Brain & Drugs

Avoid Stimulant Drugs

Stimulant drugs increase the risk of stroke and sudden death. They must be used with caution or avoided. The drugs of concern are epinephrine, norepinephrine, ephedrine, ephedra, pseudoephedrine, phenylpropanolamine, methyphenidate, ampthetamine, and methamphetamine. Children and adults are prescribed stimulants such as Ritalin and amphetamines. Many stimulants are sympathomimetic agents that act on the fight and flight sympathetic nervous system. Effects include tachycardia, hypertension, sweating, hyperthermia, agitation, and combativeness.

Multiple doses of caffeine are added to stimulant drugs found in weight loss products, cold remedies, cough syrups, energy drinks and prescription drugs. Sympathetic amines increase blood pressure, heart rate and decrease brain perfusion. Stimulant drugs are often hidden in over the counter remedies - decongestant syrups and sprays, cough syrups, pills and capsules sold to "treat" colds and flu ( none of these products work as promised and none should be used.)

Emma Hitt reviewed the dangers posed by high caffeine "Energy Drinks." She wrote:" A lack of research and regulation associated with energy drinks, combined with reports of toxicity and high consumption, may result in dangerous consequences in children, adolescents, and young adults, according to a review of scientific literature and Internet sources." Sara M. Seifert et al reported that energy drinks are regularly consumed by 30% to 50% of children, adolescents, and young adults. They suggested that the use of energy drinks provide no benefit and can have serious adverse health effects. Energy drinks are categorized in the US under the bizarre category "nutritional supplements" which includes many products that have nothing to do with nutrition. Under this category the drinks can have high caffeine content of 75 to 400 mg caffeine per container, avoiding the limit of 71 mg caffeine per 12 fluid ounces that the US FDA set for sodas. They cited a New Zealand report that found that children, teenagers, and young men would exceed an adverse effect level of 3 mg/kg per day of caffeine after consuming a single retail unit of energy drink or energy shot in addition to dietary exposure. Germany, Australia, and New Zealand have reported numerous adverse outcomes associated with energy drink consumption. These include liver damage, kidney failure, respiratory disorders, agitation, confusion, seizures, psychotic conditions, nausea, vomiting, abdominal pain, rhabdomyolysis, tachycardia, cardiac :dysrhythmias, hypertension, myocardial infarction, heart failure, and death. Other ingredient in the drinks are also potentially harmful such as 5-hydroxy tryptophan, vinpocetine, yohimbine, and ginseng. (Emma Hitt. Energy Drinks Pose Serious Health Risks for Young People. Medscape Medical News. Feb 2011. Pediatrics. 2011;127:511-528.)

Mephedrone, a synthetic stimulant

Mephedrone, a synthetic stimulant, comes in tablet or powder forms and users typically swallow, snort, or inject this drug. Bath salts are designer drugs that often contain mephedrone and are available on the Internet. The street names for mephedrone bath salts are numerous and include ivory snow, vanilla sky, arctic blast, white rush, and white knight. During a 4-month period, 35 patients who had inhaled, injected, or ingested bath salts presented to emergency departments in Michigan. Of these 35 patients, 17 were hospitalized and one was dead upon arrival. After September 2011, possessing and selling these chemicals became illegal in the US.

Cocaine

Cocaine made from coca leaves is a common abused drug. Cocaine is the second most popular illegal drug in the United States, the world's largest consumer of cocaine. The estimated U.S. cocaine market exceeded US$70 billion in street value (2005). In Canada cocaine bought on the street costs $80/gm. The drug is marketed by drug cartels in Mexico and South America. Cocaine is commonly used in middle to upper-class communities and is known as a "rich man's drug". It is also popular amongst college students, as a party drug. Cocaine addicts become drug dealers, thieves, and commit violent crimes. Cocaine is snorted, inhaled as smoke, injected into a vein as a solution. Effects may include loss of contact with reality, an intense feeling of happiness, strengthen or confidence, or agitation. Physical symptoms may include a fast heart rate, sweating, and large pupils. High doses can result in high blood pressure and/or body temperature. After a short period of use, there is a risk that dependence will occur. Cocaine use increases the risk of stroke, myocardial infarction, lung problems, blood infections, and sudden death. Cocaine sold on the street is commonly mixed with local anesthetics, cornstarch, quinine, caffeine, amphetamine, or sugar which can result in additional toxicity.

Ephedra

Haller and Benowitz warned that: “Dietary supplements that contain ephedra alkaloids (also known as ma huang) and guarana-derived caffeine are widely consumed in the United States for purposes of weight reduction and energy enhancement. A number of reports of adverse reactions to dietary supplements that contain ephedra alkaloids, some of which resulted in permanent injury or death, have appeared in the medical literature. In response to growing concern about the safety of ephedra alkaloids in dietary supplements, the Food and Drug Administration (FDA) requested an independent review of reports of adverse events related to the use of ephedra alkaloids to assess causation and determine the level of risk these products pose to consumers.”

Ritalin and Amphetamines

In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “

Professor Sroufe wrote: “Three million children in the USA take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning. But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled? In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder. As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs. Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth. Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.”

A highly regarded Cochrane Review showed that there is only very low-quality evidence to support the use of methylphenidate (Ritalin, Concerta, other brands) in children with attention deficit hyperactivity disorder (ADHD) leading the reviewers to urge more caution when prescribing stimulants. Dr Storebø and Dr Zwi stated: "We should view the average reduction in symptom scores attributable to treatment with a high degree of caution," they add. "Clinicians need to weigh what we now believe to be an uncertain degree of benefit against the many adverse events that are known to be associated with methylphenidate, such as appetite suppression and sleep difficulties. The general perception of methylphenidate as an effective drug for all children with ADHD seems out of step with the new evidence. This new information from our review should challenge the mindset of clinicians because there is more uncertainty to factor in to balancing the benefits and risks of these medications." (Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD) Cochrane Database of Systematic Reviews. November 25 2015.)

May 26 2006 Canada's health ministry warned individuals with hypertension, heart disease or abnormalities, arthrosclerosis or hyperthyroidism not to take drugs used to manage attention deficit hyperactivity disorder (ADHD). All ADHD drugs stimulate the heart and blood vessels... in some patients this stimulation may result in cardiac arrests, strokes or death.

The drugs mentioned by Health Canada include:

Adderall XR, made by Britain's Shire Pharmaceuticals Group Plc

* Concerta, made by Johnson & Johnson

* Ritalin and Ritalin SR, made by Novartis AG

* Dexedrine, made by GlaxoSmithKline Plc

* Strattera, made by Eli Lilly and Co.

Walter N. Kernan, et al. Phenylpropanolamine and the Risk of Hemorrhagic Stroke N Engl J Med 2000;343:1826-32

Nissen S. ADHD Drugs and Cardiovascular Risk. Published at www.nejm.org March 20, 2006

High Blood Pressure According to the Canadian Coalition for High Blood Pressure Prevention and Control, non-drug strategies should be the priority for hypertension control.

The Alpha Nutrition Program can be recommended, along with exercise and rational learning assistance without drugs to manage ADHD.


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