Cardiovascular Complications of Acute Amphetamine Abuse: Cross-sectional study

Consecutive treatments of methamphetamine promote the development of cardiac pathological symptoms in zebrafish

Chronic methamphetamine use, a widespread drug epidemic, has been associated with cardiac morphological and electrical remodeling, leading to the development of numerous cardiovascular diseases. While methamphetamine has been documented to induce arrhythmia, most results originate from clinical trials from users who experienced different durations of methamphetamine abuse, providing no documentation on the use of methamphetamine in standardized settings. Additionally, the underlying molecular mechanism on how methamphetamine affects the cardiovascular system remains elusive. A relationship was sought between cardiotoxicity and arrhythmia with associated methamphetamine abuse in zebrafish to identify and to understand the adverse cardiac symptoms associated with methamphetamine. Zebrafish were first treated with methamphetamine 3 times a week over a 2-week duration. Immediately after treatment, zebrafish underwent electrocardiogram (ECG) measurement using an in-house developed acquisition system for electrophysiological analysis. Subsequent analyses of cAMP expression and Ca2+ regulation in zebrafish cardiomyocytes were conducted. cAMP is vital to development of myocardial fibrosis and arrhythmia, prominent symptoms in the development of cardiovascular diseases. Ca2+ dysregulation is also a factor in inducing arrhythmias. During the first week of treatment, zebrafish that were administered with methamphetamine displayed a decrease in heart rate, which persisted throughout the second week and remained significantly lower than the heart rate of untreated fish. Results also indicate an increased heart rate variability during the early stage of treatment followed by a decrease in the late stage for methamphetamine-treated fish over the duration of the experiment, suggesting a biphasic response to methamphetamine exposure. Methamphetamine-treated fish also exhibited reduced QTc intervals throughout the experiment. Results from the cAMP and Ca2+ assays demonstrate that cAMP was upregulated and Ca2+ was dysregulated in response to methamphetamine treatment. Collagenic assays indicated significant fibrotic response to methamphetamine treatment. These results provide potential insight into the role of methamphetamine in the development of fibrosis and arrhythmia due to downstream effectors of cAMP.

Psychometric properties of the Treatment Effectiveness Assessment in methamphetamine use disorder

INTRODUCTION

The ability for people living with stimulant use disorder to live meaningful lives requires not only abstinence from addictive substances, but also healthy engagement with their community, lifestyle practices, and overall health. The Treatment Effectiveness Assessment (TEA) assesses components of recovery consisting of four functional domains: substance use, health, lifestyle, and community. This secondary data analysis of 403 participants with severe methamphetamine use disorder tested the reliability and validity of the TEA.

METHODS

Participants were enrolled in the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) for methamphetamine use disorder. The study used total TEA and domain scores at baseline to assess factor structure and internal consistency, as well as construct validity related to substance cravings (visual analog scale [VAS]), quality of life (quality-of-life assessment [QoL]), mental health (Patient Health Questionnaire-9 [PHQ-9], Concise Health Risk Tracking Scale Self-Report [CHRT-SR16]), and social support (CHRT-SR16).

RESULTS

Individual TEA items showed moderate to large correlations with each other (r = 0.27-0.51; p < .001), and strong correlations to the total score (r = 0.69-0.78; p < .001). Internal consistency was strong (coefficient α = 0.73 [0.68-0.77]; coefficient ω = 0.73 [0.69-0.78]). Construct validity was acceptable, with the strongest correlation between the TEA Health item and the general health status item on the QoL (r = 0.53, p < .001).

CONCLUSIONS

TEA has acceptable levels of reliability and validity supporting prior similar findings in a sample of participants with moderate to severe methamphetamine use disorder. Results from this study provide support for its use in assessing clinically meaningful changes beyond simply reduced substance use.

The effects of methamphetamine on electrocardiographic parameters in male patients

OBJECTIVE

We aimed to compare the electrocardiographic parameters in patients with methamphetamine use to healthy controls.

METHODS

The study is a cross-sectional case-control study. Sixty-eight patients diagnosed with methamphetamine use disorder (MUD) according to DSM-5 criteria and 65 subjects in healthy control group who can match the patient group with demographic data were included in the study. Heart rate, P wave dispersion, QT dispersion, QTc and Tp-e/QTc ratios were calculated in the ECGs of all participants.

