Methamphetamine and MDMA: 'Safe' drugs of abuse

Allana M. Krolikowski, Alex Koyfman
2014 African Journal of Emergency Medicine  
Methamphetamine and MDMA have been called safe drugs of abuse. Worldwide there is an increased consumption of these drugs, which has become a focus of research in South Africa. As the number of methamphetamine users has increased in many African countries, it is essential that emergency care practitioners are able to diagnose and manage intoxication with methamphetamine, MDMA, and other derivatives. The most common presentations include restlessness, agitation, hypertension, tachycardia, and
more » ... tachycardia, and headache while hyperthermia, hyponatraemia, and rhabdomyolysis are among the most common serious complications. Most deaths are secondary to hyperthermia complicated by multiple organ failure. A number of laboratory analyses should be obtained if locally available. We provide a review of the current recommended general and specific management approaches. Benzodiazepines are the first line therapy for hyperthermia, agitation, critical hypertension, and seizures. Patients with serious complications are best managed in an intensive care unit if available. Emergency centres should create protocols and/or further train staff in the recognition and management of intoxication with these 'not so safe' drugs. La me´thamphe´tamine et le MDMA ont e´te´qualifie´es de drogues « re´cre´atives ». Partout dans le monde, la consommation de ces drogues est en augmentation, ce qui a attire´l'attention des chercheurs en Afrique du Sud. Du fait que le nombre d'usagers de me´thamphe´tamine a augmente´dans plusieurs pays d'Afrique, il est primordial que les me´decins des services d'urgence soient capables de diagnostiquer et de prendre en charge une intoxication a'la me´tamphe´tamine, au MDMA et autres de´rive´s. Les symptoˆmes les plus fre´quents sont la nervosite´, l'agitation, l'hypertension, la tachycardie et les maux de teˆte, l'hyperthermie, l'hyponatre´mie et la rhabdomyolise e´tant les complications se´rieuses les plus fre´quentes. La plupart des de´ce's font suite a'une hyperthermie qui se complique par une de´faillance multivisce´rale. Il conviendra de proce´der a'des analyses de laboratoire, si elles sont localement disponibles. Nous fournissons un compte-rendu des modes de prise en charge ge´ne´raux et spe´cifiques actuellement pre´conise´s. Les benzodiaze´pines constituent le traitement de premie're intention pour l'hyperthermie, l'agitation, l'hypertension se´ve're et les crises. Les patients pre´sentant des se´rieuses complications devraient eˆtre pris en charge dans une unite´de soins intensifs, le cas e´che´ant. Les services d'urgence devraient de´velopper des protocoles et/ou former leur personnel a'la reconnaissance et la prise en charge de l'intoxication par ces drogues qui ne sont pas aussi « re´cre´atives » qu'elles le paraissent. African relevance The prevalence of methamphetamine use is increasing in Africa. Patients with methamphetamine or MDMA intoxication often present to an emergency centre and thus emergency health practitioners should be comfortable with appropriate management. The use of methamphetamine often leads to increased sexual risk taking behaviour, which could fuel the spread of HIV infection. This is of particular concern in areas with high HIV prevalence.
doi:10.1016/j.afjem.2013.01.005 fatcat:chyhn26ocfar3laimrm4ae6yfq