One Student's Adderall Story
- posted by Jim Leitzel @ 11:10 PM

Via Reihan writing at Andrew Sullivan's blog we learn of this article by a college senior describing her experiences of studying under the influence of Adderall. She thinks the drug was performance enhancing for her, at least if "performance" refers to grades. Here's a brief excerpt:

If the proof is in the transcript, then Adderall is hardly a self-punishing habit. Sometimes I think about how Marion Jones has to return all the prize money she earned while taking steroids, and I wonder whether I should be stripped of all the A’s I received for papers written on Adderall. This is a haunting or a comical thought, depending on my mood.

Despite the grade enhancement, she stopped using Adderall in her senior year -- grades aren't everything. As for her ability to study and churn out papers while using Adderall, in her case, "It turns out that the feverish moral imperative to work was an effect of the drug, not a cause."

The use of pharmaceuticals for "recreational" purposes is much more prevalent in the US than is the use of cocaine and heroin and hallucinogens, combined. Yet another good reason to legalize and regulate the currently illicit drugs: it isn't that hard to find close substitutes among the legal drugs.

Here's a table reproduced from SAMHSA showing prevalence rates:

70410

Table 1.1B – Types of Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Percentages, 2005 and 2006

Drug	TIME PERIOD
	Lifetime		Past Year		Past Month
	2005	2006	2005	2006	2005	2006
*Low precision; no estimate reported. a Difference between estimate and 2006 estimate is statistically significant at the 0.05 level. b Difference between estimate and 2006 estimate is statistically significant at the 0.01 level. 1 Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically. Illicit Drugs Other Than Marijuana include cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically. 2 Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2005 and 2006.
ILLICIT DRUGS1	46.1	45.4	14.4	14.5	8.1	8.3
Marijuana and Hashish	40.1	39.8	10.4	10.3	6.0	6.0
Cocaine	13.8	14.3	2.3	2.5	1.0	1.0
Crack	3.3	3.5	0.6	0.6	0.3	0.3
Heroin	1.5	1.5	0.2	0.2	0.1a	0.1
Hallucinogens	13.9	14.3	1.6	1.6	0.4	0.4
LSD	9.2	9.5	0.2	0.3	0.0	0.1
PCP	2.7	2.7	0.1	0.1	0.0	0.0
Ecstasy	4.7	5.0	0.8	0.9	0.2	0.2
Inhalants	9.4	9.3	0.9	0.9	0.3	0.3
Nonmedical Use of Psychotherapeutics2	20.0	20.3	6.2a	6.6	2.6	2.8
Pain Relievers	13.4	13.6	4.9	5.1	1.9	2.1
OxyContin®	1.4b	1.7	0.5	0.5	0.1	0.1
Tranquilizers	8.7	8.7	2.2	2.1	0.7	0.7
Stimulants	7.8	8.2	1.1b	1.4	0.4	0.5
Sedatives	3.7	3.6	0.3	0.4	0.1	0.2
ILLICIT DRUGS OTHER THAN MARIJUANA1	29.5	29.6	8.3	8.6	3.7	3.9

Labels: prescription drugs, teens

 
England's Smoking Ban
- posted by Jim Leitzel @ 7:09 AM

England will join the policy of the rest of Britain on July 1 by instituting a public smoking ban that will apply to restaurants and pubs. The Guardian marks the occasion by devoting a special edition of its second section to smoking. Included in the festivities is a debate on the propriety of the ban between the ubiquitous Christopher Hitchens and the redoubtable Simon Hoggart. Hitchens, who last appeared in Vice Squad on January 16, 2004, in the aftermath of breaking New York City's smoking ban, is almost religiously opposed to the upcoming prohibition. Here's a sample:

...I do not object to smoking being banned on aeroplanes, in hospitals or in offices. But it has been a long time since any non-smoker has been forced to breathe the same air as a smoker. The upcoming general ban - Ms Hewitt's [Patricia Hewitt, Britain's Secretary of State for health] triumphant legislative monument - crosses a completely different line. It is no longer "about" the protection of non-smokers. It is "about" state-enforced behaviour-modification.

Hitchens also uses the debate to suggest again that Afghanistan's opium crop should be purchased for legal pharmaceuticals -- an argument he presented in the May/June 2007 issue of Foreign Policy.

