The “Logic” of Researchers in ADHD

 

About 15-20 years ago or so, when I was still Director of Psychiatric Residency Training at the University of Tennessee Medical School, I went to a grand rounds (a teaching conference involving the whole department) to hear a talk by a doctor about adult ADHD. It turned out to be more of a drug commercial for some or other stimulant the sponsor of the talk was selling.

The guy basically said that this pseudo-diagnosis was in fact incredibly common – up to 14% of the adult population – and all of them should be taking significant doses of one of the most dangerous and addictive class of drugs that are available by prescription – classified by the FDA in the same category of abuse potential as opiates like morphine. Wow.

During the Q&A at the end of the talk, the subject of ADHD in children came up. Someone asked him why so many kids diagnosed with the disorder could go to a video game arcade (which had at the time only recently gone the way of the dinosaurs) and concentrate with tremendous focus on the game they were playing despite all sorts of buzzers and bells going off, flashing lights everywhere, and scores of people milling all around talking to each other. The speaker opined that this was “not concentration.” I’ve heard that sentiment many times before and since from Pharma shills. Well if it isn't concentration, I wondered, then WFT is it?

Another skeptic in the audience from child psychiatry asked him about the high incidence of alcoholism in the parents of ADHD patients. His response: “If you had a kid like that, you’d probably drink too!” Oh, I see. Alcoholism is caused by having rambunctious children.

I should have gotten up and cussed the dude out for saying heinous stuff like this, but my boss in the department might have frowned on it.

All this reminds me of another talk I once heard from someone from the National Institute for Drug Abuse during an outside medical meeting. He was going on and on about how cocaine, another stimulant BTW, depletes a chemical in the brain called Dopamine, which makes it nearly impossible for abusers to enjoy anything but the drug. Someone (again, not me) got up and asked, “But aren’t we doing that when we prescribe stimulants to our kids?” The speaker’s answer, “But the drugs work so well.”

So I’m guessing that the answer to the question that was actually asked, which the speaker completely avoided, was, “Yes.”

An Unpleasant Diversion

Statistics using the term drug diversion usually refer to the sum of the amount of prescription drugs being abused by the person to whom the drug was prescribed and the amount of drugs being sold to or given to other people. So, what class of prescription drugs do you think is most frequently "diverted" for non-medical uses? Opiate narcotics like Oxycontin, Vicoden, and Percodan? How about sleeping pills and tranquilizers like Xanax and Ambien?

Not even close! Far and away the most commonly diverted prescription drugs are stimulants like Ritalin, Adderall, and Concerta - drugs that are prescribed for ADHD. According to a study in the Journal of Clinical Psychiatry, about 60% of students with a prescription for ADHD medication shared or sold the medication for non-medical use. Other studies have quoted somewhat lower figures (22-50%), but comparably, people who deal in their oxycontin prescriptions are complete pikers!

Stimulants, a class of drugs which also includes street drugs like cocaine and methamphetamine, are well known to be performancing enhancing drugs. They not only help kids with attention problems concentrate and focus, they help anyone concentrate and focus. And with them, you can stay up all night and study. On college campuses across the country, they are known as academic steroids.

They are so commonly used in colleges by students and faculty alike to get a leg up on the competition that the satirical newspaper the Onion recently reported that Harvard awarded an honorary degree to Adderall ("In its 14 years of availability by prescription, Adderall has had a profound and wide-reaching effect on the works of countless academics, contributing to an estimated 3.2 million research papers and blazing the trail for the several thousand grants, fellowships, and high-grade point averages that followed."). (http://www.theonion.com/articles/adderall-receives-honorary-degree-from-harvard,17527/).

When was the last time you heard a news story about the horrors of illegal Valium abuse? Even if you have, which would make you a rare bird, compare that to how many news stories you have heard about the horrors of meth and cocaine abuse.

The FDA classifies stimulants and narcotics in the same category - Schedule II. (Only illegal drugs like Heroin are Schedule I). By comparison, benzodiazepines like Valium and Xanax are schedule IV - which means they are considered to have far less abuse potential. Instructive in this regards is the fact that calls to poison control centers regarding stimulant abuse rose 76% between 1998 and 2005, paralleling an increase in prescriptions for ADHD (Setlik and others, Pediatrics, 124 (3), pp.875-880, 2009).

Joseph Biederman, the Harvard Guru of using psychiatric drugs on Children, was active in ADHD research before he was pushing the diagnosis of childhood bipolar disorder. He published a paper that purported to show that kids who were prescribed stimulants were no more likely than anyone else to abuse drugs as adults. Maybe he should have talked to the kids' older siblings. Besides, if you get your drugs of abuse by prescription, you are still using the drugs. As if people in Methadone maintenance programs are not still opiate addicts. I wonder if Biederman's study was compromised by all that drug company money he's accepted over the years?

And how are kids on stimulants doing in school? One study showed that they gained about three more months in school over kids who were diagnosed with ADHD but were not given stimulants. How impressive. A little tutoring would have probably worked just as well. Other studies show that those who were given stimulants continued to have just as many problems in their adult personal life as those who were not treated. And they're shorter as well. Really.