First off, Desoxyn or any amphetamine derivative can be very helpful to people and children with ADHD. It does do the job of fixing the problem, this I can't argue. Without the societal beliefs that come along with methamphetamine and ampetamine (Desoxyn and Adderall respectively) since they are abused drugs, I would even consider being a proponent of these drugs. There are a couple facts that still bother me about their administration:
- This class of stimulant drugs increases dopamine in the mesolimbic path of the brain. In other words, this class of drugs causes a portion of the brain to fire that has been associated with addiction. There is an overwhelming body of literature substantiating that these substances are addictive.
- The fact is that America is having a huge problem with methamphetamine, it destroys many people's lives and can cause horrific health problems. Using Desoxyn may be an affective treatment, however it provides an avenue for further drug abuse and pervasion of the idea that methamphetamine is something that is ok to abuse.
- Methamphetamine (Desoxyn) titrated properly will have the same exact effect as Adderall. As I said these compounds only differ by one carbon atom, i.e. a methyl group. Sure, this is enough to change the action of a certain drug remarkably, and in the case of adding a methyl group to amphetamine to make it methamphetamine, you increase its potency not by adjusting its basic mechanism, but by allowing it to go into to the brain and affecting it much more easily. However if you give behaviorally equivalent doses of these two compounds, they will have the same effect. Regardless, the societal and addictive consequences of these drugs are harmful.
- In my medical opinion, I am a huge proponent of avoiding giving children any psychoactive drug until after the age of 18. While its true that even after this age the brain is still developing, most of the major changes occur under this age. By giving drugs such as amphetamine to children, we are altering their brain chemistry as it is developing.
- For an extreme analogy, think of the idea of the "crack baby". These are children who are addicted to crack in utero. Crack is a powerful version of cocaine, and is related in its action to how amphetamine works. I am not saying that a child who grows up taking Adderall is a crack baby, but I am saying that the extreme version of this example has proven that this class of drugs can have horrible effects on the developing brain. So if you turn down the dial to the case of Adderall or Desoxyn, the effects wouldn't be as bad, but none the less they would have left their mark.
- If you wish to read further there is a mass of literature on the developmental effects on children I have selected a few below:
- PRENATAL EXPOSURE TO AMPHETAMINES: Risks and Adverse Outcomes in Pregnancy
- Early Methylphenidate Administration to Young Rats Causes a Persistent Reduction in the Density of Striatal Dopamine Transporters
- Can a therapeutic dose of amphetamine during pre-adolescence modify the pattern of synaptic organization of the brain
My proposition is that many of these kids who are being given Adderall or Desoxyn should at least be given Ritalin instead. As I mentioned before, I'd prefer to let these kids wait until they are adults before prescribing any psychoactive compound because even Ritalin (methylphenidate) can cause changes to the developing brain (the second article above mentions this). However, Ritalin does not activate the mesolimbic pathway to the same extent ie it does not have nearly the same addiction profile that amphetamines have. So at least kids aren't experiencing drug-reward related stimuli with Ritalin. Additionally, Ritalin does have negative societal beliefs attached to it, however they are very much separate from the drug abuse stigmas attached to amphetamine and methamphetamine use.
Since my original post on this subject, Israel has legalized the use of Ritalin as an over-the-counter drug. OTC is not covered by insurance unless coupled with a prescription. I find this to be a very interesting piece of legislation. This raises the question of whether people who don't have ADHD should be allowed to use this drug to enhance their basal state of concentration to gain an advantage over others. I personally think that this will contribute to the trend of giving children stimulants which as I explained above I am fundamentally against. Should adults who have reasonably developed brains be allowed to gain this advantage? I think this is a philosophical question best left to the reader and if you're interested in reading more about this type of question than you should look into the idea of cosmetic pharmacology first introduced in the book Listening to Prozac.