I’m a big fan of Pharma. Of course, big Pharma makes mistakes. Most big things that are driven by profit make mistakes. But life saving and life changing drugs are amazing and wonderful. I just want to reflect on the enormous gains that have been made in treating ADHD since I was diagnosed about 37 years ago, so roughly a generation.
When I was diagnosed in the late 80’s there were really two (good) options. There was Ritalin and Dexedrine. Dexedrine was less prescribed and largely thought of as a quick fix weight loss drug for women in the 70’s and 80’s. And all stimulants were pooh-poohed as drastic, crazy, dangerous, and untested. Of course that was untrue. But I digress.
Ritalin was only available in the short acting or IR (immediate release) formulation. And Dexedrine was delivered in the same manner. So, for a kid like me, who needed to be medicated for the whole school day and for homework, I needed to take three daily doses of Ritalin that took about half an hour to kick in and only gave me peak efficacy for about 2 1/2 – 3 hours. They were a blunt instrument and didn’t make me feel great.
I did go on Dexedrine for a while in junior high. The effect was about the same for me because they way the short acting meds are metabolized was about the same. Granted I was 10 years old and I can’t compare, apples to apples, what I take now because I’m a fully grown man now. But the technology has improved so much.
Next came LA or long acting. Essentially, this was an IR Ritalin buried inside another IR Ritalin. So, it lasted about six hours and had two peaks. Better, but still not great. Though two LA and one IR did cover most of my day.
Somewhere along the way Adderall was invented, which is closely related to Dexedrine. And, with Adderall can another LA. And then the real revolution came in the late 90’s and early 2000’s with ER and XR medication. (Extended release.) These meds are much more sophisticated. They mete out the medication over a longer period of time with different percentages being metabolized at different times throughout the release. This gives a much longer and much more even effect.
Along the way Strattera (atomoxetine) was discovered. I say “discovered” and not invented because it was designed to me an SSRI but didn’t really work on depression. Though is does have some nice anti-anxiety properties. Though totally different from stimulants and statistically less effective, it is a valuable tool for treating ADHD. And, there are many other meds that are used to varying degrees of effectiveness on and off label, often as adjunct therapies for ADHD.
The medication that changed my life for a second time is called Concerta. (Methylphenidate ER.) I’ve posted about it’s construction before but not in years. It is 100% amazing. It is shaped like a barrel and is made of a sort of mesh-like material. It has IR Ritalin sprayed on the outside so the med gets into your system quickly as that layer dissolves. Then it has a granules of Ritalin inside at the top of the barrel. In the bottom of the barrel. As the liquid in the stomach acid gets into the barrel though the mesh, it activated a layer in the bottom of the barrel that expands to expel the granules out through a laser-drilled hole. Thus, a slow and consistent administration of Ritalin over 10-12 hours. (10 for most people.)
How FUCKING INSANE is that. Yay, science! I, for one, am grateful that for the production of this and other amazing drugs that don’t just cure cancer and save people from early death, but for those drugs that treat less visible conditions, like my ADHD, and make my quality of life possible. So, sure, the opioid epidemic is in so small part due to the rapacious greed of one pharmaceutical company. But, much of that industry is doing really good work. We would be smart not to throw the baby out with the bath water and only hate on those who really deserve it.