The idea behind the text is to destroy the myths, taboos and stereotypes regarding the use of psychostimulant drugs – psychostimulants.
At the very beginning I would like to ask a simple question: “Have you ever used some kind of a stimulant in your life.” Answer honestly to this and the next question, “If the answer is YES, then which ones?”
According to the definition a psychostimulant is a psychoactive substance that stimulates the central nervous system (CNS) or the body, or both, enhancing alertness and concentration.
In plain words, they are “uppers” that lift the mood, energy, alertness, opposite of some other drugs that are “downers”, for instance opioids.
Stimulants are used all over the world, some legal or illegal, prescription or non-prescription drugs, substances for daily and recreational use.
The possibility as well as the need for people to additionally stimulate the body and senses, to enhance their concentration and alertness result from certain substances which introduced to the human body can stimulate the CNS. Some of these psychoactive substances can be found in some plants in nature, while with the development of pharmacology towards the end of the 19th century, particularly in the 20th century, new substances were discovered that simulate the CNS. Arguably, some are legally available for sale and used popularly throughout the world, while other are controlled and prohibited (illegal) substances or prescribed by a doctor.
History of stimulants use
The ephedra is a medical plant used in China 5000 years ago. Tobacco use was first recorded on European ground with the discovery of the New Continent and the return of Christopher Columbus in Europe towards the end of the 15th century. The 17th century brought the first use of coffee. Cocaine was isolated in its pure form in 1855. Sigmund Freud used cocaine for treatment of depression in 1884. The synthetic stimulant amphetamine was synthesized in 1887, while the psychoactive substance MDMA was discovered by accident in 1912. The new era of research with psychostimulant substances arrived with the discovery of psychedelic drugs, such as LSD, by the chemist Albert Hoffman, first in 1938 in Sandoz Laboratories in Switzerland, then with the research and experimentation with psychostimulants and psychedelics in treating psychiatric diseases and conditions or for recreational use towards the end of the 1960s. And so we arrive to present days and the synthesizing of new psychoactive substances (NPS), some of which are psychostimulants.
Regulation of legal and illegal stimulants
The division into legal and illegal substances and drugs in general was introduced with the adoption of the Single Convention on Narcotic Drugs in 1961, the Convention on Psychotropic Substances in 1971, as well as the UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances in 1988. And so coffee and nicotine remained legal while everything else, including psychostimulants such as amphetamines, MDMA and cocaine became controlled and prohibited (illegal) substances.
Use of Legal Stimulants in Our Daily Lives
Coffee is the most widely spread and most often consumed psychoactive substance or a drug in the world. Caffeine is a derivate of the Xantine class found in coffee, tea and to a lesser amount in cocoa and chocolate as well. Apart from coffee, caffeine can be found in many carbonated drinks (cola etc.), and in bigger amounts in energy drinks. It can also be found in some medicaments, and of course it is legal and available for sale throughout the world.
Tobacco is also a known legal stimulant popularly used on the entire planet. The active ingredient in tobacco is nicotine. It can be found naturally in the leaves of the tobacco plant which can be then consumed raw or processed, mostly by inhalation. Nowadays, there are electronic cigarettes as substitution or an alternative to cigarettes which contain liquid nicotine that evaporates and is then inhaled.
Despite the numerous harmful effects and bad influence on people’s health and the high percentage of death cases resulting from the consummation of these legal drugs, they are available for sale, and are often consumed at an early age. After all, the sales accumulate large profits for this industry, and of course, treating the effects caused by their use is also expensive. However, we say they are legal, i.e. they are not banned and so we partially suppress our awareness and personal responsibility for the harm they inflict.
