Basics

Addiction pathway ~ dopamine pathway which is activated by positive reinforcement (i.e reward pathway or mesolimbic pathway)

Amphetamines

Slang names include meph, drone, MCAT, bubbles, white magic or meow meow

See Substance Abuse in Emergency Medicine

Inhalant abuse

the intentional inhalation of volatile hydrocarbons, such as model glue, correction fluid, spray paint, and gasoline, to achieve an altered mental state.

It is a common health problem in adolescence.

Inhalant abuse poses a significant health threat to teenagers. Surveys have shown that about 15% to 20% of high school seniors have used inhalants in the past. These figures, however, likely underestimate the true prevalence because of under-reporting and school dropouts. A high level of suspicion is needed to diagnose inhalant abuse. A good history is essential because there is no drug screen test that can detect inhalant hydrocarbons.

The effect of inhaling a large quantity of hydrocarbons has been described as "quick drunk" because it resembles alcoholic intoxication. Initially, euphoria develops; then, lightheadedness and agitation. Disorientation, ataxia, and dizziness might develop with increasing intoxication. In extreme cases, generalized weakness, hallucinations, and nystagmus can occur.

Abusers often show deterioration in school performance, disturbance of family relationships, and increased risk-taking behaviors.

Encephalopathy is the major chronic morbidity following chronic inhalant abuse. Hydrocarbons are highly lipophilic and can easily distribute to the brain. Studies have shown that chronic abusers have radiographic evidence of CNS damage, such as loss of brain mass on CT and white matter degeneration on MRI. Clinically, chronic abusers often have cognitive and cerebellar dysfunction, including peripheral and cranial neuropathy, visual loss, and parkinsonism.

Phenyclidine (PCP)

a.k.a "angel dust" and "sernyl"

a dissociative anesthetic

available illicitly as LSD, mescaline, psilocybin and tetrahydrocannabinol

behavioral changes - physical aggression, severe agitation, impulsivity, impaired judgement, psychosis, paranoia, or hallucinations

develop shortly after ingestion of the drug