An Argument for the Reconsideration of Amphetamine Use in Children to Treat Attention-Deficit/Hyperactivity Disorder and Exploration of Possible Alternatives

Abstract

This paper objectively explores the problem of amphetamine use in children in the United States of America by analysis of publications, online and offline, and statistics. Scholarly articles that contain relevant data were used in the analysis and to formulate an argument against the continued growth of production and prescription of amphetamines to children. A deep understanding of amphetamine in America is necessary to understand why it is a problem in the first place. The data presented here indicate that a change is necessary because it shows that this practice puts the future of the children at risk. Analysis of the cost of having amphetamine in American culture, along with analysis of the side effects is presented. Long and short term side effects and their implications are discussed. This paper will also report on alternatives to amphetamines, natural and synthetic, for the treatment of attention-deficit/hyperactivity disorder (ADHD) and show that the possibility exists that children need not be given amphetamines for the treatment of this neurological disorder.

Introduction

The production of amphetamine in the United States of America rose by 2000% from the year 1990 to the year 2000 and has since leveled. The majority of amphetamine that is produced is used to treat children with some form of mental disorder (Frontline, 2014). The major disorder that renders prescription of amphetamine is the neurological disorder, attention-deficit/hyperactivity disorder (ADHD), and has seen a substantial rise in diagnoses in the last 20 years. The increase in this disorder warrants an investigation on how to solve the problem. Amphetamine was first introduced to the world about one hundred years ago and in the 1930s was first seen on the prescription drug market in the United States. Since then the United States has enforced regulations on the quantity of amphetamine that may be produced in a given year such that the quantity will appropriately treat the number of patients in need and no more. Many studies have shown that amphetamine stimulant use has a very high potential for abuse and also can permanently affect the developing brain of a child. Considering the abuse potential, the cost to the public, biochemical effects, and alternatives should the United States reconsider the use of amphetamine and other similar drugs with children?

The understanding of the effects of amphetamines and other drugs like it begins with the origin and use of the chemical compound and its integration into American society. In 1929, Gordon Alles made the first publication on the physiological effects of the compound amphetamine; by 1934, the drug was approved for use in medicine for congestion and bronchodilator (Rasmussen, 2008, p. 975). One major agitator of the soon to come widespread amphetamine abuse was the Second World War. The United States government fed its military this drug for alertness and to fight depression. America was not alone in using amphetamines in this way; Great Britain also supplied amphetamines to their forces for these same reasons. German and Japanese militaries were fed an amphetamine derivative called methamphetamine (Rasmussen, 2008), which would come to later have significant effects on the world and everyone who used it. Amphetamine was the prescription of choice for doctors all over the world fueled by retail incentives and also good intentions. The production, and indirectly the use, of amphetamine in America did not decline until strict regulations were put into place after 1970. During the first thirty years of public exposure to amphetamine, the notion of addiction came into light. Patients needing higher doses and exhibiting severe withdrawal symptoms helped to surface the idea that amphetamines may be more addictive than once believed.

High Abuse Potential and Cost to the Public

Amphetamines have been shown to have one of the highest potentials for substance abuse for any known drug to date. The nature of the mechanism of this drug is that tolerance for the drug increases rapidly once the medication is started. The fact is that millions of people in the United States alone are addicted to this substance and it is causing problems in society that are rooted in the pharmacy industry. The drug is being manufactured and is primarily prescribed to children with ADHD, therefore the exhibition of such a large abuse potential is relevant for the safety of the children in the United States. The industry must be analyzed and the problem appropriately rectified.

The pharmacy industry is a big advocate of the use of amphetamines to treat ADHD. This is because of the profits that they take in due to increased diagnoses and prescriptions. Pharmaceutical manufacturing companies have leaders that have a vested interest in maintaining illness throughout the population. For example, should there be a natural method or onetime use drug for the treatment of ADHD or any other condition or disease the profits for the pharmaceutical manufacturers is limited by the number of diagnoses. However, a once-daily administration of a drug produced by a company expands the limits of profitability by an enormous factor. The increase in profitability, yearly, can be described by multiplying the number of diagnoses by the number of days in a year. There are currently approximately three million children in the United States diagnosed with ADHD; that is a billion treatments per year compared to three million. It is obvious why the companies have this interest in maintaining an illness throughout a population. It is a disgusting fact that haunts the United States healthcare system and it is costing the United States much more than it needs to.

