – Because Amphetamines reduce the users appetite, they are less likely to eat properly and because of this are less resistant to infections. Chronic Psychosis – Symptoms include paranoia, delusions, and bizarre behavior. This can be seen as early as 1 week after the user has stopped using. Chronic Anxiety/Tension - To combat this users often turn to alcohol and barbiturates for help. Chronic Anxiety may also lead to violent behavior. Brain Damage – Long term use of Amphetamines can cause damage to the brain, specifically areas that deal with memory and everyday thinking.

Proposed Mechanism for Chronic Amphetamine-Induced Psychosis:

Proposed Mechanism for Chronic Amphetamine-Induced Psychosis AMPH use (by anyone) causes increased pre-synaptic DA activity which result in positive psychotic symptoms Chronic exposure will result in pre-synaptic neuron degeneration causing a relative state of DA deprivation, may result in negative symptoms Decrease in DA results in increased post-synaptic neuron sensitivity which will result in positive symptoms during times of transiently elevated DA

Amphetamine induced psychosis:

Amphetamine induced psychosis Delusional disorder. Psychotic depression. Schizophreniform psychosis. Schizophrenia.

ADDICTION:

Physical Dependence - When the users body cannot function properly without ingestion of the drug. Psychological Dependence - When the consumption of the drug takes priority over other activities within the users daily life. ADDICTION

Adverse effects: Amphetamine causes addiction and drug seeking behavior:

Adverse effects: Amphetamine causes addiction and drug seeking behavior Central effects: These include insomnia, irritability, weakness, tremor, confusion, delirium, panic states and suicidal tendencies. Chronic use produces symptoms similar to an acute schizophrenic episode (amphetamine psychosis). Treatment with anti-psychotic agents can greatly reduce these symptoms. The anorectic effect of amphetamine is somewhat resistant to tolerance and is due to direct action in the feeding center located In the lateral hypothalamus. Cardiovascular effects: palpitations, tachyarrthymias , hypertension acute coronary ischemia and cardiovascular collapse can occur. GI effects: Nausea, vomiting, abdominal cramps and diarrhea.

Meth Brain Atrophy:

Meth Brain Atrophy

WITHDRAWAL:

When a dependent person stops taking amphetamines their body must readjust to functioning with the drug. Symptoms of withdrawal can include: WITHDRAWAL Hunger Extreme Fatigue Anxiety/Irritability Chronic Depression Restless Sleep Severe Nightmares Severe Distress Panic Attacks

Slide 56:

Three forms of Amphetamines Powder, Base & Crystal meth/amphetamine powder approx 10% pure meth /amphetamine base approx 20% pure methamphetamine crystal–‘ice’ approx 80% pure Powder Base Crystal Amphetamines

Slide 57:

Withdrawal is characterized by three phases: Crash Withdrawal Extinction Indications and guidelines Managing psychostimulant withdrawal

Withdrawal phase 1:

Phase Time since last stimulant use Common signs and symptoms Crash Amphetamines : typically commences 12-24 hours after last amphetamine use, and subsides by days 2-4. Exhaustion/fatigue Sleep disturbances (typically increased sleep, although insomnia or restless sleep may occur) Mood disturbances – typically flat mood or dysphoria; may be associated with anxiety or agitation Low cravings Generalized aches and pains Withdrawal phase 1

Withdrawal phase 2:

Phase Time since last stimulant use Common signs and symptoms Withdrawal Amphetamines: typically commences 2-4 days after last use, peaks in severity over 7-10 days, and then subsides over 2-4 weeks. Strong cravings Fluctuating mood and energy levels, alternating between irritability, restlessness, anxiety, and agitation Fatigue, lacking energy, anhedonia Disturbed sleep, including vivid dreams, insomnia General aches and pains, headaches Muscle tension Increased appetite Poor concentration and attention Disturbances of thought (e.g. paranoid ideation, strange beliefs) and perception (misperceptions, hallucinations) can re-emerge during withdrawal phase after having been masked during crash. Withdrawal phase 2

Withdrawal phase 3:

Phase Time since last stimulant use Common signs and symptoms Extinction Weeks to months Gradual resumption of normal mood with episodic fluctuations in mood and energy levels alternating between: irritability, restlessness, anxiety, agitation, fatigue, lacking energy and anhedonia Episodic cravings Disturbed sleep Withdrawal phase 3

Slide 61:

Four-hourly monitoring is recommended as nurses/midwives need to be aware of changing signs & symptoms that the patient may present with as they pass through the crash & withdrawal phases Mood & energy levels may fluctuate e.g. a patient may initially present with a low mood and psychomotor retardation & then swing towards being restless & agitated later the same day Assess for underlying mental health problems as these may have been masked during the crash phase but become evident later in the withdrawal period Withdrawal scales have not been routinely used in clinical practice Indications and guidelines Managing psychostimulant withdrawal – Monitoring

Slide 62:

no specific effective pharmacological therapy has been identified Benzodiazepines for anxiety, agitation, insomnia & aggressive outbursts – not to be used for more than two weeks without review Antipsychotic medication for psychotic symptoms (delusions, hallucinations etc) Antidepressants for symptoms of depression that persist after stimulant withdrawal Indications and guidelines Pharmacological treatment

AMPHETAMINE USE IN THE UNITED STATES:

AMPHETAMINE USE IN THE UNITED STATES Percentages Reporting Lifetime, Past Year, and Past Month Use of Amphetamines Among Persons Aged 18 to 25: 1999 and 2000 ***2000 National Household Survey On Drug Abuse

Prevention:

sarhan Prevention Primary. Secondary. Tertiary .

The Role of physicians:

sarhan The Role of physicians Public awareness. Careful prescribing. Case finding. Management. Referral. Follow up. Reporting

National forum:

sarhan National forum Decision makers. Police. Customs. Physicians. Pharmacists. Government institutions. Non-governmental organizations. The media.

ADDITIONAL RESOURCES:

ADDITIONAL RESOURCES http://www.amphetamines.com http://www.erowid.org/chemicals/amphetamines/amphetamines.shtml http://www.nida.nih.gov/Infofax/lsd.html http://www.health.org http://msn.espn.go.com/special/s/drugsandsports/amphet.html http://www.drugs.indiana.edu/publications/iprc/factline/ampet.html http://www.get-it-here-for-free-information.com/drug/amphetamines.htm

THANK YOU:

THANK YOU www.walidsarhan.net

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