Oral Amphetamine and MPH as Replacement Therapy for Cocaine and Meth Addicts

[DexyDevil]

I absolutely rely on Adderall to stay off IV meth in the same way an opiate addict would use Methadone to stay off other opiates. Yes, I'm truly ADHD but more than anything the Adderall improves my quality of life by removing that voice in my head that screams "fix me!."

I believe Methylphenidate and oral amphetamine should be used as substitution therapy for meth and cocaine addicts. The issue with this, primarily, seems to be that methadone or buprenorphine will largely block the effects of opiates while cocaine and meth could still be used to increased, rather than decreased, effect when an addict is taking amps or MPH.

From a chemical standpoint, this form of replacement therapy would seem to make a great deal of sense. My personal experience also supports it. I know there have been studies on this, but I'm unsure of the results. Is this an an effective treatment? Will we see it used in the future? What have studies indicated? Is there any biological reason why this treatment would do more harm than good or be ineffective?

 

[Psychedelic Jay]

Opiate replacement is there because opiates have a very harsh physical withdrawal...

Stimulants are primarily psychological addictions. Mental anguish is the result of withdrawal.

You will burn out if you simply replace stimulants. Each moment you spend on it, the crash will get worse and worse.

The longer you stay on, the longer the apathy and depression is going to last...

I am against it personally.

 

[Tussmann]

Stimulants are primarily psychological addictions. Mental anguish is the result of withdrawal.

Sorry, but I disagree immensely with this statement. There are meth users who can't even conjure a laugh 10 years post-cessation because their receptors are so down regulated.

 

[Psychedelic Jay]

Sorry, but I disagree immensely with this statement. There are meth users who can't even conjure a laugh 10 years post-cessation because their receptors are so down regulated.

That is in the mind... Depression is a mental disorder... Not a physical one.

There are physical manifestations of mental disorders. You can't just cover those up and expect it to be peachy.

Brain damage is not a withdrawal... It is a consequence in using the drug.

Staying on them will indeed make this damage worse on top of everything.

Time, and therapy. The brain needs to heal.

An assessment of the damage that has been done should be made along with replenishing nutrients, then insert any medication that is needed....

We know these people aren't eating well. We know that they are eating holes away in their heads.

That is an unsustainable way to go through it...

They will need more and more.

 

[Solipsis]

That is in the mind... Depression is a mental disorder... Not a physical one.

There are physical manifestations of mental disorders. You can't just cover those up and expect it to be peachy.

It's worth mentioning that this is an opinion / theory about the nature of depression and I don't think it is even the most popular one. There is the monoamine hypothesis which seems evidently relevant here: if you abuse stimulants over time the risk of impairing your monoamine systems seems pretty real to me.
I get what you're saying about the brain damage, but you make it sound like depression is psychological self-delusion while it can have an organic basis that causes the dysthemic or depressive symptoms. Yes there are MANY psychological causes for depression, but there are also chemical and genetic ones.

Anyway on-topic:
The problem with addiction is that people associate drug effects in such ways that it makes people seem like it is the solution or answer to problems, which is very strong and persistent and doesn't necessarily require backing it up rationally to addicts. When problems escalate in the life of an addict craving drugs can be almost like a reflex.
The neurological pathways involving the reward circuits of your brain are very strong.

Switching one drug for another is not the answer. Initially it may help in some cases to switch to a drug that can be managed and tapered more effectively or more safely. There can be several reasons for that and it depends on the drug we are talking about.
But conceptually / in principle the drugs in the TT play equal roles and they are in the same classes (amphetamine and meth are mostly monoamine releasers while cocaine and MPH are mostly reuptake inhibitors).

It can indeed be helpful to choose the lesser of two (or more evils), as that can give advantages that can help you continue to the next stage of quitting drugs.

Don't fool yourself into thinking that drug use can be justified in the way you do if it still impairs your life in some way, if only for the fact that you are still dependent on it.

I have experience with addiction and I do have empathy and understanding for being in a situation or 'place' where quitting completely is not yet going to happen. Of course you should always be realistic and it is risky to set the bar unrealistically high and expecting from yourself that you can just get off dope from one day to the next if you just fight hard enough... such motivation is admirable but addiction wires us in a way that can really defy willpower, and it takes step by step progress to reverse that because of the uneven "firepower" of addiction and strategies to get off it.

So: yes for the time being it can be a success you can be happy with - but just don't let it make you think you are off the hook.
Sorry to be a party pooper.

