Drugs, Drugs, Drugs, ADHD

Note: If I remember, and I also feel like it. I will hyperlink to the various research papers I discuss below. If you are reading this, and you want me to update, just leave a comment. Don’t worry about the age of the post, I will see your comment.

This is a semi-private place for me to discuss personal findings. As well as, Maybe, at some level, provide useful information to someone looking for info on the 12th page of a google search.

If you are here, Welcome! I hope my research can help you at some level.

I have ADHD, at least, I have been diagnosed by a medical professional as having the disorder. The currently accepted front line treatment for ADHD are stimulants. Almost the entirety of these stimulants are amphetamines of some type. Methylphenidate(Ritalin) is not a true amphetamine, but instead a dopamine reuptake inhibitor. It works, by preventing the brain from breaking down and removing brain produced dopamine. It has similar if less powerful effects than true amphetamines like Adderall. Adderall a racemic mix of both dextroamphetamine and levoamphetamine, increases concentrations of dopamine as well as noradrenaline. This is why it is often a “drug of abuse”, the dopamine makes life more “fun”, tasks become more enjoyable, and focus becomes easier. The noradrenaline gives that tweaky “rush”. Body metabolism is increased, felt energy is increased, and inhibitions are reduced.

Amphetamines work for ADHD, for this same reason. People with ADHD have less access to brain produced dopamine, either their brain reuptakes the dopamine faster, or they produce less dopamine in the first place. This is why those suffering from ADHD have issues “focusing”, but the problems that stem from the disorder are much more far reaching than this.

People with ADHD, are less interested in everything. They are more likely to be bored and depressed, and they are less likely to be successful in life, for this reason, since success stems, in part, if not almost entirely, from the amount of work an individual is able to perform. Sufferers have to devote more “energy”, across the board, to performing tasks that require attention. Things that are “fun”, such as tv, or video games, are less fun, and things that are “boring” are even more boring for someone with the disorder. Imagine if your job was even more boring than it currently is. Imagine how much more you would be fatigued after work, and how much more you would loathe your work.

Well, that has always been my problem, and Adderall has been a proverbial god-send for these issues. Where I was demotivated, I can perform, in spite of how much I hate a task, mostly because it reduces how much I hate that task, because it reduces how boring that task is. I can read, for hours, I can study, for hours, I can research, for hours. I still have to choose what I focus on, and I still have to fight my desire to focus on more entertaining things over less entertaining ones, but the soul-crushing boredom preventing me from doing necessary tasks, has been solved.

But, I have been very concerned about the long term effects of amphetamine use, and whether it could lead to long term brain changes. Mostly through destroying dopamine receptors, as seen in abusers of methamphetamine(an amphetamine).

But, thanks to the Adderall, I have been able to go on a research binge of sorts. Day after day, in my free time. For these past 14 or so hours I have been on an Adderall fueld research spree.

Though its unhealthy, I am once again trying to fix my sleep schedule by staying up through the night. I woke up around 5pm yesterday, and its about 12am now. I will try to pass out around 8pm tonight. Hopefully I can get that to work without the use of benadryl. I don’t want to use dementia causing anticholinergics, if I can help it.

I know what you are thinking, the Adderall is keeping me up! But no, I have always had insomnia, at least since I was around 15. I blame this, mostly on environmental factors, stemming from my insane parents, and how they handled their rocky divorce, but that is for another post entirely. The characteristics of my insomnia hasn’t changed, beyond a very sleepless first week on the drug.

In any case. I am have been researching options for treating the anxiety and depression I seem to be suffering from. I am currently prescribed generic adderall, at 45mg, 15mg 3 times daily. Along with generic guanfacine ER.

Its been about 3 months now, give or take. The effects of the amphetamines are wonderful. Increased focus, motivation and quality of life. Unfortunately the stress is still there and the suicidal ideation is still there. I hoped that a dopaminergic drug like amphetamine could cure these problems, and it certainly seemed to help for the first month or two. However, I have adjusted to the substance, and it doesn’t help with the depression or anxiety as much anymore.

