Brain drugs, a review (performance enhancement, side effects, and addiction)

 From the Free Press,  tasting notes on a variety of performance enhancing drugs for concentration, finally converging on what sounds like nicotine addiction.

I Tried Wall Street’s Famous Brain Drugs
My experimental high and crash through the not-quite-legal, sort of effective, occasionally heart-pounding medicine cabinet of Wall Street and Silicon Valley’s productivity optimizers.  by  Park MacDougald

"Vyvanse:
The brand name for lisdexamfetamine, a prodrug that, once ingested, slowly converts to dextroamphetamine, one of the active ingredients in Adderall. Originally developed as a longer acting and less easily abused alternative to dextroamphetamine, lisdexamfetamine is now the third most commonly prescribed stimulant in the United States, according to the Drug Enforcement Agency (DEA), with around 15 million prescriptions dispensed in 2023. With insurance, a 30-day supply of Vyvanse can run around $60.

...

" Strattera:  Generic name atomoxetine, Strattera is a selective norepinephrine reuptake inhibitor initially developed by Eli Lilly to treat depression, but later approved by the Food and Drug Administration (FDA) as an ADHD treatment when it was found to be ineffective for its intended use. Strattera is far less commonly prescribed than Adderall, Vyvanse, or Ritalin—4.3 million prescriptions were dispensed in 2023, per the DEA—but may be favored for patients with a history of addiction, due to its low potential for abuse. It’s also cheap; with my insurance, a month’s supply of Strattera cost less than $10.

...

"Dextroamphetamine: Basically like Adderall but without levoamphetamine, a less potent amphetamine isomer that helps to smooth the overall effects of the drug. Dextroamphetamine, or “dexy,” has been available since the 1930s, and was issued to U.S. bomber pilots in World War II to help keep them awake on nighttime missions. It’s still around today, but far less common than Adderall or Ritalin (methylphenidate). Around 915,000 dextroamphetamine prescriptions were dispensed in the United States in 2023, according to the DEA.

...

"Modafinil: Unlike the other drugs on this list, Modafinil is not primarily an ADHD treatment. It’s a non-amphetamine stimulant and “wakefulness-promoting agent” developed in France during the 1970s and 1980s as a treatment for narcolepsy, but its current claim to fame is for its use by the U.S. Air Force to manage pilot fatigue on long missions (it’s also frequently prescribed for night-shift workers). Prescription modafinil is generally cheap with insurance, but the variant I bought—a supplement containing adrafinil, a closely related substance—cost $40 for a jar of 30 pills.

...

 "Zyn: Zyn is the original brand of smokeless tobacco pouches, introduced by a Swedish company, Swedish Match, as a tobacco-free alternative to Snus in 2014 (its major competitor, Velo, is also Swedish, though both companies are now owned by international tobacco conglomerates). In the United States, Zyn is sold in tins of 3 mg or 6 mg pouches, though the European version of the product—which I purchase from my local Yemeni-owned bodega in New York City—also comes in 9 mg, 11 mg, and 13.5 mg varieties. Retail, in New York, a tin costs around $9—up from $5–$6 only a few years ago.

...

"For me, however, 6 mg of Zyn—rising to 9 mg in times of crisis—has become a necessity akin to drinking water. I no longer know what Zyn “feels like,” per se, since I only feel its absence, in the form of scattered attention, forgetfulness, and low-level irritability. When I am on deadline or otherwise swamped with work, I rarely go 10 minutes without a pouch in my mouth."

 

Tour de France competitions: conditioning, bikes, and drugs?

 Agence France Presse (AFP) reports on the bike race, and speculates on the historical competition between drug takers and drug testers.

Pogacar's Tour superiority stirs up old doping debate.  Tadej Pogacar's towering domination of this year's Tour de France is once again raising eyebrows in a sport long tainted by the spectre of doping.

"Pogacar himself brushes off the suggestions of skulduggery he has had to face ever since his first Tour win five years ago, always insisting that he should be "trusted".

"Last October he said to dope "is to ruin your life". "I don't want to take the risk of falling ill one day," he added, pointing out that cycling was "a victim of its past".
"
He continued, with an air of resignation: "There is no trust, and I don't know what can be done to restore it."

Dope-testing on the Tour

"Around 600 blood and urine samples will be collected from the peloton during this year's race, with 350 out-of-competition samples taken in the run-up to cycling's blue riband event. 

...

"A selection of the samples are held for 10 years to allow for retro-testing with the advance of new detection techniques.

The UCI also inspects bikes to prevent any technical cheating.

While ketones to help store energy are permitted and widely used, the UCI banned the inhalation of carbon monoxide earlier this year.

...

"Pogacar's ability to smash records set by infamous dopers like disgraced seven-time winner Lance Armstrong or Pantani is remarkable.

...

