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Cheat, or Quit | Within 1000 Days, Neo-Pro Cyclists Make a Difficult Choice

History has shown that society is very critical of athletes who take drugs to gain a competitive edge. Sometimes referred to as “doping,” taking steroids and other performance enhancers is considered to be “cheating” by fans and organizational bodies, even when the evidence shows that everyone is doing it.

Why is society so critical of athletes who take steroids? One explanation is that fans are simply unaware that doping is ubiquitous in professional sports. In a recent episode of Straight Talk MD, international anti-doping policy expert, Professor Paul Dimeo, explains that, in cycling, “doping” is practically a requirement, and how all new cyclists must face the conundrum at some point: Cheat, or give up your dreams.

Dimeo

“There’s a Scottish cyclist called David Miller, and he was caught with EPO. He wasn’t actually tested positive, but because he was in a team where other people had been caught, he had his apartment raided and they found syringes. Then eventually, under police interrogation, he confessed. But he hadn’t used them for very long, and in his autobiographical account, he says that when he arrived in the early 2000s, people said to him, “There’s no way you can do this clean. You’re gonna have to make a tough choice at some stage. Do you want to stay and compete at the highest level, or do you want to give up? If you want to be on a team and stay clean, you won’t get a good position in the team, and you won’t get a high place in any of the major events.”

"There's no way you can do this clean. You're gonna have to make a tough choice at some stage."

Dimeo

“There’s a lot of evidence which does suggest that cyclists were given that difficult choice to make. Tyler Hamilton, one of Lance Armstrong’s teammates, says that there’s this “thousand day” rule, almost a three year process. The first year, a neo-pro, a young professional, would turn up full of idealism, hoping to do it clean. Then the second year, he would come to realize, like David Miller did, that actually this may not be possible. And the third year would be the point where they had the choice. They had to make the choice whether to stay and dope and compete, or basically give up; give up their ambitions.”

Want to learn more? Click to listen to the full interview with Paul Dimeo

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Medication Is An Incomplete Treatment For ADHD In Children

ADHD Medication ChildrenA 2015 report from the George Washington University Milken Institute School of Public Health finds that the number of diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) has risen by 43% since 2011. What the hell is going on?

In a recent episode of Straight Talk MD, author of “ADD Explosion”, Dr. Stephen Hinshaw, explains the various causes for this dramatic rise in ADD and ADHD diagnosis. He also discusses the treatment of ADD and ADHD in children, and explains how the healthcare system is set up to incentivize treating these disorders through medication alone, which is only part of a healthy and effective treatment for these disorders.

Sweeny:

“You outline how a combination of medication and behavioral therapy usually leads to the best outcomes for ADHD, but is our health care and mental health system even set up for this kind of treatment?”

Hinshaw:

“One of the policy changes back in the ’90s that led to a lot of the ADHD diagnosis was a change in authorization of Medicaid, which out here in California is Medical, where ADHD was a reimbursable diagnosis for doing, again a fairly cursory, but the assessment of it. There’s only one reimbursed treatment under Medicaid which is medication. There’s no reimbursement for family management training or doing a school consult which are the evidence based psychosocial treatments.

So medicine is reimbursed sometimes only, or exclusively, as a quick way to get at the symptoms.”

"So medicine is reimbursed, sometimes only or exclusively, as a quick way to get at the symptoms."

Sweeny:

“Medication means giving stimulants or something like that?”

Hinshaw:

“Stimulants are the primary medication for ADHD, and that’s confusing! Why would you stimulate a kid who seems already too active? The short story here is that the stimulants are SDRIs, selective dopamine re-uptake inhibitors. They stop dopamine once it’s squirted out from the first neuron in the chain from being taken back into that first neuron. It allows more dopamine to be active.

Dopamine is the neurotransmitter that gives you that sense of intrinsic reward. It helps you regulate your motor behavior. It has implications for learning, with the projections that go out to the frontal lobes (planning and organization). The medications do a good job in about 80% of cases, if you get the right kind of stimulant and the right dose, of keeping those symptoms in check, for as they are as long as they’re in the bloodstream, which is just a day at a time.

But what the medications, of course, can’t do is actually teach academics, or teach better social skills, or teach families how to discipline in a more consistent way. So almost by definition, it’s an incomplete part of a multimodal package that requires building skills in families and in schools and in the kids themselves, to learn in groups and learn how to interact socially better.

It’s those combination treatments that have the best chance of treating the whole child, and persisting in their effects longer than just medication alone.”

Want to learn more? Click to listen to the full interview with Dr. Stephen Hinshaw.

