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
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,
SUBSTANCE ABUSE AND PREGNANCY
• National Drug Help Hotline 1-800-662-4357
• National Alcohol and Drug Abuse 1-800-234-1253
Physicians Desk Reference 57th ed. Montvale, NJ: Thomson PDR;
2. King JC, Substance abuse in pregnancy. A bigger problem than you think.
Postgrad Med.1997;102(3):135-7, 140-5, 149-50.
3. Using Illegal Street Drugs During Pregnancy. American Pregnancy
4. Bateman DN, et al. A case control study to examine the pharmacological
factors underlying ventricular septal defects in the North of England.Eur
J Clin Pharmacol. 2004 ;60(9):635-41.PUBMED
5. Werler MM, Sheehan JE, Mitchell AA.Association of vasoconstrictive
exposures with risks of gastroschisis and small intestinal atresia.Epidemiology.
6. Thomas DB Cleft palate, mortality and morbidity in infants of substance
abusing mothers.J Paediatr Child Health.1995 ;31:457-60.
7. Little BB, Snell LM, Gilstrap LC. Methamphetamine abuse during pregnancy:
outcome and fetal effects.Obstet Gynecol.1988 ;72:541-4.
8. Shaw GM, Velie EM, Morland KB. Parental recreational drug use and risk for neural tube defects.Am J Epidemiol.
9. Oro AS, Dixon SD. Perinatal cocaine and methamphetamine exposure:
maternal and neonatal correlates. J Pediatr.1987(4);111:571-8.J Pediatr.1987;111(4):571-8.PUBMED
10. Naeye RL Maternal use of dextroamphetamine and growth of the fetus.Pharmacology.1983;26(2):117-20.PUBMED
11. Ramer CM . The case history of an infant born to an amphetamine-addicted
mother.Clin Pediatr (Phila).1974;13:596-7.
12. Smith L, et al.Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term.J Dev Behav