ER Visits Related to Brain Stimulants Have Quadrupled

For ADHD medications and other stimulants, a reprise
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Ad for Ritalin as a treatment for "Minimal Brain Dysfunction," a precursor to what is now known as "Attention Deficit Hyperactivity Disorder" (Amphetamines.com)

In the mid twentieth century, amphetamines could treat just about anything. In a 1946 medical journal article, Dr. W.R. Brett documented the effectiveness of benzedrine for narcolepsy, Parkinson's disease, alcoholism, sea sickness, barbiturate intoxication, inability to control urination, "problem children," anesthetic overdose, epilepsy, morphine addiction, schizophrenia, migraines, heart block, multiple sclerosis, myasthenia gravis, muscular rigidity, cerebral palsy, hives, painful menstruation, colic, radiation sickness, and low blood pressure.

Not only did physicians regularly recommend amphetamine as a nasal decongestant, obesity treatment, and as one of the first widely used medications for depression, but up until 1965 people could also self-medicate over-the-counter at will.

The popularity may have been in part because amphetamines hit our brains with some extra dopamine (in a "tonic" fashion that's subtler than the "phasic" mechanism of drugs like cocaine), but they also really did work for many of the advertised purposes. In 1967, around 8 billion amphetamine tablets were sold in the U.S. as treatments for obesity alone.

SHARK300200.jpg1940s Dexadrine ad (Amphetamines.com)

They fell out of favor among medical professionals for most conditions, though, as tends to happen for drugs with amphetamine-grade addiction potential. Not only did we find more effective treatments for things like depression, but it also became apparent as the National Institute on Drug Abuse now warns  that central nervous system (CNS) stimulants "can lead to feelings of hostility or paranoia, even psychosis." That's in addition to potentially catastrophic bodily concerns like cardiac failure, seizures, irregular heartbeats, and "dangerously high body temperature."

As you know from a billion trend stories, CNS stimulants are back in demand now, especially for the flourishing diagnosis of ADHD. Some pharmacies consistently struggle to keep amphetamines in stock, and there are wait lists for prescription refills. The primary drugs prescribed today are dextroamphetamine (Dexedrine, Adderall) and non-amphetamine methylphenidate (Ritalin, Concerta). What these medications do, like amphetamines of old, is mimic and enhance the actions of norepinephrine (noradrenaline) and dopamine in our brains. 

What the National Institute of Drug Abuse classifies as a "dramatic" return of stimulant prescriptions to the medical scene in the last two decades does feed a black market, and the ubiquity, ease of access, and the fact that they're often prescribed to children (and used safely and to good effect) seem to paint a health halo, or a picture of benignity, that for some effectively condones recreational and off-label use (especially for cognitive and physical performance enhancement).

It's with that concern in mind that the U.S. Substance Abuse and Mental Health Services Administration is looking at the effects of "nonmedical use" of CNS stimulants. In a report released on Friday they tell us that emergency department visits among young adults related to these stimulants quadrupled — from 5,600 in 2005 to almost 23,000 in 2011.

Stimulant-related ED visits among people 18 to 34

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SAMHSA

SAMHSA defined the "nonmedical use" as either taking too much, taking something that wasn't prescribed for you, or taking more than the recommended dose of an over-the-counter product. The prescriptions included amphetamine and non-amphetamine stimulants. Meth was not included.

A few months ago I wrote about SAMHSA's report that indicted energy drinks, citing a ten-fold in energy-drink related ER visits in recent years. The stimulant numbers in the current report do include some energy drinks, but SAMHSA says the drinks "had a minor effect" on these nonmedical use numbers, because they're usually classified under "adverse reactions." In  2011, for example, 70 percent of 20,000+ energy-drink related visits involved "adverse reactions."

I don't read this as an indictment of these medications, but as a solid case for their judicious and supervised use as they become increasingly prevalent. We can learn from our historic love affair with CNS stimulants. It didn't work out, and that doesn't mean we can't still be friends, but we shouldn't sleep together.

The question remains, as we're told we can't trust high doses of brightly-colored canned products like Monster, Full Throttle, CHARGE!, Hardcore Energize Bullet, Facedrink, Eruption, Crakshot, Crave, Crunk, DynaPep, Rage Inferno, SLAP, and even Venom Death Adder — and prescription stimulants are sending us to the hospital in increasing numbers — why do we young adults so demand this sort of stimulation? How does one get through the modern day, and keep up with his modern peers, without stimulants? Should everything always begin and end with coffee?

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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