> Drug use is a health-related issue, whether it is a doctor prescribing medications, a patient taking meds off-label, a person self-medicating, an addict, or some kind experimentation
> We have a caricatured view of the drug addict -- the unwashed, illiterate, toothless junkie hiding out in a crack house. Yes, addiction ends up that way for some, but by and large addicts are middle-class, educated, and live in houses with their friends or families
Excellent points. If there were just two things I wish everyone in the world (or at least in the US) would understand, it's this:
1. The drugs that you are prescribed and the drugs people consume recreationally are not fundamentally different. In fact, in many cases, they're essentially interchangeable from a chemical perspective (Adderall/Desoxyn/Methamphetamine/"Speed" are a great example; Marijuana/Marinol is a partial example too). The prescription vs. "everything else" divide is almost arbitrary. If someone told you that they were prescribed diacetylmorphine for chronic pain, what would you say? What would you say if they took heroin for pain?
2. The stereotypes of 'drug addicts' and 'drug users' are grossly inaccurate. Yes, some people who use heroin/meth/coke/etc. fall into the respective stereotypes. But many don't - you just don't know it, because they're the ones who manage to maintain normal lives. Look up diactylmorphine (heroin) maintenance programs in Switzerland and the UK, and you'll see that many people who used to fit the stereotypes of the homeless sex-working heroin addict are able to maintain steady 'normal' jobs if they are given regular access to heroin of a consistent quality/potency and with no adulterants (this requirement is key!)
In the UK, there was a 'Nice People Use Drugs' campaign, which was aimed at exactly that - demonstrating to people that the stereotypical drug users are just more visible; the invisible majority of people who use or have used drugs have no lasting/debiltating/noticeable problems (if any at all). Everybody knows people who use drugs of some sort; they just don't always know that those people use drugs. (And sometimes, they're not the ones you'd expect!)
> Adderall/Desoxyn/Methamphetamine/"Speed" are a great example
Small clarification: Adderall isn't methamphetamine, it's amphetamine. When discussing street drugs, for some value of safe, it is a considerably safer substance.
(Real, lab-made methamphetamine, even abused, is naturally much less bad for you than the typical battery acid sold on the street, too.)
I should have been clearer - I was just trying to be concise to prove a point. And I'm making the assumption that we're comparing drugs of high quality in either category (because obviously drugs that are mixed with adulterants are going to have other problems). You seem to understand what's going on, but for anybody else who's curious:
Adderall isn't methamphetamine. However, the methyl group doesn't change the way that the drug affects the brain; it just makes the drug cross the blood-brain barrier more easily. The increased bioavailability means that less of the drug (by weight) is needed to achieve the same result, but the drug isn't activating any different receptors or having a substantially different neurological effect in any other way or for any other reason. Subjectively, there may appear to be a difference for that reason (more efficient access to the brain), but the same pathways are being accessed - just to a greater degree.
An analogous and more familiar (but not identical) example would be Vyvanse and Adderall. The actual metabolic process is different from the example above, but in essence, about 50% of Vyvanse is lost when converting from a form which has no effect on the brain to a form which does. Once it's converted, it's chemically equivalent to Adderall. That's part of why Adderall XR is prescribed in doses about half the weight of Vyvanse.
[Nitpick: Yes, this isn't a perfect analogy; pharmacology is complicated! Vyvanse contains a single enantiomer of a single amphetamine; Adderall contains two enantiomers each of two amphetamines, but if you know that, you probably already know everything else I'm clarifying here anyway. The reason Vyvanse has reportedly lower side-effects is because it lacks the less effective l-enantiomer, not because the amphetamine is otherwise radically different.]
Maybe I should have been a bit clearer, but my point was that Adderall (legally prescribed amphetamine), Desoxyn (legally prescribed methamphetamine), [street] methamphetamine, and [street] amphetamines ('speed') are pharmacokinetically different because of the way that they are taken, the mode of ingestion, and the set & setting, not because of the active ingredient itself. In general, people don't seem to understand that difference, and for that matter, neither do our laws.