The cost of treatment for addicts is not negligible. In fact, addiction treatment in the United States is over $600 billion annually (National Institute on Drug Abuse, 2012) and if you include the costs of incarcerating individuals for possession or distribution, the cost is outrageous. The addiction treatments are a good thing, but if there was a chance to reduce the cost to the nation, there is no reason why it should not be explored. Secondly, the effects of prolonged amphetamine use on the adult brain are major and some permanent. Amphetamine changes brain chemistry by diminishing the reuptake of dopamine, a powerful neurotransmitter that gives an individual that “feel good” sensation that is experienced when on the drug. Once use ceases, the individual will have drastically reduced levels of this neurotransmitter for an extended period of time which can lead to depression, another costly condition to treat, and suicide. Thirdly, the majority of prescriptions are going to children and recent studies are showing that prolonged use of the drug in adolescents can cause permanent changes in the brain even after cessation of the medication (Labonte, et al., 2012). Children have no say in the medication that is given to them, in most cases. All effects, long and short term, should be thoroughly investigated before administration of a drug to an entire population of ADHD children, especially when that population is growing at such a substantial rate. Discussion of the long and short term effects of amphetamine use is observed in the following section.

Effects of Amphetamine on the Body

The known effects of amphetamines on the human body, especially the adolescent body are numerous. There are many studies that indicate that the use of amphetamine has long-lasting effects even after an individual stops use. The long and short term effects of amphetamine are easily obtained and are facts proven by many experiments over the years. Specific experimentation data regarding the effect on mood, cognition, and normal growth are becoming widely available and suggest a move to an alternative treatment of ADHD in children is warranted. As outlined above, the pharmacy industry would not necessarily benefit with regards to sales and profits, which is something that unfortunately drives the push to keep production alive. The long term effects include some very serious potential health concerns.

Long Term Effects of Amphetamine

It is only recently that the long term effects of amphetamine use in adults and children have become fact by repeated experimentation. A research study in which adolescent rats were used as test subjects shows that even moderate doses in adolescence can affect behavior in adulthood (Gustafsson, Hansson, Eidevall, Thernlund, & Svedin, 2007). The changes described by the conclusion in this study suggest that an adult would have an increased risk of seeking drugs in the future, risk-taking behaviors, and chemical imbalances that remain in the brain long term.

The effect of amphetamine on the progression of normal growth in a developing adolescent is concerning. One of the major issues with amphetamine use in children is that it has been determined that the use is correlated with slowed growth of a wide range of tissues in a developing body (Berman, Kuczenski, McCracken, & London, 2008). This is a fact that makes sense because one of the short term side effects of amphetamine use is the loss of appetite, which will also be discussed in the following section. A child that does not eat appropriately can be at risk for deficiencies in many nutrients. Caloric intake as a child is important for the continuation of normal growth of body tissue and amphetamine use decreases this intake. Another way that amphetamine use can stunt growth can be found directly in its mechanism of action. Amphetamine use increases the amount of dopamine running through the brain at any given point and increased dopamine levels have been associated with a decrease in the secretion of growth hormone (Higgins, 2009). The growth hormone is secreted in the brain and functions to increase levels of free fatty acids and sugars in the body. The secretion of this hormone at a normal rate directly impacts how tall an individual will be and other areas of growth in the body.

