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This is Leia. She turned a squeaker toy into a nose flute and would like to play a few notes for you. She’s still learning so please be nice. 14/10

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This is Leia. She turned a squeaker toy into a nose flute and would like to play a few notes for you. She’s still learning so please be nice. 14/10

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Worries Rise that NPA Board Could Run Extremist Candidates in 2022

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Photos taken in 2017 show Angelo Isidorou, now a director of the Non-Partisan Association municipal party in Vancouver, wearing a MAGA hat and using a symbol widely considered to mean “white power.”

The images obtained by The Tyee compound worries by political observers that next year’s municipal election could see an NPA slate with far-right extremist views.

The party has seen an exodus of high-profile members in the past year, with many saying they fear the board has moved too far right. Some are ringing alarms that the NPA is embroiled in a potential political power play by savvy extremists achieving a strong foothold on the board.

Extremist views espoused online by current members of the NPA board include statements that are sexist, anti-immigration, anti-LGBTQ2S(IA)+, against wearing masks despite public health officials’ urgings and questioning the legitimacy of the U.S. election, as reported by the Vancouver Sun’s Dan Fumano.

The Tyee has learned that it’s up to the NPA board who gets to run as a candidate for the party, and that decision may not be made until a few months before the next municipal election in fall of 2022, depending on how the board moves forward within its bylaws.

The NPA’s bylaws are not published or publicly available, but The Tyee has seen portions of them. They require any candidate to be approved in writing by the directors; the directors may appoint candidates, revoke approval of candidates and “in their discretion may fix the number of candidates running for office.”

Any director who wishes to be a candidate must resign three months before any meeting for the endorsement of candidates.

According to the bylaws, it is possible that any member of the current caucus could be effectively shut out and new candidates be approved. In addition, a section states that membership is approved by the directors, who determine the membership fees.

Coun. Rebecca Bligh was elected to council in October 2018 on the NPA slate but quit the party in December 2019 over concerns that one or more board members held anti-LGBTQ+ views. Now an independent, she said the photos of Isidorou flashing a white power symbol and supporting Trump further underscore her growing worry that there’s been a far-right “takeover” of the NPA that quietly continues.

She worries that voters have come to assume NPA candidates are moderate in their views, and could be fooled into voting for hard-right, socially conservative candidates if the party’s board drops them into the slate at the last minute.

“NPA voters need to know that it’s happening. And it’s a growing problem for that party and for the city,” Bligh said. “What’s happening with the board in the NPA poses a great risk to the party. And to Vancouver if NPA supporters do not engage sooner rather than later.”

The NPA has an “extremely reliable and loyal voter base” that is generally disengaged outside of the election year, Bligh said. The party was founded in 1937 to claim the centre-right and appeal to Vancouver’s business class under an ethos of fiscally-conservative, socially-progressive values.

“And what they know is that NPA voters will vote slate,” Bligh explained. “We could see a really difficult and toxic council form.”

The divide between the NPA board and its caucus — elected councillors and members of the park and school board — is deep and continues to widen.

Caucus members have distanced themselves from the board through public statements and created their own channels to communicate, as evidenced by their NPA caucus Twitter account and website. The first NPA caucus tweet denounced comments made by one board member and another one pushed back on anti-mask rhetoric, reported the Sun’s Fumano.

Bligh said the current caucus is in a “very difficult position.” Still, they need to be realistic about the intent of the board, she said. “It cannot be ignored. Silence is complicity for many issues.”

Isidorou was photographed wearing a Make America Great Again hat and showing the inflammatory gesture at a public protest against the opening of the Trump International Hotel and Tower Vancouver in February 2017. Trump’s sons, Donald Jr. and Eric, were at the nearby opening ceremony, which was boycotted by then-mayor Gregor Robertson and other politicians.

Trump had by then issued executive orders for a Muslim travel ban and for the construction of the wall at the Mexico-U.S. border.

The sign Isidorou flashes along with two other people whose faces are out of the frame is identical to a widely recognized white power signal. He forms a “w” with three fingers extended while the thumb and index finger form part of a “p.” The uninitiated might mistake the gesture for the “OK” symbol, which white supremacists appropriated and display in the manner adopted by Isidorou.