RESULTS

The mean age of the patients was 25.60 ± 5.70 and of the control group was 27.43 ± 6.10 (p = 0.076). There was no statistically significant difference between the blood pressure, body mass index, HDL-LDL-total cholesterol and triglyceride values of the participants (p > 0.05). Although QT dispersion was 13.68 ± 9.12 in patients with methamphetamine use disorder, it was calculated as 9.08 ± 7.85 in the control group (p = 0.002). Finally, the Tp-e/QTc ratio of the patients was higher than the healthy controls (p = 0.014).

CONCLUSION

In our study, we found a significant deterioration in QT dispersion and Tp-e/QTc ratio in the MUD group. Therefore, it should be kept in mind that there is a risk of malignant arrhythmia in this patient group and care should be taken in terms of arrhythmic events during follow-up in this patient group.Key pointsPatients with methamphetamine use showed significant deterioration in QTd and Tp-e/QTcMethamphetamine users have prolonged Tp-e/QTc ratio and QTdCaution should be exercised in terms of arrhythmic events in methamphetamine users.

Understanding the Impact of Deviant Peer Association on Risk for Stimulant/Amphetamine Use: The Moderating Role of Exposure to Violence

Prior research has indicated that deviant peer association is associated with increased risk for stimulant/amphetamine use. However, there remain gaps in our understanding of the context under which this relationship occurs. This study examined two forms of exposure to violence (direct victimization, witnessed violence) as moderators of the relationship between deviant peer association and stimulant/amphetamine use risk. All 11 waves of the Pathways to Desistance longitudinal data were used in analyses. Mixed effects logistic regression models were used to estimate relationships of interest while accounting for repeated measures nested within individual participants across time. Findings indicated that greater deviant peer association was associated with greater odds of stimulant/amphetamine use. Experiencing direct victimization significantly moderated this relationship, but in the opposite of the hypothesized direction, with individuals reporting direct victimization also reporting less reactivity to deviant peer association as it pertained to stimulant/amphetamine use. Witnessed violence did not moderate this relationship.

Increased Inflammatory Markers at AMPH-Addicts Are Related to Neurodegenerative Conditions: Alzheimer’s Disease

Amphetamine addiction is widespread worldwide despite causing severe physical and mental problems, including neurodegeneration. One of the most common neurodegenerative disorders is Alzheimer’s disease (AD). Several inflammatory markers have been linked to AD. Previous studies have also found these biomarkers in amphetamine-addicts (AMPH-add). This study thus seeks to understand how AD and AMPH-addiction are related. A case–control observational study was conducted. Seventeen AMPH-adds ranging in age from 23 to 40 were recruited from Al Amal Psychiatric Hospital. In addition, 19 healthy subjects matching their age and gender were also recruited. The Luminex technique was used to measure serum alpha 1 antichymotrypsin (ACT), pigment epithelium-derived factor (PEDF), and macrophage inflammatory protein-4 (MIP-4), after complying with ethical guidelines and obtaining informed consent. In addition, liver function enzymes were correlated to AD’s predictive biomarkers in AMPH-adds. AMPH-adds had significantly higher serum levels of ACT, PEDF, and MIP-4 when compared to healthy controls (p = 0.03, p = 0.001, and p = 0.012, respectively). Furthermore, there is a significant correlation between lower ALT levels and elevated AST to ALT ratios in AMPH-adds (r = 0.618, 0.651, and p = 0.0001). These changes in inflammatory biomarkers may be linked to the onset of AD at a young age in amphetamine-drug addicts.

Correlation between loneliness, personality traits, and treatment outcomes in patients with methamphetamine use disorder

The aim of this study was to investigate whether loneliness and personality traits correlate with the treatment outcome of methamphetamine use disorder. In this 1-year longitudinal study, a total 106 participants (98 males, 8 females), with a mean age 36.3 ± 9.6 years were enrolled. We measured UCLA Loneliness Scale and Tridimensional Personality Questionnaire at baseline, while craving level at baseline, week 12, 24, 36, and 48. Urinary methamphetamine tests were given 17 times. For the evaluation of the data, multiple linear regression and generalized linear mixed models were used. The baseline results showed lower levels of the harm avoidance trait and higher levels of loneliness were significantly associated with higher craving levels (p=0.04 and 0.04). Moreover, loneliness was not only positively associated with craving levels (B=0.05, p<0.01) but with urinary methamphetamine positive results (B= 0.08, p=0.03) during one-year treatment. The findings suggested that loneliness was associated with poor methamphetamine treatment outcome (greater craving levels and higher proportion of positive methamphetamine urine tests) and lower harm avoidance traits are associated with higher craving levels.

