Psychostimulants

Trainer Notes

& Activities

Overview

KEY POINTS

  1. Psychostimulants comprise a family of related compounds that share similar properties. Several psychostimulants (such as caffeine and Ritalin®) are legal. The psychostimulant Ecstasy (MDMA) is often referred to as a ‘party drug’ due to its pattern of use and association with the party drug scene, rather than due to its psychostimulant effects (see Topic 4.4 Ecstasy & Party Drugs).
  1. Although amphetamine use is increasing, most users are not dependent. Users may present to a GP in the first instance with a variety of issues (e.g., insomnia, ‘speed hangover’).
  1. Regular users may need a break from use for a day or two following a binge (‘run’).
  1. Psychostimulant-related harms may include those related to obtaining, using, coming down from, or ceasing the use of, drugs.
  1. Although amphetamine withdrawal is a well-described clinical entity, there is little evidence-based information (or medications) that will ameliorate withdrawal discomfort in the short- or long-term, or facilitate long-term abstinence (as per opioids).
  1. Mental health problems may arise as a direct result of using psychostimulants (see Topic 3.7 Comorbidity).

SUGGESTED Objectives

To enable GPs to:

  • identify the effects and consequences associated with using psychostimulants
  • apply skills gained in other topics (such as Assessment and Brief Intervention) to identify, assess, and respond to, psychostimulant-related harms
  • identify and implement harm reduction strategies relevant to the use of psychostimulants
  • identify, treat and refer patients with problems requiring specific care, such as cardiovascular problems, paranoia or symptoms of psychosis associated with psychostimulant use.


Resource Kit for GP Trainers on Illicit Drug Issues

Part B4 Drugs: Psychostimulants

Topic Contents

Slides

The slides with slide notes cover:

  • forms of psychostimulants (content refers primarily to methamphetamine and cocaine)
  • patterns of use
  • effects and harms associated with use
  • pharmacology
  • clinical practice issues (assessment, brief intervention, harm reduction, withdrawal).

The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of their participants.

Activities

The activities complement skill-based learning activities provided in other topics, especially those in B3: Clinical Process. These activities provide opportunities for GPs to:

  • identify issues related to the use of psychostimulants within the general practice context
  • identify relative benefits and harms (as perceived by society and users) related to psychostimulant use
  • plan and implement harm reduction strategies specific to psychostimulant use.

Handouts

  1. Australia’s Dynamic Methamphetamine Markets

Topp, L. & Churchill, A. 2002, ‘Australia’s Dynamic Methamphetamine Markets’,Drug Trends Bulletin, IDRS June 2002, National Drug and Alcohol Research Centre (NDARC), Sydney.

  1. Amphetamine Dependence and Withdrawal

McKetin, R. & McKenna, S. 2000, Amphetamine Dependence and Withdrawal,GP Drug and Alcohol Supplement No. 12,

  1. Amphetamines SDS

Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W. & Strang, J. 1995, ‘The Severity of Dependence Scale (SDS): Psychometric Properties of the SDS in English and Australian Samples of Heroin, Cocaine and Amphetamine Users’, Addiction, vol. 90, pp. 607–614.

Dawe, S., Loxton, N., Hides, L., Kavanagh, D., & Mattick, R. 2002, Review of Diagnostic Screening Instruments for Alcohol and Other Drug Use and Other Psychiatric Disorders 2nd edn, Commonwealth Department of Health and Ageing, Canberra.

  1. Amphetamine Withdrawal Scale

DASC Amphetamine Withdrawal Scale. Cited in DeCrespigny, C. et al. 2003, Alcohol Tobacco and Other Drugs Guidelines for Nurses and Midwives: Clinical Guidelines. FlindersUniversity and Drug and Alcohol Services Council, Adelaide. Also available at w

Please refer to the Resource Kit CDROM for a copy of handouts in PDF and Word.


Resource Kit for GP Trainers on Illicit Drug Issues

Part B4 Drugs: Psychostimulants

Sources of Additional Information

patient resources

Australian Drug Foundation 2000, Cocaine: How Drugs Affect You, Australian Drug Foundation, North Melbourne.

Lintzeris, N., Dunlop, D. & Thornton, D. 1999, Getting Through Amphetamine Withdrawal, (revised), Turning Point Alcohol & Drug Centre Inc., Fitzroy, Victoria.

Topp, L., McKetin, R., Hando, J., & Dillon, P. no date, A User’s Guide to Speed. National Drug and Alcohol Research Centre (NDARC), Sydney.