The sign has become so identified with racist beliefs that it has been listed as a hate symbol by the Jewish Anti-Defamation League and was flashed by the suspected white supremacist who murdered 49 people at mosques in New Zealand when he appeared in court to face charges on March 15 of last year.

The Tyee asked Isidorou why he made the gesture and his reasons for wearing a MAGA hat at the 2017 event. He responded that he could not comment due to a non-disclosure agreement he signed when he was appointed to the NPA board late in 2020.

As the director of the University of British Columbia Free Speech Club, Isidorou came under fire for booking events featuring speakers espousing far-right, anti-immigration, anti-LGBTQ+ and, at times, openly racist views. He has described himself as a “socially liberal free speech activist.”

He worked as an organizer with the People’s Party of Canada led by anti-immigration hardliner Maxime Bernier, but in 2019 publicly denounced the populist party for moving, he said, too far right on social issues. The PPC was attracting people with “a racist bent” in B.C., he said upon quitting. Isidorou then rejoined the federal Conservatives.

Isidorou is a writer for the Post Millennial, an online publication geared to conservatives with a large amount of opinion content, much of it written by political operatives. He has been active almost daily on the site over the last three months.

Isidorou also hosts Post Millennial’s weekly podcast “Cancel This.”

Isidorou publicly denounced Trump in a tweet on Jan. 6, 2021, the day pro-Trump supporters, whipped up by baseless claims of a rigged election and many of them white supremacists, stormed the U.S. Capitol, hunting and threatening to capture and harm members of Congress.

Other current NPA board members are president David Mawhinney, treasurer Phyllis Tang, and directors Maxwell Manley, Robert Boyd, Federico Fuoco, Wesley Mussio, David Pasin, Ryan Warawa, Christopher Wilson and Wei Jie (Grant) Zhang, according to the NPA website.

NPA board member Christopher Wilson is the former B.C. bureau chief for the right-wing outlet Rebel Media. He first made national headlines in late 2017, after calling then-federal environment minister Catherine McKenna the misogynistic nickname “Climate Barbie.”

During his time at Rebel, Wilson made YouTube videos stoking fears of possible “race wars” in South Africa, complaining about “white shaming” on university campuses and disparaging the left’s “hypocritical defence of Islam.” Wilson defended U.S. president Donald’s Trump’s response to the Charlottesville, Va. white nationalist rally in a video entitled “Why he’s right and the media is wrong.”

Most recently, Wilson was mired in scandal after using his personal Facebook account to denigrate the city’s homeless and drug-using population, commenting “start harassing these low-lifes.” Wilson is listed as the head of the NPA’s fundraising committee, according to a release on its website.

Following the exchange with McKenna, Wilson deactivated his Twitter account. Following his comments on Vancouver’s homeless, Wilson scrubbed and deleted his Facebook account. The screenshots were shared by Scout Magazine contributor Sean Orr.

NPA councillors subsequently released a statement on Twitter which read, “We categorically denounce statements made by Mr. Wilson. They do not reflect the values of the NPA caucus.”

On Nov. 7, four days after Americans went to the polls, NPA board member David Pasin echoed Trump by tweeting the election was rigged, suggesting votes “mysteriously appear.” It has since been deleted.

NPA treasurer Phyllis Tang, when she ran in 2018 for city councillor under the banner of the conservative municipal party Yes Vancouver, was endorsed by Let’s Vote Association, which states it is a pro-life, pro-family socially conservative organization, according to the Sun’s Fumano. Let’s Vote also endorsed Chilliwack trustee Barry Neufeld, whose comments slamming the province’s sexual orientation and gender identity school policies resulted in a human-rights complaint being filed against him by the BC Teachers’ Federation.

NPA board member Wes Mussio is an outspoken supporter of Trump, who has reportedly cheered on Vancouver’s anti-mask protesters and criticized B.C. health officials and politicians for their handling of the pandemic online. He was on the NPA board before joining the new, right-leaning party Coalition Vancouver in 2018. Now he’s back on the NPA board.

Mussio is also the lawyer representing a group of Vancouver voters seeking a court order to remove Green Coun. Michael Wiebe from office.

