Nicotine as ADHD treatment

2009-11-08T21:57:00.000-08:00

What a weekend. Baby's been pretty fussy, we think he might have reflux issues. My battery died for the first time, I measured it at 2.8v. The hilariously-poorly translated booklet gave (apparently) incorrect blink codes so I thought perhaps there was a short in the atomizer, but no, just a low battery. I haven't been able to "vape" for about ten hours, I messed with it thinking the atomizer needed flushing, and then forgot about it for a few hours. I've thought about it a few times, but it never got much past "I wonder where my backup is..."

That's understandable, given a bit of research I just found indicating that while classic ADHD patients have a more difficult time quitting smoking than controls, ADHD-I (inattentive type, like myself) had comparable results. That should give an interesting perspective to any researcher looking to understand the differences between the subtypes.

There's something I've been wanting to do but haven't had a chance to yet, and that's review my "personal vaporizer". I have the DSE801 "pen style" model made by Sailebao. The battery is slightly narrower and longer than the atomizer, so except for the mouthpiece at the top it looks just like a pen. This has been handy in the office as I think it's avoided several "what is that?" moments. I still feel a little uneasy explaining what it is and why I'm using it to people, except smokers of couse. Over the last few weeks I've developed more of an understanding of what it's like to be a smoker without actually being one myself, perhaps by identifying with the smokers in some of the articles I've been reading about this subject.

Apart from appearance, I've felt that the 801 is a reliable device with good performance, battery life, and overall build quality. I feel that what it lacks in appearance it makes up for with its other qualities (like myself! :p). It's not the smallest e-cigarette out there, though. In fact it's pretty hefty if you're comparing it to a cigarette. I suppose you could classify this alongside cigars such as the ubiquitous "black'n'mild".

The e-liquid I have currently is unflavored so I can't speak to its ability to enhance or detract from this quality of the experience. I did however win a bottle of "cappuccino" flavored liquid in a chat-room trivia contest from ecigsupply.com (thanks!).

Overall, I'd say it's a good starter model, I haven't had to mess with it much.

The FDA Report

2009-11-04T11:08:00.000-08:00

When discussing this subject with people marginally familiar with the media attention given to e-cigarettes recently, the subject of the recent FDA analysis of a very small subset of liquid nicotine products available on the open market always comes up. In most articles about the subject, the most "damning" aspects of the report are featured front and center. Since part of this blog is to defuse the FUD surrounding e-cigarettes, I will give you a brief rebuttal to the report followed by a link to a more thorough analysis.

Essentially, the report analyzed 18 samples of prefilled nicotine cartridges supplied by two relatively large suppliers of e-cigarette products. These samples are not representative of the market, I might add, but do represent the larger and more commercialized entries into the market.

In one of the samples, the FDA found "detectable amounts" of diethylene glycol (DEG), a component of antifreeze. (This fact is entirely irrelevant, yet is repeatedly noted in articles. This substance, while toxic, is also used as a humectant in existing "analog" cigarettes. Technically, water is a component of brain tumors.) Firstly, the term "detectable amounts" needs some definition. The FDA used a device known as a "gas chromatograph and mass spectrometer" also known as GC/MS to analyze the samples. This device is the gold standard for analyzing pretty much anything in chemistry as it is extremely sensitive and accurate, as well as relatively cheap to operate. The thing about GC/MS is that it is EXTREMELY sensitive, able to detect substances in the "parts per billion" range.

The reports indicates that DEG was identified "qualitatively". This means "we found it". It does not indicate how much was found. For reference, DEG is a natural contaminant of polyethylene glycol (a common food additive, as is propylene glycol). The U.S. Code of Federal Regulations allows no more than 0.2% of diethylene glycol in polyethylene glycol when the latter is used as a food additive. This means that there are "detectable amounts" of DEG in your toothpaste. While I don't think that DEG contamination is a non-issue, I believe that its presence in "detectable amounts" in one sample out of 18 is more of a quality control issue than a reason to ban e-cigarettes outright.

Secondly, the FDA report found tobacco-specific nitrosamines in five of the samples. This would be expected, because five of the samples were flavored with tobacco extract. Interestingly, other nicotine replacement therapy products contain tobacco-specific nitrosamines, and yet the FDA does not see this as a problem. Again, the FDA does not indicate the amounts of these substances except to describe them as "very low levels".

