Psychiatric Bulletin (2002) 26: 196. doi: 10.1192/pb.26.5.196-b
© 2002 The Royal College of Psychiatrists
Psychiatric Bulletin (2002) 26: 196
© 2002 The Royal College of Psychiatrists
The natural history of amphetamine misuse
Rupert White, Specialist Registrar
Calshot Community Care Centre, 57 Calshot Street, Islington, London
N19XH
Sir: Though Moselhy et al (Psychiatric Bulletin, February
2002, 26, 61-62) describe a reluctance by some services to make use of
amphetamine substitution therapy, across the UK as a whole there is a large
number of individuals who are receiving it. The fact that it is yet to be
subjected to a randomised controlled trial is therefore of some concern.
With more substantial evidence lacking, there is a danger that amphetamine
substitution will be regarded as entirely analogous to methadone substitution.
This would be erroneous. Long-term prescribing of methadone can be justified,
and has been shown to be effective, because heroin dependence has the quality
of a long-term relapsing illness. Unfortunately, little is known about the
natural history of amphetamine use, and users may be much better able to make
changes without the help of a prescription.
An analysis of 156 amphetamine and heroin users who presented for treatment
in Cornwall on more than one occasion over 7 years, showed that amphetamine
users were more likely to switch both their main drug and their main route of
use between presentations (details available from the author upon request).
Taken together with the fact that cohorts of amphetamine users in the UK have
been found to be younger than comparable heroin users, this would imply that
amphetamine users are less likely to experience long-term patterns of
problematic use over many years. If this is the case, long-term prescribing
may do more harm than good.
