What have studies shown about the long-term effects for adults of
taking dexedrine (dextroamphetamine) for Attention Deficit Disorder
(ADD)? Specifically, I would like to know if there are side-effects
that show up over the long term, and if the effectiveness of the drug
has been shown to increase/decrease over the long term.  Please cite
references.

By "long-term," I mean two years or more.

I am an adult male who has been taking dexedrine for Attention Deficit
Disorder for six years.

I'm not particularly interested in opinions and anecdotes -- the ones
I've come across seem to contradict one another.

---

Request for Question Clarification by journalist-ga on 11 Sep 2002 07:24 PDT

Dexedrine is an amphetamine.  There are studies on long-term use of
amphetamines.  Would you accept these as an answer?  A sample of
long-term effects of dexedrine (from one source) is below:

Stimulants

Enhance brain activity to increase alertness, attention and energy. 
Used to treat asthma, respiratory problems, obesity, neurological
disorders, attention deficit hyperactivity disorder
Amphetamine, methamphetamine, khat

Brand Names
Dexedrine, Ritalin, Meridia

Immediate effects:
Elevated blood pressure, increased heart rate, increased respiration,
suppressed appetite and sleep deprivation

Long Term effects:
Irregular heart beat, heart failure and lethal seizures, hostility,
paranoia, addiction

Hi, mdg-ga,

  I explored your question in two parts according to how you addressed
each topic. I want to assure you that I have also kept in mind that
you are an adult taking Dexadrine as opposed to a child. However, I
did not find too much difference in the mention of long-term side
effects between the age levels. However, I will only address those
potential long-term effects that would be specific to an adult.

  First, as a preface, here is some information I am sure you already
know:

   “Only recently has attention deficit/hyperactivity disorder (ADHD)
been recognized in adults. Previously, it was thought that ADHD
symptoms resolved in adolescence after brain development reached a
certain point or when hormonal or other developmental changes
occurred. Studies have since documented, however, that many children
with ADHD continue to have symptoms in adolescence and adulthood.
  “An estimated 2 to 5 million adults have ADHD. In many cases, adults
with ADHD symptoms never received a diagnosis or treatment as
children. The common clinical complaints among adults with ADHD are
disorganization, poor concentration, inability to finish tasks before
shifting activities, procrastination, anticipatory anxiety and
impulsive outbursts.
  “The consequences of untreated or inadequately treated adult ADHD
include fewer completed years of education and more complaints of a
disabling symptom, such as inattentiveness or restlessness. Other
complaints may include sexual dysfunction, interpersonal problems, and
antisocial personality disorders.
  “The three psychostimulants most often used to treat adults with
ADHD are dextroamphetamine sulfate (Dexedrine), methylphenidate HCI
(Ritalin HCI), and pemoline (Cylert). Some adults do not respond to or
cannot tolerate CNS stimulants. These patients may respond to a
tricyclic antidepressant, such as imipramine.”
  Read “Attention Deficit Disorder” at
http://www.etenet.com/Apps/Library/Corporate.asp?ID=23

  Now, to your question and what I have found!

1. “Specifically, I would like to know if there are side-effects that
show up over the long term…”

   The most often mentioned long-term side effect concerning long-term
use of Dexadrine is the potential for addiction.
   “The habit-forming potential is high. Psychological and physical
dependence is possible. Addiction is rare in children but a problem
with adults.” Refer to http://www.psyweb.com/Drughtm/dexed.html. Also,
please note the rare (though not necessarily long-term) side effects
of taking Dexadrine.
  “It is important to note that the Drug Enforcement Administration
(DEA), and all other drug enforcement agencies worldwide, classify
methylphenidate (the generic name for Ritalin) and amphetamine
(Dexedrine and Adderall) in the same Schedule II category as
methamphetamine, cocaine, and the most potent opiates and
barbiturates. Schedule II includes only those drugs with the very
highest potential for addiction and abuse.” Read “Why to Avoid
Dexedrine and Ritalin” at http://www.healthysource.com/dexedrine.html

  Other long-term side effects noted are irregular heartbeat, heart
failure and lethal seizures, hostility, and paranoia. Read
“Prescription Drugs: Most Commonly Abused.” Metropolitan Drug
Commission at http://www.metrodrug.org/prescription_drugs.html

