A study of brain scans is positing the use of the ADHD drug Ritalin to treat cocaine addiction. The lead author of the study, done at Mount Sinai School of Medicine in New York City, says a single dose of methylphenidate may normalize brain pathways that are hijacked by the addiction process. We also look at the rather astounding amount of money being poured by venture capitalists into marijuana oriented websites, and business prospects, in spite of its still largely illegal status. PODCAST.
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Howard: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. Cocaine and cocaine vaccines in treatment continue to be in the news even though the use of cocaine has gradually gone down, it’s still an extremely addictive substance, traditionally very difficult to treat and to get people off of. Also many stories about marijuana pot as biz and a couple stories on the addictive qualities of food. So, Darryl, research that just came out involves using the drug Ritalin which has traditionally been used for attention deficit hyperactivity disorder to treat cocaine addiction. And what researchers are saying is, it seems to have the effect of normalizing the nerve pathways that go haywire in cocaine addicts. Darryl, what do you know about Ritalin in general and does this make sense from a pharmacological point of view?
Darryl: I think it’s humorous, Howard. You know, Ritalin is an upper. Ritalin is like a methamphetamine. Ritalin, like methamphetamine, has been used to treat attention deficit disorder and seemingly has a different effect on treating people with that condition, but overall both meth and cocaine are stimulants – uppers – and I think the only reason why cocaine use has been on a gradual decline is that people have finally realized that methamphetamine or any kind of amphetamine is a lot better bargain than coke. You can get off just as much, at least for the first few seconds, and you pay a lot less for a much longer acting reaction than you would for cocaine – and you’ve got to repeat cocaine every 40 minutes or so at a huge expense, so it runs in to money quite quickly. But it’s humorous even though I don’t think these researchers are intentionally trying to disguise the fact that basically it is just a replacement – substituting another stimulant drug of abuse for one that people are more concerned about. We do know that Ritalin and ADHD drugs are subject to diversion and abuse from questionable prescription practices so there might be some motivation to get in on this by creating a new, treatment consciousness for this drug that will encourage more doctors to prescribe it which will cause those patients to take more and more. Now, the researchers in this case are quick to point out .let me see, where was this research done? Does it say in your article there, Howard?
Howard: I think it was done at Stony Brook in New York.
Darryl: .it’s actually Mount Sinai I just looked at it now Dr. Rita Goldstein, the principle author, is chief of Neuropsychoimaging of Addiction and Related Conditions (NARC) Research Programs at the Icahn School of Medicine at Mount Sinai in New York and she was quick to point out, if you read closely and toward the end of the article, that this study was done, not on patients, not on people who are struggling to recover from cocaine addiction but by merely looking at brain imaging. From examining images of the brain – functional MRI scans and other scans – researchers project that one treatment, just one injection of Ritalin seems to normalize the brain activity for natural catacolomines, dopamine, other chemicals that are neurotransmitters involved with cocaine and methamphetamine addiction – and Ritalin use as well. It seems to normalize those pathways and the way the brain synapses in order to restore a homeostasis or a more natural functionality in the brain which eliminates the need to use cocaine. I think that’s a big jump from looking at a brain scan and observing what a drug has already done to the brain to projecting how a drug will impact the addict in terms of their feelings and emotions. Drugs don’t just work in one area of the brain and we know that cocaine – all addictive drugs impact several areas of the brain including the unconscious areas in the mesocortex, especially the dopamine rich areas of the nucleus accumbens and the VTA and other areas where the unconscious process of addiction is happening. They also impact the conscious areas of the brain where people feel good people feel high and it’s conceivable that in that area of the brain in the area where a person has control or the ability to stop, that Ritalin, when given to actual patients is just like cocaine. A person is not going to be able to use it just once and stop any desire to ever use cocaine or Ritalin again. It reminds me of the 1960’s and early 70’s there were researchers and physicians in the Bay area who felt that all opiate addiction morphine addiction, Demerol addiction, Dilaudid addiction, and heroin addiction was unresolved euphoria a little tease, if you will, that when you took those drugs it brought you closer to the idyllic, marvelous wonderful feeling of euphoria but you just couldn’t quite get there. And so they created a treatment where they put up a beautiful bed in the middle of a forest next to this light waterfall just an idyllic situation and let the patient lay on that bed while they injected them with morphine and allowed them, knowing that they would be safe, to fulfill the totally euphoric experience. They were going to cure all opiate addiction by fulfilling that desire so they would no longer crave to achieve it. I remember clients trying it out and immediately going back and saying, “you know, I almost got there but not quite. Can we do it again, and again?” And that’s my forecast for this treatment technique. I don’t believe you can just look at brain scans without looking at how the patient is responding and whether or not their cravings and their urgency to use again is abated. So, I think this is not a good idea, or not a good direction to go especially if those scans are looking at only the more unconscious areas of survival need rather than also the conscious areas where people are going to feel effects.
