Furious Seasons

May 08, 2008

New Abbott ADHD Drug Is "Drug Dealing," Plus Adderall Snorting Explained

Yesterday, my good friends at Abbott Labs rolled out phase II data on its experimental adult ADHD drug known as ABT-089. One assumes that the phase III trials are well underway and that the drug will have a much sexier name if it ever heads to the FDA for approval. I'm betting that it will because Abbott is clearly aiming this drug at the adult ADHD market and in its press release the company talks about it as a lifestyle drug:

"Phase II study results show that ABT-089 appears to significantly improve the core symptoms of ADHD, improve quality-of-life and work effectiveness, and reduce overall work impairment in adults with ADHD. Data also revealed that ABT-089 appears to be generally well tolerated with no significant negative effects on sleep, appetite or vital signs (heart rate and blood pressure).
"ADHD, an ailment historically associated with childhood, persists into adulthood in more than two-thirds of cases."

How much ADHD persists into adulthood is debatable (recent studies put it at closer to 50 percent), but you know how the ads for this drug will go: "Having trouble getting your reports done on time for the boss and still having spare moments to catch the kid's soccer practice and shag the wife? Abbo-Fix is the answer for you." Something like that at any rate.

Given the company's emphasis on lifestyle improvement, you know Abbott will market the hell out of the drug once it hits the market, possibly in 2010. And why wouldn't they? Abbott hasn't had a homerun mental health drug since it turned Depakote into a "mood stabilizer" for bipolar disorder in the early-1990s (David Healy is deeply critical of Abbott for creating that terminology). But one does have to wonder about just what we are doing when we are introducing a lifestyle drug into the marketplace as opposed to something that addresses a truly debilitating problem. I guess that would make ABT-089 the Viagra of psych meds.

Aaron Rowe over at Wired Science put it thus:

"In my opinion, selling chemicals which affect the brain, but do not treat a major human malady, is a legitimized form of recreational drug dealing. But from a capitalistic point of view, it is a brilliant idea: A drug which strikes α4β2 nicotinic acetylcholine receptors is sure to have more off-label uses than duct tape, which means it could be a really big seller for the pharmaceutical giant."

That's a bit more harsh than I'd be, but since he opened the door, let me budge on in: So many ADHD scrips wind up being diverted into the underground market and so many teens and college students (and, hell, probably adults) are laying hands on ADHD drugs without a scrip, grinding the pills and snorting them like speed that I think Rowe's terminology is apt. This is especially true of Adderall, which goes for about $5 a pill on da' street and is quite popular among the college crowd as a, ahem, study aid.

I recently had a chat with an admitted Adderall snorter, who told me she didn't have an ADHD diagnosis, but that she and her friends in college often use the drug to help them stay up for days on end and cram for mid-terms and finals and term papers and such. She liked how easily available it was and how focused she was while on the drug. It also gets her high as a kite. I asked about side effects, fluttery heart beat and the like. She said she'd had no problems and that the only downside of using the drug in this fashion was when she had finals later than her fellow whiffers. They'd come off the drug first and be all zonked out and she'd have no one to stay up late and study with.

Oh, yes: there is apparently a very big crash coming off Adderall and the once-snorter becomes the many-hours-sleeper. This has become much larger phenomenon than I'd thought a few years ago (witness all the busts of teens for dealing Adderall) and whenever I speak at a college, I get asked about it.

I once took speed ("greenies") to keep me up all night for a Econ final when I was a freshman in college, in the days before ADHD meds were commonplace. So did a few pals of mine. The speed made me shiver internally and I felt chilled. It was such an icky feeling that I promised myself after the final that I'd never touch speed again (I haven't) and that I'd make sure to organize my life better so that I never had to pull an all-nighter ever again. And I never have.

What's interesting and spooky is that ABT-089 is not a stimulant, it's a neuronal nicotinic receptor agonist, making it somewhat akin to Chantix (Champix outside the US), the very messy stop-smoking drug that keeps acting like an SSRI and causes erratic behavior, suicidality, suicide and, in some reported cases, depression. It'll be very, very interesting to see how ABT-089 performs in the real world.

BTW, Rowe implies that ADHD is not a major human malady. I have no idea whether it is a major one or not since I don't have it myself and the adults I know with the disorder don't seem particularly disabled to me. What do you think? ADHD: major or minor malady? Is Abbott trotting out a mere lifestyle drug or are they addressing a major health issue?

Full disclosure: In the late-1980s, I was a sales rep (and a very good one) for Abbott Labs for its then-tiny Abbott Critical Care Systems which sold critical care monitoring devices commonly used in operating rooms and ICUs. I never repped drugs for Abbott.

Posted by Philip Dawdy at May 8, 2008 12:05 AM

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Comments

An interesting poll yesterday on Medscape Weekly, a newsletter aimed at MD's:

According to a recent poll in Nature of 1400 academic scientists (70% from the United States), 20% reported nonmedical use of cognitive performance–enhancing drugs such as Ritalin, Provigil, and Inderal. Do you think a similar problem exists or does not exist among clinicians?

