Thursday, October 23, 2008

How Addictive is Ritalin?

ADHD Medications

The controversy and discussion surrounding the safety of medications for ADD and ADHD is nothing new. Among the most common criticisms of these drugs are concerns about their abuse potential and their potential risks of being habit-forming drugs. Methylphenidate (the generic name for Ritalin and Concerta), has often been mentioned in the same sentence as "cocaine", especially among the "anti-medication" and "alternative treatment" sites for ADHD treatment options. While some of these comparisons are definitely warranted, the chemical structures and modes of action of ADHD stimulants such as amphetamines and the amphetamine-like methylphenidate and the illegal street drug cocaine do bear some striking resemblances. However, it is important that we do not get lost in the hype surrounding these relationships, and instead immerse ourselves in only the facts.

In the field of organic chemistry, even minor alterations to a drug's molecular makeup can result in significant functional differences. With this in mind, however, investigation into the abuse potential of stimulant ADHD medications such as Ritalin, Concerta, Daytrana, Adderall, Dexedrine, and Focalin should be carried out in a thorough, unbiased manner. A review article from the Journal of Clinical Psychiatry on the abuse potential of the ADHD drug methylphenidate investigated key properties of the drug that play a major role in abuse potential (such as drug absorption, products produced when the drug is metabolized, and how fast the drug clears from the body). Some key findings of the article on this popular stimulant medication are summarized below:

  1. When injected, methylphenidate, cocaine, and d-amphetamine all produced similar reinforcing effects in human subjects (keep in mind that injections produce drug effects that occur much faster than those taken orally in almost all cases)
  2. Sleep deprivation boosted the reinforcing effects of methylphenidate.
  3. Methylphenidate displayed similar abuse potential to d-amphetamine for a number of studies of the general population (read "non-ADHD" population).
  4. PET scans of the brain following methylphenidate and cocaine (when both were injected) showed similar absorption rates and binding levels to their target (called the Dopamine Transporter Protein or DAT. For more more info on the DAT and ADHD, please click here). However, methylphenidate was cleared much more slowly than cocaine, which correlates to a significantly lower addiction potential for the popular ADHD drug. A quick note about this: The faster a drug is absorbed in the brain, the greater the "high" is, typically. Since injections and snorting both get the drug into the system faster than when taken orally, these methods typically lead to much greater highs and addiction potentials. Additionally, the faster this drug is then cleared, the more it is "missed" by the brain, which also results in a greater addiction potential. So for a fast-acting and fast-clearing drug, the addiction potential is typically very high. For comparison sake, methylphenidate takes about 10 minutes to enter the brain when injected (for cocaine, it is about 5 minutes), and then takes about 90 minutes to clear halfway (for cocaine it is around 20 minutes). Thus, due to its slower uptake and even slower clearance rate, methylphenidate runs a much lower risk of being habit-forming than cocaine.
  5. Oral administration of methylphenidate is much slower than this, often taking at least 1-2 hours to peak in concentration in the brain. Extended and slow-release versions of the drug (Concerta, Ritalin-SR) reduce the abuse potential even further.
  6. Individuals with ADHD are thought to have a higher amount of binding sites (DAT, see point #4) for these stimulant medications than do those without ADHD. According to the author, this makes individuals with ADHD less susceptible than the general population to habit-forming addictions surrounding the use of the stimulant methylphenidate. A more detailed explanation for this is given below:

Further explanation for Item #6 above: Although neuroscientists still disagree over the mechanism of action of both medicated and illegal stimulants, it is believed that when this DAT protein is "plugged up" or "blocked" by these stimulants, it cannot shuttle free amounts of the brain chemical dopamine into the surrounding cells. As a result, the levels of free dopamine between neuronal cells builds up. Since dopamine plays a key role in the "reward" process, it can also play a major role in both "highs" and "addictions" (both of which seek out these "rewards").

If individuals with ADHD have more of these transporter proteins to begin with, they are less likely to oversaturate all of these transporters. As a result, they are less susceptible to this dopamine buildup and the highs and addiction potentials that go along with it. In other words, individuals with ADHD can often accommodate higher levels of stimulant medications such as methylphenidate, making them less susceptible to addiction-level effects.