[Disclaimer: Everything I've said above is 'false' in the sense that it is an oversimplification, but this is HN, not a discussion board on pharmacology, so I'm sacrificing some precision in favor of accessibility/simplicity and (attempted) conciseness.]
While unrelated to the science, I am a previous user of Adderall XR and then Vyvanse and I want to share some advice on the subject for any hackers out there using these drugs or thinking about them:
It's crazy, it makes you operate on a different level, and I feel bad for anyone in a competitive college or learning situation that isn't using it: it's just unfair. But is cheating at being smart unethical? Oh, nootropics.
However, for hackers, for developers, for designers: it's not what you need. I've written code and spent months in photoshop on and off of those drugs, and that stuff will not put you in the mindset you need to be a great hacker. Highly productive for hours on end? Sure! But it tends to tunnel your vision and cause you to waste time on details.
My work is always better, hands down, off that stuff. That's because the intensity they brought were fantastic for my grueling science degree, but terrible for creating great apps. Nothing beats 8 hours of sleep, healthy diet and exercise for developing good software. Nothing.
If you're going to use it, in my experience, Vyvanse was 100X better than Addy. Addy felt like it crammed energy and focus down your throat and you were a passenger on the productivity express. Vyvanse, I felt, allowed me to be calm when I wanted to be calm, and focused and energetic when I wanted that. I could sleep and eat on it fine. Also, keep your dose small, increasing it is a slippery slope, you will build tolerance, and quitting might take effort. Best not to start.
Hacking and code need a non sedating opiate/opioid. Hydrocodone to start, maybe hydromorphone, then into oxycodone and oxymorphone. Stay away fro the morphines, diacetylmorphine, as they are too sedating. The others give you focus and drive.
Just wanted to offer a second opinion. I too went from Adderall to Vyvanse; I still take the latter. It doesn't give me tunnel vision, and it helps me focus where sleep/diet/exercise did not. So don't rule it out or go for it based on our anecdotal experience. If your psychiatrist thinks it's a good idea, try it and see how it interacts with your individual brain chemistry!
Thanks for your explanation. I know I like knowing /how/ drugs / medical treatments actually work, and I think many of the people on here also appreciate this.
Doctors, in the US at least, are a bit less than helpful when you ask about this kind of stuff, and I've had more than one actually act offended when asked about how/why what they're prescribing works. I know that in IT, if a client asks us how something works, I'm more than happy to explain, or at least point them in the right direction and link them to some documentation and/or how-to articles. With doctors, I typically get more of a "it just does" / "it's complicated and you wouldn't understand" / [very technical explanation, not even trying to make it make sense to laypersons].
It's a rare doctor that really knows -- in many cases, nobody really knows.
For example: How do SSRIs work? Statistically, they do "work," for certain values of work. We know that they result in more serotonin in the synapse. But we also know that that's not the reason they work, because that happens immediately but it usually takes a few weeks for the drug to actually work. Evidently they work by inducing some kind of structural change, but nobody knows what.. Nor do we need to know what to know that they're good drugs to prescribe in certain circumstances.
Meanwhile, many people want "reassurance" to be part of the product that they receive when they go to the doctor. If your doctor said, "these pill seem to sort of go with your symptoms in the massive table I have painstakingly memorized, nobody really knows what they do, try eating them", she would be providing a strictly worse product in many people's eyes than if she said "You have condition X. It happened because of Y. Take these pills and you'll be all right."
The curious will get labeled as doctor shoppers, then you will get nothing but an entry in their database. It's crazy, they treat the stats not the patient.
Vyvanse needs to go through the gut to be converted to its active form, which means that injecting it or crushing it and snorting it does nothing. This is intended to prevent abuse, but it does nothing extra for the user.
I'd add as a third point, that among people who've used a relatively broad range of legal and illegal substances, alcohol and tobacco are widely considered two of the most disgusting, damaging, abuse-prone substances known to man
> The drugs that you are prescribed and the drugs people consume recreationally are not fundamentally different.
That is not true.
> In fact, in many cases, they're essentially interchangeable from a chemical perspective
This is true.
In a sane society, both would be true. But they are not. The "war on drugs" is not an innocent mistake. It is calculated and it is doing precisely what it was designed to do.