After Trump supporters invaded the Capitol and Twitter dumped Trump along with many extremists spreading baseless claims about election rigging, Mussio urged people to join Parler, an alternative to Twitter. Parler had become an online refuge for right-wing extremists because of its lax regulating of what could be said on the platform.

The Tyee asked Mussio whether he persisted in his support for Trump after the president’s lies about being robbed of an election win and his incitement of the Capitol insurrection, and why he was against wearing masks during the pandemic, which has been shown to slow spread of infection and save lives.

Mussio responded by email, saying that he does not speak for the party.

He said his endorsement of Parler after Jan. 6 was because he advocated for freedom of speech and small businesses who get suppressed by “Big Tech.”

“Up until it became known to me that Twitter was trying to wipe out its main competition in guise of some national emergency in the United States, I didn’t even know Parler existed,” he said, adding his tweet had nothing to do with Trump.

Mussio said that he supports peaceful protests and not the Capitol Building violence. “If it is true that Donald Trump caused or supported the actions of the illegal rioters, a matter for debate if one looks at all the evidence, I do not support that action.”

Mussio said his position on the board has nothing to do with his federal or provincial political views, adding that the NPA bylaws state the party attracts a range of members.

Mussio denied being an anti-masker and said he is in favour of the freedoms set out in the Charter. “While the media may like to paint this NPA board swing-to-the-right story, it is actually false and misleading. It is definitely untrue about me,” he said.

Some of the current makeup of NPA directors traces to the 2019 NPA annual general meeting, which saw a mostly new board elected. Six of the 10 directors then are no longer on the board. There was no 2020 meeting, and some current directors were appointed after other directors departed. Isidorou was among recent appointees. Mussio is also a recent addition.

Other high-profile NPA members who have left the party include longtime member and donor Peter Armstrong and former mayoral candidate Ken Sim, who narrowly lost to Mayor Kennedy Stewart in 2018. During that election, the NPA board blocked Hector Bremner, who won his seat on council during a byelection in 2017, from running for mayor for the party.

Sim plans to run for mayor in 2022 and is building a coalition of support, he said in a statement to The Tyee. “We need a new way forward, where sensible policies focused on making life better for everyone in this city can be discussed.”

Though there was a potential for new directors to be elected in the 2020 AGM, the meeting was said to be cancelled due to the pandemic, Bligh said. The board did not respond to requests for comment.

The province is allowing societies to seek an extension of their 2020 AGM to November 2021. It is unclear whether the next AGM is scheduled and if the board has communicated with NPA members.

Multiple requests to the NPA councillors, park board commissioners, school board trustees and president of the board David Mawhinney were met with no response.

Gordon Price is a former six-term councillor with the NPA and the first openly gay member of council, who served under then-mayor Gordon Campbell. He said there was a time when the NPA expected its board members to be bland and avoid controversy. Directors were there to raise money, pull in volunteers and keep things on simmer until the next election.

Price said he joined the NPA because of its core value of creating a tent in which the centre-left and the party’s right-leaning base could coalesce. Now, observing from the outside, Price said it seems the board might be “playing chess.”

He’ll be keeping a close eye out for next year’s election, to see how the right may split, who the mayoral candidate is, and what the incumbent councillors decide to do.

Former NPA mayor Sam Sullivan expressed little concern about extremist views espoused by the party’s board members.

The NPA comprises centre-left to right voters, he said. Historically, any extremes on either side have “cancelled each other out.” And right-wing board members have always nominated “very moderate to left-wing candidates.”

He notes that Isidorou, now 24, was 19 when he made the white power symbol and wore the MAGA hat. “I don’t necessarily hold anything against people and the things they did when they were teenagers,” Sullivan said.

He further noted that Isidorou had brought in a left-wing speaker in his role at Free Speech Club. “He’s an equal opportunist.”

Sullivan, who failed to be re-elected as a BC Liberal MLA in Vancouver-False Creek during the 2020 provincial election, fell under public scrutiny for promoting a group called Safer Vancouver, which lambasts harm reduction and has been criticized for demonizing homeless people.

Isidorou was seen in a photo with Sullivan on the campaign trail days before the provincial election. Sullivan said he only recalled Isidorou being at that specific event. It is unclear if Isidorou had any relationship with the campaign.

