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EDITORIALS:
Nosa A Akporehwe, Paul R Wilkinson, Rachel Quibell, and Kerstin A Akporehwe
Ketamine: a misunderstood analgesic?
BMJ 2006; 332: 1466 [Full text]
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[Read Rapid Response] Amphetamine: A misunderstood psychostimulant?
Mark Taubert   (30 June 2006)

Amphetamine: A misunderstood psychostimulant? 30 June 2006
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Mark Taubert,
SHO palliative medicine
Holme Tower Marie Curie Hospital, Cardiff CF64 3YR

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Re: Amphetamine: A misunderstood psychostimulant?

Editor- Akporehwe et al make a valid point of highlighting the stigmatisation ketamine has suffered as a result of being known as a drug of abuse and that clinicians view it with some suspicion(1). Historically, there are a number of other drugs that have been vilified by both society and the medical profession and are now enjoying somewhat of a ‘renaissance’, albeit with some caution (2,3).

Amphetamines, for instance, are viewed with some apprehension due to their more common association as recreational “street” drugs. The British National Formulary says that they have no place in the management of depression or fatigue. However in a palliative care setting they are of proven value(4) and are used for patients with fatigue and clinical depression, especially when other antidepressants have a much longer period of onset.

Of course, drugs such as ketamine and amphetamine need to be prescribed with caution and instituted in a safe setting. On the other hand, not prescribing them at all due to over-caution and negative current or historical associations will probably do a disservice to those patients for whom there would be clear benefits or where more conventional interventions have failed.

(1) Akporehwe NA, Wilkinson PR, Quibell R, Akporehwe KA Ketamine: A misunderstood analgesic? BMJ 2006;332:1466

(2) Martin D The use of psychostimulants in the terminally ill European Journal of Palliative Care 2001, 8 (6)

(3) Baker D, Pryce G, Giovannoni G, Thompson AJ The therapeutic potential of cannabis Lancet Neurol. 2003 May;2(5):291-8

(4) Block SD. Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med 2000;132: 209-18

Competing interests: None declared