The guanfacine is barely noticable, it might be helping with anxiety at some level, but it certainly isn’t significant enough to ameliorate the stress, especially stress induced from social interaction.

So I have been researching the use of anti-depressants, opiates, and other options to reach some base level of sanity.

Though I realize that the source of the depression/anxiety is likely tied at some level to my childhood. My shitty parents being what they were. I can’t deal with that right now. I also can’t really afford a quality therapist.

I am searching for an effective medical solution to keep me functional in the meantime.

Surprisingly, in opposition to our current societies collective opinion, and perhaps even the majority of the medical community, I have found that opiates are not really as dangerous as they have been made out to be. At least in regards to addictive potential. Apparently less than 1% of patients, prescribed opiates for treatment resistant pain, become would could be qualified as “abusers”. On top of this, the dreaded tolerance you see spoken of, either in medical papers, or in online opiate user communities, doesn’t seem to be a problem specifically for the treatment of pain. The papers that I have seen state that dosage stabilizes, and even is reduced in many cases, after initial stabilization. This apparently holds for years. With certain patients being on a stable dosage of opiates for decades.

 

More research is needed of course. And anxiety/depression is different than chronic pain. But it is surprising to see peer reviewed research flying in the face of commonly accepted medical knowledge.

On top of this, I have discovered that the use of a “speedball” is generally safe. Namely, the mixture of either amphetamines such as dexamphetamine, or methylphenidate, can be mixed with opiates with minimal risk, at least in the short term treatment of cancer patient’s pain. The risks of speedball use, is primarily seen among users who take excessively high doses. Using the stimulant effects of the amphetamine to allow an even higher dose of opiates, without risk of respiratory depression, and ensuing coma. When the amphetamine wears off, however, if the opiates remain in the blood at sufficient level, the user will go into respiratory depression if amphetamines are not re-administered. As a side note, if you have taken too much of an opiate, say, heroin in the form of IV, taking a significantly large dose of any amphetamine is likely to keep you alive, stimulating your CNS system and overcoming the CNS depression caused by the opiates. It is less safe than using something to block the opiates, say Narcan, but its better than dying.

As an aside, interestingly, this is known as a Brompton cocktail. A mixture of a stimulant and an opiate. It was popular apparently during the 18th and 19th centuries for various treatments. But, with our current Western society’s and government’s very strict view on both narcotics and stimulants, it is unsurprising that this has fallen out of favor.

At lower doses, the amphetamine treats the somnolence (daytime sleepiness) of the opiate, reduces the “mental fog” caused by the sedative effects, and also reduces the required opiate dose needed for therapeutic effect, due to boosting the analgesic properties of the opiate.

From what I can tell, the two drugs do not counteract in other, or cause deadly or even problematic symptoms in the vast majority of patients.

Once again, the negative stigma tied to a “speedball” seems to be due to the relatively small percentage of drug abusers who fail to measure dosage, and cause either opiate toxicity or amphetamine toxicity due to overdose. This seems to be the cause of most stigma tied to “hard” drug use. A small percentage of morons, cause over-anxious moral busybodies to limit the freedoms of the rest of the populace. Both amphetamines and opiates seem very safe to both the brain and other organs, as long as dosages are kept lower than what might be considered “recreational”. This seems to be at least under 2mg/kilogram for the amphetamines. For the opiates, I am unsure of dosage rates, as it is currently outside of my interest. But, opiates in the studies I have seen, are kept at a low enough dose to treat felt pain. Dosages for euphoria are much different than doses for reducing pain, at least according to my current understanding. This is possibly why pain patients have much lower rates of addiction than those seeking euphoria from opiates.

On top of this, several studies have shown that the use of Buprenorphine(suboxone, but without naloxone which “kills the high”)  is incredibly effective at treating treatment resistant depression (TRD). As well as reducing suicidal ideation in those at high risk of suicide. This isn’t particularly surprising. Opiates generally make you feel good. But buprenorphine in particular is unique in its safety profile. It can not be overdosed on like heroin, since it doesn’t seem to cause respiratory depression, even at very high dosages.