As for the future of the NPA, “Who cares who is on the board? That actually doesn’t matter,” Sullivan said of the party that was his home for 15 years as councillor and then mayor. “I’ve never seen any far-right candidates actually be put forward and they would immediately kill the NPA if that ever happened.”

But Mario Canseco, president of the polling firm Research Co., says Bligh and others are not wrong to raise concerns that a hard-right element within the power structure of Vancouver’s longest running municipal party could harness more moderate voters to their aims.

Voters in the municipal elections tend to be older and vote for slates, Canseco said, suggesting a lack of media coverage contributes to that behaviour given there is little name recognition.

He noted that through the city evolving, demographics may shift more influence to younger, centre-left voters. B.C.’s largest urban areas aren’t electing Conservatives at the federal level, and there is only one BC Liberal MLA in Victoria. This leaves a vacuum that could be occupied by a new brand of conservative, Canseco said.

“It’s a situation that is very similar to what we saw when Trump ran for president,” he explained about the NPA’s identity crisis. “As it started to snowball, it became more of a situation where the Republican Party became effectively Trump’s party.”

Canseco said it’s apparent that Republicans who were perhaps uncomfortable with Trump’s appeal to white supremacists nevertheless were not willing to vote Democrat.

In Vancouver’s next election, he said, there is a real possibility for people to say, “I’m just going to vote for the NPA without even realizing the past or present of the people who you’re voting for.”  [Tyee]

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why are we talking about FTV (force the vote) when we could instead be talking about VFT (very fast trains)?

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why are we talking about FTV (force the vote) when we could instead be talking about VFT (very fast trains)?

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Wenn dein Doggo den Funk macht

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Know Your Amphetamines

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In the 1950s, a shady outfit called Obetrol Pharmaceuticals made a popular over-the-counter diet pill called Obetrol. If you're familiar with any of: the 1950s, shady pharma, or diet pills, your next question will be "did it contain amphetamines?" and the answer is yes, loads of them. Obetrol was a mix of four different amphetamine salts: racemic amphetamine sulfate, dextroamphetamine sulfate, methamphetamine saccharate, and methamphetamine hydrochloride. Why did they need four different kinds of speed? I'm not sure. The uncharitable explanation is: for the same reason Dr. Nick's Cure-All Home Remedy has twelve different herbs, ie customers think things with more ingredients are better.

By the 1970s, people figured out meth was bad, so Obetrol replaced their two methamphetamine salts with two more kinds of non-methylated amphetamine. But the FDA continued to crack down, and although the historical paper trail goes kind of dark, it looks like Obetrol had disappeared by the 1980s.

As usual in pharma, someone bought Obetrol Pharmaceuticals, then someone else bought them, and after a few iterations of this, all their intellectual property ended up with a company called Richwood. They decided to rebrand Obetrol as "Adderall" and pitch it as an ADHD cure.

Treating ADHD with amphetamines was hardly a new invention. Psychiatrists had been doing it since the 1930s, albeit with slightly different drugs. Remember, many organic chemicals come in two versions, a "right-handed" or "d" version and a "left-handed" or "l" version. Benzedrine (a 50-50 d/l split) and Dexedrine (pure d-amphetamine) were the treatments of choice throughout the mid-20th century. So why was it Adderall - a weird combination of four different salts selected kind of at random by a sketchy diet pill company - that caught on?

I'm not sure. My best guess is good timing plus good advertising. In the early 20th century, ADHD was called "minimal brain dysfunction" and diagnosed only in the most extreme cases. A few children with absolute and total inability to function at all got diagnosed and given Benzedrine or Dexedrine; everyone else was left to fend for themselves. As far as I know, this wasn't because doctors had a principled commitment only to diagnose extreme cases - I found a paper from 1975 arguing that up to 5 - 10% of children probably had minimal brain dysfunction, the same number estimated to have ADHD today. Parents just didn't know about it and didn't really have "take my kid to a psychiatrist" in their set of plausible options to consider.

In the early 1990s, psychiatric research, a series of popular self-help books, and the business interests of Richwell Pharmaceuticals all converged on the idea that it was important to get more people diagnosed with ADHD. Adderall entered the market at exactly the right time, and it became everyone's go-to ADHD medication.

