Management of substance abuse

Amphetamine-type stimulants

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 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, abuse of amphetamine-type stimulants (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 the substances believing rather erroneously that the substances are safe and benign. Meanwhile, ATS are posing a serious threat to the health, social and economic fabric of families, communities and nations.

For many countries, the problem of ATS is relatively new, growing quickly and unlikely to go away. The geographical spread is widening, but awareness of it is limited and responses are neither integrated nor consistent. Recent data has shown a decline in ATS use in the regions of the Americas and Europe, while the highest levels of abuse worldwide have emerged in East Asia and Oceania. According to a review of ATS by UNDCP in 1996, there are about 20 countries in which the abuse of ATS is more widespread than that of heroin and cocaine combined. Japan, Korea and the Philippines all register 5-7 times the rate of ATS use compared with 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 like Australia, where over 90 per cent 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 the high rates of usage are dramatically escalating levels of presentation of methamphetamine psychosis to mental health services.

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.