Dependence on High-Dose Veterinary Adenosine: A Case Analysis

Understanding adenosine monophosphate (AMP)

AMP is a naturally produced nucleotide that plays a crucial role in energy metabolism and cellular signaling. ^[1][2][3] AMP is produced in the body’s cells during several metabolic processes. ^[2] In veterinary medicine, it can be used to aid muscle recovery, but its use in humans has not been widely researched. Primarily, this veterinary medicine is used in dogs and race horses to improve circulation and boost performance. Aside from this case study, there is no known research on human use of AMP or its effects on the body and brain. ^[1]

Overview of the published case

A 41-year-old man was seen in the clinic reporting 6 months of several physical and mental health symptoms, including anxiety, paranoia, low mood, poor sleep, and fatigue. ^[1] He was thought to be suffering primarily from anxiety disorder or depressive disorder, and was commenced on medications to help treat this. He also displayed some symptoms of a delusional disorder, including excessive paranoia and worry. ^[1]

The individual was followed up regularly over the subsequent four months, reporting fluctuations in symptoms during this time. ^[1] At the four-month review, he disclosed AMP use to clinicians. ^[1] At this point, he has been using AMP for two years, initially a 0.5ml intramuscular injection once a day, increasing over time up to 20ml intravenously five times per day. ^[1] This amount greatly exceeds any guidelines for AMP use. ^[1]

As a result, his diagnosis was revised to stimulant use disorder (AMP dependence), with his symptoms attributed to withdrawal symptoms from AMP use. ^[1] Medications were targeted toward withdrawal management, although there were no significant changes in his treatment regimen. ^[1] At 12 months following his initial presentation, he reported several relapses in AMP use, but at a much lower frequency than he was previously using. ^[1] Despite this, several symptoms, including anxiety and low mood, did not recur with relapses in AMP use, highlighting a partial long-term response to medical treatment. ^[1]

Can adenosine cause dependence?

This case has highlighted that the use of high-dose AMP can lead to dependence, but there is not sufficient research to determine whether AMP can cause dependence. ^[1] By administering adenosine to the body, it exceeds the amount of adenosine that is usually present. Over time, the body can become accustomed to this higher amount, leading to dependence. While adenosine is a naturally produced compound and is not viewed as addictive in the traditional sense, it’s also involved in dependence on other substances, such as caffeine. ^[4] 

Why people misuse veterinary AMP

While misuse of veterinary AMP is rare, it’s part of an increasing trend of veterinary medicine being used for its performance-enhancing or euphoric effects. ^[1][5] In this case analysis, the individual reported using the AMP due to the temporary increase in energy, focus, and mental clarity that it provided. ^[1] However, this was balanced by severe withdrawal effects, particularly as the dosage became higher. ^[1] 

Aside from their perceived desirable effects, veterinary medicines are often easier to access and more affordable than other drugs, which are both factors for why people may misuse veterinary AMP. They can also be perceived as safe due to their use in animals; however, unregulated use of veterinary AMP in humans can be dangerous. ^[1]

Withdrawal management and lessons from the study

In this case analysis, the individual was initially started on the following medications to help treat his symptoms, before disclosing his AMP use: ^[1]

• Risperidone - for paranoia, delusions, and agitation.
• Escitalopram - for mood and anxiety.
• Clonazepam - for restlessness and anxiety.
• Zolpidem - for sleep problems.
• Propranolol - for heart palpitations and tremors. 

After the individual disclosed their AMP use, his medication regimen remained largely the same, with doses titrated as needed to ensure his withdrawal symptoms were controlled. ^[1] This highlights a key lesson from the study, which is that AMP withdrawal management can be focused on targeted symptom control with these types of medications, instead of having a specific, unique treatment. AMP withdrawal management is also likely to be highly specific to the individual, with different withdrawal symptoms requiring different medications to counteract them.

Clinical challenges in diagnosing rare dependencies

The main challenge with rare dependencies is that, because they are unusual, if the patient does not disclose their usage, the clinician is unlikely to think of it as a diagnostic possibility. In this case, the individual's AMP use was not disclosed until four months following his initial presentation, meaning his symptoms were initially attributed to a primary anxiety or depressive disorder. ^[1] This delay in diagnosis is common with rare dependencies and can subsequently lead to a delay in effective treatment.

Additionally, standard substance use assessments tend to focus on common drugs of abuse, meaning veterinary medicines and other novel substances may not be considered during these routine assessments. There is also often an absence of established diagnostic criteria for these substances, again making the diagnosis more challenging. To counter this, clinicians should ask open questions and keep a broad mindset when evaluating patients. 

Finally, the abuse of novel substances like AMP means there is not enough research to understand the short and long-term risks associated with abuse. Case studies like this are often the first source of data on emerging trends of novel substance abuse and the associated effects on physical and mental health. The lack of research and data also means that clinicians do not have an established set of recommendations to draw from in order to formulate a treatment plan. 

Rare dependency case studies and their implications for public health

This case analysis of veterinary AMP dependence is contributing to an increased amount of research highlighting the misuse of non-traditional substances. From a public health standpoint, cases like this act as an early warning sign in the evolving landscape of substance use disorders. They can help prompt regulatory bodies and healthcare organizations to update their policies and guidelines to help target new and emerging substance use disorders. They can also discuss stricter laws and regulations around buying and possessing certain substances, particularly veterinary medicines. 

Additionally, a vital aspect of public health is education, addressing the misconception that naturally occurring compounds or veterinary medicines are safe for human use. Many veterinary medicines have not undergone rigorous human testing and therefore are not guaranteed to be safe, particularly if they are used unregulated and at higher doses. 

Ultimately, this case is a reminder that dependence on unexpected substances can develop. If you, or someone you know, is struggling with addiction or substance dependence, please reach out to a professional for help.