An editorial by Professor Hamid Ghodse, Director for the International Centre for Drug policy, in the October issue of the British Journal of Psychiatry warns that a co-ordinated global response is needed to the increasing illegal use of amphetamines ('uppers') sold on the internet.
35 million people worldwide take amphetamines, which are the second most widely used drugs in the world. Misuse of these stimulants goes back many years. Members of the armed forces and the industrial workforce took them during the second World War; and in the 1960s and 70s they were increasingly prescribed as antidepressants and slimming aids, and misuse became common.
Many people prescribed amphetamines became dependent on them, and others, such as students and long-distance lorry drivers, started taking them to stay awake. Overprescribing led to surplus tablets being diverted to the black market, and by the 1960s it was estimated that half the amphetamines manufactured by pharmaceutical companies found their way into illicit channels of distribution.
The twin problems of overprescribing and misuse became so serious that national and international control measures became inevitable. Yet demand for drug misuse remained high, and was increasingly met by illicitly manufactured amphetamines rather than by overspill of prescribed drugs.
In the USA, there was a marked resurgence in the early 1990s in the use of amphetamines as 'anorectics', to suppress appetite, which decreased after the withdrawal of fenfluramine, one of the prescribed drugs. Other countries experienced a similar trend later on.
Methylphenidate is a stimulant developed for the treatment of attention- deficit hyperactivity disorder (ADHD). Global manufacture on a large scale led to its misuse worldwide, along with concerns about overdiagnosis of ADHD, and overprescribing of the drug for children.
Methamphetamine misuse is now perceived as the most serious drug misuse problem in the USA, especially in rural and semi-rural areas. It is also popular in far Eastern countries, including South East Asia and Thailand, as well as in some European countries, like the Czech Republic.
The internet has become an increasingly important part of the illicit market, and online pharmacies advertise and sell prescription drugs through regular mail channels. With modern computer technology, and chemists' increasing willingness to share their knowledge, drug recipes are now widely available.
Prevention is vital, says the editorial. Psychiatrists, in particular, should play a role in educating healthcare professionals - as well as the wider public - to encourage rational prescribing of amphetamines and other mind-altering drugs.
There needs to be intensified cooperation between law enforcement and drug regulatory authorities, including prompt exchange of information - particularly between countries where the drugs are manufactured and those into which they are imported. Control of the 9 substances used in the illicit manufacture of amphetamine-type stimulants is essential.
With over a billion internet users worldwide, governments must ensure that appropriate laws are introduced to deal with crimes committed electronically. Specifically, the online sale of psychotropic drugs, including stimulants, should be banned.
The editorial concludes that enthusiastic overprescription has contributed to the recreational use of amphetamines and other drugs, as well as to the development of dependence, and the establishment of a black market. The global nature of misuse, with the internet massively increasing opportunities to manufacture and market prescription drugs, must be tackled internationally.
Ghodse H (2007)
British Journal of Psychiatry, 191, 279-281.