Simon Hoggart, the Guardian's witty and insightful parliamentary sketch columnist (also previously mentioned in Vice Squad, December 20, 2004) is an ex-smoker, and he adopts the position that, essentially, there are no benefits to smoking:

Smoking is not like drinking. Booze has its drawbacks, as a visit to any British town centre on a Friday night will demonstrate. But we drink wine and beer because we like it. People do not like smoking. They smoke because smoking is the only relief from the pain of not having a cigarette. It is a wholly negative pleasure. That is why there has been so little fuss over the ban. Most smokers are privately relieved that it might help them give up.

Hitchens is a current smoker, and he has no use for the 'no benefits' argument: "There have been moments of reverie, wreathed in smoke and alone with a book, and moments of conversation, perfumed with ashtrays and cocktails and decent company, which I would not have exchanged for a year of ordinary existence."

The special section also features a contribution from the frequently hilarious columnist Charlie Brooker, another ex-smoker:

For years, cigarettes and I were trapped in an abusive relationship. They beat me up, internally speaking, yet I couldn't live without them. To say I smoked like a chimney would be misleading. A chimney emits smoke serenely, with little apparent effort. I screwed my face up like a constipated pug, dragging on one deathstick after another like it was my second career. I even smoked in the shower.

In the course of describing his own past smoking and multiple attempts to quit, Brooker mentions his (presumed) reaction to an antidepressant prescribed to help him quit smoking. The title of Brooker's column is "Warning: giving up smoking can seriously damage your health." The problems associated with some frequently-prescribed drugs, including very serious withdrawal symptoms, have not received much attention from Vice Squad, but they are immense. Here's a page devoted to withdrawal from benzodiazepines.

On a lighter note, Brooker has previously suggested pharmaceutical interventions to prevent romance; here's his anti-party rant.

Labels: Britain, prescription drugs, smoking ban

 
OxyContin Developments
- posted by Jim Leitzel @ 4:48 PM

Purdue Pharma LP sold almost $2 billion worth of the popular painkiller OxyContin last year. OxyContin (with active ingredient oxycodone) was designed to be a time-released opioid that provides 12 hours of pain relief from a single tablet. Crushing the tablet prior to injesting, however, undoes the time release chemistry, and the crushed powder can be chewed, snorted, drunk in an alcohol or water cocktail, or further prepared and injected for an intense high. This discovery has led to lots of problems and even death for some OxyContin addicts and experimenters.

The Wall Street Journal reports today (page D3) that a reformulated version of OxyContin (which is no longer under patent protection) developed by Pain Therapeutics, Inc., may make it harder to undermine the time-release mechanism. From the WSJ article:

The company mixes oxycodone with three other substances it declines to identify, yielding a viscous fluid that Pain Therapeutics says won't release the oxycodone when crushed or dissolved in water or alcohol. Taken normally, the company says, the drug is still slowly released in a 12-hour period through the stomach and intestinal lining.

Pain Therapeutics issued this press release today.

Pressure has been growing on Purdue Pharma to do more to prevent OxyContin abuse. Last week, one of the manufacturing subsidiaries of Purdue paid $2 million to settle a case brought by the DEA alleging insufficient record-keeping. In December, the Government Accounting Office released a report (63-page pdf available here) concerning the abuse and diversion of OxyContin. Among the factors that the GAO identified as contributing to abuse was the original warning label, which advised against crushing the pill as that would lead to rapid release of the oxycodone. Purdue also has taken to training doctors, nurses, pharmacists, and law enforcement officers on how to detect potential abuses:

Two years after beginning their law enforcement training efforts, the three trained directors are in big demand, booking nearly six months in advance. Ritch Wagner was a former Nebraska Drug Enforcement Officer, and is now director of the Purdue Pharma program. Wagner says his team is training law enforcement and health care professionals about what to look for and what steps they can take to minimize prescription drug abuse.

Vice control has a way of enlisting "civilians" as informants. Meanwhile, the feds continue their dreadful, over-the-top campaign against pain-treatment doctors and their patients -- a campaign mentioned previously by Vice Squad in December and in February.