However, this gives me a sort of nuclear option, that is relatively safe. If I am prepared for some level of dependency and I have a “stack” of sorts to treat withdrawal if cessation is needed, I can use a combination of buprenorphine and either methylphenidate or dextrooamphetamine to simultaneously keep me active, alert, calm, and happy.

I will write a post on treating withdrawal symptoms later perhaps. If I do I will link it here.

It is risky at some level, I am mixing two separate classes of drugs known for their addiction and abuse potential. But if I use dosage schedules taken from research papers as well as publicly available titration tables from places like http://www.pdr.net or UpToDate.com. I can stay at safe levels, and probably use this longterm.

There is some concern for amphetamine toxicity as mentioned in the paper detailing treatment of cancer patients with both amphetamines and buprenorphine. However, according to the paper, the toxic symptoms were only found in the first trial that used a non-amphetamine stimulant. Methylphenidate was found to be safe, and caused no toxicity among the tested population. However, if toxicity occurs, I can simply cessate use.

The largest issue at this point would be getting a reliable supply of the buprenorphine. It is only schedule III, so I am less likely to be targeted by law enforcement if I went with DarkNet options. But I would prefer to follow the legal route to minimize both cost and risk. However, I find it unlikely I could find a doc that would be comfortable with prescribing an opiate off-label, even if it is a safe-ish one like buprenorphine. Especially alongside an amphetamine. There is a reason the paper discusses cancer patients. Good luck getting prescribed the combo without having a painful, chronic and likely fatal condition like cancer.

However it could be possible. Though it would probably be worth getting my hands on a supply of bupe first to test efficacy, and then going from there. Once again this is the nuclear option. I should try an SSRI or SNRI first, and then maybe progress to Tianeptine, which is unscheduled and easily purchased online. It probably would even be better to get a prescription of benzodiazapines before I went with opiates as a treatment option.

However, buprenorphine or another opiate is probably the most powerful solution to my anxiety and depression issues, though it also carries the most risk. Either in the form of a jail sentence, or addiction and abuse.

It is frustrating to me the lack of research on opiates in the treatment of depression and anxiety. If addiction and abuse rates truly are so low, then the aversion of the medical community as a whole to the use of opiates in treatment is irrational at best.

 

Drugs, Drugs, Drugs, ADHD

Partial-Birth Abortions within an Atheist Ethics Framework , Or my problems with the “Violinist Argument”

NOTE: I have decided to start a free blog to post my personal opinion on certain issues that bother me. I don’t expect anyone to read this, but if you found yourself here through some Google byway, you are certainly welcome!

I want to talk about an issue that I seem to have a somewhat unpopular opinion on, namely the morality of Partial-Birth abortions from the perspective of an Atheist.

By partial-birth abortion, I mean abortion after and including the point a fetus reaches mental development to the point where it could be said to be reasonably equal to a newborn infant. I will use “personhood” status to refer to this, for the rest of the post.

First, to clarify, I believe that before a fetus has developed to a point to be considered, at least mostly equal in mental capability, to a newborn fetus, it is morally acceptable to allow an abortion to occur. This is because the fetus is not really person at this point.

We use this same line of reasoning to give personhood status to humans with low and high IQ’s but not personhood status to humans considered to be in a vegetative state.

It is very difficult, at least currently to know exactly when this happens in a fetus, so I generally accept that abortion is morally acceptable until the third trimester. This, however, is only a rather uneducated arbitrary line, a fetus might achieve personhood a little earlier or a little later than this.

With that in mind, I do not believe that it is moral to allow the abortion of a fetus determined to be a person, or to have personhood status. Except in cases where the mother’s life is at risk.

This seems to be a somewhat unique opinion on the internet among those who do not believe in a God, and I decided to elaborate on why I believe this.