Serum Metabolomic Analysis of Male Patients with Cannabis or Amphetamine Use Disorder

Studies have demonstrated that chronic consumption of abused drugs induces alterations in several proteins that regulate metabolism. For instance, methamphetamine exposure reduces glucose levels. Fatty and amino acid levels were altered in groups exposed to abused drugs. Therefore, in our study, we investigated the serum metabolomic profile of patients diagnosed with cannabis and/or amphetamine use disorders. Blood was obtained from subjects (control, amphetamine, and cannabis). Detection of serum metabolites was performed using gas chromatography. The ratio peak areas for metabolites were analyzed across the three groups. Both cannabis and amphetamine groups showed higher d-erythrotetrafuranose, octadecanoic acid, hexadecenoic acid, trans-9-octadecanoic acid, lactic acid and methyl thio hydantoin metabolites compared with the control group. Moreover, cannabis patients were found to possess higher glycine, 9,12 octadecanoic acid malonic acid, phosphoric acid and prostaglandin F1a than controls. Our analysis showed that the identified metabolic profile of cannabis or amphetamine use disorder patients was different than control group. Our data indicated that chronic exposure to cannabis or amphetamine dysregulated metabolites in the serum. Future studies are warranted to explore the effects of these abused drugs on the metabolic proteins.

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

A Systematic Review of the European Rapid Alert System for Food and Feed: Tendencies in Illegal Food Supplements for Weight Loss

Background: Slimming products represent a dynamically growing group of food supplements worldwide. The efficacy of safely usable natural ingredients is usually below consumers' expectations. Certain manufacturers add unauthorized or prohibited ingredients to weight loss supplements in order to increase their efficacy. Hence, many of these products are adulterated and may pose a risk to the consumers' health. Aims: The aim of our work was to give an overview on natural ingredients used in slimming products, to summarize the frequently used synthetic adulterants and also to assess the trends of adulterated and illegal food supplements in the European Union based on the warnings of the Rapid Alert System for Food and Feed (RASFF) in the time period of 1988-2019. Methods: Reports between 1988-2019 were extracted from the RASFF portal on January 1, 2020. Each entry was individually reviewed. Results: 2,559 records of food supplements with quality problems were identified in the RASFF, several of which [319 (12,5%)] were marketed to facilitate weight loss. 202 (63,3%) contained unapproved, synthetic drug ingredients. The major adulterant (113 of 319, 35.4%) was DNP (2,4-dinitrophenol), whereas sibutramine was the second most frequent adulterant agent (69 products, 21,6%) between 1988 and 2019. Conclusion: The number of approved medicines for the indication of weight loss is relatively low and their efficacy (and also that of the natural ingredients) is limited. Therefore, a significant number of weight loss supplements is adulterated to satisfy patients' expectations. Hence, these products may cause serious adverse effects in sensitive patients.

Potential Role of Serum S-100β Protein as a Predictor of Cardiotoxicity and Clinical Poor Outcome in Acute Amphetamine Intoxication

Cardio- and neurotoxicity of amphetamines play an important role in worsening morbidity, making the initial evaluation of the patient's status a potentially lifesaving action. The current study hypothesized that the S-100β serum level could predict the severity of acute amphetamine toxicity and the in-hospital outcome. The current study is a prospective cohort study conducted on 77 patients diagnosed with acute amphetamine exposure and referred to Aseer Poison Control Center, Saudi Arabia. The patients admitted to ICU showed significantly higher serum levels of S-100β in comparison to those not admitted (p < 0.05). Moreover, the S-100β level was significantly elevated among patients with prolonged QTc intervals. Receiver-operating characteristic curve of S-100β serum level as an in-hospital outcome predictor showed that at a cutoff value > 0.430 ug/L, the sensitivity of S-100β serum level as severity predictor was 100%, and the specificity was 74.1%. In conclusion, the current study revealed that the S-100β serum level could be used as an outcome predictor in hospital admission cases due to toxic amphetamine exposure and offers an idea about the cardiac and neuronal involvement. This can help select patients who will benefit most from ICU admission and early management and assess the severity of cases in settings where GC-MS is not available.