US Ritalin consumption in millions of doses/year, probably a good proxy for number of ADHD diagnoses, approximately septupled during the 1990s (source)

Even if we agree that amphetamines are the right treatment for ADHD (many people don't!), how concerned should we be that the particular amphetamines we use are a random mix of salts selected by sketchy 1950s diet-pill peddlers? Dexedrine is an older formulation with pure d-amphetamine (sulfate). No l-amphetamine, no weird combination of salts. Should we just use that?

This is hard to study, because it's not obvious how to dose both medications. If we start out suspecting that both isomers are equally strong, we might dose 10 mg of Dexedrine vs. 10 mg of Adderall. But in fact we have reason to think that d-amphetamine is a bit stronger, so maybe 7 mg of Dexedrine vs. 10 mg of Adderall? But then any difference we find might just be a question of choosing the wrong doses rather than a real distinction.

Arnold, Huestis, and Smeltzer, 1976 and Gross, 1976 compare pure d-amphetamine to a mix of d and l amphetamines. Both studies find that both d-amphetamine and l-amphetamine are effective stimulants, but that d-amphetamine seems to work better for most people. A rat model also finds some modest superiority for d-amphetamine, showing that both isomers improve attention, but d-amphetamine additionally improves hyperactivity and impulsivity.

Is there any advantage at all to including l-amphetamine? AHS find that a small subgroup of patients seem to do better on it, but this is a study from 1976 and honestly I don't trust them to find small subgroups responsibly. And Gross finds that some people have fewer side effects on a mix of both than on d-amphetamine alone. This is a bit strange - shouldn't two chemicals have more side effects than one chemical? My guess is that d-amphetamine is just stronger, and so people getting their amphetamines as a mix of a strong chemical and a weak chemical are effectively on a lower dose and get fewer side effects.

James et al switch children back and forth between Adderall and Dexedrine to see which works best. They find the winner changes from measure to measure. But the tiebreaker was just asking the teacher which week the child seemed to be doing the best work in class, and the teacher chose a Dexedrine week almost twice as often as an Adderall week.

Joyce, Glaser, and Gerhardt claim to find that Adderall creates stronger and more prolonged changes in dopamine release than other amphetamines. But they use a bizarre dosing regimen which equates 0.5 nmol Dexedrine, 0.68 nmol Adderall, and 1 nmol racemic amphetamine as "identical doses" of each, based on a theory that l-amphetamine has no independent action but just modulates d-amphetamine. As far as I can tell this is totally false, and their study contradicts everything else I know, so I am going to nervously ignore it for now.

What about the evidence from patient ratings? Online databases contain several thousand of these...

...and they pretty conclusively show that on average patients prefer Dexedrine to Adderall. This is unblinded and uncontrolled, we don't know what dose any of them were on, and patients sometimes like addictive medications that aren't very good for them by normal medical standards. But again it seems like a pretty resounding victory for Dexedrine, which is what I'd expect. Honestly it's pretty weird that our go-to ADHD medication includes four random salts and a bunch of l-amphetamine when a pure d-amphetamine medication we could use instead is right there.

I do appreciate Dr. Charles Popper's contribution here; he notes that since Adderall has so many different salts, they take different amounts of time to get absorbed by your body, which means Adderall has a more gradual onset and offset compared to something purer like Dexedrine. Things with gradual onsets and offsets are probably less addictive and less likely to produce withdrawals and "crashes". As far as I can tell, this is the strongest pro-Adderall argument.

Vyvanse is the newest and most expensive member of the amphetamine stimulant family. It's lisdexamphetamine - ie Dexedrine attached to a random inactive molecule called lysine. As long as the lysine is attached, it can't stimulate anything. The liver removes the lysine at a slow, consistent rate, which means that you get a slow, consistent release of stimulant into the bloodstream. This is advertised as especially good for people who are worried about addiction. It's hard to abuse or overdose on Vyvanse; no matter how much you take, your liver will still only activate it at the same, slow rate.

My patients love Vyvanse. I try hard to convince people to take older, less expensive medications unless they're absolutely sure that the newer flashier one works better, but my patients are very convinced Vyvanse works better than Adderall. I used to think this was because something about the complicated timed liver release mechanism makes it "smoother". This is definitely what the pharma company that designed it wants me to think, and I admit there is some evidence for it.