 

[Psychedelic Jay]

but you make it sound like depression is psychological self-delusion while it can have an organic basis that causes the dysthemic or depressive symptoms. Yes there are MANY psychological causes for depression, but there are also chemical and genetic ones.

I made it sound not as such...

The depression I spoke of is the completely inevitable burden one puts on their brain using...

You make more unstable the compounds that your brain relies on for proper regulation of how you feel and think... It's an unstable perpetuation.

Yes, there are many life burdens that can cause one to dwell on into the abyss that is depression. Drug usage is definitely at the top of the list, especially if one is already prone to searching out crutches... AKA Depression. (relationships, distracting activities, risk taking, etc...)

If one was not already depressed, you are most certainly creating the catalyst to be so...

If I made that sound like a self delusion... I really don't know what to tell you.

 

[DexyDevil]

I guess I should also emphasize again, that I am taking Adderall on prescription in therapeutic dose (20mg 2x daily) and have been for years. I am genuinely very ADHD and also have Autism Spectrum Disorder. Adderall greatly improves my executive functioning and impulse control. However, it was also essential to getting through PAWs from meth.

Life off meth for many addicts is very difficult because of depression/anhedonia which may not respond to traditional antidepressants. I doubt I'd be off meth today if I didn't resume my Adderall therapy (there was no point in taking it on dope) a couple weeks after detoxing.

 

[atara]

Methylphenidate at sufficient dosage can absolutely block the primary effects of methamphetamine. Adderall I'm not so sure. Bupropion (wellbutrin) was basically designed for this, and it mimics methadone's pharmacology, binding to the DAT/NET and antagonizing nAChR.

For your sake, years and years of clinical testing have shown amphetamine under steady usage conditions to be one of the most well-tolerated drugs in the pharmacopoeia. If it isn't broke, don't fix it.

Cocaine is weird, realistically coca itself can be taken orally with little abuse potential. Cocaine addiction is extremely psychological, people don't just want to get high but they want to do cocaine, even cutting up the lines is enticing, the idiosyncratic self-confidence in the cocaine high has a draw that is more than the sum of its parts. BZP -- yes benzylpiperazine -- has been shown to replace cocaine effectively. So I wouldn't compare it to meth addiction, which is basically physical.

I get what you're saying about the brain damage, but you make it sound like depression is psychological self-delusion while it can have an organic basis that causes the dysthemic or depressive symptoms. Yes there are MANY psychological causes for depression, but there are also chemical and genetic ones.

The psychological/physiological distinction doesn't exist anyway. Thoughts are things.

 

[endotropic]

The purpose of methadone or buprenorphine maintenance therapy should be twofold:

#1 to get the user off of street drugs, reducing the chance of dangerous complications or overdose
#2 to allow the user a path to reduce usage over time, while avoiding painful/psychologically damaging withdrawal

If replacement therapy for stimulant users followed the same principles then it's hard to see the argument against it. If the purpose of replacement therapy is to find a weaker stimulant that one can take for the rest of their life, well then I think the shortcomings of that approach have already been mentioned

The psychological/physiological distinction doesn't exist anyway. Thoughts are things.

There's so much resistance to this concept amongst the general public it's unreal. I think part of it is religious (non-duality doesn't leave much room for the soul), part of it is ignorance, but part of it is also fear.

 

[pofacedhoe]

for me i found that coming off stimulants altogether was the way to break the addiction. replacement therapy sounds like another addiction to me because the pattern of stim use is often a binge for a few days then abstinence followed by another binge. the key to breaking the addiction is to leave a bigger gap between binges over time until it becomes an occasional indulgence rather than a problematic addiction.

i had a serious daily addiction to amphetamine a few years ago and it fucked me up in a big way. i also had a problem with mephedrone. either way at some point you just have to stop and then get over the months of feeling tired and shit and then after that things get better.

its different with opiates because the problem is that addicts shit and vomit a lot when withdrawing off a high dose and that doesn't mix well with work. at the same time amphetamines leave you so tired and sad after you come off them and that is physical BUT if you had replaced them with a script i would still be hooked on them today and have more damage to my dopamine neurons and feel even more empty and unable to feel pleasure than i did back then.

 

[endotropic]

for me i found that coming off stimulants altogether was the way to break the addiction. replacement therapy sounds like another addiction to me because the pattern of stim use is often a binge for a few days then abstinence followed by another binge. the key to breaking the addiction is to leave a bigger gap between binges over time until it becomes an occasional indulgence rather than a problematic addiction.

i had a serious daily addiction to amphetamine a few years ago and it fucked me up in a big way. i also had a problem with mephedrone. either way at some point you just have to stop and then get over the months of feeling tired and shit and then after that things get better.

its different with opiates because the problem is that addicts shit and vomit a lot when withdrawing off a high dose and that doesn't mix well with work. at the same time amphetamines leave you so tired and sad after you come off them and that is physical BUT if you had replaced them with a script i would still be hooked on them today and have more damage to my dopamine neurons and feel even more empty and unable to feel pleasure than i did back then.

