Dr. Carl hart: Adderall and meth are the same drug [update]

[poledriver]

DR. CARL HART: ADDERALL AND METH ARE THE SAME DRUG [UPDATE]

[Updated Jan 10, 2016]

Dr. Carl Hart is a neuropsychopharmacologist at Columbia University, who has dedicated his career to educating the public about drugs and drug policy, and ending the war on drugs.

He shares scientifically supported truths that go against much of our "conventional wisdom" regarding drugs, to show just how badly the public perception of drugs has been distorted by the hysteria of the war on drugs. Check out his appearance on All In with Chris Hayes on MSNBC below, where he talks about misconceptions about crack and meth.


While it's true that Adderall and methamphetamine are not chemically identical, the point Dr. Hart makes is that they have very similar effects.

And Dr. Hart isn't the only authoritative voice pointing out the incredible similarities between prescription ADHD drugs and street meth. This excellent editorial by Alexander Zaitchik on Motherboard corroborates Dr. Harts claims, from the perspective of a former user.

Aside from some foul cutting material, Winnebago methamphetamine and pharmaceutical amphetamine are kissing chemical cousins. The difference between them boils down to one methyl-group molecule that lets crank race a little faster across the blood-brain barrier and kick just a little harder. After that, meth breaks down fast into good old dextroamphetamine, the dominant salt in America’s leading ADHD drug and cram-study aid, Adderall.

Writing as someone who has consumed his share of product from both buckets (more about which below) I can attest that the difference between Adderall and street crank is much overstated, bordering on complete social fiction.

This is not exactly a state secret. After legal speed started its comeback as a treatment for Attention Deficit Disorder, The Journal of Neuroscience published a study that functioned as a polite tap on the shoulder. Amphetamine and methamphetamine, the researchers wrote, are “about equipotent” and “produce qualitatively similar behavioral responses.” Both excite the central nervous system in nearly identical ways, flooding and blocking dopamine, serotonin, and adrenaline receptors. Also, meth is meth is meth. The brain responds the same whether it’s produced by the Sinaloa boys and slung by the gram-baggie as glass, or made by Lundbeck Inc. and sold in orange bottles at CVS as the meth-based ADHD drug Desoxyn®.

Most people understand that heroin and Oxycontin are both hard, addictive drugs. Not so with speed. When it comes to amphetamine, we’ve chosen a national split-screen in which doctors airily put millions of healthy children and adults on daily speed regimens while SWAT teams throw concussion bombs in baby cribs in pursuit of small-fry meth dealers.

Here's another interview with Dr Hart, where he explains more about his stance on drugs in society, and details how context determines our vastly different perceptions of similar drugs.



With comments -

http://edm.com/articles/2015-11-09/dr-carl-hart-adderall-meth

 

[RDP89]

Glad somebody is trying to educate the general public on psychoactives and the perceptions/misconceptions surrounding them.

 

[Burnt Offerings]

To me it's kind of like arguing, hey, heroin and codeine tablets aren't that different because what's ultimately happening is a morphine-mediated response in your body.

I get what he's doing. Saying that x socially-accepted drug is comparable to y highly-illegal and taboo drug, in terms of pharmacological action. What a drug is, though...that's a socially/legally mediated concept, and coming from a user of both d-amphetamine and d-methamphetamine (and someone familiar with the "scenes"), they are very different drugs.

 

[belligerent drunk]

^ are they different because of subjective pharmacology assuming both are pure, unadulterated substances? Or is the difference more due to different scenes and other external and secondary factors?

I agree though that saying that meth and amphetamine are the same drug is a bit too much. They're different molecules to start with; yeah the difference may not be big, but still methyl groups can make a hell of a difference. In any case, though, it's nice to see someone talk about this side of the perspective.

 

[slimvictor]

Happy to read this article.
I have tried meth a couple handfulls of times, and adderall a similar number of times.
I found them to be strikingly similar, especially when I took 1.5x the adderall prescription dosage.
(I have little other experience with stimulants other than caffeine, and I am sure someone with lots of experience might seem them as more different, but for me they seemed to have vast overlap and only minimal differences - the sexual pleasure that comes with meth was missing on the adderall.)

 

[AlphaMethylPhenyl]

Never tried meth, thankfully enough or I'm quite sure I would've become an addict.

As for Adderall, well, I believe it left me destitute and wanting it badly more than any other. Alcohol, benzos, and opiates were quite a bitch to kick. Tobacco will stay for now. Hallucinogens and weed severely screwed with my head, but I don't, or hardly ever, crave them. But I still get those adderall cravings every now and then. Even seeing those tablets in the picture, I was like "oh shit, cue craving number 120,954 in thirty minutes". It's my belief that the worst drugs are those that best simulate how it feels to make a free decision, those that have taken over so much that it genuinely feels like it's your decision to take more even as your mind and brain get utterly bombarded.