Howard: Well it’s always about that. It’s so much about the craving, the constant return to the drugs generated by craving the feeling. Now, what does Ritalin do for ADD patients?
Darryl: We haven’t yet agreed on the precise differences neurological differences and brain cell differences between those with ADD or ADHD and those without. Dr. Daniel Amen has examined spec scans that he says can actively identify these conditions with diagnosis objectively without interviewing the patient or observing their behaviors. There is still a lot of controversy surrounding ADHD even more so than addiction, and because of that there are all kinds of misdiagnosis. Regular kids are being diagnosed with hyperactivity disorder when they’re just being kids. There are spacey people diagnosed with ADD, attention deficit disorder even though they are just normally, kind of spacey people. I just met with clients yesterday in our drug treatment program who were diagnosed with ADHD as adults and as adults they got prescriptions of Ritalin, Adderall, Concerta and they didn’t like them. They didn’t particularly feel that the drugs calmed them down or did anything. They didn’t like how the drug made them feel so they didn’t take them and that’s what we’re finding with kids too. If you have been truly diagnosed with ADHD we can give you this stuff and you’re not going to like any of it and you probably won’t want to take them. Whereas if you don’t have ADHD .if you have normal brain processes and you take cocaine or Adderall or methamphetamine or Ritalin, you’re going to love it! You’re going to feel so good and so awake and alert, you’re going to want more of it. We find that a lot of the diversion of ADHD drugs from medical practices and prescriptions to abuse practices comes from friends who want to have other people be their friends .little kids who are being treated for ADHD with these drugs start just giving them away, giving it to friends who desperately want them and like them. For some kids it is a way to connect – have a group of people look up to them or hang out with them because they want the Ritalin or Adderall. What the medication does if you have true ADHD – what it does for even people who don’t have ADHD is stimulate the brain, makes you feel more awake and more conscious, but more than anything it helps to focus attention. It gets your attention and allows you to focus on one thing rather than – like all of us who try to focus on too many things at once – because if your brain is sensitive and you focus on too many other things, you can’t even do one thing very well. I remember some experiments with football players in the 1970’s – they were being weaned off methamphetamine and they couldn’t focus. They couldn’t focus on the game plan. They couldn’t focus on their plays and what they had to do at any one time. This was chronicled in a book “The Nightmare Season” by Dr. Arnie Mandell about the San Diego Chargers. In an attempt to detoxify some of the players he actively prescribed amphetamine and then slowly tried to wean them off the more dangerous street speed the players got just over the border in Mexico. The whole thing backfired and Mandell found himself in a legal battle for his license.
Howard: More studies need to be done. So, we’ll see .
Darryl: They were human brain scans. I didn’t mean to imply they weren’t .but they need to not just look at the brain scans, they need to talk to the patients.
Howard: Yes it’s the whole package deal.
