5 ms·

Methamphetamine is much less frequently prescribed than other forms of amphetamines for ADHD, but I wouldn't say "extremely rare". And there's very little evide

by Lazare 5y ago

Methamphetamine is much less frequently prescribed than other forms of amphetamines for ADHD, but I wouldn't say "extremely rare". And there's very little evidence it's any more addictive or harmful than normal amphetamines. I also think you're conflating addiction to dependency or withdrawal symptoms. Physical withdrawal symptoms are extremely common with stimulants - then again, they're common for basically all other drugs too. Adderall, caffeine, hell, even Tylenol all have withdrawal symptoms. If you're a daily coffee drinker, going a day without will likely cause a splitting migraine and some personality changes for a day or two! Many OTC nasal sprays for hayfever are known for having ferocious withdrawal symptoms, but they aren't addictive or abusable. People who abuse stimulants take a dose vastly higher than any therapeutic dose. The effects end up being very different. You mention heroin, but heroin itself was originally marketed - for years! - as a non-addictive alternative to morphine, and was sold as a cough suppressant. Many people used it; most didn't get addicted. Cocaine was a fairly common additive to drinks for years; Thomas Edison was famously a fan of https://en.wikipedia.org/wiki/Vin_Mariani https://en.wikipedia.org/wiki/Vin_Mariani (as were two popes and numerous other famous figures). There's nothing magical about heroin. Prescribe a therapeutic dose of a strong opioid, and maybe 1% (the data here is bad, but most studies cluster around this point) of your patients will get addicted and start abusing it (by taking a vastly higher dose); the other 99% will not. We keep demonising drugs, seemingly almost at random, but it doesn't seem to have much to do with the nature of the drugs.

qwerty456127 5y ago
> And there's very little evidence it's any more addictive or harmful than normal amphetamines. Well, I won't say "just try and compare" because recommending to try that would be a devil's advice but the difference is huge and I don't need any scientific paper to confirm that. For a person having actual ADHD amphetamine can be a reasonable tool to manage it sustainably, at the same time meth would at least cause rapid tolerance build-up leading them to increase dosage very fast and face all sorts of health issues. You also won't be able to return to amphetamine soon after having tried meth, the former is going to have almost no effect until your brain chemistry actually recovers.
- sobani 5y ago
  https://astralcodexten.substack.com/p/know-your-amphetamines https://astralcodexten.substack.com/p/know-your-amphetamines Start reading from "There's a lot of confusion around the difference between amphetamine and methamphetamine." Most relevant quote: "Moreover, there are no known neurobiological differences in action between METH and AMPH that would account for the [supposedly] greater addictive, rewarding, or psychomotor properties of METH."
asxd 5y ago
Thanks for this thoughtful reply. I should probably not have commented on frequency of meth prescriptions, my only reference point is that it's never been brought up to me by my doctor and don't know any friends who take it for ADHD. Regarding withdrawal symptoms, it's again anecdotal on my end. I have been taking prescribed adderall for ADD since I was a teen. When I do go off it for a prolonged period of time, I don't notice withdrawal so much as a mood shift and a decline in productivity. I'm more or less comfortable being lethargic and lazy when I'm off it, but I take it because I think it makes me better at being a person (ability to focus for one, but also just taking the time to do menial but important every-day tasks I might otherwise let go by the wayside, for example). I think this speaks to your point though, that in correct dosages the withdrawal in (pharmaceutical grade) drugs can be safely mitigated. On a slight tangent, I'd like to point to the ongoing opioid crisis. I wonder if the reason it occurred was not only because doctors made the drug readily available, but because so many people were told by their doctor--a generally trusted authority--to take larger doses? If it were only accessibility that led to the crisis, there may be some truth to the idea that some drugs are true public health hazards. Apologies for rambling a bit, I'm somewhat on the fence about this topic, and I know this is a complicated issue to unravel.
- Lazare 5y ago
  The opioid crisis is a difficult topic, but the role of legal opioids in it is highly contested. Note that the rate of opioid prescription in the US had dropped by nearly 50% since 2012 [1], while the overdose rate has more than doubled [2]][3]. Meanwhile the same crackdown that has led to a huge decline in prescriptions has also led to a decrease in the amount prescribed, to the extent that there is strong evidence it is harming patients because doctors are so afraid of losing their license they are unwilling to prescribe the correct therapeutic dose to patients. A study in JAMA recently found that when doctors reduce the dosage of pain medication prescribed to long term opioid therapy, it leads to a threefold increase in suicide attempts and a 69% increase in overdoses[4]. In other words, the federal guidelines adopted to try and ensure that the drug was less readily available from doctors and prescribed in smaller doses seems likely to have cost a significant number of lives. There don't seem to be easy answers, and the driving forces behind (and possible solutions to) the massive increase in overdose deaths in the US remain elusive. But at a minimum a simple model of "it's caused by doctors giving people prescriptions for painkillers" seems to not be supported by evidence at this time. [1]: https://www.cdc.gov/drugoverdose/rxrate-maps/index.html https://www.cdc.gov/drugoverdose/rxrate-maps/index.html [2]: https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/drug-topics/trends-statistics/over... [3]: https://apnews.com/article/overdose-deaths-record-covid-pandemic-fd43b5d91a81179def5ac596253b0304 https://apnews.com/article/overdose-deaths-record-covid-pand... [4]: https://jamanetwork.com/journals/jama/fullarticle/2782643?guestAccessKey=a13d0857-892c-4c51-b888-0412f36c9640&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=080321 https://jamanetwork.com/journals/jama/fullarticle/2782643?gu...

