Stimulant methamphetamine and dextromethorphan use by the Thai youth

Abstract

Recreational use of stimulants in Thailand has been widespread for the past 2 decades. Beginning in the mid 1990s, methamphetamine has made its appearance and since has replaced other illicit drugs such as heroin as the street drug of choice for addicts. Recently, recreational use of dextromethorphan has been gaining enormous popularity among experimenting teens as well. Overdoses and adverse effects resulting from these two drugs have helped to characterize the nature of the drugs' usages, their toxicology and pharmacology in the Thai population, and their widespread psychosocial implications for Thailand. In Thailand, methamphetamine is available in several forms. The cheapest and by far the most popular form is that of the methamphetamine tablets. Other forms also include methamphetamine crystals (ICE), Methylene-dioxymethamphetamine or MDMA (ecstasy),or legal prescription drugs such as dextroamphetamine (Ritalin®). In 1996, the former Prime Minister Dr. Taksin Chinnawatr has instituted a radical drug war. Possession of more than a few tablets of methamphetamine is considered trafficking and the suspects can be executed. As a result, the price of tablet methamphetamine skyrocketed from 50 THB to 200THB and there have been a few cases of Ritalin® intoxication seen in the ED during that time. Users are usually young men and their wives and use during pregnancy is common. Since Dr. Taksin's political exile, methamphetamine usage among youths has once again shown a steady increase. The group of pregnant women who uses the drug during pregnancy often admits to concurrent abuse with other substances such as alcohol and inhalants.Accidental poisoning in children is seen occasionally in the ED. Some case examples of methamphetamine poisoning in different population is given.In contrast, Dextromethorphan is a drug of mainly young early and middle adolescence. It is available in Thailand as an over-the-counter 5 mg. pill of dextromethorphan hydrobromide at approximately 1 THB per tablet. Its use seems to be purely recreational because of its reputation for giving a good ‘high' that is short-lived and cannot be detected by parents. It also shows a social component with usually a few friends using the drug together. In a large poisoning in Bangkok, Thailand where the drug is distributed at school and more than 50 students have taken it, the milligram per kilogram of drug taken does not seem to coincide with the clinical symptoms seen. Although in such a case, it is hard to discern the real from the socially-induced symptoms. The details of dextromethorphan poisoning and its proposed pharmacology and toxicology are presented.There are also many more stimulants made, at least partly, from legal substances. Those which have been widely distributed in Thailand include;• ‘4x100': a concoction of cough medicine which are sold as stimulants in Southern Thailand • ‘Pocodyl”: a combination cough medication with promethazine, ephedrine and codeine. It is now all the rage among teenagers because of its supposed ‘high'. Conclusion: Stimulant use among Thai teenagers is on the rise. Merely making outlawing the drugs involved cannot solve the entire problem. An active community, cyber and hospitalbased surveillance needs to be instituted in order to educate and prevent dangerous uses of these chemicals.