I definitely see your point, and I agree that current prescription practices really won't do anything to help an addict.

It just seems like all of the arguments against replacement therapy for stimulants are the same arguments that are made against opiate maintenance therapy. Maybe when we discover the buprenorphine of the stimulant world it will seem more realistic.

 

[ebola?]

The psychological/physiological distinction doesn't exist anyway. Thoughts are things.

This is a huge can of worms, and requires thoroughly rigorous metaphysics, establishing what "things" are, and how they differ from "non-things". However, just by establishing that neurons are physical, one can speak of "physical addiction" to stimulants and to some extent cannabis pretty readily.

ebola

 

[Psychedelic Jay]

I definitely see your point, and I agree that current prescription practices really won't do anything to help an addict.

It just seems like all of the arguments against replacement therapy for stimulants are the same arguments that are made against opiate maintenance therapy.

They most certainly do. The street is what doesn't help addicts.

When you get a pharmaceutical addiction, you can very well be easily cut of out of fear from the doctor.

A drug dealer on the other hand will keep feeding you dope if you keep feeding him money.

Opiates are just not plain and simple as taxing on the physical body as stimulants.

Stimulants replacement can be just as counterproductive on health based on shear effects...

Stimulant users are ticking time bombs for things you just will not see in opiate users.

The rather severe hypertensive states most of them can put you in are heavily taxing.

It's a disaster to try and rationalize feeding a heavily psychological addiction... That is just mostly so... Psychological.

There is no physical symptoms to warrant more stimulants or weaning...

Being tired and depressed is refractory... It can't be avoided one way or the other. You are going to blow a gasket or burn out too many receptors eventually...

 

[Tussmann]

I made it sound not as such...

The depression I spoke of is the completely inevitable burden one puts on their brain using...

You make more unstable the compounds that your brain relies on for proper regulation of how you feel and think... It's an unstable perpetuation.

Yes, there are many life burdens that can cause one to dwell on into the abyss that is depression. Drug usage is definitely at the top of the list, especially if one is already prone to searching out crutches... AKA Depression. (relationships, distracting activities, risk taking, etc...)

If one was not already depressed, you are most certainly creating the catalyst to be so...

If I made that sound like a self delusion... I really don't know what to tell you.

I'm assuming you're talking about abuse here, and not therapeutic levels...

 

[AlphaMethylPhenyl]

This is a huge can of worms, and requires thoroughly rigorous metaphysics, establishing what "things" are, and how they differ from "non-things". However, just by establishing that neurons are physical, one can speak of "physical addiction" to stimulants and to some extent cannabis pretty readily.

ebola

In my mind (or brain? haha) this is a great point. It's characteristic of me seeing distinctions as "blurred" these days, the lack of ability to easily comprehend categories even. While we can look at neurons firing less after addiction to cannabis, for instance, most of the medical population defines "physical" in this instance to include effects which either permanently, significantly (this is determined through statistical methods) affect the brain through observable means (neurotoxins for instance, though it's true that substances which cause neurogenesis, such as lithium carbonate, fall within these bounds; in a sense lithium is a more helpful medicine because of this permanent affect, though its a "neurotoxin" by this definition. I guess helpful versus harmful effects to the brain (and status of being a toxin) would be judged by the patient's ability to function in life.), or effects which can be felt with more of a physical than mental connotation, according to the patient's subjective experience.

Psychiatry is a lot more art than, say, oncology. No matter how you break down definitions, there is still a lot of variability in designations. Perhaps that's why it appeals to me.

 

[moor12]

I can't make my mind up as to the idea, to be honest. Will oral amphetamine or methiopropamine taken by an ex meth addict make them content with the high they've got, or will it reinforce the memory of meth experience and make them crave for more? Also, what about comedowns? Fiends will fiend.

 

[Psychedelic Jay]

or will it reinforce the memory of meth experience and make them crave for more? Also, what about comedowns? Fiends will fiend.

This part.

 

[dopamimetic]

Maybe NMDA antagonists are still underrated for this. Don't know how they would work in someone with an previously acquired tolerance, but it's the only thing that comes to my mind to really keep dopaminergics working on and on.