  A somewhat alarming article on the effects of Amphetamines, which
includes Dexedrine, mentions these long-term side effects:
  Long term effects: Malnutrition, fatigue, sleeplessness, Severe
anxiety, tension, high blood pressure, Lowered resistance to disease,
Long term users may also exhibit bizarre or violent behavior,
Amphetamine Psychosis may develop in long term heavy users. This
condition is similar to paranoid schizophrenia and includes symptoms
such as hallucinations, paranoid delusions and compulsive behavior. It
usually disappears when the user stops taking the drug.
 Read “Amphetamines and Methamphetamines” at
http://www.woinfluence.yk.net/drugs/amphetamine.html

  Contrary to the above articles is a reference by William Coleman MD
and Henry Shapiro MD. Again, the article refers to childhood use of
stimulant medications including Dexadrine. As quoted from the article:
 “There are no dangerous, irreversible long-term side effects when the
medication is appropriately prescribed…..”  “Stimulant medications do
not cause addiction or lead to drug or alcohol abuse.”
Read “Stimulant Medication Fact Sheet” at
http://www.dbpeds.org/pdf/stimfact.pdf

  As another article mentions, “The people who need actual
prescriptions for amphetamines (which includes Dexedrine) rarely
develop addictions because their brains start out with a lack of the
natural “speedy” chemicals. Read “Don’t Stay in the Dark, Get in the
Know.” at http://www.syndistar.com/pdf/amphetamine.pdf
 
  Though not specifically listed under long-term side effects, I would
feel irresponsible if I did not include this list of adverse reactions
for your consideration along with potential long-term effects:
ADVERSE REACTIONS
Cardiovascular: Palpitations, tachycardia, elevation of blood
pressure.
Central Nervous System: Psychotic episodes at recommended doses
(rare), overstimulation, restlessness, dizziness, insomnia, euphoria,
dyskinesia, dysphoria, tremor, headache, exacerbation of motor and
phonic tics and Tourette's syndrome.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea,
constipation, other gastrointestinal disturbances. Anorexia or weight
loss may occur as undesirable effects when amphetamines are used for
other than the anorectic effect.
Allergic: Urticaria.
Endocrine: Impotence, changes in libido.(**This may be a concern for
you in the long run!)
DRUG ABUSE AND DEPENDENCE 
Dextroamphetamine sulfate (DEXEDRINE) is a Schedule II controlled
substance.
Amphetamines have been extensively abused. Tolerance, extreme
psychological dependence, and severe social disability have occurred."
 Read “Dexedrine..Excerpt from the Physician’s Desk Reference” at
http://members.fortunecity.com/siriusw/dexedrine.htm

2. “and if the effectiveness of the drug has been shown to
increase/decrease over the long term.”

  No significant lasting improvement in behaviour has been shown to
result from the use of Dexedrine.
  “Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD. Read “Why to Avoid Dexedrine and
Ritalin” at http://www.healthysource.com/dexedrine.html

  Although the following excerpt is a reference to children, I believe
it is worth noting as an answer to your question: "Until recently, the
most important question concerning Ritalin or Amphetamine
administration has not been asked. Do these drugs make a difference in
the long-term outcome of the minimal brain dysfunction? A
comprehensive examination of this subject carried out at the Montreal
Children's Hospital discovered a startling fact. At the end of five
years, hyper kinetic children who received drugs (either Ritalin or
Chlorpromazine) did not differ significantly from children who had not
received. Although it appeared that hyperactive kids treated with
Ritalin were initially more manageable, the degree of improvement and
emotional adjustment was essentially identical at the end of five
years to that seen in a group of kids who had received no medication
at all. Read “Adderall” at http://pychealth.com/adderall.html

  Tolerance develops with regular use of a drug. As a person develops
tolerance to a drug, they need to take more and more of the drug to
get the same effects they once got from smaller amounts. Users develop
tolerance to amphetamines fairly quickly, even with taking only low
doses of the drug. Read “Amphetamines and Methamphetamines” at
http://www.woinfluence.yk.net/drugs/amphetamine.html

  In terms of whether the effectiveness of stimulant drugs like
Dexedrine increase or decrease over time, it may be of interest to
read the following excerpt which highlights the fact that the drugs
may have no real lasting benefits. (again, this refers primarily to
children, but should be of interest to adults using the medicine for
ADD as well)
  “Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD.
 A compilation of all the review studies published over the last
twenty years on the effects of stimulant medication for ADD/ADHD
showed that the medications only temporarily managed the symptoms of
overactivity, inattention and impulsivity, as well as increased
compliance, effort, and academic productivity, decreased aggression
and negative behaviors.
 Published research has found the long-term value of Ritalin
disappointing. Studies beginning in the 1960s showed that children who
took stimulants for hyperactivity (the name for ADD at the time) over
several years did just as poorly in later life as the group of
hyperactive children who took no medication. Compared to children
without hyperactivity, both groups were less likely to have finished
high school or to be employed, and more likely to have had trouble
with the law or to have drug or alcohol problems. A large percentage
of the hyperactive group, medicated or not, did relatively well, but
overall those in this category wound up struggling much more
frequently than their normal peers.”
 Read “Ritalin, Side Effects and Warnings” at
http://pychealth.com/ritalin.html
   
