DRUG REPLACEMENT TREATMENTS - IS AMPHETAMINE SUBSTITUTION A HORSE OF A DIFFERENT COLOR

Advocates of amphetamine substitution therapy argue that needle sharin g by amphetamine users, and associated infectious disease risk, outwei gh the risks associated with oral dexamphetamine substitution prescrib ing, and that substitution can allow stabilization and gradual withdra wal of patients, or maintenance. Others note that amphetamine users ar e not generally physically dependent, dexamphetamine prescribing can l ead to increased drug use and psychosis, and that there are possible n eurotoxic effects from prolonged chronic exposure to amphetamines. Res earch on the impact of amphetamine and cocaine prescribing on drug use , injecting, social adjustment and criminal involvement is lacking apa rt from a small number of retrospective case reports. Early experience in the United Kingdom leads to the view that amphetamine maintenance was a therapeutic failure. More recently, clinicians have expressed co nfidence that the approach has merit, and while their claims should no t be discounted there remains no empirical basis to support them. Alth ough dexamphetamine substitution therapy has been heralded as an impor tant intervention to reduce injecting behaviour and associated infecti ous disease risk, there is very little research which attests to its s uccess in reaching this goal. Indeed, what is known regarding patterns of amphetamine use and the effects of prolonged use of the drug raise serious doubts as to the efficacy of amphetamine maintenance. There i s an urgent need for randomized or case-controlled traits of the effic acy of these procedures. Until such empirical comparative research is available, the benefits to be gained from dexamphetamine substitution therapy remain speculative and opinion-based.