But one neglected perspective is that once you take away the lysine, Vyvanse is basically Dexedrine, not Adderall. Almost everyone likes Vyvanse better than what they were taking before. But usually they were taking Adderall before. If Dexedrine is really better than Adderall - and common sense and the patient rating websites say it is - then that goes some of the way to explaining Vyvanse's superiority before we even get to the complicated liver stuff. Pharmaceutical companies are always trying to re-release old medications in ways that bamboozle you into thinking they're new medications, so they can charge more money for them. In this case they did so good a job that I honestly can't tell if that's what they're doing or not.

Evekeo takes Adderall's questionable decision to include l-amphetamine and doubles down on it. Remember, Dexedrine is 100% d-amphetamine and Adderall is 75% d, 25% l. Well, Evekeo is 50-50. This should make it strictly worse than Adderall, and my patients' feedback seems to agree with this. The supposed point of making it is those studies that show a small subgroup of people seem to get some extra benefit from l-amphetamine. The real point of making it is probably as a me-too drug; it doesn't require any research, since l-amphetamine and d-amphetamine have both been around forever, but since it's new and different you can charge a lot of money for it.

I can't think of any situation where it would be reasonable to prescribe Evekeo as a first-line stimulant. If someone has done sort of okay on Adderall but has lots of side effects, and you put them on Dexedrine and they get worse instead of better, I suppose you could try putting them on Evekeo to see if they really are in the small subgroup of l-amphetamine beneficiaries. I'm just annoyed that this relatively rare legitimate use case serves a fig leaf for the inevitable Big Pharma campaign to push this new on-patent very expensive medication on a bunch of people who don't need it.

Desoxyn is the undisputed king of the patient rating websites. Here's the same graph as before, except I've added Desoxyn to the last column:

These are some amazing numbers. Adderall itself usually has one of the highest ratings of the thousands of drugs on the site, Dexedrine beats Adderall handily, and Desoxyn wipes the floor with Dexedrine (except on WebMD, which has the smallest sample size). This drug is getting ratings that shouldn't even be possible. And the patient summaries are in line with this - here are a few:

I have been on every derivative and variation of stimulant, SSNRis SSRI, Tricyclics, beta blockers and all sorts of combinations of above and never have come across such an amazing compound. as Desoxyn. I think that there is a definable difference in mood thoughts and the way thoughts flow with memory and with present day crises.


After dealing with depression and ADD for most of my life, and having tried literally every conventional anti-depressant and ADD medication, I can honestly and without hesitation say that Desoxyn is the absolute best medication I've ever used to treat my ADD.


How is this not more widely prescribed? My doc had me on Strattera at first, didn't help at all. Next I switched to Concerta, which worked, but increased my anxiety, and I had a crash. Next I switched to Adderall, which had almost the same effect as Concerta but on top of that I had no appetite. Finally I switched to Desoxyn and that's when my life started to turn around. My grades instantly went up and homework became fun for me. Math problems became like a puzzle, and history became fun, like watching a real-life movie. Right when I made the switch to Desoxyn, I got caught up on ALL my homework and my grades instantly switched from D's and F's to B's and A's. Not only that, but my social anxiety was completely GONE.

All the reviews are like this. And I bet all of these patients are telling the truth. Sometimes I read drug reviews and I wonder whether these people are special cases, or driven to exaggerate, but these descriptions match my impression of how the average Desoxyn patient feels.

What's the catch? Desoxyn is methamphetamine. The FDA and DEA discourage doctors from prescribing it, but it's still technically legal with an MD's prescription, and there are still some doctors who will use it for the most refractory cases. It is officially indicated for ADHD and obesity (really!), but gets used off-label for narcolepsy and various sleep disorders.

There's a lot of confusion around the difference between amphetamine and methamphetamine. On the one hand you have anti-psychiatry activists who will say that using Adderall for ADHD is exactly like giving kids crystal meth; on the other you'll have people who say that obviously normal amphetamine is okay, but meth-amphetamine is a demonic substance that will hijack your brain and destroy your life. The truth is more complicated.