Thirdly, the FDA found "detectable quantities" of nicotine in the supposedly nicotine-free sample. Again, the detection limits being what they are, it is possible that this is the result of inadvertent contamination on the part of the FDA or the manufacturing facility of the cartridges. If the latter, then that is a quality control issue that needs to be addressed, rather than a reason to ban the product outright.

Here is a more detailed and reasoned rebuttals of the FDA report as promised:
From Michael Siegel at tobaccoanalysis.blogspot.com

Long-term effects of inhaled nicotine.

2009-11-04T09:57:00.000-08:00

I found the article referenced in the previous post, courtesy of "Lucky Kitty" over at e-cigarette-forum.com.

Another gem from the NIH:

Long-term effects of inhaled nicotine.

Waldum HL, Nilsen OG, Nilsen T, Rørvik H, Syversen V, Sanvik AK, Haugen OA, Torp SH, Brenna E.

Department of Medicine, University Hospital, Tronheim, Norway.

Tobacco smoking has been reported to be associated with increased risk of cardiovascular disease and cancer, particularly of the lungs. In spite of extensive research on the health effects of tobacco smoking, the substances in tobacco smoke exerting these negative health effects are not completely known. Nicotine is the substance giving the subjective pleasure of smoking as well as inducing addiction. For the first time we report the effect on the rat of long-term (two years) inhalation of nicotine.

The rats breathed in a chamber with nicotine at a concentration giving twice the plasma concentration found in heavy smokers. Nicotine was given for 20 h a day, five days a week during a two-year period. We could not find any increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. Throughout the study, however, the body weight of the nicotine exposed rats was reduced as compared with controls. In conclusion, our study does not indicate any harmful effect of nicotine when given in its pure form by inhalation.

Propylene Glycol as inhaled germicide

2009-11-04T08:27:00.000-08:00

It's possible that "vaping" (I still can't not use quotes) may have more benefits than I initially anticipated. It seems that the carrier - propylene glycol - may act as an inhaled germicide, giving me protection from various forms of lung illness. I asked around a bit on the forums I frequent, and found several anecdotal reports of "everyone else got sick but me."

Genius!

The article referenced above discusses an experiment that involved immersing various animals in a propylene glycol mist, 24/7, for several years. They did not appear to suffer any harm from this.

I've also got another study of a similar thing done to rats, except with nicotine mist. They also did not suffer ill effects beyond minor weight loss. I'll see if I can dig that up later.

2009-11-03T22:35:00.000-08:00

From the NIH (link):

Mr. A, a 43-year-old white man, was self-referred in June 2006 for an ADHD evaluation. Although he had symptoms of depression and anxiety, he only fulfilled DSM-IV-TR criteria for ADHD. Mr. A had been taking metoprolol (50 mg daily) for mild hypertension for several years, and after evaluation in our facility in 2006, he began medication trials with amphetamine mixed salts (10 mg 3 times daily), methyl-phenidate (36 mg), and bupropion (150 mg). He experienced marked irritability; each stimulant needed to be discontinued within a couple of days, and the bupropion was stopped within 3 weeks of starting. Mr. A then began a trial using the 7 mg trans-dermal nicotine patch from 7 a.m. until 4 p.m. on Monday through Friday, and on weekends as needed.

He developed mild chest discomfort at around noon of the first treatment day. Mr. A was instructed to remove the patch and begin again the following morning using the equivalent of a 3.5 mg transdermal patch. This was crafted by partially peeling the foil backing and cutting the foil in half with scissors, being certain not to cut or disturb the patch's delivery system in any way. (Caution: the manufacturer does not endorse this technique, and dosing may be inconsistent from day-to-day.) In this way, Mr. A applied a half-exposed 7 mg patch—about 3.5 mg—from 7 a.m. until 4 p.m. on alternate mornings. A fully exposed patch was to be applied on the following day. Mr. A's ADHD symptoms, which mainly consisted of inattentiveness and poor reading comprehension, completely resolved within an hour of starting approximately 3.5 mg of nicotine from the transdermal patch, as did his depressive and anxious symptoms. Problems with inattentiveness, reading comprehension, depression, and anxiety partially returned (about 30%) after the patch was removed each day. He continued to respond for about 1 year as long as the patch was applied, without the need to increase the transdermal dose. His blood pressure remained stable throughout, and although Mr. A is a recovering cigarette smoker with over 10 years clean, use of the transdermal patch has not led to cigarette relapse. He continues to report fewer thoughts and cravings to pick up “just one” cigarette as compared to his prepatch thought and craving frequency.