  For what it’s worth, if you are interested in reading about a
natural alternative to Dexedrine that keeps popping up in my search,
you might go to the Health-n-Nutrition Website and read about a
product called Masquelier's OPCs. I am not advocating it as I know
nothing about it! The website is at http://health-n-nutrition.com/add

Additional Reading
  “Prescription Drugs: Abuse and Addiction.” National Institute on
Drug Abuse.(2/21/2002) at
http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.html
  “Adults with ADD,” by Betsy Van Dorn. familyeducation.com at
http://www.familyeducation.com/article/0,1120,5-251,00.html
  “The Role of Medication in Attention Deficit Disorder,” by Dr. John
D. Murray. Add Toronto (4/2 2002) at
http://www.add-toronto.org/art_medication.html

  I hope this information helps to ease your mind one way or the
other. Each individual must weigh for themselves the benefits they
derive from a medication versus the possible side effects which may,
or may never, occur!

Good health and best wishes to you!

umiat-ga  

Google Search Terms
+dexedrine +long-term effects
+dexedrine +adults +ADD

---

Clarification of Answer by umiat-ga on 09 Sep 2002 11:27 PDT

Hello again, mjd-ga,

  I am very sorry for the dissatisfaction you feel in my answer. In
some respects, I agree that you have legitimate gripes. In others, I
don’t. However, you have spent a lot of money to ask this question, so
I would be very irresponsible if I did not try to clear this up for
you.

  First of all, the references I directed you to did, I feel, answer
your questions about long-term effects and the effectiveness of the
drug over time. Though many of them were not actual scientific
studies, I believe they are legitimate references that have compiled
the results of many, many clinical studies into accurate information.
You asked "What have studies shown..." You did not ask for scientific
references, per se. Therefore, I did point you to compilations of
information from studies. However, at this point, that is neither here
nor there. I want you to feel you have received good information. To
pour through clinical studies and come up with small details relating
to your question, which would then have to be compiled into a lengthy
text, you might try the following:
  Go to PubMed and do a study search on the long-term effects of
dexedrine. Click on the following link, 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi , and type in the search
term “dexedrine long term effects.” (without the quotation marks.) As
you can see, there are 844 articles relating to minute aspects of the
effects of dexedrine on various physiological components. Many of the
studies are done on rats and guinea pigs.
  However, to look at an example of one abstract which gives some
partial information to your question, click on Article Number 12 - 
“Treatment of attention-deficit/hyperactivity disorder.”
Evid Rep Technol Assess (Summ). 1999 Nov;(11):i-viii, 1-341.  It
should bring you to the article abstract at the following URL -
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10790990&dopt=Abstract
  Although I suggest you read through the abstract and order the
article or go to a medical library, here are some of the excerpts that
pertain somewhat to your question:
  “OBJECTIVES: To determine (a) the long-term and short-term
effectiveness and safety of pharmacological and nonpharmacological
interventions for attention-deficit/hyperactivity disorder (ADHD) in
children and adults and (b) whether combined interventions are more
effective than individual interventions.”…. “MAIN RESULTS:
Seventy-eight studies (77 randomized controlled trials) met the
inclusion criteria. Twenty-three studies compared drugs and showed
few, if any, differences among methylphenidate (MPH),
dextroamphetamine (DEX), and pemoline; studies comparing stimulants
with tricyclic antidepressants (2) were inconclusive. Six studies
compared drugs with nondrug interventions and showed consistently that
stimulants, particularly MPH, may be more effective than
nonpharmacological interventions. Twenty studies compared combination
therapies with a stimulant or a nondrug intervention alone; no
additional beneficial effects for combination therapies were shown……
“Twelve studies evaluated treatment in adults with ADHD. For MPH vs.
placebo, the results were contradictory. Antidepressants may be
effective in adults, but no beneficial effect was seen with pemoline,
nicotine, or phenylalanine compared with placebo. Thirty-two reports
(29 studies) evaluated adverse effects of drug therapy; many of the
side effects associated with stimulant use appear to be relatively
mild and of short duration and to respond to dosing or timing
adjustments. Data are inadequate on the long-term effects and severity
of adverse effects of most interventions. CONCLUSIONS: This report
describes rigorous systematic reviews on the treatment of ADHD, ready
for incorporation into evidence-based clinical practice guidelines or
performance measures. The report also provides a detailed description
of the many limitations of the evidence available and provides
recommendations to fill existing knowledge gaps. Studies on ADHD have
low reporting quality, methodological flaws, and heterogeneity across
outcome measures and tests. A detailed description is included of the
many limitations of the available evidence plus recommendations to
fill existing knowledge gaps. Fulfilling such knowledge gaps will not
be easy and will require genuine collaboration among decisionmakers.”