Labels: informants, pain, prescription drugs

 
DEA Plays Doctor Again
- posted by Jim Leitzel @ 10:00 AM

I think that access to some potentially addictive drugs should be strictly controlled --though the drugs should remain legally available, and without a prescription, to adults. An article in today's Chicago Tribune (via the Washington Post; registration required) reports on the DEA’s intention to reschedule the painkiller hydrocodone as a Schedule II drug. This rescheduling will severely tighten the conditions under which hydrocodone is available via prescription. Hydrocodone use can easily become a problem for people, as it did for Rush Limbaugh. But tightening the prescription regime, I think, is an inappropriate response (even ignoring my general unease with making a drug legally available only by prescription.) The article notes that hydrocodone was prescribed 100 million times last year, and no one suggests that more than a tiny minority of these prescriptions were "abusive." Hydrocodone is obviously a painkiller that millions of patients and their doctors think is quite valuable for them. To make hydrocodone harder to get – for instance, the rescheduling would mean that prescriptions could not be refilled without another visit to the doctor – ensures that these people will receive a lower level of care.

The DEA, it seems, wants to ensure that Americans must live with more pain than is necessary. (Here’s a previous Vice Squad post on the DEA’s campaign against pain treatment, and here is the main webpage of the Pain Relief Network; a march on Washington on behalf of patients in pain is slated for April 18-20, 2004.) It’s not pure sadism, oh no, the DEA has a "noble" purpose. What is that noble purpose? To try to make it a little harder for other Americans to consume a drug that they want to consume.

Labels: pain, policing, prescription drugs

 
Rush Limbaugh Plea Negotiations Made Public
- posted by Jim Leitzel @ 12:02 PM

The on-line Chicago Tribune includes this story (registration required) from the South Florida Sun-Sentinel about the prosecutors in the Rush Limbaugh drug and doctor-shopping case holding out for a guilty plea to a felony count. Limbaugh's lawyer, Roy Black, apparently was suggesting a plea bargain in which criminal charges would be put aside in exchange for further drug rehabilitation for Rush. Prosecutors would not go along, though they appear to be willing to pursue probation and not jail time in exchange for a guilty plea to a felony count of doctor shopping.

According to the linked article, Black's December letter to the Palm Beach County State Attorney proposing the rehab deal included this line: "The public is better served by treating addicts as patients rather than criminals." Hear hear. And it is better served by treating non-addicted users as law-abiding citizens than as either patients or criminals.

Labels: addiction, prescription drugs, recreational drug use, treatment

 
Pain Accentuation
- posted by Jim Leitzel @ 5:09 PM

The Drug Enforcement Agency knows better than medical boards and
individual physicians about how best to treat patients with chronic
pain. They are so certain of their superior knowledge that they are
happy to use our tax money to bring criminal cases against physicians
whose treatment of pain doesn't meet DEA standards.

No doubt there are some unscrupulous physicians who knowingly over-
prescribe narcotics. But remember, it was once legal in the US to
prescribe large amounts of narcotics to addicts, and is an accepted
medical procedure in other countries today. There are medical boards
that exist to control bad doctoring -- why is the DEA even necessary
for this purpose? The result is that few promising young physicians
will choose pain relief as a specialty and all of us will risk being under-
treated for pain.

Here's a Washington Post report (registration required) on the
DEA's activities; thanks to DRCNet for the pointer.

Labels: pain, policing, prescription drugs

 
Naming Operations
- posted by Jim Leitzel @ 6:24 PM

The FDA and the DEA are teaming up to combat the illegal sales of
prescription narcotics over the Internet, according to this article
(registration required) in the NY Times on Saturday, October 18.
"And for the first time, regulators are hinting that those who order
the drugs may face prosecution."

But this post isn't to examine the merits of the crackdown, or the
prescription system more generally. I want to focus on the name of
the new initiative: Operation Gray Lord. This apt moniker should bring
a little flutter of nostalgia into the hearts of Chicagoans. In the early to
mid-1980s, corruption in the Cook County Court System was unearthed
by a federal sting operation named....Operation Greylord. Some 15 judges,
more than three times that number of attorneys, and others working in
the justice system were convicted under Greylord auspices. Eminence
grise, indeed.

In the overall naming competition, however, I am afraid that Operation Gray Lord
cannot match the coca-plant eradication effort in Colombia: Operation Holocaust.

Labels: prescription drugs