Methamphetamine crosses the blood-brain barrier more effectively than unsubstituted amphetamine, but I'm not sure how much that matters since people take different doses of both, and a high dose of unsubstituted will end up with more reaching the brain than a low dose of meth. It seems to inhibit the dopamine transporter more effectively, which might matter, but I'm not enough of a pharmacologist to know how much. Meth takes effect more quickly, which seems to increase addictiveness in a sort of behaviorist sense where the sooner a stimulus gets reinforced, the more rewarding it will feel. If all of this sounds kind of weak to you, you're not alone. Shoblock et al write:

Despite the repeated claims of METH being more addictive or preferred than AMPH, proven differences between METH and AMPH in addiction liability and in reward efficacy have evaded researchers. Animals self-administer METH and AMPH at comparable rates (Balster and Schuster 1973) and humans prefer similar doses (Martin et al. 1971). Also, neither humans nor animals discriminate between equal doses of METH and AMPH (Huang and Ho 1974; Kuhn et al. 1974; Lamb and Henningfield 1994). Furthermore, while METH is commonly believed to be a more potent central psychostimulant than AMPH, no direct comparison on the potency of the two drugs to stimulate central processes have been verified. In addition, no previous study has directly compared the acute effects of the two drugs on locomotor activity, an important central process that contributes tothe definition of psychostimulant. Moreover, there are no known neurobiological differences in action between METH and AMPH that would account for the putatively greater addictive, rewarding, or psychomotor properties of METH.

I think there's been a little bit more research since then, but the general takeaway - that the science doesn't support the vast gulf between these two drugs in the popular imagination - still seems true.

What's going on? I think addicts use meth very differently from the way generally responsible ADHD patients use amphetamine. It's weirdly hard to find good data on methamphetamine route of administration, but this study shows that about 60% of users inject it, 23% snort it, and 52% smoke it - also, see this paper about "the second case of rectal methamphetamine abuse in the literature". Route of administration makes a really big difference in how addictive and dangerous a drug is (see eg crack cocaine vs. regular cocaine), and I think this is a big part of the difference between seemingly okay Adderall users and very-not-okay meth users.

But maybe even bringing up route of administration is getting too complicated. The simplest explanation of the difference between meth users and responsible amphetamine users is that the meth users take much, much more. This study asks abusers how much they use in an average day, and gets numbers from about 300 to 800 mg. An average clinical dose of either Adderall or Desoxyn would be about 20 mg a day.

So abusers are taking about 25x a normal dose, and are usually snorting or injecting it. I think this explains the lion's share of the difference between "methamphetamine abuse" and "responsible Adderall use" without having to appeal to chemical differences between meth and unsubstituted amphetamines. Those differences do exist, and they're one reason why drug abusers prefer the methylated version. They're just not as dramatic as you would think from seeing a successful college student on Adderall vs. a toothless vagrant on meth.

All of this would seem to suggest that doctors should be less scared of prescribing Desoxyn - except that if it were true, Desoxyn wouldn't have as big an advantage over Adderall as the ratings suggest. I'm not sure what's going on here. Maybe this is just the effect of the small but real advantages in BBB penetration and level of dopamine transporter inhibition. Or maybe it's at least partly placebo - an ADHD patient whose doctor gives them meth feels like they've been allowed to dabble in forbidden magics, and is properly grateful in a way that makes them feel like their medication is more effective. I'm not sure. I only have secondhand accounts to go on - I'm too much of a wuss to prescribe Desoxyn myself.

When I treat ADHD with amphetamines, I usually start with Adderall/extended release Adderall, even though realistically Dexedrine would probably be an equally good or better choice. If it's not working very well or there are too many side effects, I switch to Dexedrine/extended release Dexedrine. If Dexedrine doesn't work because it seems too strong or the patient "crashes" too hard afterwards, or if I'm worried the patient is at risk of addiction, I will try Vyvanse (or some other solution to stimulant “crashes”); if Dexedrine works less well than Adderall and I am very confused and the patient is in an experimenting kind of mood, I might try Evekeo. If none of these work, a braver person than I am might try Desoxyn. As for me, I give up on amphetamines and start looking at Ritalin, modafinil, or other options.

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