"And as in other sports, cycling has made enormous progress since the EPO years.

"Technology has led to faster bikes, with the Tour's technical director Thierry Gouvenou suggesting a there has been a 10% gain in performance just thanks to better two-wheeled machines. Nutrition and training have also evolved."

The science and politics of vaping in the U.S

 The Washington Post has the story:

FDA lets Juul market vapes in the U.S. three years after trying to ban them
Federal regulators first announced a ban of Juul products in 2022, although a court order allowed them to stay on store shelves while the company filed an appeal.  By David Ovalle and Shannon Najmabadi
 

"The Food and Drug Administration has authorized Juul Labs to market its electronic cigarettes, years after the agency tried to ban the company’s products amid outcry over its role in fueling the popularity of vapes among young people.

"The agency, after reviewing scientific data provided by the company, concluded that Juul’s electronic cigarette device and refillable cartridges in tobacco and menthol flavors can help adult cigarette users reduce smoking or switch to less harmful products, outweighing the risk to youth.

...

"The news comes a few days after the Vapor Technology Association, an industry group, said it launched a seven-figure ad campaign urging President Donald Trump to draw a distinction between vape products targeting youths and “safer, adult-focused alternatives” touted as smoking-cessation tools. Trump previously offered enthusiastic support for vaping and promised to protect the industry while campaigning in 2024.

...

"A 2024 Centers for Disease Control and Prevention survey found vapes were the most common tobacco product used by middle- and high-schoolers. About 1.6 million students use electronic cigarettes, according to the survey — and nearly 90 percent of those who vape prefer the flavored liquids, the survey reported.

Thursday’s Juul decision drew immediate outcry from public health groups that assert vapes are addictive and can harm the development of maturing brains."

Helping meth users quit, by paying them

 The NYT has the story:

Upended by Meth, Some Communities Are Paying Users to Quit
Unlike with opioids, there is no medication to suppress cravings for meth and other stimulants. As use soars, hundreds of clinics are trying a radically different approach.   By Jan Hoffman

“Give me something that’s going to help me with this,” she begged her doctor.

“There is nothing,” the doctor replied.

"Overcoming meth addiction has become one of the biggest challenges of the national drug crisis. Fentanyl deaths have been dropping, in part because of medications that can reverse overdoses and curb the urge to use opioids. But no such prescriptions exist for meth, which works differently on the brain.

...

"Lacking a medical treatment, a growing number of clinics are trying a startlingly different strategy: To induce patients to stop using meth, they pay them.

...

"Even those who are uncomfortable with the general concept are starting to come around, said Dr. Sally Satel, medical director at a methadone clinic in Washington, D.C., and a senior fellow at the American Enterprise Institute. “Most people recoil at paying people to do the right thing,” she said. “But we’ve got plenty of data that shows this works. So I think we just have to bite the utilitarian bullet.”

Doping in the Tour de France: new dimensions

 There was a time when only riders had to be tested for doping, but advances in electric motors and batteries mean that bikes too can be suspect.  However it's the riders who get the most, increasingly sophisticated scrutiny.

Here's the story from Cycling News:

Tour de France judges to study video for 'suspicious behaviour' in continued fight against motor doping
By Laura Weislo  

"For the Tour de France, the ITA has increased its traditional urine and blood doping controls and analysis to detect performance-enhancing drugs directly. They will also be emphasizing longitudinal analysis (changes over time) by expanding the blood biological passport to include steroid and hormone levels to detect markers of abuse of difficult-to-detect substances such as human Growth Hormone (hGH).

...

"During the Tour de France, ITA expects to collect upwards of 600 urine and blood samples, with 350 coming as out-of-competition tests before the Grand Depart in Lille on Saturday. They will also use data and intelligence to select samples to be retained for long-term storage and re-analysis during the allowed 10-year window. The ITA re-analysed 490 samples collected in 2015 and all came back negative."

Ritalin and Adderall

 The NYT has a long story this morning on attention deficit hyperactivity disorder (ADHD) and the amphetamines prescribed to treat it, which go by the brand names Adderall and Ritalin.  College students sometimes take one of these  as a performance-enhancing study aide, so I read the story with attention.The undergraduates I meet always deny taking it but know those who do, and acknowledge that it is readily available.  The story suggests that it might be most helpful for studying boring material...

Have We Been Thinking About A.D.H.D. All Wrong?
Even as prescriptions rise to a record high, some experts have begun to question our assumptions about the condition — and how to treat it.   By Paul Tough 

" The number of American children diagnosed with A.D.H.D. more than doubled in the early 1990s, from fewer than a million patients in 1990 to more than two million in 1993, almost two-thirds of whom were prescribed Ritalin.

...

