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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

BOX 4.7

Growing epidemic of amphetamine-type stimulants (ATS) use
Amphetamine-type stimulants (ATS) refer to a group of drugs whose principal
members include amphetamine and methamphetamine. However, a range of other
substances also fall into this group, such as methcathinone, fenetylline, ephedrine,
pseudoephedrine, methylphenidate and 3,4-methylenedioxymethamphetamine
(MDMA) or ‘Ecstasy’ – an amphetamine-type derivative with hallucinogenic
properties. The use of ATS is a global and growing phenomenon and in recent
years, there has been a pronounced increase in the production and use of ATS
worldwide.

Over the past decade, use of ATS has infiltrated its way into the mainstream
culture in certain countries. Younger people in particular seem to possess a
skewed sense of safety about these substances, believing rather erroneously
that they are safe and benign. Meanwhile, ATS are posing a serious threat to the
health, social and economic fabric of families, communities and countries. For
many countries, the problem of ATS is relatively new, growing quickly and unlikely
to go away. Geographically, its occurrence is spreading, but awareness of ATS is
limited and responses are neither integrated nor consistent.

Recent data have shown a stabilization in ATS use in north America and western
Europe, while the highest levels of abuse worldwide have emerged in East Asia
and Oceania. According to a review conducted by UNDCP in 1996, there are
about 20 countries in this region in which the abuse of ATS is more widespread
than that of heroin and cocaine combined. In Japan, the Republic of Korea and
the Philippines use of ATS is 5–7 times that of heroin and cocaine use.

Smoking, sniffing and inhaling are the most popular methods of ATS use, but
ways to take the drug vary widely across the region. In countries such as Australia,
where over 90% of those who report using ATS (mostly methamphetamine) inject,
the drug represents a significant risk factor in the transmission of blood-borne
viruses. The Philippines and Viet Nam are also reporting signs that injecting
methamphetamine is increasing while in Thailand, the number of methamphetamine
users now represents the majority of all new drug treatment cases. There are
currently very limited data to indicate what proportion of current users are
dependent. Researchers have pointed out that it is likely that dependence and
chronic usage is associated with methamphetamine psychosis and related adverse
consequences, and that because of the high rates of usage, levels of presentation
of methamphetamine psychosis to mental health services are dramatically
escalating.
In short, the present situation warrants immediate attention, with a major epidemic
of methamphetamine use in Thailand that appears to be spreading across the
entire Asia Pacific Region. Researchers have stressed an urgent need to map out
this epidemic to assess the spread and scale of the problems, consequences
and responses.
Sources: WHO, 1997b; Farrell et al., 2002; UNODCCP, 2002.

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