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Early Experiments With LSD: Treating Alcoholism With LSD Was A Proven Success

031312_vitals_lsd_alcoholLysergic acid diethylamide (LSD), also known as acid, is a psychedelic drug known for its psychological effects. Currently, it is illegal in the United States, and the DEA has categorized it as a Schedule I Drug, meaning that LSD has been deemed to have no legitimate medical use. However, LSD wasn’t always illegal, and during the early years after its discovery, doctors conducted experiments on patients with alcoholism. They found that LSD was a legitimate and proven treatment for the disease.

In a recent episode of Straight Talk MD, our guest Tom Shroder, author of the “Acid Test”, explained the interesting story behind these early experiments, and how LSD helped many alcoholics overcome their addiction.

Sweeny:

“Every person who studied this, self-experimented with it. Today, people would definitely look at you like you’re crazy. I’m an anesthesiologist and if I started experimenting with fentanyl, I’m a dead man. I’m done. Here, it was like standard.”

Shroder:

“Well early in the history of psychopharmacology, this is what people did. They did do self-experimenting. It does sound a little crazy, but when Hoffman’s first did it, he took a tiny, tiny, tiny, tiny dose, a fraction of what you think might have an effect, and then slowly he worked his way up.

A lot of people were doing this. And the other thing is, that the effects were so profound, that someone who did do that would likely want to continue in the research, because suddenly they’re thinking ‘This is the most valuable insight of my life. So, obviously, this has to be something that could be useful.’ Humphry Osmond was one of these people, and he went to a tiny psychiatric hospital, in nowhere in Canada. I mean, in the middle of nowhere in Saskatchewan, and they started doing experiments.”

"It wasn't the drug that cured them, but it was rather the experience that the drug enabled."

Shroder

“They were treating alcoholics by giving them an LSD experience, and what they discovered was that – unlike with penicillin, where you have an infection and you give somebody penicillin, and without any conscious involvement on the patient’s part, the drug attacks the infection, kills off the bacteria and the wound heals. In the case of psychedelics, it wasn’t like you gave them the drug, and it sort of somehow attacked the alcoholism and made it go away. Instead, it enabled these profound, spiritual type experiences, that gave people the insight that made them not want to drink anymore because they had a new attitude about themselves and their bodies. It wasn’t the drug that cured them, but it was rather the experience that the drug enabled. This was sort of the core of all future therapeutic uses of these drugs.”

Sweeny:

“He was very successful. He was far more successful in fact than any other treatment of alcoholism.”

Shroder:

“Yes! In fact, Canada had said that this was no longer an experimental treatment. It was, in fact, a proven treatment, and this was right about 1970 and the late 60s, where it all got shut down because everybody started freaking out about it, and they put it on the most restrictive category of prohibited drugs.”

Want to learn more? Click to listen to the full interview with Tom Shroder.

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Why Are Psychedelics Threatening To Western Society?

pasted-image-2Lysergic acid diethylamide (LSD), also known as acid, is a psychedelic drug known for its psychological effects. Many who have taken LSD describe the experience as one of the most insightful events of their lives, with long lasting effects that have significantly changed them for the better. Despite the overwhelmingly positive reaction from those who have taken LSD, LSD is illegal in the United States, and is classified as a Schedule I Drug by the DEA, meaning that LSD was deemed to have no legitimate medical use.

In a recent episode of Straight Talk MD, Dr. Frank Sweeny spoke with Tom Shroder, author of the “Acid Test,” a book that examines the proven efficacy of LSD in treating psychological disorders such as Post Traumatic Stress Disorder.

Sweeny:

“Early on in your book, you said that psychedelics were really threatening to Western culture. Why are they any more threatening than OxyContin or Valium? It seems like these took a different course. People were much more concerned about Psychedelics.”

Shroder:

“Heroin and opiates, like Oxycontin, worked on the brain in a way that people understood rationally. It stimulated the pleasure centers and dulled the pain centers, and it worked on the brain in a way that that made sense in a mechanistic way. Press this button, and this button, and this happened. People understood that, in the rational western view. But psychedelics did something else. It worked in this mysterious way, in which the entire perception of the world altered dramatically.

After Albert Hofmann sort of stumbled on the invention of LSD in ’47, Sandoz, a pharmaceutical company that Hoffman worked for, started sending out LSD to researchers around the world. They just got these envelopes and here was some LSD, and they said, basically, ‘Hey just go wild with this stuff. See what it does.’

Originally they had this idea that it mimicked psychosis, that you took it and you were temporarily psychotic. Psychosis was such a difficult illness for people to deal with or even understand, that they thought maybe these doctors could take it themselves and get insight into what their psychotic patients were feeling.