I have to admit, not even opiates could match that wild, charged, godly experience for me.

But of course the stuff turns you into some sort of morally ambivalent robot. Even if its prescribed. After two months of taking it, during which you've been convinced that you're cured, you wake up wanting just a little more...

So much more tempting because it can indirectly facilitate more smooth thinking in some manners. This is at the cost of the large amount of stress and corrosion it causes the brain, hampered creativity, not being able to socialize as well, and a kind of obnoxious chemically-induced autism. It's freakin scary how the US gives this stuff out so freely. All it really does is make you think technically. Rubbish.

 

[Clocktower]

What a drug is, though...that's a socially/legally mediated concept, and coming from a user of both d-amphetamine and d-methamphetamine (and someone familiar with the "scenes"), they are very different drugs.

Is this a valuable insight, though? Should a doctor prescribe amphetamine preferentially over methamphetamine because the two drugs have different 'scenes,' even if both will have the same effect on a patient?

They're different molecules to start with; yeah the difference may not be big, but still methyl groups can make a hell of a difference.

In this case, studies seem to suggest that the methyl group does not make much of a difference.

 

[Burnt Offerings]

You could argue that drugs should be treated purely how the react pharmacologically, I'd be sympathetic to that position actually, but that's not how it works today and I don't see an end coming to the law butting its nose into the medical community anytime soon

 

[AlphaMethylPhenyl]

Is this a valuable insight, though? Should a doctor prescribe amphetamine preferentially over methamphetamine because the two drugs have different 'scenes,' even if both will have the same effect on a patient?


In this case, studies seem to suggest that the methyl group does not make much of a difference.

But they simply do not have the same effect. Similar, though. It's hard to control the variables in comparing the two.

It's more of a hunch than something backed by legitimate data (which surprise, there isn't much at all), but I believe taking adderall daily for years at doses of 30mg and over is neurotoxic.

As for meth, clearly there is a bias of studies in the other direction. That said, I think it's fairly clear that methamphetamine is neurotoxic at just about any dose, even when one doesn't take it every day. I have no idea where you pulled that it doesn't "make much of a difference" from, seeing as it couldn't be more wrong.

 

[belligerent drunk]

As for meth, clearly there is a bias of studies in the other direction. That said, I think it's fairly clear that methamphetamine is neurotoxic at just about any dose, even when one doesn't take it every day. I have no idea where you pulled that it doesn't "make much of a difference" from, seeing as it couldn't be more wrong.

I think it is clear that meth has that bias. But then I challenge you to provide a study or two that backs the claim up that methamphetamine is more neurotoxic than amphetamine with other conditions being constant. Is there a certain pharmacological reason for the increased neurotoxicity or it is just improper observation? Bias?

Methyl groups often have strictly pharmocokinetical repercussions, as I expect in the case of methamphetamine vs amphetamine.

 

[ro4eva]

Even if Methamphetamine is directly neurotoxic and Dextroamphetamine supposedly isn't, I think he definitely has a good point.

A similar argument can be made regarding Crack vs. Powder Cocaine.

What bothers me is the massive and long running disparity with respect to drug laws between both of the above couples.

And then there is the whole double standards issue. For example: the U.S. Military regularly 'Amps' up troops who're taking part in prolonged missions (especially pilots) without a second thought, and meanwhile, U.S. law enforcement regularly busts U.S. citizens (many of them non-violent, otherwise law-abiding individuals) who - for reasons possibly related to genetics as well as personal tastes and preferences - have resorted to consuming clandestinely synthesized Methamphetamine in a personal setting.

I'd recommend against using Meth whatsoever due to its neurotoxicity, but I'd also recommend against throwing Meth users in jail and/or prison among rapists, murderers and pedophiles (who've actually victimized their prey) solely because they were caught in possession of the potent stimulant for personal use. But since such prisoners are a precious commodity to the private prison industry, well, I'm sure they don't wanna hear any part of my opinion on the matter.

 

[AlphaMethylPhenyl]

belligerent drunk,

I honestly don't know too much about it. I also would suspect that such a study may not exist. What I do know, though, is that every study I've seen assessing the toxicity of meth finds something, not so with amphetamine. I understand that a lot of studies on meth are dealing with high recreational doses.

No doubt a bias exists.

I think there was a thread on here a couple months ago in which a former desoxyn user was trying to make the case that small doses of meth were healthy...lol. The dialogue conclusively proved them wrong.

I'm sure there are theories as to the reason, but my knowledge of it is so basic that it's not worth saying.

