Journal of Toxicology: Clinical Toxicology

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Amphetamines in Nasal Inhalers

Joseph Gal

To cite this article: Joseph Gal (1982) Amphetamines in Nasal Inhalers, Journal of Toxicology:
Clinical Toxicology, 19:5, 517-518, DOI: 10.3109/15563658208992508
To link to this article: https://doi.org/10.3109/15563658208992508

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J. TOXICOL. - CLIN. TOXICOL., 19(5), pp. 517-518 (1982)

LETTER TO THE EDITOR

Amphetamines in Nasal Inhalers

The recent paper by Anderson e t al. [l] provides an interesting

account of the history of the abuse of nasal inhalers, and gives a time-
ly warning about the abuse of the propylhexedrine nasal inhaler. In
describing the career of amphetamines as nasal decongestants, the
authors conclude, in reference to the 1959 Food and Drug Adminis-
tration ban of the over-the-counter sale of amphetamine inhalers: "So
ended the legal, over-the-counter sale of amphetamines in nasal in-
halers" [l]. This conclusion is not entirely correct. A s Grinspoon
and Hedblom [2] pointed out, the FDA banned only amphetamine and
dextroamphetamine, but not methamphetamine o r other amphetamine
congeners. This loophole resulted in the marketing, a f t e r 1959, of
inhalers containing methamphetamine o r other close analogs of a m -
phetamine, and some of these products w e r e highly abused [2, 31.
Subsequently, most such products were withdrawn, but one p e r s i s t s
on the market to this day: The Vicks Inhaler (Vicks Inc. ). This
nasal decongestant preparation contains 50 mg of Q-desoxyephedrine
together with menthol, camphor, methyl salicylate, and bornyl acetate.
P -Desoxyephedrine is another name f o r levo-methamphetamine.
(There is a l s o confusion in the l i t e r a t u r e in naming the s t e r e o i s o m e r s
of methamphetamine: some sources [4] r e s e r v e the name "metham-
phetamine" to designate exclusively the d-isomers, while others [5]
u s e the d- and/or 8- prefix in conjunction with "methamphetamine?' to
identify the i s o m e r (s)in question. ) The Vicks Inhaler is sold over the
counter f o r -$2.00 in the Denver area.
Although specific analytical procedures are available f o r the iden-
tification of the particular optical i s o m e r ( s ) of methamphetamine [6]
and the i s o m e r ( s ) of i t s metabolite amphetamine [q in biological fluids,
toxicology laboratories generally do not perform such procedures
routinely. Therefore, the presence of either ( o r of both) i s o m e r ( s ) of
methamphetamine in body fluids is usually reported only as ?'metham-
phetamine." It is not clear, therefore, to what extent Q-methamphet-
amine has been involved in methamphetamine intoxication, of which
numerous r e p o r t s have appeared in the literature. It is noteworthy,
though, that d, P ( r a c e m i c ) methamphetamine has been extensively
abused [3]. Furthermore, in a reported case [6], a subject, suspected

517
Copyright 0 1983 by Marcel Dekker, Inc.
518 LETTERS TO THE EDITOR

of abusing d-methamphetamine-the ingredient of several (legal) stim-

ulant and anorexigenic medications-denied such abuse, and claimed
heavy use of the Vick' s Inhaler [6]. H i s claim was consistent with
the laboratory finding that his urine contained only Q-methamphetamine
PI *
d-Amphetamine is about three to four times as potent as the II iso-
m e r in eliciting CNS excitatory effects, while the Q isomer is slightly
more potent than the d in its cardiovascular actions [8]. Metham-
phetamine is reported to be similar to amphetamine in pharmacological
actions, but with a different ratio between central and peripheral ef-
fects [9]. It is not clear, however, precisely how the optical isomers
of methamphetamine differ from each other in their human pharma-
cology and toxicity.
The ready availability and low cost of the Vick's Inhaler, and the
ingenuity of the drug abuser in extracting drugs from inhalers [l],
strongly suggest that the product may have high abuse potential. It
remains to be seen whether this potential is realized in practice. Clear-
ly, identifying the specific optical isomer of methamphetamine involved
in abuse and overdose cases may help to pinpoint the origin of the drug.

REFERENCES

R. J. Anderson, W. G. Reed, and L. D. Hills, History, epidemi-

ology, and medical complications of nasal inhaler abuse, - Clin.
Toxicol., 19, 95 (1982).
L. Grinspoon and P. Hedblom, in The Speed Culture, Harvard
University Press, Cambridge, 1975, p. 17
J. Griffith, A study of illicit amphetamine drug traffic in Okla-
homa City, Am. J. Psychiatry, 123, 560 (1966).
Martindale The Extra Pharmacopoeia, 27th ed. (A. Wade, ed.),
Pharmaceutical Press, London, 1977, p: 314.
D. Eskes, A procedure for the differentiation of the optical iso-
m e r s of amphetamine and methamphetamine by thin-layer chro-
matography, J. Chromatogr., 117, 442 ( 1976).
M. D. Solomon and J. A. Wright, A false-positive for (+)-meth-
amphetamine, Clin. Chem., 23, 1504 (1977).
J. Gal, Stereochemistry of metabolism of amphetamines: Use of
(-)-u-methoxy-a- (trifluoromethy1)phenylacetyl chloride for GLC
resolution of chiral amines, J. Pharm. Sci., g , 169 (1977).
N. Weiner, "Norepinephrine, epinephrine, and the sympathomi-
metic amines," in The Pharmacological Basis of Therapeutics,
6th ed. (A. G. Gilman, L. S. Goodman, and A. Gilman, eds.),
Macmillan, New York, 1980, p. 160.
[91 N. Weiner, in Ref. 8, p. 162.
Joseph Gal, Ph.D.
Division of Clinical Pharmacology, Box C237
University of Colorado Health Sciences Center
Denver, Colorado 80262