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ARE PRESENT DAY WORLDWIDE CONTROLS
ON THE SALE OF METHYLPHENIDATE JUSTIFIED?
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Armando Filomeno, M.D.
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¿What
proof exists that methylphenidate is a drug that can cause addiction
or that it has a high abuse potential that justifies the present day
control on its sale?
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None;
many
medical articles endorse this statement. The present day standpoint,
widely accepted by physicians who have knowledge and experience in
the subject, is that far from producing or favoring addiction,
methylphenidate protects ADHD patients from that risk. The studies
have been done on stimulant drugs; as methylphenidate has been the
most widely used stimulant drug in the last 30 years, the results
apply especially to it.
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There
are at least twelve studies in the academic medical literature that
endorse this, against one single study —which has been widely
criticized due to its defective methodology— which states
otherwise. This is thoroughly discussed by Dr. Russel Barkley — a
pychologist who is an authority in the field of ADHD— in an
article published in Pediatrics in January 2003:
Russell
A. Barkley, Mariellen Fischer, Lori Smallish and Kenneth Fletcher.
Does the Treatment of Attention-Deficit/Hyperactivity Disorder with
Stimulants Contribute to Drug Use/Abuse? A 13-year Prospective
Study. Pediatrics,
Vol. 111 n.º 1. January
2003
(pages 98 and 99 are especially pertinent).
Link
to the full text article:
http://pediatrics.aappublications.org/cgi/content/full/111/1/97
Link to an abstract of the article:
http://pediatrics.aappublications.org/cgi/content/abstract/111/1/97
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Dr.
Joseph Biederman from Harvard Medical School and the
Massachusetts General Hospital —a recognized medical
authority in the field of ADHD— demonstrated, in two excellent
articles published in 1999 and 2003, that stimulant drugs
protect ADHD patients from addiction.
Joseph
Biederman, Timothy Wilens, Eric Mick, Thomas Spencer and Stephen V.
Faraone. Phamacotherapy of Attention-deficit/Hyperactivity Disorder
Reduces Risk for Substance Use Disorder. Pediatrics, Vol. 104, n.º
2, August 1999.
Link
to the full text article:
http://pediatrics.aappublications.org/cgi/content/full/104/2/e20
Link to an
abstract of the article:
http://pediatrics.aappublications.org/cgi/content/abstract/104/2/e20
Joseph
Biederman. Pharmacotherapy for Attention-Deficit/Hyperactivity
Disorder (ADHD) Decreases the Risk for Substance Abuse: Findings
from a Longitudinal Follow-Up of Youths With and Without ADHD.
Journal of Clinical Psychiatry. 2003.
Vol. 64 (suppl 11).
Link
to the full text article:
http://www.psychiatrist.com/supplenet/v64s11/v64s1101.pdf
Link
to an abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14529323&query_hl=10&itool=pubmed_docsum
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Dr.
Nora Volkow, Director of the National Institute on Drug Abuse, NIH,
and the distinguished neuroscientist Dr. James Swanson, have shown that, after oral administration, methylphenidate's
slow entrance to the brain and its even slower exit set it apart
from drugs which produce addiction.
Volkow, N.D. and James M.
Swanson. Variables That Affect the Clinical Use and Abuse of
Methylphenidate in the Treatment of ADHD. American J. Psychiatary.
160:1909-1918. 2003.
Link
to the full text article:
http://ajp.psychiatryonline.org/cgi/content/full/160/11/1909
Link
to an abstract of the article
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14594733
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There
is evidence that the abuse potential of methylphenidate is lower in
ADHD people, probably due to the increased number of dopamine
transporters they have.
Kollins,
Scott H. Comparing the Abuse Potential of Methylphenidate Versus
Other Stimulants: A Review of Available Evidence and Relevance to
the ADHD Patient. J Clin Psychiatry. 2003;64(suppl 11):14-18.
Link
to the full text article (especially page 17):
http://www.psychiatrist.com/supplenet/v64s11/v64s1103.pdf
Link
to an abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14529325&query_hl=12&itool=pubmed_docsum
The
abuse potential of methylphenidate would be limited to the abnormal
routes of administration, like intravenous injection and inhalation.
James M. Swanson and Nora
D. Volkow. Serum and brain concentrations of methylphenidate: implications for use and abuse. Neurosci
Biobehav Rev. 2003 Nov,27(7):615-21.
Link
to an abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14624806
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The phenomenon known as sensitization in
experimental animals has never been shown to happen in humans. There
is no evidence that children treated with methylphenidate have a
higer risk of addiction in adult life. Researchers from NYU Child
Study Center have studied this aspect thoroughly:
Klein R. and Mannuzza S. Is there stimulant sensitivity
in children? J Atten Disord. 2002;6 Suppl 1:S61-3
Link to an abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12685520
Klein R. and Mannuzza S. Does stimulant treatment
place children at risk for adult substance abuse? A controlled,
prospective follow-up study. J Child Adolesc Psychopharmacol 2003
Fall; 13(3):273-82.
Link to an abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14642015
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Finally,
besides all the evidence that has been shown, it is
reasonable to think that if methylphenidate helps people with ADHD normalize their lives —a fact demonstrated beyond any doubt—
the risk of drug addiction, due to repeated frustrations and
decreased likelyhood of success, must necessarily be lower in those
who are being or who have been treated with this drug.
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This
translated text has been extracted from:" Reunión con la Ministra de
Salud sobre la venta del Ritalin", published in APDA’s newletter
nº
5, September 19, 2004, which can be read on this website: http://www.deficitdeatencionperu.org/reunion%20ministra.htm
Modified
in September2006.
Dr.
Filomeno’s e-mail is: armandofilomeno@telefonica.net.pe
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