[phainopepla2]

Duration of effect matters when it comes to successful treatments.

If we take your position and apply reductio ad absurdum, we could say that cocaine is a highly effective treatment for anxiety, although of course we know that in the not-so-long run it has the opposite effect.

[andoando]

But a lot of psychatric treatments are just that. Treatment for ADHD for example is giving ampethamines (which btw are chemically no different than a low dose of meth), which have a duration of 3-6 hours and its back to worse than baseline after the effect has worn off.

[Aurornis]

There are multiple treatments for ADHD, including alpha-2 receptor agonists and norepinephrine reuptake inhibitors. Some of them show patterns of increasing efficacy out to a year (the length of the study).

The reason amphetamines are used for ADHD but not depression is that they've been studied to show that the ADHD improving effect can remain for many months, while the mood-improving effect will taper off quickly if you take them every day. Almost everyone who takes ADHD stimulant, feels a mood and motivation boost ("so happy I could cry" is the common phrase) and then is disappointed when that mood boost stops happening after a few weeks or months will learn this. Attention enhancement is less prone to tolerance, though it still accumulates tolerance too. There are some studies showing that the effects of stimulants in ADHD diminish substantially on a multi-year time frame, and it's probably not a coincidence that many people (though not all) who take stimulants discontinue after several years.

[thesmtsolver2]

Just like how Hydrogen peroxide is chemically no different than a low dose of dihydrogen monoxide?

[andoando]

No not just like it, because the only difference with methampathemines is that the added meth group makes it able to cross the blood barrier much quicker, hence why I said its equivalent to a lose dose of meth. The chemical/biological response on the body and brain are very similar, the difference is in potency

[briHass]

But onset of action is a very important distinction in medicine/pharmacology, as is dose.

Most abusers of methamphetamine are not taking it orally (slow route of administration) and are generally using much higher relative dosing than ADHD patients are using amphetamines. Potential for addiction and other physical harms are greatly affected by both of those things, so the comparison has some truth, but is obviously sensationalized.

[DontForgetMe]

No, the difference between amphetamine and methamphetamine is that they are literal different chemicals.

If one could 'add meth'(??) to chemicals to make them more potent, without changing the chemical, it would be the difference between (for example) citric acid and really strong citric acid, or codeine 2.5mg and codeine 5mg.

You'll note that neither of these involves changing the name of the chemical, because that is not how chemical names work.

As someone else has pointed out, the difference between 'hydrogen monoxide' and 'dihydrogen monoxide' isn't 'it's like hydrogen monoxide with added di', because that is ridiculous.

Please stop saying anything beginning with 'meth' is just meth with added bits.

It's a really odd misinterpretation of the terrible dangers of: methane, Methodists, methanol, Methaemoglobin, methicillin, etc.

[sillywabbit]

Meth causes brain damage. Dex doesn't.

[landl0rd]

Well, it's not that simple. It's reasonable to expect that you could see some increased level of oxidative and excitotoxicity. It's harder to draw a bright line around the dopaminergic system specifically because some level of neuronal death is expected over the course of a lifetime. We lose 5-10% starting with middle age yet don't tend to show parkinsonian symptoms until 60-80% are gone.

It's pretty reasonable to expect reversing DAT and inhibiting VMAT2 increases oxidative flux, the question is really how much not if. Methheads certainly get "brain damage", but is nudging the average loss from 5-10% to 7-12% "damage"? Is it meaningful? Over 30, 40 years that could very well add up.

[sillywabbit]

Could you point me to your research?

[estimator7292]

You made the first unsubstantiated claim

[cyberax]

Meth is also used as an ADHD treatment. I think the reason is just the dosages that are used by addicts compared to people who just need the ADHD treatment.

A typical legitimate therapeutic methamphetamine dose is around ~20mg (up to maybe 60mg a day). A typical dose used by addicts is around 1 gram. And it's usually smoked, resulting in immediate bioavailability.

[andoando]

Pretty sure a gram of pure meth or even adderall would kill you

[cyberax]

I should have clarified that it's a daily dose: https://www.medrxiv.org/content/10.1101/2025.05.09.25327334v...

Not that it matters that much. It's no wonder that it fries your brain when you're using 25 _times_ the normal therapeutic dose.

[dns_snek]

That's a terrible oversimplification. Stimulant treatments for ADHD are not supposed to produce pronounced mood-enhancing effects. Stimulant treatment has been shown to be effective indefinitely in majority of people without increasing the dosage over time.

These days formulations like lisdexamfetamine and extended release methylphenidate are preferred because they have all-day efficacy with typical duration of action of around 8-12h which carries lower abuse potential.

[andoando]

extended release are just two doses of the drug where half the beads are delayed by ~4 hours. How is that different from taking two edibles a day and claiming full day efficacy?

[dns_snek]

That's not the case for lisdex nor Concerta methylphenidate. Some generics work that way and they're generally regarded as being worse than Concerta.

The benefit is that the medication automatically produces a smooth effects profile allowing you to live your life without timing medication to perfection.

A pronounced come-up and crash is a risk factor for abuse and addiction, so smoothing or removing the peaks and valleys is important.

[yosame]

I mean the difference is that you just take one in the morning? Which makes adherence easier, makes sure that the delay is constant rather than variable, and reduces abuse liability.

(As an aside, there are more complex extended release mechanisms than just delayed bead release - like lisfexamfetamine is a inactive prodrug, so cleaving the lysine off the amphetamine is rate limited. This has the effect of extended the duration of effect, and reduces the potential to abuse by snorting/iv/etc).

[harimau777]

Shouldn't that be up to bodily autonomy? If someone feels that cocane relieves their symptoms then who is the doctor to say that they don't. Perhaps releaving those symptoms even for a short period of time is worth the consequences.

[XorNot]

That's just arguing for drug legalization with extra pseudoscience.

I am all for people doing however much cocaine they feel they need. In broad daylight - let's just drag that into the light and let people go to the dispensary for cocaine hydrochloride, metered, measured and with warning labels.

Because the war on drugs is a stupid waste of time and lives, but no doctor or medical professional has to justify your own stupid actions.

[ryandrake]

It’s also an argument for quackery and snake oil, as long as the salesman declares “some people said it works!”

“People should be allowed bodily autonomy to take whatever chemicals they want” easily and dangerously turns into “People should be able to advertise and sell miracle cures that don’t work as long as their victims are gullible.”

Every snake oil fraudster hides their fraud behind principles like bodily autonomy.

[Jach]

There is already much snake oil sales and marketing going on, it's already enabled by arguments that are not based on bodily autonomy, which suggests that a move towards more respect to bodily autonomy will not noticeably increase such snake oil. The resistance to homeopathy has not gone well. I actually believe the resistance is actively harmed by making legit chemicals harder to get instead of easier. When people can easily get the good stuff that works there's not much of a market for the easy to get snake oil that doesn't.