There are many other possible side effects of amphetamine use, some of which have only been associated with excessive use, which is more likely in adults that have been prescribed amphetamines such as Adderall than for children. They include insomnia, psychosis, hallucinations, violence, aggression, weight loss, and tremors (Moore, 2010). Every one of those effects can be analyzed to show a disadvantage for individuals and society. Insomnia, restlessness, and inability to rest the body properly at night, in any individual who works in America, impact society negatively, whether they be a doctor, a bus or truck driver, a teacher, a student, or any other profession for that matter. Psychosis is defined as a loss of contact with reality and it is obvious why this is a disadvantage for society. A person suffering from psychosis will report hearing and seeing things that are not there as well as believing things that are evidently not true. Violent and aggressive behavior can lead an individual to commit crimes and hurt other people. Although weight loss is an effect that actually counters another surfacing epidemic in society, obesity, extreme weight loss can lead to loss of mass that is essential muscle that the body needs to function. It is generally accepted that these conditions are not desirable features for a human being, yet there are so many people willing to risk these conditions by using amphetamines or allowing the use of them to treat their children, including advocacy by the United States government and FDA as a common medication. Aside from the long term conditions that have been outlined, there are many short term effects as well.

Short Term Effects of Amphetamine

Similarly to the way long term effects were discovered, short term effects were uncovered by researchers. Known short term effects of amphetamine are increased heart rate and blood pressure, reduced appetite, pupil dilation, happiness feeling, and reduced fatigue (Moore, 2010). These short-lived effects can have major implications if they are continued for extended periods of time, for example, an entire childhood. Increased heart rate and blood pressure can have disastrous effects on the body if maintained for long periods of time as proven by the leading cause of death in the United States, heart disease. There are major cardiovascular risks associated with the prolonged use of amphetamines (Hammerslag, Waldman, & Gulley, 2014). This is more so in adults but is still noteworthy. Other than the cardiovascular-related short term effects of amphetamine, these effects seem like pleasant ones and ones that would be desirable, unlike the previously mentioned long term effects. This suggests that an outside intervention must be made in order to remove the problem from society.

Summation of Short and Long Term Effects

Given both the short term and long term effects of amphetamine use in children and adults alike it seems beneficial to seek alternative medicine for children with ADHD so to decrease the amount of amphetamine being manufactured. With less of the drug being produced, the number of people, especially children, using the drug will decrease. There exists only one method to reduce the quantity of amphetamine being produced in the United States. There needs to be a decline in the number of amphetamine prescriptions being ordered by physicians for children. This can be made practical by the emergence of many less destructive alternatives. Alternatives to amphetamine for the purpose of treating ADHD in children are becoming more available for adolescents with ADHD and clinical trials for some are already complete.

Alternative Medications for the Near Future

In response to such increases in diagnoses of ADHD and prescriptions of amphetamines to treat it, there have been many research experiments conducted aimed at finding an acceptable alternative to drugs in the amphetamine category. Some have been available for some time now, such as Strattera, and some are just emerging, such as agomelatine. Aside from new pharmaceuticals that are now available, science is finding new natural methods for the treatment of ADHD in children. A variety of herbs and physical therapy type treatments are encouraged and can help regulate the excessive energy exhibited by ADHD children. These practices may seem to require increased attention by caregivers of these children; however, the outcome for the child is much healthier.

Strattera

A very common name in the pharmaceutical community is Strattera. Strattera, the brand name of atomoxetine, is a non-stimulant alternative medication approved for use in treating ADHD. The major benefit of this and similar drugs is that they possess no abuse potential. Strattera has even been found to help with weight loss and depression (Oakland & Brue, 2002, pp. 68-70). ADHD individuals are at an increased risk of developing major depression, which amphetamines are also used to treat.

Agomelatine (Valdoxan)

Agomelatine is one example of a new pharmaceutical being investigated for its potential to replace amphetamines as a treatment for ADHD in children. This particular drug shows major benefits for children who also have a sleep disorder, which commonly is paired with ADHD in children (Niederhofer, 2012). This prospective drug can revolutionize the way we treat several diseases and disorders. Clinical trials lead doctors to believe that this drug can be as effective as amphetamines in treating behavioral problems as well as cognitive ones observed in ADHD children (Niederhofer, 2012). Along with this already available new way to treat ADHD in children, there is room for significant improvement in the near future.

