Amphetamines in the treatment of adult attention-deficit/ hyperactivity disorder (ADHD) and cocaine use disorder (CUD): The role of pharmacists

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattentiveness, hyperactivity, and impulsivity. This review paper outlines the role that pharmacists can play in monitoring amphetamine use, to reduce the possibility of medication abuse by those with ADHD and/or Cocaine Use Disorder (CUD). Because individuals with ADHD also struggle with impulsivity, they are more likely to abuse substances, particularly illegal stimulants (such as cocaine), in an effort to self-medicate. This article also reviews the pharmacokinetics of amphetamine derivatives as well as the evidence for their use to manage ADHD and CUD. Neuropharmacologically, the proposed mechanism of action of amphetamines in the treatment of CUD is also detailed. Finally, the
implications of these findings for pharmacy practice are discussed. The primary findings and principal conclusions are that amphetamines have been found to improve both ADHD and CUD symptomatology, primarily through increasing DA release from nerve terminals in the central nervous system, as well as increasing the release of NE and serotonin. Pharmacists can play an important role in monitoring use of these medications by working in collaboration with family physicians and psychiatrists to ensure that ADHD/CUD patients are taking their amphetamines as prescribed.