I thought the military was phasing out amp in favor of modafinil.

Yeah some people use it like that, but then there's people who blow themselves to smithereens trying to make it, become violently psychotic, and otherwise lose their brain, sanity, money, and life because of it.

I'm definitely concerned about how often stimulants are prescribed in some areas, so freely.

 

[neurotic]

To me it's kind of like arguing, hey, heroin and codeine tablets aren't that different because what's ultimately happening is a morphine-mediated response in your body.

I get what he's doing. Saying that x socially-accepted drug is comparable to y highly-illegal and taboo drug, in terms of pharmacological action. What a drug is, though...that's a socially/legally mediated concept, and coming from a user of both d-amphetamine and d-methamphetamine (and someone familiar with the "scenes"), they are very different drugs.

very well put.

Is this a valuable insight, though? Should a doctor prescribe amphetamine preferentially over methamphetamine because the two drugs have different 'scenes,' even if both will have the same effect on a patient?

even though i agree with what you seem to be suggesting, i find that this generally doesn't work with people.

that is, even though meth is the same or almost the same in pharmacodynamics as amphetamine, people can't just forget about all the bad things they associate with meth all of a sudden. people don't usually think very rationally, and it seems to be kinda pointless to fight against it (though i'm sure a few generations of can fix the stigma around meth. can't fix people thinking irrationally though). people think there are differences between name brands, you know? it's the same thing that makes people buy pointlessly expensive things, for lack of a better example... that's why design exists

 

[Mycophile]

I have a hard time believing that taking a 5mg pill of Dex for example, and smoking a pipe full of highly concentrated crystal Meth, ends up having the same overall effect on the body.

Running to the pipe for hit after hit also must have a different addictive component to it vs simply taking one pill.

If they were the same wouldn't they also do the same level of damage to the user??

Then why do we have so many before and after photos of Meth heads where they looked like they aged 15 years in 2 years and are missing teeth due to whatever action the meth has (I'm not up on this stuff) while your friend who's been on Adderall for ADHD since 8th grade looks just fine??

Based on all these things, I don't think they are essentially the same at all, just like Codeine and Heroin are both Opiates but aren't the same.

 

[belligerent drunk]

^ see, that's the observational bias I'm talking about. You can't compare a drug taken recreationally in a way that resembles abuse, has different (and arguably more damaging) ROA to another drug taken orally in a therapeutic setting and then conclude that one is more harmful than the other. Honestly, how much do you hear about small (therapeutic) doses of methamphetamine being used orally; and how often do you hear about people smoking or shooting up massive doses of regular amphetamine?

You have to separate variables from constants. It's like saying that heroin is two different drugs because if you take it orally it very much resembles oral morphine, but if you shoot it up it's slightly different from IV morphine. Or that heroin and morphine are the same drug, because you can take them both orally and they'll be the same. Codeine and heroin, on the other hand, are very different drugs regardless of ROA - they have different pharmacodynamics AND pharmacokinetics. Amphetamine and methamphetamine to my knowledge are very similar pharmacodynamically, perhaps being slightly different in their pharmacokinetics. They are different drugs, though, as I don't believe there can be two drugs with completely identical pharmacological profiles in all imaginable settings but different molecules. But they are not as different as the media, and to my surprise, even drug users portray them to be.

 

[Mycophile]

^ see, that's the observational bias I'm talking about. You can't compare a drug taken recreationally in a way that resembles abuse, has different (and arguably more damaging) ROA to another drug taken orally in a therapeutic setting and then conclude that one is more harmful than the other. Honestly, how much do you hear about small (therapeutic) doses of methamphetamine being used orally; and how often do you hear about people smoking or shooting up massive doses of regular amphetamine?

You have to separate variables from constants. It's like saying that heroin is two different drugs because if you take it orally it very much resembles oral morphine, but if you shoot it up it's slightly different from IV morphine. Or that heroin and morphine are the same drug, because you can take them both orally and they'll be the same. Codeine and heroin, on the other hand, are very different drugs regardless of ROA - they have different pharmacodynamics AND pharmacokinetics. Amphetamine and methamphetamine to my knowledge are very similar pharmacodynamically, perhaps being slightly different in their pharmacokinetics. They are different drugs, though, as I don't believe there can be two drugs with completely identical pharmacological profiles in all imaginable settings but different molecules. But they are not as different as the media, and to my surprise, even drug users portray them to be.

Fair enough, I see you point.

I guess the better way to put it would be that the WAY crystal meth is usually used in our society makes it MUCH more dangerous than the way Adderall or Dexamphetamine are usually used.

But societal norms have a lot to do with how these drugs end up being used so that's really a part of it.

When we say "Adderall" we mean orally ingested pills and when we say Meth we mean glass smoked in a pipe.