Based on this article and a number of other sources I have either read or followed, here is my overall take on the topic of addictions to ADHD stimulant medications:

I earnestly believe that when properly diagnosed, properly monitored by a competent physician or related professional, and by proper compliance by the medicated individual, ADHD medications are relatively safe, and the risk of developing an addiction a medication such as methylphenidate is relatively low.

Of course, as we've seen above, individuals who are not diagnosed with ADHD and take methylphenidate for recreational purposes, the potential habit-forming effects of the drug can at least approach the levels of cocaine or amphetamines. Keep in mind that the right medication at the wrong dosage can easily be just as (or even more) damaging than having the wrong medication.

Yes, stimulant drugs prescribed for ADHD are often closely related to cocaine in both chemical structure and mode of function, but the small differences between the two are sufficient enough to form a "safety barrier". Given the fact that so many undiagnosed individuals with ADHD or other related disorders often tend to "self-medicate", the dangers of "un-treatment" are just as real and just as hazardous. Keep in mind that "self-medication" is, by nature, a much more erratic form of treatment and typically abounds in negative side effects.

This is not to say that non-medication treatments should never be explored or considered as viable options for treating ADHD. Many of the so-called "alternative treatments for ADHD" are surprisingly well-grounded and increasingly-researched. However, I remain highly skeptical to those who claim that all cases of ADHD can be handled exclusively and completely by natural means. Natural remedies can be very effective for numerous cases involving ADHD, but their scope and range of applications are somewhat limited.

Please check back later for future posts related to many of these important topics on ADHD!

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10 comments:

Ms. Matters said...

I am writing this two months after your blog post, which I have only now read.

Whenever someone wrings their hands about the addictive potential of the psychostimulants, I offer them my idea that the person who forgets to take the medication could not reasonably called addicted.

Anonymous said...

Hi,

I was diagnosed with ADHD in my early teens (now I'm 31) and have been treated ever since. After moving to the UK from Europe, they dropped my medication as I had to be reassessed as it is a controlled medication.

It took me TEN years to get treated!

Anyway, I was moved from 10mg of ritalin (methylp.) i.e. 2 x 5 a day to 54mg concerta XL (slow release) (mornings) a,d at 4, a 5mg topup of methylp. as a topup as I was starting to feel anxious and had feelings of "dispair and that something was going to go wrong". ALl this dose did was nudge those feelings up to a later time.

Anyway, I've been on this higher dose for over 3 months now, and I can confirm that there could be addictive sides to methylp.

In the mornings, I wake up feeling like I need a cigarette (so I have one) and the feeling doesn't go away. Once taking my morningly dose of concerta, I can feel that craving anxiety slowly ebb.

Very concerning, but I won't shun it as being on concerta considerably changed my list in terms of motivation etc...

Being an adult with ADHD probably means that I will be on these meds for the rest of my life, so I guess the cravings are something I'll have to deal with.

Anyway, I thought my input might help, but may I say that even though it "might" have addictive tendancies... it works wonders... Focus is better, the hyperactivity hasn't ebbed, but the focus keeps that under control... My motivation is ALOT better... i.e. I'm doing things I don't particularly like now, like paperwork etc.. haha.. I'm feeling more positive, have more self-esteem...

It would be nice if the medical guru's could work out which role of the barbs/amphets play in the brain of someone with ADHD and come up with something less drastic than a controlled drug.

being on this drug also means that I am unable to join the police force nor army (not that I care lol) as I'd fail the urine tests. Major sporting events would be a no no for the same reason, and on top of that some countries, usually the east/middle east will have me locked up for years for taking it, even though it's been prescribed.

Anonymous said...

@ Ms. Matters.....just to add to my last comment, you also forget that forgetfulness is a common trait of people who have ADHD.

I for one am addicted to smoking, but there are times when I'm too busy doing something else that I only smoke 1 or 2 a day. They days when I have nothing distracting me, I can smoke up to 20.

Cheers

AdriHD

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RR said...

My physician prescribed vyvanse for my adult ADHD and I have found it to be very useful. I am glad to see it being covered by more plans. I know it is affordable from a reliable Canadian pharmacy. Vyvanse seems like a good alternative to adderall and others.

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