Sci got this comment to her Ritalin post the other day:
It sounds like you are suggesting that cocaine taken in the same form as Ritalin — as low-dose, slow release pills — would produce the same effects as the ADHD medication does. But, clearly, the FDA has seen fit to outlaw cocaine and place its seal of approval on doctor-prescribed Ritalin. Not that I think the FDA is infallible or anything, but did they really make the mistake of controlling one substance and permitting another that are essentially equivalents? Benzoylmethylecgonine and methylphenidate are clearly not the same chemical compounds, but if they act in synonymous ways on the brain, shouldn’t they be treated equally under the law?
And what about the all-touted maxim that patients who have not been prescribed Ritalin should not take it but those who have been shouldn’t miss a dose? Is there really such a neurological difference between those with ADHD and those who haven’t been diagnosed with it, or is it just a matter of how much rapport you establish with your psychiatrist? (I am not trying to patronize; I legitimately want to know!)
Similarly, are their patients for whom controlled doses of cocaine would yield medical benefits equal to or exceeding those of Ritalin? Or are there manifold side effects that discourage the use of cocaine as an ADHD/ concentration medication in spite of its similarities to Ritalin?
Personally, I’m skeptical of many of the diagnoses of ADHD that I see and of the politician-worthy campaigns that I hear that deny the efficacy of Ritalin for patients who have not been diagnosed with ADHD. It seems to me that for a disorder whose diagnosis is so imprecise and objective, it’s a convenient coincidence that most takers of Ritalin who have been diagnosed with ADHD (regardless of whether or not the diagnosis is accurate) show marked improvement in concentration…
As you can see, it’s long and has a lot of questions. And some of them are very good ones. But I knew that answering it within the comment thread was going to be long, and also I needed to use lots of links. So congrats, cerebration! You’re getting your very own post!!!
Here we go.
It sounds like you are suggesting that cocaine taken in the same form as Ritalin — as low-dose, slow release pills — would produce the same effects as the ADHD medication does. But, clearly, the FDA has seen fit to outlaw cocaine and place its seal of approval on doctor-prescribed Ritalin. Not that I think the FDA is infallible or anything, but did they really make the mistake of controlling one substance and permitting another that are essentially equivalents? Benzoylmethylecgonine and methylphenidate are clearly not the same chemical compounds, but if they act in synonymous ways on the brain, shouldn’t they be treated equally under the law?
…
Similarly, are their patients for whom controlled doses of cocaine would yield medical benefits equal to or exceeding those of Ritalin? Or are there manifold side effects that discourage the use of cocaine as an ADHD/ concentration medication in spite of its similarities to Ritalin?
Ok, first off, I don’t want to sound like I’m suggesting that cocaine if taken orally in and in the correct amounts would be therapeutic. This is partially because cocaine, as well know is addictive and illegal, but mostly I don’t want to suggest that because it’s wrong and probably wouldn’t work well.
Cocaine is in fact still useful medically, it’s a topical anesthetic (painkiller) and vasoconstrictor (tightens blood vessels to restrict flow and raise pressure) and works great for things like eye surgery, though it’s not used like that very often. Here’s the issue: cocaine has a REALLY short active period. It would be incredibly difficult to make a pill, even a REALLY slow release form, that would release cocaine in slow enough, steady enough amounts to produce focusing effects. Honestly, we’re far better off just using drugs with longer half lives, like Ritalin.
As far as the potential legality or illegality of this issue: Sci doesn’t like politics.
And I would like to point out that Ritalin and cocaine are not really equivalent, though they have a very similar mechanism of action (blocking the dopamine and norepinephrine transporters). The longer half-life is a HUGE difference, for one thing. For another, cocaine hits serotonin pretty heavily, while Ritalin does not. Additionally, some animals studies have shown that therapeutic doses of Ritalin preferentially affect norepinephrine in the prefrontal cortex (see Berridge, 2006), as opposed to dopamine in the mesolimbic dopamine system, which would create more of a high effect. It’s hard to compare this with cocaine, as low doses of cocaine haven’t really been looked at for this, but the activation of norepi over dopamine implies that the behavioral effects of low-dose cocaine and low-dose Ritalin will be different.
For those who need serotonin activity along with dopamine and norepinephrine, there’s Adderall, which is amphetamine, and has those actions (though the mechanism is different). I imagine some people with ADHD might be helped by low doses of cocaine, but again, I think it would be very hard to get the doses controlled enough, and the short action is always an issue.
And what about the all-touted maxim that patients who have not been prescribed Ritalin should not take it but those who have been shouldn’t miss a dose? Is there really such a neurological difference between those with ADHD and those who haven’t been diagnosed with it, or is it just a matter of how much rapport you establish with your psychiatrist? (I am not trying to patronize; I legitimately want to know!)
The issue here is control over the problems that Ritalin can have. Ritalin IS a psychostimulant similar to the cocaine class of drugs. It WILL have effects in people who do not have ADHD. When taken improperly, it can give you a high, which can make you want to take it again. So rules are put in place trying to ensure that those who might be vulnerable to the addictive properties do not take it.
For those with ADHD, they often really don’t LIKE their meds (why is still a question people are trying to answer, or at least, Sci doesn’t know why). So they will skip unless you tell them not to miss a dose. Additionally, people with severe ADHD often have quality of life issues (low grades, difficult socializing, etc) that Ritalin can help with, and not taking your dose will obviously not give you the benefits.
There IS a neurological difference between people with severe ADHD and those without (studies point to changes in the dopamine system, particularly in reward-related areas, showing these kids may have decreased ability to wait for a long-term reward rather than a short one, though other studies have looked at changes in brain development in children as well, probably a combination of several factors), though there are cases of over- and under-diagnosis of the disorder. It’s a really subjective diagnosis, and for those seeking cognitive enhancement or just drugs, psychiatrists are human and can be fooled. Whether or not it’s good for you to attempt to fool your psychiatrist or diagnose yourself, well that’s not something Sci wants to talk about.
And yes, people who take Ritalin DO show improvements in concentration. It works, and it works well, for everyone. The question is whether those improvements should be confined to those who are seriously deficient in the ability to concentrate in the first place, or whether this is an opportunity and should be open to everyone. Sci doesn’t feel like dealing with that one right now. Have at in the comments if you like.
So that’s what I’ve got for you, cerebration! I hope it helped a little!
