Letter to JAMA Editor “Re: Pay Attention: Ritalin Acts Much Like Cocaine” - by Fred A. Baughman Jr., MD 9/25/01

Letters Editor, JAMA                                                          September
25, 2001

515 N. State Street

Chicago, IL 60610

also to: JAMA-letters@ama-assn.org

also to: fax 312 464 5824

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To the Editor

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Re: Pay Attention: Ritalin Acts Much Like Cocaine, by Brian
Vastag, Associate Editor, JAMA, August 23, 2001 (submission delayed by events
of September 11, 2001)

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In his essay regarding methylphenidate’s (Ritalin’s)
blocking of dopamine transporters, Vastag, makes two unwarranted claims; (1)
that methylphenidate is not addictive, and (2) that ADHD is a bona fide
disease. 

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Regarding the addictive potential of methylphenidate, he
writes:  “Taken orally, in pill form,
methylphenidate rarely produces a high and has not been reported to be
addictive.” 

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The DEA [1] states: “In reality, however, there is an
abundance of scientific literature
which indicates that methylphenidate shares the same abuse potential as other
Schedule II stimulants…”  Also:
“Internationally, methylphenidate is viewed as having a very high potential for
abuse and is listed in Schedule II of the Psychotropic Convention.” 

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Additionally, in a prospective, longitudinal study of 292
ADHD subjects, Lambert [2] concluded that the childhood use of stimulant
treatment is significantly implicated in daily smoking in adulthood and in the
lifetime use of cocaine and stimulants.

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However Biederman et al [3] having assessed substance use
disorders (SUD), in a mere 56 medicated, and 19 (nineteen) non-medicated,
subjects, concluded (1) that untreated ADHD was a risk factor for SUD in
adolescence, and (2) that treatment with psychostimulants was associated with
an 85% reduction in risk for SUD in ADHD youth.

It appears that, based upon this study alone, Vastag has
chosen to believe that methylphenidate is non-addictive. 

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Theories that seek to explain the presumed lack of
addictiveness of methylphenidate are based upon the claim of Dougherty et al
[4] that individuals with ADHD have an excess of brain dopamine
transporters.  These researchers
excluded 6 (six) adults with ADHD from 
“therapy with drugs which affect the dopamine system, within one month
before participation”.   Saying “drugs
which affect the dopamine system”  they
likely refer to methylphenidate and amphetamines.  Drug histories were not otherwise described.  There was no mention of exactly which drugs
they had been on, or, how long they were on them.  Not only has this research not been replicated, but given it’s
deficiencies, it would be impossible to replicate. Responding to Dougherty et
al [4], Baughman [5] wrote: “The fact that they were on some psychotropic
medications until one month or more prior to SPECT scanning  means that they—the 6 ADHD subjects–were
not drug-naïve, and that the scan differences between the subjects and controls
were likely drug-induced…. it cannot be concluded that the study defines an
ADHD phenotype, pathology, pathological physiology or pathological
chemistry.” 

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In effect, Vastag has stated (1) that the millions of
children in the US labeled ADHD have a proven disease, and (2) that
methylphenidate, the drug which most are prescribed, is non-addictive.  Why has Vastag made these statements which
are not supported by the scientific record? 
Why has JAMA published such statements? 

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Sincerely,

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Fred A. Baughman Jr., MD, Neurology & Child Neurology

Fellow, American Academy of Neurology

1303 Hidden Mountain Drive.

El Cajon, CA

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References:

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1.      METHYLPHENIDATE
(A Background Paper) US Department of Justice, Drug Enforcement Administration.
October,1995, pps. 4,7]

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2.      Lambert
N, Hartsough CS.  Prospective study of
tobacco smoking and substance dependence among samples of ADHD and non-ADHD
subjects.  J Learn. Disabil.
1998;31:533-544

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3.      Biederman
J, Wilens T,  Mick E,  Spencer T, 
Faraone SV.  Pharmacotherapy of
Attention-deficit/HyperactivityDisorder Reduces Risk for Substance Use
Disorder. PEDIATRICS Vol. 104 No. 2 August 1999, p. e20.

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4.      Dougherty
DD, Bonab AA, Spencer TJ Rauch SL, et. al. Dopamine transporter density in
patients with attention deficit hyperactivity disorder. Lancet.
1999;354:2132-2133  

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5.      Baughman
F. Dopamine-transporter density in patients with ADHD. The Lancet. 2000;
355:1460.

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