Key Readings

Baker, A., Lee, N. & Jenner, L. 2004,Models of Intervention and Care for Psychostimulant Users, National Drug Strategy Monograph Number 51. Australian Government Department of Health and Ageing.

Baker, A., Kay-Lambkin, F., Lee, N., Claire, M. & Jenner, L. 2003,A Brief Cognitive Behavioural Intervention for Regular Amphetamine Users. Australian Government Department of Health and Ageing.

Latt, N., White, J., McLean, S., Lenton, S., Young, R. & Saunders, J. 2002, ‘Central Nervous System Stimulants. Disorders’ in Hulse, G., White, J. & Cape, G. (eds.) 2002, Management of Alcohol and Drug Problems, Oxford University Press, South Melbourne, pp.124-140.

Todd, F. 2002, ‘Coexisting Alcohol and Drug Use and Mental Health Disorders’ in Hulse, G., White, J. & Cape, G. (eds.) 2002, Management of Alcohol and Drug Problems ch.20, Oxford University Press, South Melbourne, pp.359–373.

Additional Resources

Alliance of NSW Divisions GP Liaison Project Tip Sheet Series. Available from:

  • Amphetamines: A general information guide for the General Practice setting
  • Amphetamines: Other drugs, pregnancy, the law, driving and those ‘most at risk’
  • Effects of amphetamines
  • Treatment for amphetamine dependence and withdrawal in the General Practice setting
  • Amphetamines – overdose, tolerance, dependence and withdrawal
  • Cocaine: a general information guide for the General Practice setting
  • Cocaine: other drugs, pregnancy, the law, driving and those ‘most at risk’
  • Effects of cocaine
  • Cocaine – overdose, tolerance, dependence and withdrawal
  • Treatment matching for alcohol and other drugs in General Practice
  • Treatment matching after detoxification in General Practice

Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W. & Strang, J. 1995, The Severity of Dependence Scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users, Addiction, 90, 607–614.

Pead, J., Lintzeris, N., & Churchill, A. 1996, From Go To Whoa: Amphetamines and Analogues. The Trainer’s Package for Health Professionals, Commonwealth Department of Human Services and Health, Canberra.

Victoria Police 2002, Custodial Drug Guide: Medical Management of People in Custody with Alcohol and Drug Problems, Custodial Medicine Unit, Mornington, Victoria.

WHO (World Health Organisation) 2001, Systematic review of treatment for amphetamine-related disorders, [paper], Management of Substance Dependence Review series, Geneva.

Psychostimulants

Activities

Activity 1: Recognising Psychostimulant Intoxication

PURPOSE

To increase recognition of the symptoms of psychostimulant intoxication and its management through the use of the video and associated discussion.

process

1.1Show Vignette 1: ‘Thunderbirds are go’ (2:40min) from the video ‘From Go to Whoa’ (See Part C2 in this Resource Kit for details of this training package)

1.2Request participants to form pairs/small groups and discuss the main features of intoxication, such as:

  • behaviour demonstrated in the video
  • other behaviours or features you might expect this person to display
  • is this behaviour consistent with your experience?
  • how might you manage a person who is intoxicated with amphetamines in your practice?

Refer to the table below (if needed) to assist you to elicit responses from participants.

Features of intoxication may include:

Talkative / Vague concerns / Fidgety
Scratching / Twitching/shaking / Ambivalent
Nervous / Tension / Rocking
Sniffing / Feeling great / Tangential thinking
Stereotypical motor behaviour / Decreased appetite / Repetitiveness/pressure of speech

1.3Discuss findings as a whole group. Facilitate discussion of:

  • types of support GPs have, or may need, in order to appropriately manage a person affected by amphetamines.
    For example, do you have safety and management policies and procedures in place for your practice? These may include the management of intoxication in general practice settings, managing and organising referrals, policies on managing patients who present with inappropriate behaviours.

Activity 2: Amphetamine Users’ Concerns

Purpose

To increase GP awareness of the typical concerns of people experiencing amphetamine-related harms.

Process

2.1Show Vignette 5: ‘Lets Party’ from the video ‘From Go to Whoa’

2.2Ask participants to describe the patient and identify her concerns

2.3From this description discuss the ‘typical’ features of presentation for amphetamine use.

The following notes, adapted from Pead et al.1996, may assist you to elicit responses from participants.