The problem of the morality of abortion seems to , though not always, generally tie into whether we accept that a fetus is a person at some point before birth, and whether we accept that a woman’s right to bodily autonomy outweighs a fetus’s right to bodily autonomy, or life.

Generally, among atheists, it seems to be stated that bodily autonomy, namely the right to do what you will with your body, always trumps the right of life of a fetus.

I do not accept this. Though bodily autonomy certainly has value, in our culture, we do not accept bodily autonomy as more important than the right of life of another individual.

You do not have, for instance, the right to take a club and bash someones head in. This is a limit on your personal bodily autonomy. This is due morally, to the fact that you are infringing on the right to life of another person. It is also based practically on the fact that if murder was allowed, society as we know it would be much less stable and developed.

I will not be discussing practicalities, however. Instead I will focus on how we deal legally with the abortion rights issue compared to other right to life issues. I decided to focus on our legal culture, because discussions of morality tend to be so arbitrary among individuals that it tends to be about as productive as discussions about politics, sports, or your favorite color.

Now on to the meat of the post.

It has been stated that the “violinist argument” is one of the best, if not the best argument for support of unlimited restrictions on abortion. Here is the original form of the argument by Judith J. Thomson, a somewhat renowned moral philosopher.

“It sounds plausible. But now let me ask you to imagine this. You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist’s circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. The director of the hospital now tells you, “Look, we’re sorry the Society of Music Lovers did this to you–we would never have permitted it if we had known. But still, they did it, and the violinist is now plugged into you. To unplug you would be to kill him. But never mind, it’s only for nine months. By then he will have recovered from his ailment, and can safely be unplugged from you.” Is it morally incumbent on you to accede to this situation? No doubt it would be very nice of you if you did, a great kindness. But do you have to accede to it? What if it were not nine months, but nine years? Or longer still? What if the director of the hospital says. “Tough luck. I agree. but now you’ve got to stay in bed, with the violinist plugged into you, for the rest of your life. Because remember this. All persons have a right to life, and violinists are persons. Granted you have a right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body. So you cannot ever be unplugged from him.” I imagine you would regard this as outrageous, which suggests that something really is wrong with that plausible-sounding argument I mentioned a moment ago.”

First of all, I agree that it is morally acceptable to unplug yourself from the violinist in this example. You are not responsible for the injuries suffered by the violinist, and you can not be made to perform a positive action, namely the giving of your blood and the freedom of your movement, to save his life. In this case, your bodily autonomy trumps the violinist’s right to life, because you are not at all responsible for his injuries, nor obligated to save him.

But the violinist argument makes a fatal error, it fails to consider the fact that the mother is not kidnapped, but instead ultimately responsible, along with the father, for the conception of the fetus.

A more reasonable example would be the following:

A man, who I will from this point on call subject A, for whatever reason, decides to attack another man, subject B, with a lead pipe. He walks up behind the man, and beats him over the head with the pipe, causing the man to bleed profusely and go unconscious. Subject A did not originally plan to kill Subject B, only to gravely injure him. Subject B is taken to the hospital, and subject A is arrested for assault. Both men have the same blood type, and it is only possible for the man who committed the aggressive act to donate his blood, no other blood is available for transfusion. If subject A does not donate his blood, subject B will die, if he does donate, over a period of nine months, subject B will make a full recovery.

Should subject A, the attacker, be legally obligated to donate his blood to subject B, the attacked?

Well, in our current legal system, we already have an answer to this.

If the attacked man, subject B were to survive, the attacker, subject A, would only be charged with assault with a deadly weapon, or at worst, attempted murder. If subject B were to die, however, subject A, the attacker, would be charged with murder and suffer the increased legal repercussions of this.

The legal system is not concerned with the motivations of Subject A, at least not when determining the distinction between assault and murder. (Motivations do play a part in determining the degree of murder committed, but that is not entirely relevant here.)

It is important to note that subject A continues to hold bodily autonomy, he is not required to donate his blood. The legal system will not charge him with murder for not giving up his bodily autonomy, the legal system will charge him with murder for being ultimately responsible for causing the death of subject B, due entirely to his consensual and lucid action, the attacking of subject B with a lead pipe.