Its purpose it to line the pockets of the politicians who support it.
By prosecuting drug dealers and users, you bring the cost of using illegals drugs up. Significantly. In other words, you make illegal drugs less competitive vs legal drugs. This allows the pharmaceutical companies to maintain or increase prices for legal drugs. The additional funds the pharmaceutical companies get, they do not get to keep. They funnel that into the regulatory apparatus and more importantly, into the campaigns of the very politicians who support the system.
Maybe. I think that you're at least partially right, but I also think it has a lot to do with the Christian values that affect our laws way more than they should (see also: abortion laws in USA.)
>Its purpose it to line the pockets of the politicians who support it.
I would say that it's more for the large pharmaceutical companies. Politicians are cheap these days, and the profits from the "war on drugs" are orders of magnitude larger than the money given to politicians to support it. The ATT/T-Mo merger "only" had $9 million in lobbying support -- an order of magnitude less than they stand/stood to lose if the deal fell through REF: http://www.electronista.com/articles/11/12/09/attmay.have.tr... .
I think both of you are on the right track but may be mistaken regarding who stands to profit the most from continued prohibition.
Both local law enforcement and the for-profit companies behind our jails profit enormously from the US having the highest percentage of population incarcerated of any first world country. The majority of individuals currently doing time are in for drug-related crimes.
You are right. There are indeed various entities whose advocacy of their own self-interests and belief systems tends to promote the traditional failed American drug policy. Drug makers, religious zealots, etc... even individuals, small businesses, and schools (such as, say, those located where aggressive or even thuggish levels of law enforcement make that particular place safer on a local, short-term basis).
For-profit prisons, however, are the most direct beneficiaries of the (completely fucking insane) "war on drugs". For-profit prisons are one of the best examples of how an otherwise fairly functional democratic society can end up with a system of profoundly deranged incentives that visits grievous harm upon a staggering number of people.
These institutions conduct a program of systematic, industrialized dehumanization of millions of people -- including millions of people who have never harmed another person. In my view, this makes them evil, profoundly evil.
Although this sounds extreme to some people (especially those who have never paused to think it through), I put America's industrial prisons in the same league with the Nazi extermination camps. America doesn't actually starve people to death or gas them in ovens, but that's a matter of degrees. America does separate children from parents and force nonviolent human beings to live out their lives as caged animals. Millions and millions and millions of them.
There is not much about America so disgusting and disgraceful.
> We have a caricatured view of the drug addict -- the unwashed, illiterate, toothless junkie hiding out in a crack house. Yes, addiction ends up that way for some, but by and large addicts are middle-class, educated, and live in houses with their friends or families
Excellent points. If there were just two things I wish everyone in the world (or at least in the US) would understand, it's this:
1. The drugs that you are prescribed and the drugs people consume recreationally are not fundamentally different. In fact, in many cases, they're essentially interchangeable from a chemical perspective (Adderall/Desoxyn/Methamphetamine/"Speed" are a great example; Marijuana/Marinol is a partial example too). The prescription vs. "everything else" divide is almost arbitrary. If someone told you that they were prescribed diacetylmorphine for chronic pain, what would you say? What would you say if they took heroin for pain?
2. The stereotypes of 'drug addicts' and 'drug users' are grossly inaccurate. Yes, some people who use heroin/meth/coke/etc. fall into the respective stereotypes. But many don't - you just don't know it, because they're the ones who manage to maintain normal lives. Look up diactylmorphine (heroin) maintenance programs in Switzerland and the UK, and you'll see that many people who used to fit the stereotypes of the homeless sex-working heroin addict are able to maintain steady 'normal' jobs if they are given regular access to heroin of a consistent quality/potency and with no adulterants (this requirement is key!)
In the UK, there was a 'Nice People Use Drugs' campaign, which was aimed at exactly that - demonstrating to people that the stereotypical drug users are just more visible; the invisible majority of people who use or have used drugs have no lasting/debiltating/noticeable problems (if any at all). Everybody knows people who use drugs of some sort; they just don't always know that those people use drugs. (And sometimes, they're not the ones you'd expect!)