Overview of disorders of stimulant use

Central nervous system stimulants enhance dopaminergic, adrenergic and serotonergic neurotransmission. They produce desired effects, such as euphoria, a sense of wellbeing and confidence, alertness, increased sexual drive and appetite suppression, but are also associated with harmsDocherty, 2021.

Stimulants (also known as amfetamine-type substances) are used across the spectrum of society; they includeAustralian Institute of Health and Welfare (AIHW)Australian Institute of Health and Welfare (AIHW)Omar, 2015:

• amfetamine and metamfetamine
• methylenedioxymetamfetamine (methylenedioxymethamphetamine, MDMA, ‘ecstasy’, ‘Molly’)
• cocaine
• prescription and over-the-counter amfetamines:
  • dexamfetamine, lisdexamfetamine, methylphenidate—to manage attention deficit hyperactivity disorder (ADHD), binge eating disorder and narcolepsy
  • phentermine—to manage obesity
  • ephedrine—intravenously to manage shock and hypotension in spinal anaesthesia, and intranasally to reduce nasal congestion
  • pseudoephedrine—to reduce nasal congestion
• novel psychoactive substances (discussed in the Toxicology and Toxinology Guidelines)
  • synthetic cannabinoid-receptor agonists (SCRAs) which have stimulant as well as cannabinoid effects
  • novel stimulant drugs (eg cathinones)
• khat—a plant chewed for euphoric effect; for more information, see the Australian Drug Foundation website.

Stimulants are produced as:

• powders or pills
• crystals, such as crystalline metamfetamine (‘ice’, which is usually inhaled [‘smoked’] or injected) or ‘crack’ cocaine (which can be inhaled [‘smoked’])
• pastesAustralian Institute of Health and Welfare (AIHW)Grigg, 2018.

Routes of stimulant administration include oral, intravenous, intranasal (‘snorting’) and vapour inhalation (‘smoking’).

Unregulated drugs sold as stimulants may not actually contain the advertised substance and may have a range of ingredients of unknown identity and strength.

Prescribed and over-the-counter stimulants are sometimes used in a way that does not align with the directed use (nonmedical use)Australian Institute of Health and Welfare (AIHW)McNeely, 2014. For example, a person may use them to treat a symptom other than the clinician intended, or to become intoxicated. The extent of nonmedical use of stimulants is unclear because data are not collected separately for each category of stimulantAustralian Institute of Health and Welfare (AIHW). Wider availability of stimulant medications in the last 50 years may be contributing to nonmedical useDunlop, 2016. Each state and territory has legislation, policies, and real-time prescription monitoring systems for dexamfetamine, lisdexamfetamine and methylphenidate.