But then, people around the world began taking this, and they began realizing – wait a second, this isn’t just making me psychotic. This is giving me these incredible insights that are changing my life for the better.”

Want to learn more? Click to listen to the full interview with Tom Shroder.

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Are Doctors Aware They Are Causing The Opioid Epidemic In The United States?

pasted-imageAccording to the CDC, “more people died from drug overdoses in 2014 than in any year on record”, and “more than 6 out of 10 of those overdose deaths involve an opioid”. Most surprising is that “at least half of all opioid overdose deaths involve a prescription opioid”, meaning that the drugs were obtained legally through a valid prescription by a doctor.

In a recent episode of Straight Talk MD, Dr. Frank Sweeny interviewed Anna Lembke, author of “Drug Dealer MD”, a book that examines the opioid epidemic in the United States. She explains how the U.S. healthcare system is a driving force behind this epidemic:

Sweeny:

“Are doctors in general aware that they’re the source of this prescription drug epidemic?”

Lembke:

“You know, it’s a great question because you really can’t read a major newspaper or listen to media without some story about the horrible epidemic, people dying of accidental overdoses, people turning to heroin because they can’t get their pills from their doctors anymore, or whatever it is. It’s hard to imagine that there’s a doctor in the country who’s not aware, but you know what? There are a lot. And they keep prescribing. It’s unfathomable.

What my book tries to get at is, Why? How can that be? Because it’s still happening. In 2011, the CDC declared to the nation that we were in the midst of a prescription drug epidemic. Now, that’s their job, like they announce when there’s a tuberculosis epidemic or an HIV epidemic. So, here they say in 2011, we are in the midst of a prescription drug epidemic and it is driven by doctors overprescribing. Ok, that’s 2011. In 2014, doctors write a record high number of prescriptions for opioids. What’s going on here?”

"As much as 50% of patients who receive an opioid long-term for a chronic pain condition will develop some kind of addiction or addictive behaviors around that drug."

Sweeny:

There’s a disconnect here. The reason I say that is because, a lot of time, I don’t think they’re hearing that second part of it. There’s a prescription drug epidemic, but a lot of them just come to the conclusion that this is a diversion. You know, people sharing pills, selling pills and so on. No, a lot of these patients, from what you’ve written here, over 80% of them or so, started out with the gateway drug being from a prescription by a doctor.

Lembke:

Absolutely. The other thing that I think is a myth and a misconception among a lot of doctors, is that people who get addicted to prescription drugs were already addicts anyway. If they hadn’t found prescription drugs, they would have used alcohol, or they would have found something else. But what they don’t realize is how much iatrogenic addiction is going on. By that I mean, how many people actually come in with no history of addiction, get put on a prescription that’s addictive by a doctor, and become addicted because of that prescription. That’s a huge number. Some studies show as high as 50%, as much as 50% of patients who receive an opioid long-term for a chronic pain condition will develop some kind of addiction or addictive behaviors around that drug. That’s just a startling number.

Want to learn more? Click to listen to the full interview with Anna Lembke.

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Risk Factors For Addiction: Why Do Some People Get Addicted When Others Do Not?

drug-addictionIn 2011, the CDC announced that the United States was in the midst of a prescription opioid epidemic. The epidemic persists, and today, over half of all overdose deaths caused by opioid abuse are from patients abusing legitimate prescriptions from their own doctors. Simply stated, some people are at a high-risk for addiction, and a seemingly harmless prescription from a doctor to treat a legitimate ailment, can be a gateway to a life-long problem of substance abuse.

In a recent episode of Straight Talk MD, Dr. Frank Sweeny welcomed Anna Lembke, author of “Drug Dealer, MD”, into the virtual studio, and she explained what the important risk factors are for people who are likely to form a substance use problem.

Sweeny:

“Ok so that raises this question – Some people drink a glass of wine a day, forever. No problem. They don’t have any of these symptoms: of the control, the compulsion, or the consequences. There are lots of people with ADHD, taking Adderall or Ritalin for twenty years for a diagnosis of ADHD, but they don’t manifest the symptoms of addiction.

Why does one person take the Adderall and Ritalin and go off the deep end? You described a couple of cases like that, or at least one case of a lady whose life was ruined by it. Why do some people take it compulsively, and other people just say, I’ll take five milligrams of Adderall once a day and that’s fine. Why doesn’t everybody cross that line and develop an addiction with the same drug?”

