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'repping' For Traditional Stimulants 9/24


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#1 doinmdirndest

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Posted 09 September 2013 - 02:09 AM

there are a few of us-i'm one- who benefit from traditional stimulants in high doses.

it's important for all pwn who can to participate in the fda's patient-focused meeting 9/24.

it's especially important the scant few pwn amongst us who prefer/benefit from traditional stimulants in higher doses to represent our own interests.

there are very, very few of us receiving such treatment. likely an indeterminate # of pwn needlessly suffer from eds simply because although their amphetamine rx is/always has been well tolerated, the md rx'ing does not exceed guidelines such as manufacturer's recommended maximums. these guidelines are not rules, any amount an md is prepared to justify medically may be prescribed.

these guidelines reflect doses fair to describe as puny. consider this: for Adderall (mixed amphetamine salts) 60mg/d is the maximum amount reflected in guidelines anyone should be prescribed, ever.

if we convert to desoxyn (methamphetamine usp) we are looking at 30 mg/d. if street meth sells for 10$ a decagram, the = of 60mg Adderall in street meth is 3$ worth.

this amount or its = in any amphetamine isomer if taken for the first time for medicinal or any reasons will get a response. it have an eds sufferer wakeful. and a first time abuser of stimulants shall have perceptible effects.

but to expect this amount to get a response if taken daily for years is unrealistic. increasing doses of these meds so as to maintain a response can be done in some cases w/the med remaining well tolerated.


I believe 120-200mg/d Adderall is a more realistic max. for this med. a cautionary advisement is likely a good idea for the higher doses.

this access (to treatment) issue should be made apparent to the fda 9/24.

the deadline is 9/13 to apply to participate, if my info. is correct.

#2 Potato

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Posted 09 September 2013 - 05:35 PM

I would be very surprised if the guidelines were updated to allow higher doses. The primary reason being no drug manufacturer wants to be responsible for causing brain damage in patients, especially when it's a drug that already has a negative stigma attached to it. Stimulant drugs like methylphenidate, amphetamine, and methamphetamine aren't neurotoxic directly, but the dopamine they release is, at higher concentrations. When dopamine is not cleared from the synapse quickly or not degraded to harmless metabolites, it can auto-oxidize to form free radicals. Some of them get mopped up by antioxidants but the ones that don't exert oxidative stress on the brain and begin to damage cells. A good example of the issue would be the observed neurotoxicity that occurs in recreational methamphetamine usage. Unfortunately tolerance provides little if any protection from this type of damage because the majority of tolerance stems from downregulation of receptors rather than a decrease of dopamine concentration in the synapse.

 

Ultimately, while some individuals do build significant tolerance to stimulants over time, you can't just keep increasing the dose without causing toxicity. I would imagine it's this situation that is the main issue, and saying patients should be allowed to be prescribed drugs in such high doses it's likely to cause brain damage over time is a tough argument to sell. I would only support something like that as an absolute last resort.

 

Also, why you're including the price of street meth I'm not sure, but you can't so easily make comparisons between the two. Pharmaceutical drugs are always measured by amount of the active ingredient. Street drugs are always measured by total weight, including whatever they're cut with. 10 grams of streeth meth would not equate to 10 grams of pure methamphetamine -- there's likely a large amount of filler included in that weight. If you're told it's pure meth, you're almost certainly being lied to.



#3 SleepyResearcher

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Posted 09 September 2013 - 08:51 PM

no one thinks you're getting pure meth, but the fact of the matter is that stimulants stop working the way they used to and the brain damage has probably already been done.  What Dr.'s cant quantify is the cost of suicide.  No one with narcolepsy is gong to win a "you ruined my brain" malpractice law suit.  if that can happen, I like to sue every single psychiatrist that I have ever seen.  I have been forced to take stimulants since I was 8 years old (just got diagnosed N with C and I am 28) under the auspice of ADHD and my "personality". No one gave a *BEEP* about my brain when the primary reason for medicating me was to control my behavior.  Now that it is my success on the line I feel no shame Dr. Shopping or extorting Dr.'s (psychiatrists) who don't know enough about the medications or diagnosis which they speak of.  Get what you need and worry about the consequences later.



#4 IdiopathicHypersomniac

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Posted 09 September 2013 - 10:35 PM

Interesting.  I was told Ritalin was not neurotoxic, but that Adderall, Dexedrine/Vyvanse, Desoxyn, and MDMA were because of the dopamine push.  If the patient signs a waiver with informed consent, I think they should be allowed to go higher on compassionate grounds.  At those doses though, I'd be more worried about the heart than the brain.



#5 doinmdirndest

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Posted 10 September 2013 - 01:12 AM

if what you guys are telling me is true, i'm supposed to be a genius, but now i'm so fouled up that i'm just a modestly capable, competent blue collar worker.

if i'm not mistaken, Ritalin is an amphetamine.

the 3$ worth of meth thing I thought could offer perspective; older people here may recall Richard pryor (comic) doing a routine where he reflects upon a boxing champ's (sugar ray? can't be sure) arrest for $1.25 worth of cocaine. 60 mg of amphetamine is not much, particularly if taken daily.

the waivier idea is excellent. heart issues should be monitored by an md in a patient on a high dose amphetamine regimen. hypertension is a contraindication if antihypertensives such as lisinopril do not restore normotensive status the med must be stopped.

my md wathches my bp closely. 110/70 avg bp, smooth sailing so far.

sleepy r.- i'm not the least bit suicidal, and I note your composition skills are not sub-optimal insofar as the brief post reflects; what is no longer do-able for you?

I think I was sharper in my early 20's-teens, maybe you're onto something.

#6 collegewriter

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Posted 10 September 2013 - 04:24 PM

Ritalin is a dopamine reuptake inhibitor; not a dopamine agonist like amphetamine.

#7 steaks

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Posted 26 October 2013 - 03:32 PM

The big problem in my opinion is excitotoxicity.  When any cell is highly stimulated, it generates massive amounts of free radicals.  There is at least one study that indicates that antioxidants such as vitamin C or Alpha Lipoic Acid dramatically decreases brain cell damage from MDMA, which of course is an amphetamine.

 

Again, in my opinion, it isn't so much the drug which is the culprit, but the highly excited state that these drugs can create in high doses in people who don't have adequate nutrition.  Taking a stimulant without excellent corresponding nutrition is like driving a car hard without first making sure that it has plenty of oil and coolant.  There are mechanisms that prevent the body from going to such a high level, but stimulants can cause the body to bypass these mechanisms--so can any highly activated state.

 

Blood acidity from lactic acid can make the body less resiliant, making the problem even worse.  In my opinion this is a huge reason why heavy meth users often have tooth loss.  There are people who take amphetamines their entire lives under the supervision of a competent physician, while eating a highly alkalizing diet who never suffer from any major tooth loss, let alone major health problems as a result.

 

Ritalin is not an amphetamine, it is primarily a dopamine reuptake inhibitor, similar to cocaine, so while it has similar effects to amphetamines, which are primarily releasers, it is not the same.  Amphetamines actually stimulate the release of dopamine, norepinephrine, and to a lesser extent seratonin.  An example of a dopamine agonist would be Cabergoline, which is not very stimulating at all.

 

A big thing that some people with fatigue should check is their prolactin levels.  Often dopamine based stimulants provide relief simply because they reduce prolactin by increasing dopamine.