2009-11-03T16:31:00.000-08:00

Apparently, smokers don't self-administer pure nicotine. This could explain the high failure rates for passive NRT.

This article further bolsters my belief that pure nicotine is not significantly addictive.

So far my own experience is bearing this out. I never feel the "need" to 'vape' (I don't feel comfortable with that term yet, somehow). I forget to do so for hours at a time. In fact, for me the primary motivation seems to come from my existing desire to munch on things, or needing something to fiddle with.

Wow

2009-11-02T23:32:00.001-08:00

Who knew? If you aren't savvy, there is a strange backlash against e-cigarettes by prosecutors, state governments, and the federal government. They cite a (seriously misconstrued) study by the FDA to suggest banning these devices. Furthermore, they suggest that because they are sold with flavorings that they are being targeted at children. Only children like flavorings, it seems.

Luckily, the e-cigarette "movement" is very quickly growing and gaining traction - mostly by angry ex-smokers who don't want to be denied this "lesser of two evils", lest they be tempted back to "crude plant matter".

Interesting times. The heavily cultivated anti-smoker sentiment is coming to bear on e-cigarettes, which only bear a vague resemblance to tobacco, excluding all of the reasons "analog" cigarettes are vilified for in the first instance. The association with tobacco is strong, I suppose this is why there is a suggestion in the e-cigarette community to distance this product from the word "cigarette", preferring instead "personal vaporizer".

I don't know how helpful that will be though. When I think "personal vaporizer" I think of some form of drug paraphernalia.

Day somethingth

2009-10-26T15:33:00.001-07:00

So far everything's been working well. Regular nicotine administration has markedly increased inhibition, enough at least to allow me to increase my functionality at work. I haven't noticed a drop in weight due to appetite suppression, though.

I've mentioned my e-cigarette to a few smokers that I know, most seem very interested.

2009-10-22T16:11:00.001-07:00

Today I was able to stay on task and complete the BOM tool, which our document specialist will really appreciate.

I must advise you that my results could easily be placebo effect. However, based on some of the research that I've been reading lately, I think that placebo is not responsible for 100% of the positive effects that I've noticed.

I need to research the downsides of this, besides higher blood pressure, of course.

I've noticed some mild tremors today, but that was after ingesting about 200mg of caffeine. I've also noticed a few of what seemed to be mild sinus headaches, although if that is a result of "vaping" it may be caused by the carrier substances rather than the nicotine. My body is probably still adjusting to the influx of new substances, so unless they continue for another month or so I'll discount them.

Day Three

2009-10-21T21:22:00.000-07:00

Today was really good. I was able to stay on task and really crank some difficult work out. Specifically I wrote the meaty bits to an application that connects to the database of an application called Parts and Vendors and creates a list of all the parts used in a particular product (a "BOM") that my company manufactures. This should save our document specialist about 6 hours a day.

Here's another interesting document regarding the subject of the blog. The case seems pretty clear, nicotine IS useful for treading ADHD.

Today my battery blinked 15 times at me. I need to look up the blink codes. After a while it went back to its normal behavior.

Second Day

2009-10-20T09:30:00.000-07:00

I showed my c-cigarette to a smoking co-worker today, she was interested and wanted to buy one, but mostly because it would let her smoke in a bar.

Another co-worker overheard the conversation wherein I mentioned the reason why this nonsmoker would do such a thing. He tried to convince me that all I really needed was the healing power of religion based upon his own experiences. I tried to explain that his experiences were based on the significant healing power of self-suggestion, but he was too deeply entranced to shake it (not that I necessarily want to shake him of that, there's no point, it obviously helped him). In retrospect, I shouldn't have even tried to engage him in an objective analysis of his experiences as that would have rendered the method ineffective.

Today's been good, the lightheadedness and mild nausea is less apparent today. One thing I've noticed is that the vapor catches in my throat in the same way that tobacco smoke did when I've accidentally inhaled it in the past (I used to smoke handrolled pipe-tobacco cigarettes, mostly for novelty). I asked on the forum and apparently this is called "throat hit" and is sought after by those cigarette smokers who move to electronic cigarettes. I can't see why.

The positive today is that I've felt as though I am experiencing less of the "gnatlike" attention span that I have sometimes. That's not to say I can't hyperfocus, but it's difficult to focus on things that I find uncompelling, which is one of the symptoms of ADHD-I.

Searching around...

2009-10-19T21:32:00.000-07:00

I probably should have started a bit earlier, but I searched around a bit and found some interesting (and positive) information.