by Lazare 5y ago

qwerty456127 5y ago

> And there's very little evidence it's any more addictive or harmful than normal amphetamines. Well, I won't say "just try and compare" because recommending to try that would be a devil's advice but the difference is huge and I don't need any scientific paper to confirm that. For a person having actual ADHD amphetamine can be a reasonable tool to manage it sustainably, at the same time meth would at least cause rapid tolerance build-up leading them to increase dosage very fast and face all sorts of health issues. You also won't be able to return to amphetamine soon after having tried meth, the former is going to have almost no effect until your brain chemistry actually recovers.

sobani 5y ago
https://astralcodexten.substack.com/p/know-your-amphetamines https://astralcodexten.substack.com/p/know-your-amphetamines Start reading from "There's a lot of confusion around the difference between amphetamine and methamphetamine." Most relevant quote: "Moreover, there are no known neurobiological differences in action between METH and AMPH that would account for the [supposedly] greater addictive, rewarding, or psychomotor properties of METH."

asxd 5y ago

Thanks for this thoughtful reply. I should probably not have commented on frequency of meth prescriptions, my only reference point is that it's never been brought up to me by my doctor and don't know any friends who take it for ADHD. Regarding withdrawal symptoms, it's again anecdotal on my end. I have been taking prescribed adderall for ADD since I was a teen. When I do go off it for a prolonged period of time, I don't notice withdrawal so much as a mood shift and a decline in productivity. I'm more or less comfortable being lethargic and lazy when I'm off it, but I take it because I think it makes me better at being a person (ability to focus for one, but also just taking the time to do menial but important every-day tasks I might otherwise let go by the wayside, for example). I think this speaks to your point though, that in correct dosages the withdrawal in (pharmaceutical grade) drugs can be safely mitigated. On a slight tangent, I'd like to point to the ongoing opioid crisis. I wonder if the reason it occurred was not only because doctors made the drug readily available, but because so many people were told by their doctor--a generally trusted authority--to take larger doses? If it were only accessibility that led to the crisis, there may be some truth to the idea that some drugs are true public health hazards. Apologies for rambling a bit, I'm somewhat on the fence about this topic, and I know this is a complicated issue to unravel.

Lazare 5y ago
The opioid crisis is a difficult topic, but the role of legal opioids in it is highly contested. Note that the rate of opioid prescription in the US had dropped by nearly 50% since 2012 [1], while the overdose rate has more than doubled [2]][3]. Meanwhile the same crackdown that has led to a huge decline in prescriptions has also led to a decrease in the amount prescribed, to the extent that there is strong evidence it is harming patients because doctors are so afraid of losing their license they are unwilling to prescribe the correct therapeutic dose to patients. A study in JAMA recently found that when doctors reduce the dosage of pain medication prescribed to long term opioid therapy, it leads to a threefold increase in suicide attempts and a 69% increase in overdoses[4]. In other words, the federal guidelines adopted to try and ensure that the drug was less readily available from doctors and prescribed in smaller doses seems likely to have cost a significant number of lives. There don't seem to be easy answers, and the driving forces behind (and possible solutions to) the massive increase in overdose deaths in the US remain elusive. But at a minimum a simple model of "it's caused by doctors giving people prescriptions for painkillers" seems to not be supported by evidence at this time. [1]: https://www.cdc.gov/drugoverdose/rxrate-maps/index.html https://www.cdc.gov/drugoverdose/rxrate-maps/index.html [2]: https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates https://www.drugabuse.gov/drug-topics/trends-statistics/over... [3]: https://apnews.com/article/overdose-deaths-record-covid-pandemic-fd43b5d91a81179def5ac596253b0304 https://apnews.com/article/overdose-deaths-record-covid-pand... [4]: https://jamanetwork.com/journals/jama/fullarticle/2782643?guestAccessKey=a13d0857-892c-4c51-b888-0412f36c9640&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=080321 https://jamanetwork.com/journals/jama/fullarticle/2782643?gu...