Shabu kills!

by Nestor C. Punay, MD

SHABU is a by-word since the senate drama starring Rosebud and Senator Ping Lacson. In reality, shabu already infested the highest and lowest strata of our society that the Philippines closely resembles a narco-state like Columbia. I could not find an accurate data on the prevalence of shabu use in the Philippines. Recently, it has become clear that shabu is widespread and endemic. The nearly 1,000kg shabu seized recently is concrete evidence of the huge market and demand for methamphetamine in the Philippines. The estimated worth (300 billion) of this illicit trade in the Philippines is irrefutable proof of the gravity of this problem.

Amphetamine was first synthesized in 1887. In 1932, it was marketed as over-the-counter treatment for nasal congestion and asthma. Five years after, it was used to treat narcolepsy, postencephalitic parkinsonism, depression and lethargy. Its use and distribution became widespread until the 1970's when amphetamine was regulated. Today, amphetamines are used clinically to treat ADHD (Ritalin), narcolepsy and depression.

Amphetamines are abused for its euphoric and stimulant properties. It acts by causing the release of dopamine in the presynaptic terminals located in ventral tegmental area to the cerebral cortex and the limbic area. This pathway is called the "reward pathway" -- its activation is responsible for the addicting mechanism of amphetamines. Other forms of amphetamines, so called designer amphetamines, cause the release of dopamine, norepinephrine and serotonin. Hence, the designer amphetamines cause hallucinations.

Amphetamines can be smoked, snorted, injected or ingested. Its onset of action is very rapid: immediate by injection and one hour by ingestion. Amphetamine is addictive with tolerance and classic withdrawal syndrome. Its psychological effects can last for hours, especially shabu. Pharmacologically, amphetamines are classified as stimulants, sympathomimetics and psychostimulants. Street names for amphetamines include shabu, ice, crank, khat, cat, crystal and speed.

Recently, "ecstasy" (methylenedioxyamphetamine or MDMA) became popularamong the youth in America and the Philippines. As a class, amphetamines cause euphoria and increased performance. Hence, it is widely abused by students studying for an exam, by long distance truck drivers, by business people, actors and athletes. Also, amphetamines and its related compounds are abused for its anorexic effect for weight loss.

Amphetamine overdose classically presents with rapid heart rate, high bloodpressure, sweating, dilated pupils, agitation, muscular hyperactivity, and psychosis. Depending on the severity, the patient can have hyperthermia, seizures and acidosis. Severe blood pressure elevation may lead to intracranial hemorrhage, aortic dissection, myocardial infarction (heart attack) and death.

Amphetamine withdrawal syndrome is characterized by fatigue, vivid nightmares, insomnia/hypersomnia, increased appetite and agitation. Other symptoms are tremors, anxiety, headache, muscle cramps, stomach cramps, and profuse sweating. The most serious withdrawal symptom however is depression that may lead to suicide. The withdrawal phase is very unpleasant and peaks around 2-4 days.

In addition, amphetamines can cause permanent damage to the brain including permanent depletion of dopamine stores. Amphetamine abuse induces psychosis, mainly paranoid type.

Other features of amphetamine-induced psychosis include visual hallucinations, appropriate affect, hyperactivity, hypersexuality, confusion and incoherence with little evidence of disordered thinking.

Many literatures are available on strokes in the young due to amphetamine abuse. Amphetamines cause damage to blood vessels causing vasculitis. Personally, I saw more than six cases of strokes in young patients (teens to twenties) attributed to amphetamine abuse, including one due to "ecstasy". The widespread abuse of methamphetamine and cocaine resulted to routine urine drug screen on people presenting with chest pains or changes in sensorium. Also, IV use of shabu or any illicit drugs is a risk factor for lethal infections to heart valves, brain, bones, blood and other organs. In addition, users have higher rate of HIV and hepatitis. Abuse during pregnancy causes low birth weight, growth retardation, etc. Furthermore, shabu addiction leads to increase in crime rate, broken family, hardships and other socioeconomic complications.

So, how do we stop this menace? The foremost solution is abstinence and zero demand for shabu. Then, we all should be vigilant in order to prevent "infestation" of our community with this social disease. As parents, we need to talk to our children about the dangers of shabu and other drugs. Also, we need to coordinate with authorities in the arrest, prosecution and conviction of identified "pushers". Although expensive, we need to enforce mandatory drug testing for pre-employment, athletes, police, military and all government employees. Finally, we need mandatory drug education in the curricula of our schools.

There is no room for fear and indifference during these uncertain times of our country's existence. If we are to survive as a nation, we need to fight this evil together. If Rosebud is an angel as she professes to be, then we need to do our part to save our country.

Remember: Shabu kills!

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