" Last year, the Centers for Disease Control and Prevention reported that 11.4 percent of American children had been diagnosed with A.D.H.D., a record high. That figure includes 15.5 percent of American adolescents, 21 percent of 14-year-old boys and 23 percent of 17-year-old boys. Seven million American children have received an A.D.H.D. diagnosis, up from six million in 2016 and two million in the mid-1990s.

The preferred treatment for A.D.H.D. remains stimulant medications, including Ritalin and Adderall, and the market for those stimulants has expanded rapidly in recent years, in step with the growth of the diagnosis. From 2012 to 2022, the total number of prescriptions for stimulants to treat A.D.H.D. increased in the United States by 58 percent. Although the prescription rate is highest among boys ages 10 to 14, the real growth market today for stimulant medication is adults. In 2012, Americans in their 30s were issued five million prescriptions for stimulants to treat A.D.H.D.; a decade later, that figure had more than tripled, rising to 18 million.

That ever-expanding mountain of pills rests on certain assumptions: that A.D.H.D. is a medical disorder that demands a medical solution; that it is caused by inherent deficits in children’s brains; and that the medications we give them repair those deficits. 

...

"Accurately diagnosing A.D.H.D. can be challenging, for a number of reasons. Unlike with diabetes, there is no reliable biological test for A.D.H.D. The diagnostic criteria in the D.S.M. often require subjective judgment, and historically those criteria have been quite fluid, shifting with each revision of the manual. The diagnosis encompasses a wide variety of behaviors. There are two main kinds of A.D.H.D., inattentive and hyperactive/impulsive, and children in one category often seem to have little in common with children in the other. There are people with A.D.H.D. whom you can’t get to stop talking and others whom you can’t get to start. Some are excessively eager and enthusiastic; others are irritable and moody.

...

"Farah directed me to the work of Scott Vrecko, a sociologist who conducted a series of interviews with students at an American university who used stimulant medication without a prescription. He wrote that the students he interviewed would often “frame the functional benefits of stimulants in cognitive-sounding terms.” But when he dug a little deeper, he found that the students tended to talk about their attention struggles, and the benefits they experienced with medication, in emotional terms rather than intellectual ones. Without the pills, they said, they just didn’t feel interested in the assignments they were supposed to be doing. They didn’t feel motivated. It all seemed pointless.

"On stimulant medication, those emotions flipped. “You start to feel such a connection to what you’re working on,” one undergraduate told Vrecko. “It’s almost like you fall in love with it.” As another student put it: On Adderall, “you’re interested in what you’re doing, even if it’s boring.”

"Historically, this is one of the main reasons people have taken amphetamines: They make tedious tasks seem more interesting. During World War II, the American military distributed tens of millions of amphetamine tablets to enlisted men for use during the many boring stretches of war. The pills were given to Air Force pilots flying long missions and to Navy sailors who had to keep watch all night. In the 1950s, suburban housewives took amphetamines to get through the boredom of endless days of housework and child care. Long-distance truckers have for decades used them to tolerate the tedium of the road. For the college students Scott Vrecko interviewed, term papers were just as boring as laundry or a long-haul truck route — but they became more bearable with the help of stimulants.

...

"Compared with other psychiatric medications, Gabrieli explained, Ritalin and Adderall (and the many similar formulations on the market today) are relatively safe and effective. They don’t help everyone, but in the short term, at least, they provide significant symptom control in most of the children who take them. Clinicians generally consider them easy to prescribe, in part because they’re usually easy for patients to quit. Unlike antidepressants or many anti-anxiety medications, they don’t linger in the bloodstream for more than a day, which means that even with the extended-release versions, they don’t require a weaning process. You can just stop taking them. “At some level,” Gabrieli told me, “these stimulants are not that far from Red Bull.”

CDC’s laboratory on sexually transmitted diseases is shut by Trump administration

 Statnews has the story:

CDC’s top laboratory on sexually transmitted diseases is shut by Trump administration
‘We are blind,’ researcher says, noting the lab is crucial to tracking drug-resistant gonorrhea and other diseases  By Helen Branswell April 5, 2025

"At a time when the world is down to a single drug that can reliably cure gonorrhea, the U.S. government has shuttered the country’s premier sexually transmitted diseases laboratory, leaving experts aghast and fearful about what lies ahead.

"The STD lab at the Centers for Disease Control and Prevention — a leading player in global efforts to monitor for drug resistance in the bacteria that cause these diseases — was among the targets of major staff slashing at the CDC this past week. All 28 full-time employees of the lab were fired.

...

"A CDC white paper on antibiotic resistance released during the first Trump administration listed drug-resistant gonorrhea as one of five urgent threats facing the country. Antimicrobial resistance to that last drug that reliably works to cure gonorrhea, ceftriaxone, is rare but on the rise globally."