Note: Amphetamine related problems can be fairly stereotypical, and may include those who:

  • are young (late teens to mid 20s), shift work (diversity of occupation)
  • display features of intoxication, withdrawal and crash
  • experience some health problems
  • experience some social problems
  • experience some mental state problems
  • are possibly drug-seeking (benzodiazepines, codeine, opioids)
  • have infected injection sites, lesions.

People with amphetamine problems look like anyone else presenting for help. The person in the video could just as well have problems with drinking, cannabis use, be depressed as a consequence of some life event, or be physically unwell.

Many people with amphetamine problems will present with health, social or mental state problems associated with, or exacerbated by, amphetamine intoxication, regular use, dependence or withdrawal. These associated problems may be emphasised by the patient rather than their amphetamine use. The patient may be unaware that these problems are associated with amphetamine use. Some people will seek medications such as benzodiazepines or opioids like codeine to come down from amphetamines, or to deal with features of amphetamine intoxication, crash or withdrawal.

Source: adapted from Pead. J., Lintzeris, N., & Churchill, A. 1996, From Go To Whoa: Amphetamines and Analogues. The Trainer’s Package for Health Professionals, Commonwealth Department of Human Services and Health,Canberra, p. 44.

Resource Kit for GP Trainers on Illicit Drug Issues

Part B4 Drugs: Psychostimulants

Activity 3: Psychostimulant Use and Related Harms

Purpose

To assist GPs to identify and respond to possible harms that may result from using methamphetamine.

This activity requires Slide 12 from the Psychostimulants slide set: Psychostimulant Cycles of Use

PROCESS

3.1Optional: Provide a short anecdote of a case in which a patient using methamphetamine reduced his/her intake through interaction with his/her GP, or alternatively, invite GPs to outline a case

3.2Use the slide to highlight use and the five areas of harm

3.3Divide participants into small groups

3.4Instruct participants to brainstorm specific strategies to reduce methamphetamine-related harm for one of the five areas of harm. Advise them to:

  • limit these strategies to those they can undertake in the course of their daily work
  • estimate how much time they think these ideas would take in practice
  • list possible human or physical resources they may be able to use, and how they would monitor the outcome

3.5As a whole group, compile a comprehensive list of strategies using the feedback provided by each group (complete with time and resource estimates)

3.6Select a few key ideas and encourage a critique in terms of the realities of the general practice setting – the course of a consultation

3.7Provide the Activity 3 Handout ‘Potential Amphetamine Harms Checklist’ if needed (for verification or as additional information)

Topic Link: Please refer to ‘Brief Intervention’ and ‘Harm Minimisation’ slide sets

Activity 3 Handout

Potential Psychostimulant Harms Checklist

Acquisition
/ Insufficient money
Police and jail
Criminal underworld
Poor relationships
Unknown drug quality / ‘Ripped off’ by dealers
Dealing
Uncertain supply
Alienation
Secrecy/stigma
Administration
/ Vein abscess
Vein scarring
Thrombosis
Contaminants / Bloodborne viruses
Nasal infections
Needle and equipment sharing
Intoxication
/ Agitation
Weight loss
Tachycardia
Dehydration
Hyperthermia
Poor immunity / Paranoia
Delusions
Hallucinations
Sleeplessness
Seizures
Teeth grinding
Intoxicated Behaviour
/ Increased aggression
Intoxicated driving
Parenting difficulties
Risk taking
Work accidents / Unsafe sex
Injuries
Fights
Social avoidance
Other drug use
Crash/Withdrawal
/ Depression
Restlessness
Cravings
Suicidal ideas / Lapse to drug use
Job
Bizarre thoughts
Flat mood

Source: Pead. J., Lintzeris, N. & Churchill, A. 1996, From Go to Whoa: Amphetamines and Analogues. The Trainers Package for Health Professionals, Commonwealth Department of Human Services and Health, AGPS, Canberra.

The page reference above provides case studies that address cannabis, hallucinogens, and CNS stimulant issues related to young people, as well as injection-related harms, harm reduction, drug-seeking behaviour, and treatment and management issues.

Full citation: Johnson, S., Martin, J., Liew, D., Cape, G., Edmonds, C., Baigent, M., Dunn, C., Bucci, S., Baker, A., & Cohen, M. 2004, ‘Cannabis, Hallucinogens, and CNS Stimulants’ in Hulse, G. (ed.), Alcohol and Drug Problems; A Case Studies Workbook, ch. 3, Oxford University Press, South Melbourne.

Resource Kit for GP Trainers on Illicit Drug Issues

Part B4 Drugs: Psychostimulants