3 - Stimulant use still going strong

Summary

Summary Amphetamines, cocaine and methylenedioxymethamphetamine (MDMA, ‘ecstasy’) are prominent on the UK drugs scene. Much cocaine is now in the form of ‘crack’, which produces particularly acute versions of well-known complications, including paranoid psychosis, mood disorders and cardiovascular problems. Ecstasy has additional hallucinogenic properties, and the slightly different range of psychiatric effects can be long-lasting. Assessment for stimulant misuse should include drug screening more than is currently common in general settings. Management comprises psychosocial (particularly behavioural counselling) and pharmacological approaches. A wide range of dopaminergic and other medications have been studied in cocaine misuse, and specialised substitute prescribing may be appropriate for heavy amphetamine injecting. There has been recent focus on problems of dual diagnosis, with particular strategies required to address stimulant misuse by people with severe mental illnesses.

In this chapter we revisit a subject that we reviewed almost a decade ago – the misuse of the most common illicit stimulant drugs (Seivewright & McMahon, 1996). In the drugs field, changes can certainly be expected in that length of time, particularly with substances linked to the so-called recreational drugs scene, where fashions and differences in usage come and go. Since the 1960s, when hallucinogens came into fashion, there has been prominence successively of barbiturates, pharmaceutical opioids and then smokable powdered heroin. In the decade leading up to our last review the widespread taking of methylenedioxymethamphetamine (MDMA, ‘ecstasy’) had emerged, and the long-established use of cocaine had increasingly transferred to its more potent ‘crack’ form. In 1996 we mainly considered four substances – amphetamine, powdered cocaine hydrochloride, crystalline ‘crack’ cocaine and MDMA – and since then all have remained highly prevalent on the drugs scene, with amphetamine and MDMA generally found in surveys to be the two most common drugs of misuse in the UK after cannabis.

Table 3.1 is an updated version of a table that appeared in our earlier review. It shows how the main stimulant drugs are used, approximate current street prices and their classification under the Misuse of Drugs Act 1971, which dictates the severity of penalties for supplying or possession.