By not donating his blood, the attacker is facing significant legal repercussions. In the same way, it seems reasonable to me to make it illegal for a woman to abort a fetus once it has reached an accepted personhood status, because the conception of the child is ultimately a production of the consensual and lucid action of the mother and father, and not the result of some “kidnapping” as is the case in the violinist argument.

Assuming we are willing to define a fetus, right before birth, as equally or almost as equally human as a newly born infant, and we accept that a new born infant is a person, or should at least not be killed, then an extreme late term abortion is as much a murder as that of an infant, or of that committed by subject A to subject B, when subject A fails to donate blood to subject B.

Once again, it is important to note, that subject A, the attacker, is not required to donate his blood, he only receives a much stiffer penalty for the death of the attacked. He is voluntarily capable of trading bodily autonomy for less prison time, due to the fact that it reduces the consequence of his action. In the same way, a woman carrying a fetus late term is not required to carry the fetus to term, but would suffer legal repercussions for ending its life, because she, along with the father, is ultimately responsible for giving it personhood. Bodily autonomy is not really at play here. All that is considered is whether the person in question is killed as a consequence of a deliberate act by another person or persons.

People do not argue, that, a man who assaults and kills another man should only be charged with assault because the attacked man died as a secondary result of the attackers actions, namely, bleeding to death after the attack. In the same way, it seems unreasonable to me to use special pleading in the case of a female during a late term pregnancy.

I think that the bodily autonomy argument really clouds the issue. It is only in cases of an unforeseen accident or “kidnapping”, where bodily autonomy is allowed to reign over right to life of another individual. You are not legally obligated to donate a kidney to a family member, due to this. Because the mother is responsible for her pregnancy, however, she can not claim bodily autonomy when ending the life of a late term fetus.

Now some people might ask, “What about in cases of rape?”. For me, this is a much more clouded issue, about which I am unsure. But I will use the same reasoning as above.

Is it legal to end the life of a newborn that is a product of rape? The answer is no. Well, if we consider a fetus that is late term, to be equal in value to a newborn, even in cases of rape, then it should still be illegal to end the fetus’s life. However, it is perfectly allowable for the mother to terminate the pregnancy before it reaches the late term and the fetus reaches person-hood, and I think this allowance solves the rape problem.

I believe the Violinist argument is strongest in the “rape case”, but not strong enough to justify abortion of a fetus considered to be a person. You can give birth to a child without killing it, current technology can keep an infant alive, even if born pre-term. If you can separate yourself from the violinist without killing him would it be moral to turn off the machine keeping him alive, simply because the machine inconvenienced you? I am not comfortable saying it would be.

Generally, it seems to be asked, immediately after this position is taken, “What, then, would be the punishment you would give to the woman who aborted her child late-term?” It always seems to come off as a “gotcha” question, and I never understand why.

The answer is simple: If we consider a fetus to have reached “personhood”, and it to be equal in value to a newborn, then we should hand out the same punishment you would to someone ending the life of their newborn.

Final Note: I am not trying to suggest in any sense, that consensual sex between two adults is in any way a crime or can be compared to assaulting a man with a pipe. I choose the lead pipe example because it seemed a better way to represent the responsibility for the pregnancy held by the mother and father that was not addressed in the Violinist Argument. Also, I want to make it very very clear, that the responsibility for a pregnancy is equal among the two partners, the male and female, though the female has to bear the pregnancy solely. Nature can be cruel, but as individuals with thinking minds, we can overcome the problem, either through the use of birth control, or early abortions before the “person-hood cutoff”. I believe it would be fair to require the man to pay his fair share of abortion related costs, taking complication risks for the female into account, it seems fair for the male to be required to pay more than half of these costs.

 

 

 

 

 

 

 

 

 

 

 

 

Partial-Birth Abortions within an Atheist Ethics Framework , Or my problems with the “Violinist Argument”