Here's a post about an experimental ADHD drug that stimulates nicotinic acetylcholine receptors. I wouldn't necessarily consider taking a new phamaceutical (the side-effect profile for nicotine is well established), but it is interesting in that it uses the same pathway.

Here's the abstract of a study of the use of transdermal nicotine as treatment for ADHD in both smokers and nonsmokers. The sample size is a little small (6 smokers, 11 nonsmokers), but the results are fairly promising.

Yet another article discusses the multitude of cognitive benefits found from nicotine administration, including ADHD.

First Day

2009-10-19T14:33:00.000-07:00

There are many, many models of e-cigarettes available, mostly made by a few chinese manufacturers. After discussion and some shopping, I settled on the DSE801 "Classic Pen-Style". It resembles a pen very strongly, excepting of course the rather out-of-place textured grey plastic cap on the bottom end. I won't go into detail describing what e-cigarettes are or how they work, that's been done in much greater detail over at Vapersforum.com. Let it suffice to say that I now have my e-cigarette.

And I've used it. After a few initial puffs to clear out the acrid taste of the atomizer preservative, I've inhaled the nicotine vapor - approximately three times in four hours or so.

I remember when I was very young, I obtained some cigars and proceeded to smoke them beneath a bridge with a pretty young girl. I became violently ill after the second cigar, ruining what was otherwise a very pleasant afternoon.

So, after the third puff or so I started to remember that sensation. I better go slow with this :).

Light-headed, a little dizzy, but definitely stimulated. I find I'm able to focus a bit better, similar to the beginning stages of my dextroamphetamine salt trial.

I should have gone with the lower concentration liquid, I'm using 24mg/ml currently.

First post!

2009-10-19T13:18:00.000-07:00

Welcome to my blog. I created this blog to record my experiences as a nonsmoking ADHD "sufferer" using self-administered nicotine as a treatment.

I'll begin by telling you a bit about myself. I'm in my late 20's, a father of two small children, and a systems administrator for a small company. I self-diagnosed myself as having ADHD "inattentive type" about a year ago and had this diagnosis confirmed by a trained psychiatrist. I was prescribed mixed dextroamphetamine salts, and a first they worked quite well. I experienced a good deal of focus and energy, I lost 20 lbs and overcame many of the limitations imposed on me my by condition. After a few months, however, the inertia wore off and I began to experience the side effects. I attempted to ameliorate them with co-administered magnesium complex, but ultimately decided to stop. For me, the benefits did not outweigh the side effects. Specifically, I experienced a reduced-duration temper, mild tremors, and social dysfunction. To put it bluntly, I felt like a human-shaped robot much of the time and found myself directing more of my mental energies to approximating the appropriate human response rather than having those actions flow freely from my subconscious as they do normally.

In any case, I've tried amphetamines and found them lacking. I know there are other medications indicated for ADHD-I, but the side-effect profiles of each make me queasy.

Randomly I discovered e-cigarettes. I had toyed with the idea of smoking as a method of ADHD control and weight loss, but discarded it due to the negative effects of inhaling combustion byproducts, the cost of the drug, and the social factors ("stinkiness"). E-cigarettes handily defeat all of these downsides and I decided to investigate further.

I found a few e-cigarette forums and chat rooms and discussed my ideas with them. I found rather vehement opposition to the idea of a nonsmoker willingly subjecting himself to nicotine addiction, and I think that's a good thing. However, after reviewing the available data, I think that in my case the potential benefits outweigh the risks.

There are a number of significant differences between nicotine-bearing vapor and cigarette smoke. For now we'll ignore the combustion byproducts and focus on the pharmacological situation. Tobacco contains a number of alkaloids in addition to nicotine. A number of these are MAO inhibitors, which significantly increase behavioral reinforcement in rodent studies. By itself, nicotine is markedly less addictive than when it is administered along with these other drugs. (reference)

Secondly, while nicotine stimulation does downregulate dopamine in the same fashion as cocaine and heroin, there is yet another compensation mechanism in place to counter this not experienced with other drugs! Specifically, the body responds by increasing the number of nicotinic acetylcholine receptors, sensitizing the reward pathways. (reference) The upshot of this is that the initial downregulation is mediated by the increased number of receptors, making the withdrawal less severe than the other drugs in the same class of addiction potential (heroin, alcohol, benzodiazepines).

It is entirely possible that without the co-administered MAO-I's that I will not experience the positive benefits that I seek. I am willing to take that risk, knowing then that the addiction will be similarly weak.