A similar problem exists
58% (571)

A similar problem does not exist
16% (157)

Unsure
25% (248)

My guess is that clinicians, with prescription pads in hand and closets full of samples, have a worse problem than academic scientists... What do you think?

Posted by: Johanna at May 8, 2008 07:20 AM

YES, adult ADD is a serious malady. It has a major impact on my executive functions. Without ADD meds it is not safe for me to drive, and forget being able to complete simple tasks like laundry let alone reading a book. (Look up studies on ADD and driving if you doubt my claim that it's a serious problem.) I'm actually shocked that a mental health blog would trivialize a disorder like you just did. I'm not saying people who don't need ADD meds don't abuse them, but there is an appropriate use for stimulant medications.

Posted by: Penny Century at May 8, 2008 09:56 AM

That's some powerful opinion, but how the hell did he do this: α4β2
Awesome.

Posted by: flawedplan at May 8, 2008 01:17 PM

Before I say anything more let me note that I am not on any medication, period. I was dismissed from my job at a "compassionate" non-profit here in Seattle last September and have had no health coverage since.

AD(H)D is a real disorder and can be disabling -- especially when it occurs with another disorder such as clinical depression. The trade word for this reality is "co-morbidity". I am presently seeking permanent employment while trying to cope with episodes of depression and the disruptive effect of untreated AD(H)D. I am coping the best I can with f*** all support.(I bracket the 'h' in adhd because I for one am not "hyper". I have the "primarily inattentive, without hyperactivity" variant.)

I believe it's unfair to people such as myself to dismiss the reality of living with a disorder such as AD(H)D just because the medication prescribed for that happens to be intercepted and used for unsanctioned uses. I feel that I and others are being unjustly penalized for this.

As William Gibson said: "The street has it's own uses for things." If a chemical has a psycho-active effect on humans it will be diverted for unsanctioned use. Count on it.

Posted by: Sam Lowry at May 8, 2008 01:17 PM

By far, this is one of your best ever written.

Posted by: Stephany at May 8, 2008 08:03 PM

Sam, they're just labels, approximations, no one's denying *something's* going on, but we look at how the muddies get watered around here. Take me, for instance, I was tested for ADHD and met the criteria. So according to the playbook I am officially ADHD, and eligible for the Provigil, support groups and federal accomodations accorded to ADHD people in college. But no expert who knows me believes I "have" ADHD, including the neuropsychologist who tested me for it. I also have a trauma history that left me with things that look like ADHD -- panic attacks, startle response "freezing", and big problems with information processing, and a lifelong hyperactive thyroid on top of it! So even though I meet the official criteria for ADHD I don't have to be treated for it, lucky enough the experts who evaluated me were aware of my trauma history, that diagnosing psych disorders is iffy and takes a grain of salt.

That's not to say *your* ADHD is a false positive, but that our skepticism here is warranted in light of what happens.

Posted by: flawedplan at May 8, 2008 10:12 PM

"...and the adults I know with [ADHD] don't seem particularly disabled to me."

I've been reading your blog and enjoying learning about the mental health industry (and sometimes saddened and infuriated by some articles) for a long time, but I don't think I've ever seen such a blatantly ignorant comment from you before. Please visit www.butyoudontlooksick.com. Although its primary focus is chronic physical illnesses such as lupus, the rationale behind its creation applies equally to other "invisible" disabilities and diagnoses, both mental and physical. The essay describing the spoon theory is particularly apt here. What you may be seeing on someone's surface is quite often far different from the reality of what they are experiencing just to keep up with the rest of the world.

Since this is my first comment here, I would like to temper my remarks above by saying that I think you are generally doing a fine and much-needed job in raising awareness and posing necessary questions about the state of mental health treatment in the U.S., and I hope that you continue doing so. Your blog is the first place I visit when I read an article elsewhere, and if you have a post of your own about it, your comments are very nearly always much more insightful than whatever the original article said. http://well.blogs.nytimes.com/2008/05/06/psychiatry-handbook-linked-to-drug-industry is just one example.

K

Posted by: K at May 9, 2008 11:26 AM

Reading Sam's and flaw's comments we can see how "accurate" diagnosis is nowadays.
People don't know anymore what are their real diseases.
How can you prescribe for ADHD if the main issue of this disease is hyperactivity and the drugs gives you more hiperactivity in order you feel fine?
No!
There's ADHD without hyperactivity!

"just because the medication prescribed for that happens to be intercepted and used for unsanctioned uses. I feel that I and others are being unjustly penalized for this."

I don't understand it.
Do you want to take Ritalin?
Or do you think you need a SSRI?

When a person is depressed one of the symptoms, is of course, inattentiveness but in Sam's case... she has AD(h)D and clinical depression...