Those differences alone yield MASSIVELY different outcomes.

You can argue all you want that heroin isn't more dangerous than Oxycodone IF you swallow very small amount of heroin vs if you inject massive amounts of Oxycodone, but with the mention of the drugs themselves necessarily comes the understanding that 9 times out of 10 the heroin will be injected and the Oxy will be swallowed so you are making a mute point.

PURE nicotine can straight up kill a person and probably would have a higher likelyihood of doing so though than even injected heroin, but we can't then argue that nicotine is more likely to produce an overdose than heroin because people just don't take pure nicotine.

To remove the sociological factors of HOW the drugs are usually used from the drug itself is to change EVERYTHING.

I didn't watch his video so maybe that's exactly his point...but I'm not sure how lucidly he explains this so maybe I'll go back and listen to it.

It's like saying that going 100mph in a car is safer than driving 50mph in a car and then adding as an addendum that the people driving 100mph are doing it in a desert and the people doing 50mph are doing it on a highway....except NO ONE drives in a desert.

Maybe that's not a fair argument...but it's just trying to seperate factors that are nearly inseperable due to societal uses of drugs/tools/etc.

If a drug WILL NOT be used in the safer manner vs the "supposedly same" drug that WILL be used in the less safe manner 9 times out of 10 then what point is bringing it up???

He makes a good point, but the fact is the drug companies and DEA don't give a shit.

The drug companies will keep prescribing adderall and the DEA will keep attacking people for meth use even if ESSENTAILLY at the basic pharmocological level they aren't all that different.

The outcomes of HOW they are used...and how they will almost CERTAINLY CONTINUE to be used will continue to be the same.

If he brings up ways we can ACTUALLY CHANGE the way these drugs are used to yield different outcomes I'll concede, but otherwise, if he offers no likely way to change things, then all he's doing is informing people of pharmocological similarties.

As such, for US on this forum he probably isn't saying much we don't already know.

He may be saying things that most non-drug users don't know...but in the end it will fall on deaf ears and make no difference.

Maybe he'll inform some people who have no power over changing the situation of the similarities, but really, what good will that do??

 

[belligerent drunk]

Yeah I see your point, but it's a stance of surrender. The reason there is the difference you're talking about is because our laws are fucked in the head as are the people in control of them. But that is something that can be changed, and will be changed. What you can't effectively change is the pharmacology of a molecule. That was my point. The pharmacology of a molecule remains the same for a given ROA. Now whether that ROA is practiced in reality varies, and so does the purity of said substance. But we can change all that for the better.

 

[Mycophile]

Yeah I see your point, but it's a stance of surrender. The reason there is the difference you're talking about is because our laws are fucked in the head as are the people in control of them. But that is something that can be changed, and will be changed. What you can't effectively change is the pharmacology of a molecule. That was my point. The pharmacology of a molecule remains the same for a given ROA. Now whether that ROA is practiced in reality varies, and so does the purity of said substance. But we can change all that for the better.

You mean change things be convincing meth heads on the street to take pills instead??

I'm not sure how likely that is but it's worth a shot.

 

[S.J.B.]

The methamphetamine situation in eastern Canada is a topic I always bring up in this sort of discussion. There is almost no "crystal meth" east of Toronto. It can be found, but it's one of the hardest of the common recreational drugs to come across and there is no media hysteria surrounding it in the manner that has been seen in the U.S., Australia, and western Canada. However, methamphetamine is one of the most popular recreational drugs in eastern Canada (Quebec even had the highest rate of methamphetamine use in North America for a period in the 2000s [1]), in the form of "speed pills" which contain an average dose of 30 mg (and caffeine) [2]. These are generally split up into small portions to be swallowed or snorted, and they carry none of the stigma associated with "crystal meth." It is a first-line party drug, more popular and less stigmatized than cocaine or MDMA. Most people don't even know that they are taking methamphetamine, and probably wouldn't believe you if you told them. I think this is a perfect case study in how it isn't just a drug itself, as in a molecular entity, that causes problems, but a myriad of other factors, including ROA, social expectations, purity, formulation, etc.

[1] http://www.sq.gouv.qc.ca/mission-et...ientifique/rapport-sq-drogues-de-synthese.pdf (in French)
[2] http://www.aitq.com/pdf/enligne/monographies/Rapport_RAVE2_eng.pdf

 

[SixBuckets]

You mean change things be convincing meth heads on the street to take pills instead??

I'm not sure how likely that is but it's worth a shot.

The methamphetamine substitution program at St Vincent's Hospital in Sydney has had great success in doing exactly that. They provide methamphetamine dependent patients with a daily dose of oral dexamphetamine for the duration of their treatment.