A more current medicinal use of amphetamine includes treatment for attention deficit hyperactivity disorder (ADHD). Beneficial effects for ADHD can include improved impulse control, improved concentration, decreased sensory over-stimulation and decreased irritability. The ADHD medication Adderal is composed of a timed-release combination of four different amphetamine salts. Amphetamines are also a standard treatment for narcolepsy as well as other sleeping disorders. They are generally effective over long periods of time without producing addiction or physical dependence. Amphetamines are sometimes used to augment anti-depressant therapy in treatment-resistant depression. Medical use for weight loss is still approved in some countries, but considered obsolete in the United States.

Amphetamine releases stores of norepinephrine, dopamine and serotonin from nerve endings, at the same time that it inhibits the recycling of these products. These combined effects rapidly increases the concentrations of these neurotransmitters in the spaces between nerve cells, promoting nerve impulse transmission.

Short-term physiological effects include decreased appetite, increased stamina and physical energy. Long-term abuse or overdose effects can include tremor, restlessness, changed sleep patterns, and weakened immune system.

Short-term psychological effects can include alertness, euphoria, increased concentration, rapid talking, and increased confidence. Long term psychological effects can include insomnia, mental states resembling schizophrenia, aggressiveness, addiction or dependence with accompanying withdrawal symptoms, irritability, confusion, and panic. (1)

 ILLICIT USE OF AMPHETAMINES

Illicit amphetamine and methamphetamine (an extra methyl group increases the lipid solubility of amphetamine making it better absorbed into the fatty tissue of the brain) use during pregnancy has received relatively little scientific study because of its infrequency compared with cocaine and narcotic use. Estimates vary from 5% to as high as 20%, with no statistical difference between medically indigent patients and patients with private insurance (2).


SUBSTANCE ABUSE IN PREGNANCY AND THE LAW

Currently there is only one state, South Carolina that holds prenatal substance abuse as a criminal act of child abuse and neglect. Iowa, Minnesota and North Dakota's health care professionals are required to report prenatal drug exposure. Arizona, Illinois, Massachusetts, Michigan, Utah, Virginia and Rhode Island's health care professionals are required to report and test for prenatal exposure. Reporting and testing can be evidence used in child welfare proceedings. Some states consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Florida, Illinois, Indiana, Maryland, Minnesota, Nevada, Ohio, Rhode Island, South Carolina, South Dakota, Texas, Virginia and Wisconsin. Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Carolina and Wisconsin. A 2004 Texas law made it a felony to smoke marijuana while pregnant resulting in a prison sentence of 2-20 years. (3)

EFFECTS ON THE FETUS

Human data do not suggest an increase in the risk for congenital anomalies, beyond the population risk of 2% to 4%. Recent studies have associated amphetamine use in pregnancy with a higher than expected risk for heart defects (4), gastroschisis and small intestinal atresias (5), and cleft lip and palate (6), but none of these studies involve the use of amphetamines alone, but amphetamines and sympathomimetics (cough and cold remedies) (4), “ecstasy” (methylenedioxymethamphetamine) and sympathomimetics (5), and multiple drug use (6). A study from 1988 involving the use in pregnancy of only methamphetamines failed to find an increased risk for fetal anomalies in the exposed group (7). It should be noted that this study involved only 52 pregnancies. Because of their anorectic impact, amphetamines may severely affect maternal nutrition prior and during pregnancy. These pregnancies could theoretically be at an increased risk for neural tube defects, and other fetal anomalies associated with poor folate intake. Yet a study conducted in 1986 failed to note an increased risk for neural tube defects for pregnancies exposed to “recreational” drugs, including cocaine, amphetamines, marijuana, alcohol, or tobacco. (8)

Other concerns when pregnant women use amphetamines involve the possible effects on fetal growth, prematurity, and other perinatal complications. The possibility of the newborn experiencing withdrawal symptoms has also been studied, as well as the possibility that amphetamine use in pregnancy can affect the child’s behavior and ability to learn. Studies are more consistent at showing adverse effects on fetal growth, pregnancy complications, and abnormal newborn behavior in exposed pregnancies. Amphetamine use in pregnancy has been correlated to a reduction in birth weight, prematurity, postpartum hemorrhage, and retained placenta. Babies born to amphetamine users can have an increase in jitteriness, drowsiness, and respiratory distress, suggesting an amphetamine withdrawal syndrome. (7, 9-12)