I don't understand anything at all.
Well, I guess that's exactly what is necessary to make all these misunderstandings.
And it's intentional.

Any drug will do for any mental disease.
Good!
Seroquel for depression sounds perfect when you no longer know what you have!

"and sometimes saddened and infuriated by some articles)"

Infuriated!

Yeap!

I'm furious. I really cannot take any longer.
Making profit at the expenses of people's health!
This is beyond any classification!
This is crime.
And it will keep on the same although it's out in the open.
I'm sorry if I'm being too emotional and saying the obvious.
But it's enough.
We will be saying the obvious for the next ten years. We'll be here saying the same about new drugs that make other hideous side effects.
When will this scheme of marketing diseases will end!
Dear Lord!
People are dying and killing!
CHILDREN!
Vioxx was easier to prove.
But SSRIs and all the psychiatric stuff on the market that costs too much to make people ILL will last for how long?
This mafia...

You can imagine all that follows...
I'm really angry with all of this.
If I was in US perhaps I would work for PETA or SHAC.
You cannot fight these people.
We don't have money to lobby. We don't have money to stop it.
They don't play fair. Why play fair with criminals?
This whole system is criminal.
Psychiatry, specially psychiatry, is a matter of policy.
This will go tho the History of Psychiatry as the period of the CRIMINAL DIAGNOSIS FOR CRIMINALS PRESCRIPTIONS.
But I won't be alive to see it.
That's for sure.
FDA, APA, WHO, GOVERNMENTS,POLITICIANS, PHARMACEUTICAL INDUSTRIES, SHAREHOLDERS, PHYSICIANS, RESEARCHERS all these will have their names when this era is finally over.
They won't be alive to see either.

Gee!
I believe Philip will not let it be published!

Sorry!
I'm really angry!
JUSTICE!
That's all I wanted.
At least for the next generation!
:(

Posted by: Ana at May 9, 2008 04:24 PM

I really enjoy your blog, but I feel you are off the mark when it comes to your perception of adult adhd.
Like all psychiatric disorders, the severity of adult adhd can vary, but for some of us it causes major life troubles. As stated above, driving can be extremely dangerous for people with adhd (I now stick to public transit after I caused two car accidents due to "zoning out" while driving). It also contributes to major issues in relationships, in the workplace, and with general functioning.

In my experience, stimulants effect adhd-ers differently than others. While in college my roommate would stay up all night studying and then cleaning our dorm room if I gave her one of my pills, adderall would calm my racing mind enough to allow me to take an afternoon nap, or just sit peacefully and enjoy the moment, rather than my unmedicated habits of frantically multitasking (while not ever getting anything accomplished).

When you mention your experience with speed you say "I'd make sure to organize my life better so that I never had to pull an all-nighter ever again." You're taking for granted the fact that you are able to organize your life better. With adhd, you simply can't do that. Life is in a constant state of disorganization, and simple things like sticking to a study schedule or getting the rent check in the mailbox before the 5th seem so overwhelming that you just shut down. An add-er who can "make sure to organize better" is like a depressed person who could just "make sure to be happy and positive". Its just not that simple.

Posted by: Thea at May 9, 2008 09:43 PM

Thea,

I'm sure your roommate is very happy with your help giving her Adderall! (nice name! implies "Add all" and also covers the letters of name of the disease "ADHD" - ADDerall for ADhD)

So your roommate does not need to buy cocaine! She have legal drug.

Unfortunately ABT-089 will be on the market only in 2010!
I'm sure it will be of great help.

I've visited your site and I saw you came to Brazil and you are going to write your views on Brazilian healthcare:

""I will likely get a bit off-topic, but in coming weeks I'll be writing about different aspects of this trip, including medicinal plants of the rainforest and healthcare in Brazil.""

I'm looking forward to read your views!

Let's see if we can exchange some ideas!

Posted by: Ana at May 10, 2008 04:03 AM

Thea,
Did you came to Brazil in the ecotrip 9-Day Tour you have linked on your Blog?

http://www.journeys.travel/destinations/americas/brazil/174/

I've also visited this site you have linked on your:

http://www.mayoclinic.com/

Good to know that:
"Dealing with depression: ECT is safe, effective treatment"

There is a lot of data on this site.

I hope you had a chance to visit a SUS and a CAP facility in Amazon. This would give you a good measure of Brazilian healthcare system.

I would rather go to Galápagos and appreciate what Charles Darwin's have see.

Posted by: Ana at May 10, 2008 04:55 AM

Me again!
Sorry Philip.
But I've just realized that a depressed person would never be interested in a trip to Brazilian rainforest.
Add-ers are! And some even make the trip!

Posted by: Ana at May 10, 2008 05:16 AM

Just curious -- what's are "greenies"?

Posted by: MacLeod at May 10, 2008 05:29 AM

Thea has stopped blogging.
I'm so sad!
:(

Posted by: Ana at May 22, 2008 07:37 AM