Darryl: The understanding of addiction is becoming stronger and stronger. The dark side of that understanding is the realization that if an addiction is created in the brain that hijacks the unconscious process – that causes someone to need something to survive no matter what that substance or behavior is, like online gambling, or playing Farmville – then people have no control certainly not everybody, but certain people have no control maybe a third usually the rule of thirds will have no control and they’ll do anything to continue to expose themselves to that activity or that drug. It is sometimes a challenge for medical practices to get their patients to routinely follow directives, to keep them coming in for their appointments and especially keep them paying their bills – maybe they will approach addiction in a whole different way and move towards replacement therapies and promote things like Ritalin as the best replacement therapy for cocaine. It certainly would be, .if you didn’t put any restrictions on how much you’re going to prescribe for them and whether or not it can be crushed to snort it or shoot it or whatever because Ritalin, we know, is just as addictive as methamphetamine or cocaine itself.
Howard: And that reminds me to comment on how prescription drug diversion and use and abuse continues on – there are reports from all over the world about how it’s just out of control. I don’t know where that’s going where it’s headed.
Darryl: That’s interesting also because if you work with some great statisticians and mathematicians, you can take almost any situation and apply mathematics to it to support what you believe. .
Howard: Isn’t that the voodoo magic of economics?
Darryl: Or voodonomics it’s just mathematics and statistics. More and more studies are focusing on how the crackdown on prescription opiates Oxycontin and Vicodin, and all the other prescription opiates has had this unintended consequence of really increasing the abuse of heroin because it’s harder to get prescription opiates and it’s easy to get heroin. Heroin has become cheaper. It’s become more reliable. It’s become more potent than in years past and I can see that from a statistical point of view and proposing less controls over our prescription medications. It’s better to let people abuse Oxycontin and Vicodin than to push them onto heroin because who knows what is out there. It’s like , the big marijuana push right now – everybody wants part of the action to create an economic entity or a whole marketing scheme for marijuana where there is potential to make money. The latest is Jamen Shively, the former head of Microsoft’s advertising – he is raising money through stock sales to create a marijuana brand. As we’ve always said that there’s money in addiction. There’s money in treating addiction. There’s money in supplying an addict so they become codependent. If that’s the case then marijuana, an addictive substance, is legalized for recreational use like it was in 2 states and for medical use in 19 states, people are thinking it is time to get into the act and make money. There are websites that attract investors and are making money from ad placements. I think it was “Leafy” leafy.com.
Howard: Yes, that was one of them leafy.
Darryl: Leafy.com is a site people can go to for reviews of 520 different types and species of marijuana and that’s all that is there – but it has attracted enough advertising that everybody is beginning to see that there’s money in this. The owner of the site is currently making 100,000 dollars a month. That’s a million dollars a year just from selling the ads on a website. Well if you can do that and then successfully paten all the street names and different varieties, you’re looking at potentially big money. I think that’s the direction a lot of people are moving towards. This might be the biggest thing since Starbucks.
Howard: Yes, “can you spell dot com?” is one of the phrases mentioned in one of the articles! But it is pretty amazing to see that a lot of money has already been raised, millions of dollars, in venture capital to do these things but I guess it’s not surprising because, you know, as marijuana becomes more legal, it is like a new product with a built in market share because so many people have privately and illicitly used it for a long time. So when it is legal it becomes a product that can be marketed in a more traditional sense. We are not going to know how this shakes out until it shakes out.
Darryl: I think it’s American capitalism all the way.
Howard: It’s capitalism, yes!
Darryl: That’s what we’re supposed to be about and that’s what you’re supposed to do, so in that way it’s all American. It’s just unfortunate that people always seem to want to capitalize on other people’s woes or other people’s troubles or other people’s sorrows – things that they can’t do anything about. Granted, not everyone is going to have marijuana addiction problems, but those who do are going to encounter the same type of problems as alcoholics do and maybe even someone addicted to guns! There have been big profits made from those things of doom, so why not marijuana?
Howard: We’ve talked about it a number of times in a number of different ways, but there is definitely an addictive component to humans – it seems like it’s built in and it isn’t going away anytime soon. So, treatment becomes a manner of managing things and doing less harm. Well, we are out of time once again, so thanks for listening and your comments, questions, and suggestions are always welcome. Drop us a note at cnsproductions.com, and see you next time. Thanks, Darryl.
Darryl: Hey, thank you, Howard.
Howard: That wraps our pod for today. Please check back soon for the next in the series and visit our website, www.cnsproductions.com