 

Colombia proposes coca leaf legalization

 The Guardian has the story:

Colombia urges UN to remove coca leaf from harmful substances list
Foreign minister says legalisation of main ingredient of cocaine the only way to stop drug trafficking and violence  Agence France-Press in Vienna
 
"Colombia, whose president, Gustavo Petro, is a vocal critic of the US-led war on drugs, has urged the UN to remove coca – the main ingredient in cocaine – from a list of harmful substances.

Used not only for cocaine, the coca leaf is also chewed as a stimulant in countries such as Colombia, Peru, Bolivia and Ecuador, or brewed into a tea thought to combat altitude sickness.

"Colombian foreign minister Laura Sarabia, in an address to the UN’s commission on narcotic drugs in Vienna, insisted on Monday that the leaf “is itself not harmful to health”.

"Removing it from a 1961 UN list of harmful narcotics, where it sits alongside cocaine and heroin, would allow it to be used to “its full potential in industrial applications such as fertilisers and beverages,” she said.

"She argued that legalisation was the only way to stop drug traffickers monopolising the plant – forcing rural communities to grow it for them, and razing forests for its cultivation.
...
Colombia is the world’s main producer of cocaine – much of its production in the hands of drug cartels and violent guerrilla groups.

In 2023, the South American country set a new record last year for coca leaf cultivation and cocaine production, which rose 53% from 1,738 tonnes (1,915 US tons) to 2,600 tonnes, according to the UN.

The United States is the biggest cocaine consumer.

...

“If you want peace, you have to dismantle the business (of drug trafficking),” he said during a government meeting. “It could easily be dismantled if they legalise cocaine in the world. It would be sold like wine.”

"Sarabia on Monday insisted that changing the approach from a punitive one towards a more humanitarian one did not imply “normalising or coexisting with drug trafficking”.

Mexico focuses on cross-border gun traffic after U.S. designates drug cartels as terrorists

 Politico has the story (from the Associated Press):

Mexico to reform constitution in wake of US terrorism designations
The move by the Trump administration has stirred worry that it could be a preliminary step toward U.S. military intervention on Mexican territory 

“What we want to make clear in the face of this designation is that we do not negotiate sovereignty,” Sheinbaum said. “This cannot be an opportunity for the United States to invade our sovereignty.”

"Her administration also proposed reforming the constitution to apply the most severe penalties available under law to foreigners involved in the building, smuggling and distribution of guns. Mexico has long demanded that the U.S. do more to prevent the flood of guns into Mexico from U.S. gun shops and manufacturers." 

#######

Earlier:

Wednesday, March 27, 2024 Mexico’s Law Suit Against US Gun Dealers

 

US Ranks Highest in Global Overdose Deaths

 Here's a sobering news article from JAMA:
US Ranks Highest in Global Overdose Deaths by Samantha Anderer,
JAMA. February 7, 2025. doi:10.1001/jama.2025.0240
 

"A recent Commonwealth Fund report confirmed that the US overdose death rate remains far higher than in any other country. In 2022, the US overdose rate was 324 deaths per 1 million people, 1.5 times greater than in Scotland, the second-ranked nation with 219 deaths per million people. Although Scotland saw fewer deaths in 2022 than in previous years, rates in the US continued to climb, up about 53% from 2019. For the third consecutive year, drug overdoses claimed more than 100 000 lives in the US, according to provisional 2023 data from the US Centers for Disease Control and Prevention.

"The Commonwealth Fund report cited inadequate investment in treatment and prevention strategies as a major contributor to the discrepancy between the US and the rest of the globe. Only 11% of people in the US diagnosed with opioid use disorder reported receiving substitution therapy in 2020 compared with 87% in France and 51% in Scotland. "

#########

Here's the report:

U.S. Overdose Deaths Remain Higher Than in Other Countries — Trend-Tracking and Harm-Reduction Policies Could Help by Evan D. Gumas

"Provisional data show that drug overdoses in the United States claimed more than 100,000 lives for a third consecutive year in 2023 — a more than 50 percent jump since 2019. By a substantial margin, the U.S. has the highest rate of overdose deaths in the world, followed by Puerto Rico — a U.S. territory. And while Scotland and Canada, the second- and third-ranked countries, saw decreases from 2021 to 2022, rates in the U.S. have remained high. Our analysis, using the latest mortality data from 2022, compares the U.S. overdose rate — 324 deaths per 1 million people, or almost 108,000 deaths in 2022 — to dozens of countries from across the globe and finds that the U.S. unequivocally has the highest rate of overdose deaths in the world.

The U.S. can learn from other countries by tracking emerging trends and adopting comprehensive approaches to prevention and treatment that prioritize public health and harm reduction.

 

 Source: Evan D. Gumas, “U.S. Overdose Deaths Remain Higher Than in Other Countries — Trend-Tracking and Harm-Reduction Policies Could Help,” To the Point (blog), Commonwealth Fund, Jan. 9, 2025. https://doi.org/10.26099/ppdk-qy10