Most often used illegal psychostimulants
Amphetamine-type stimulants. Amphetamine (alpha-methylphenethylamine) is a CNS stimulant. It was synthesized in 1887 by the Romanian chemists Lazăr Edeleanu at the University of Berlin. In moderate dosages it causes emotional and cognitive effects such as euphoria, change in libido, increases alertness and enhances the mental process. In therapeutic terms, in some countries such as the USA, Canada and England, amphetamine-based medicaments are used as a treatment for several medical conditions and illnesses. Apart from amphetamine, the group of amphetamine substitutes includes a range of other substances similar in the chemical composition and effect. The most popular among these are: methamphetamines, ephedrine, cathinones, MDMA (ecstasy) and DOM (STP).
MDMA‒3,4-methylenedioxymethamphetamine is a psychoactive and psychostimulant drug known for its euphoric and empathogenic effects. It was synthesized in 1912 by the German chemist Anton Köllisch in the laboratories of the German pharmaceutical company Merck, and patented in 1914. It was discovered by accident, while its psychopharmacological effects were made known by the psychopharmacologist Alexander Shulgin in the 1970s of the past century when the stimulant was used recreationally. This substance was prohibited first in Great Britain in 1977, and then in the USA in 1984. MDMA is a controlled substance in most countries throughout the world. The most common form of MDMA is the popular ecstasy pill, but it is also found in pure crystallized form. MDMA is a therapy option in research for patients with posttraumatic stress disorder (PTSD), at present in phase 3 clinical trials done by MAPS – Multidisciplinary Association for Psychedelic Studies in Santa Cruz, California.
Cocaine – Cocaine is produced from the leaves of erythroxylon coca. Its cultivation and use by the indigenous people of South America is long known. Cocaine was isolated in 1855 by the German chemist Friedrich Gaedcke. It is used in the treatment of many illnesses, in psychiatry, stomatology, anaesthesiology, and other medical fields. It became widely famous in the 1970s and 1980s of the last century with the illegal expansion first in the USA, then Europe and throughout the world. Cocaine is the most often used stimulant in Europe according to the data of the European Drug Report 2015 published by the European Monitoring Centre for Drugs and Drug Addiction – EMCDDA.
Prescription stimulants – a practice in some countries
Stimulants used as medications prescribed by a doctor are amphetamine (Adderall) and methylphenidate (Ritalin and Concerta). They are prescribed and used in the treatment of certain diseases and medical conditions, such as, attention-deficit hyperactivity disorder (ADHD) in children and adults, narcolepsy (chronic fatigue and insomnia), obesity, Parkinson’s disease etc. Studies from magnetic resonance imaging (MRI) analysis indicate that long-term amphetamine treatment decreases abnormalities in brain structure and functions in people with ADHD and improves brain function in structures like caudate nucleus and basal ganglia.
New psychoactive substances (NPS) – psychostimulants
With the development of research in chemistry and pharmacology, and due to the regulations throughout the world, numerous mimetics and analogues appear as newly discovered psychostimulants, with little research on the effects and influence on the health but increasingly present on the illegal drug market throughout the world. The decades-long synonym for MDMA – ecstasy pills contain little or no MDMA but substances from another drug class or a NPS.
Regarding opinions on legal and illegal psychostimulants, examples from Portugal, where all types of drug use and possession for personal consumption was decriminalized in 2001, demonstrate many positive experiences, the most important of which are a drastic drop in sexually transmitted infections among people who use drugs and in overdose death cases. Portugal is among the world countries with the lowest death rate as a result of drug overdose. The law was designed to treat possession and use of small amounts as a public health problem, not a criminal one. Of course, drugs are illegal but possession in legal terms implies a small fine or if necessary drug prevention treatment services, not imprisonment and a criminal file, which led to a drastic fall in criminality. Still, the use of new drugs, the so-called legal highs or NPS is very low in comparison to the rest of the world. The fears that drug decriminalization might increase the number of drug users and addicts proved fruitless and the positive experiences prevailed.
The author is a doctor of medicine, graduated general medicine at the Faculty of Medicine within the St. Cyril and Methodius University in Skopje, Macedonia. Davor Smilanov, MD is the head of the Medical Service at the Harm Reduction Center in Kapishtec within HOPS’s Harm Reduction Program. He has participated in numerous national and regional projects, conferences and campaigns for harm reduction.