Lembke:

“Right. So that’s the million dollar question that we don’t really have the answer to, except that we have identified some of the risk factors associated with crossing that line and developing addiction. One of the huge risk factors is actually genetics. If you look at family trees or twins studies, or any other studies that we typically use in the social sciences, to see which diseases are heritable, it turns out that 50- 75% of the risk of developing addiction is related to whether or not you have a parent or a grandparent who has some sort of addictive problem. Which, by the way, is much higher than the heritable risk with something like depression or even schizophrenia, which we think of as a very biological illness.

Genetics is huge. One of the things that doctors should be doing, which they’re not doing, is actually screening people for not just a personal history of addiction, but a family history of addiction. If it’s there, that individual is no doubt at much higher risk to go on to become addicted to the prescription that that that individual is prescribing.

"One of the things that doctors should be doing, which they're not doing, is actually screening people for not just a personal history of addiction, but a family history of addiction..."

Lembke

“There are other personality traits that have been linked to developing addiction, for example, impulsivity. So what is impulsivity? That means individuals who are less good at delaying gratification for positive rewards, or who tend to act on their thoughts without thinking about the consequences necessarily. Impulsivity is, in fact, a pretty stable genetic trait. We know that kids who rank high on scores of impulsivity are at increased risk to go on and develop addiction.

But I think it’s important to point out that although there are these genetic risk factors and these characterological risk factors, another huge risk factor is actually environmental risk factors. We often forget about this, but, for example, if you are poor, if you are unemployed, if you have a chaotic home and family environment, all of those are risk factors for addiction.

Probably the most important risk factor of all is simple access. If you live in a neighborhood where people are selling drugs on the street corner, you are more likely to develop a substance use problem. If you go to a doctor who freely writes prescriptions for Adderall and opioids, you are more likely to develop a substance use problem. So there’s some point at which the sheer access to a drug tips over, and it kind of becomes the most important risk factor of all. I think that’s the moment that we’ve reached in our history.”

Want to learn more? Click to listen to the full interview with Anna Lembke.

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Off-Label Use | The Unintended Side-Effects of Amphetamines

054f320a595186f4ab1fd183f1c21b98

Some inventions are destined to fail.

It’s no secret that many inventions don’t work out, like the “battery-powered battery charger” or the “umbrella tie.” Some inventions may not succeed as they were originally intended, but instead, are reimagined for other uses.

Drugs are no exception. Drugs are invented by researchers who are funded by multi-billion dollar pharmaceutical companies. Sometimes these drugs do not perform as they are expected to, and occasionally, a drug will produce unintended side-effects that garner a legendary “coming of age” tale in the medical industry.

Unintended Side-Effects

Take Rogaine, for example. This famous hair growth cream was originally intended to be used as a blood pressure medication. However, many patients complained that it was causing them to experience increased hair growth all over their bodies, so the drug was repurposed as a hair loss treatment. Another example, Viagra, was created to treat hypertension, for which it was mostly unsuccessful. Now, Viagra is a popular drug that is used to effectively treat erectile disfunction. There are many examples of these unintended consequences in pharmaceutical history, but few drugs are as prolific as amphetamines.

Amphetamines Everywhere

Today, amphetamines are commonly prescribed as Adderall to treat “Attention Deficit Disorder”

From an over-diagnosed populous of children with ADHD, to undergrads and professionals seeking a competitive edge, the use of amphetamines is growing rapidly in the United States. Commonly referred to as “speed,” amphetamines are widely used and abused for medical and recreational purposes. Little known fact though, they were originally intended to help treat asthma.

A Brief History of Amphetamines

The original Amphetamine "product", an asthma inhaler which was not as effective as competing brands.

The original Amphetamine product, an asthma inhaler, which was not as effective as competing brands.

Gordon A. Alles is known as the father of amphetamines. Although he was not the first to synthesize amphetamines in a laboratory, he was the first to synthesize amphetamines with the intention of using it as a drug. His original goal was to invent a drug that could replace ephedrine, an active ingredient in asthma inhalers which was becoming increasingly scarce.

Off-Label Use

Amphetamine-Propoganda

Fighter pilots used amphetamines to stay awake during World War II.

Alles’ invention was never quite effective in relieving asthma, but many fell in love with its stimulating side effects, which gave users an intense focus, alertness, and a sense of wellbeing. Soon, doctors were prescribing it as a treatment for Parkinson’s, narcolepsy and depression. During World War II, fighter pilots used it to stay awake during long nighttime raids. Today, more than fifteen million children and adults are prescribed Ritalin or Adderall as a treatment for Attention Deficit Disorder, a diagnosis that is arguably “too easy” to obtain.

To learn more about the history of amphetamines, its effects on the body, and its rampant abuse in the United States, check out Straight Talk MD’s podcast episode: “On Speed with Nicolas Rasmussen”.

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