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Addictive Drugs Still Best Option for Attention Deficit Disorder Spain NEWS Addictive drugs still best option for attention deficit disorder The most popular medicines for attention expected to receive FDA approval this year. deficit hyperactivity disorder (ADHD) are Drugs that trigger the release of dopamine widely abused, according to the latest damning create pleasant feelings that the brain can begin report on the controversial subject. ‘Abuse-proof’ to crave over time. By targeting norepinephrine, alternatives are increasingly becoming available, Strattera theoretically skirts the potential but they are not as effective as the addictive for addiction, and was anticipated as a safe medicines, doctors say. alternative to stimulants. But nearly four years ADHD drugs such as Ritalin and Adderall are after its release, it commands only about 15% of stimulants that help to enhance concentration by the market. Last year, the FDA also suggested that boosting levels of the ‘feel-good’ neurotransmitter Strattera may cause suicidal thoughts in some dopamine—a feature they have in common with children. cocaine. The number of Ritalin prescriptions “Strattera is relatively a bust compared to soared during the 1990s, but reports on its illegal Ritalin and Adderall,” says Lawrence Diller, use quickly began to follow. a behavioral pediatrician in Walnut Creek, The most recent report in February showed California. “Despite massive advertising and that more than 7 million people in the US have educational campaigning by Eli Lilly, the word abused ADHD stimulants, and as many as Akira Suwa/Philadelphia Inquirer on the street amongst physicians is that Strattera 750,000 teenagers and young adults show signs of Heavy dose: More than 7 million people in the US is a second-choice drug, at least in children.” addiction (Drug Alcohol Depend. published online have abused drugs for attention deficit disorder. Drugs such as Strattera and CX717 are unlikely http://www.nature.com/naturemedicine 15 February 2006; doi:10.1016/j.drugalcdep.200 to match the highly effective stimulants, doctors 5.12.011). A US Food and Drug Administration for Behavioral Medicine in Minnesota. say, and are primarily a choice for people who (FDA) panel also warned in February that the Partly in response to the stigma surrounding also suffer from other disorders such as anxiety stimulants may pose a risk for heart failure. stimulants, a few pharmaceutical companies or who may have a history of substance abuse. The warning emerged after reports of 25 deaths are developing abuse-proof ADHD treatments. Preliminary studies indicate that fast-acting and 54 cases of cardiovascular problems in adults In 2002, Eli Lilly released the nonstimulant versions of stimulant drugs—which induce and children between 1999 and 2003. Scientists Strattera, which boosts concentration by euphoric feelings right away—may be more say years of study are needed to understand increasing the levels of another mood-regulating prone to abuse. If further studies hold up such exactly how the drugs affect the heart. neurotransmitter known as norepinephrine. findings, says Lenard Adler, director of the adult But psychosocial stimulants are still the best More recently in March, California-based ADHD program at the New York University available drugs for quelling common ADHD Cortex Pharmaceuticals announced promising Medical Center, the industry could switch to Nature Publishing Group Group Nature Publishing 6 symptoms such as inattention and hyperactivity, results from phase 2 human trials for its drug longer-acting formulations of the same drugs. say doctors. “At the end of the day, stimulant CX717, which acts by boosting levels of glutamate, Companies might also develop new ways of 200 medications just work so nicely and people a neurotransmitter involved in learning and delivering the drugs that would enable the safer © tolerate them really well,” says psychiatrist Joel memory. Sparlon, a nonstimulant version of use of stimulants. Young, medical director of the Rochester Center the popular sleep-buster drug Provigil, is also Paroma Basu, Madison Spain takes aim at better clinical research schemes The Spanish Health Ministry has launched previously did so on their own time. The Rafael Molina, a clinical biochemist at the a program to boost the country’s research new scheme, launched in January, will Hospital Clínic of Barcelona. Molina says all output. The scheme will allow physicians to primarily benefit those clinicians who are physicians should be allowed to spend up to give up some of their clinical responsibilities leading research projects funded by the 25% of their time on research. in order to focus on research, but some health and science ministries, but will be The new program “might create two researchers say it’s only a bandage fix for a expanded in the next few years. The health categories of hospital physicians, with the larger problem. ministry’s Carlos III Health Institute (CHI), ‘elite’ being represented by those engaged in Most biomedical research in Spain is the primary funding agency for biomedical research,” he says. Getting doctors involved carried out in public hospitals. But because research, is expected to formalize the in research may also affect their teaching physicians have to devote most of their time agreement with the regional health duties, and further impoverish an already to clinical duties, the scheme is an important authorities. overburdened system, others caution. step toward boosting translational research. Initially, 55 staff physicians with a PhD Long-term solutions for improving “I’ve saluted the measure with enthusiasm and a recognized research trajectory will be Spain’s research will require the government since it opens a key door—the recognition able to reduce their bedside time by one- to adopt radical reforms in the curriculum of the research time of researchers with half. The CHI plans to provide $1.7 million for medicine and other life sciences, says healthcare contracts,” says Josep M. Antó, to the regional governments to cover the Antó, who notes that there is no model director of the Barcelona Municipal salary of substitute physicians. for a research-based career in Spain. “The Institute of Medical Research. But the scheme unfairly benefits only a problem seems to be deeply rooted,” he says. Physicians who wanted to do research small fraction of physician-scientists, says Xavier Bosch, Barcelona 374 VOLUME 12 | NUMBER 4 | APRIL 2006 NATURE MEDICINE.
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