A Case of Esmolol-Induced False-Positive Amphetamine Urine Drug Test

False-positive urine drug screens can occur and lead to implicit bias. Confirmatory testing with gas chromatography/mass spectrometry can be performed. A morbidly obese patient with newly diagnosed atrial fibrillation spent multiple days in the cardiac intensive care unit (ICU) due to a false-positive test for methamphetamine. The patient was planned to undergo direct cardioversion with conscious-sedation anesthesia. His care was delayed because anesthesia was not comfortable administering sedatives in the setting of a positive urine drug screen for presumed methamphetamine use. Knowing that esmolol can cause a false positive on urine drug screen is imperative for delivering the best patient-centered care.

Characteristics of online pharmacies selling Adderall

OBJECTIVES

Adderall (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

From December 2019 to February 2020, the phrase "buy Adderall online" was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included.

OUTCOME MEASURES

Online pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected.

RESULTS

Of the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%).

CONCLUSION

Rogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.

Serum proteomic profiling of patients with amphetamine use disorder

BACKGROUND

Amphetamine use disorder has been recently classified as an epidemic condition. Amphetamine use/abuse has been associated with several neurological and inflammatory effects. However, the exact mechanism involved in these effects warrants further investigation. The aim of this study was to determine any alterations in the serum proteome of individuals classified as patients with amphetamine use disorder compared to that of control subjects.

METHODS

An untargeted proteomic approach employing two-dimensional difference in gel electrophoresis coupled with mass spectrometry was used to identify the patterns of differentially expressed proteins. Serum samples were collected from 20 individuals (males) including 10 subjects with amphetamine use disorder and 10 healthy controls for the present study.

RESULTS

The analysis revealed 78 proteins with a significant difference in protein abundance between the amphetamine-addicted subjects and controls. Among them, 71 proteins were upregulated while 7 proteins remained downregulated in the amphetamine-addicted group. These proteins were further analyzed by ingenuity pathway analysis (IPA) to investigate their correlation with other biomarkers. IPA revealed the correlation of altered proteins with mitogen-activated protein kinase (MAP2K1/K2), p38MAPK, protein kinase-B (PKB; Akt), extracellular signal-regulated kinase (ERK1/2), and nuclear factor-κB signaling pathways. Importantly, these pathways are highly involved in neurological diseases, inflammatory responses, and cellular compromise.

CONCLUSIONS

Our data suggest that the changes in the levels of serum proteins between amphetamine and control groups might affect cellular compromise, inflammatory response, and neurological diseases.

Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review

Methamphetamine‐associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.

Detection, pharmacokinetics, and selected pharmacodynamic effects of methamphetamine following a single transmucosal and intravenous administration to exercised Thoroughbred horses

Methamphetamine is a central and peripheral nervous system stimulant. There is only a single study that describes exposure to and disposition of this compound in horses. The potential for abuse and inadvertent exposure in equine athletes along with the limited data available necessitates further study. The objectives of the current study were to describe drug and metabolite concentrations, develop an analytical method that could be used to regulate its use, and describe selected pharmacodynamic effects. In phase 1, six horses were randomized into three transmucosal dose groups (n = 2/group; 0.5, 1.0 or 10 mg). In phase 2, horses received a single 10 mg intravenous dose. In phase 3, the effects of urinary pH on elimination were studied. Blood and urine samples were collected for up to 72 hours post drug administration. Concentrations of methamphetamine were measured using liquid chromatography-tandem mass spectrometry. Methamphetamine was below the limit of detection (LOD) in blood by 2, 4, and 18 hours following transmucosal administration of 0.5, 1, and 10 mg, respectively. Following intravenous administration, methamphetamine fell below the LOD between 12 and 18 hours. Following urinary acidification, methamphetamine fell below the limit of quantitation (LOQ) by 12 hours. In urine, methamphetamine was no longer detected at 48, 48, and 72 hours in the 0.5, 1, and 10 mg transmucosal groups and 18 hours in the intravenous group. Increased urinary pH resulted in urinary concentrations of methamphetamine falling below detectable levels by 48 hours post transmucosal administration. While the number of animals was small, behavioral, stimulatory, and cardiac effects were minimal.