Nicotinic Medications

Nicotinic medications, those that target nicotinic receptors in the brain, are thought to be the next step in the evolution of treatment for ADHD. This is because observations of cigarette smoking rates in persons with ADHD being higher than those of persons that do not exhibit the disorder (Wilens & Decker, 2007, p. 1212). Experiments in the near future will determine if the correlation is true regarding nicotine and ADHD persons. The implication is that triggering of the same receptor for nicotine may play a role in the pathophysiology of ADHD. Nicotine has already been shown to improve cognition in humans and animal test subjects. Nicotinic receptor agonists initially developed had severe side effects, but now newly developed derivatives of these agonists show a decrease in adverse side effects (Wilens & Decker, 2007). The full potential of these types of medications is still being explored but initial experimentation shows great signs for the future of ADHD treatment.

Natural Treatments

There are many ways to aid an ADHD child to see a reduction in symptoms associated with the disorder. Relaxation techniques, routines, exercise, and dietary changes can help suppress the symptoms of ADHD in children. Relaxation techniques are aimed at calming the nervous system of the ADHD child. In ADHD children, the branch of the nervous system that initiates the “fight-or-flight” response is overstimulated and causes most of the symptoms associated with ADHD. Some ways to calm the mind and body include breathing exercises in which the child is told to focus on breathing with visualizations to accompany. Massages are another efficient method of obtaining relaxation. Routines are another natural way to control ADHD symptoms. Routines that are kept consistent, especially with regards to bedtime and evening time, help to keep the symptoms of ADHD mild and also help the affected child to obtain a full, quality night sleep (Story, 2013). Another natural treatment that is good for all individuals to incorporate into their lifestyles is regular exercise. Exercise will help the child to sleep better at night due to the stress it puts on the body and has long been thought to help in the transition between sleep cycle intermediates (Oakland & Brue, 2002). The diet of an individual contributes significantly to the overall health and is no different in children with ADHD. Evidence suggests that an increase in omega-3-fatty acids can be used to control symptoms without any outside assistance from pharmaceuticals (Belanger MD, et al., 2009). Supplements for omega-3-fatty acids exist and can also be found in certain foods, especially seafood. Herbal teas, green oats, ginseng, and other specific plant extracts can also significantly decrease ADHD symptoms (Story, 2013). Many of these considerations can be thought of as healthful lifestyle choices and changes.

The natural treatments for ADHD can be summed by the word, “lifestyle.” Lifestyle changes that have been outlined above contribute to the increased mental health of individuals with ADHD. Many of these lifestyle choices are actually encouraged for any person regardless of mental health. Sometimes the absence of some of these lifestyle choices can contribute to the development of ADHD and other mental disorders observed in society.

Conclusions and Final Thoughts

In order to eradicate this disorder from society, a complete understanding of ADHD must be attained. This is done by a review of completed research data and learning from the history of human society. The history contained in the last century of human existence offers a plethora of valuable information concerning the use and abuse of amphetamines. They have shown to change the brain chemistry of an individual and even change that individual completely in some cases. The cost the amphetamine is, directly and indirectly, imposing on the country is greater than the value of the time required to alter this practice. The pharmaceutical manufacturers have reaped massive benefits from the contribution to the destruction of society.

The fact is that decreasing or eliminating the production and prescription of amphetamine containing drugs can only benefit the community in the United States and beyond. Many other countries have followed the footsteps of America throughout the course of history. There is an increased chance that other countries will adopt new treatment methods for this disorder if the United States were to implement these new, and older, alternatives for the treatment of ADHD. By decreasing the amount of amphetamine produced in America and the number of prescriptions being ordered for children for the treatment of ADHD, the alternative treatments can be encouraged. More information about the outlined alternatives should be provided to caregivers of affected children upon diagnosis.

Amphetamine was the first solution to ADHD in children and should eventually be considered a primitive treatment for the disorder. The time has come for reconsideration of the accepted treatments of ADHD in children due to the abuse potential, resulting cost, neurochemical effects, and natural alternatives that have surfaced since the introduction of amphetamine to the world of pharmacy.

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