 To narrow down the search, I went back to
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi and typed in “dexedrine
adult ADD long term effects.” The search results brought up only one
article, and that is the one highlighted above.

  In terms of your remark that the
http://www.psyweb.com/Drughtm/dexed.html reference is basically the
same that the pharmacy gives you when you get your prescription
filled…..I have no way of knowing that, and I still consider it a
useful, and very credible reference. If you click on the reference
link at the bottom of the page, it will bring you here -
http://www.psyweb.com/refere.html , which is certainly not a small
list of books and articles concerned with the study of dexedrine,
among other medications. No, I cannot access all of them on my end,
but I have certainly provided you with a great deal of reference
information to pour through. All the books and articles mentioned are
certainly well respected sources. Many can be found at a public
library, college library or medical library. I have also read through
many of these books at bookstores over the years. “The Complete Guide
to Psychiatric Drugs,” “The Essential Guide to Psychiatric Drugs,” and
“The Essential Guide to Prescription Drugs,” can be found in almost
any library or large bookstore. “The Merck Manual,” which is a very
technical resource on drugs, their use, interaction and side effects,
as well as the “People’s Pharmacy,” are some other books that are
useful and  readily accessible. Almost all of these books cite medical
studies. Again, however, as the books are very credible, it is
interesting that you would want to pour through each article to obtain
one, small snippet of information, and work hard to combine them all
when the books have done exactly that!
  As far as your criticism of
http://www.healthysource.com/dexedrine.html, and the fact that you
have read this before….again, how can I know that? Also, although the
full article does contain references for alternative therapies, I do
not consider the scientific references at the end of the article
flimsy, to say the least. The fact that an article may be linked to an
advertisement does not automatically discount the accuracy of the
information referenced to make their point.  The multitude of
references highlighted at http://www.healthysource.com/add.html,
certainly have some pertinent information to your question. All of the
references from the article cited below are worth looking at for
long-term side effects:
11) Physicians Desk ReferenceŽ (PDRŽ), 53rd Edition, Medical Economics
Company.
13) Peter R. Breggin M.D., "Psychostimulants in the treatment of
children diagnosed with ADHD: Risks and mechanism of action,"
International Journal of Risk and Safety in Medicine, 12, 3-35, 1999.
14) N. Lambert, "Stimulant treatment as a risk factor for nicotine use
and substance abuse," Program and Abstracts, 191-8, 1998. NIH
Consensus Development Conference Diagnosis and Treatment of Attention
Deficit Hyperactivity Disorder. November 16-18, 1998. William H.
Natcher Conference Center. National Institutes of Health. Bethesda,
Maryland.
18) L. Rebecca Campbell, M.D., and Morris Cohen, Ed.D., "Management of
Attention Deficit Hyperactivity Disorder: A Continuing Dilemma for
Physicians and Educators," Clinical Pediatrics, March, 1990, 29:
191-3.
26) Paul H. Wender, Attention Deficit Disorder in Adults, New
York/Oxford: Oxford University Press, 1995, 166.
27) J.M. Swanson, et al., "Effect of Stimulant Medication on Children
with Attention Deficit Disorder: A Review of Reviews," Exceptional
Children, 60, 1993: 154-162.

  The link to http://www.metrodrug.org/prescription_drugs.html may be
one that you consider biased because it is linked to drug
abuse……however, you asked for potential long-term side effects, and
drug abuse is one of them. In no way does this suggest that you are a
candidate. I guess I assumed that a link to an article would prompt
you to look around the site a bit more. I’m sorry I didn’t direct you
further by taking you through the links, so that you would feel the
information was credible. A link from the above page takes you here -
http://www.metrodrug.org/prescription_drugs.html#Stimulants . From
this page, if you click on the link for “Prescription Drug
Information,” you will come to this page -
http://www.drugabuse.gov/DrugPages/Prescription.html . From here,
there are numerous interesting links. For instance, if you click on
NIDA Notes Volume 16 “Facts about Prescription Drug Abuse and
Addiction”, you will arrive here -
http://www.drugabuse.gov/NIDA_Notes/NNVol16N3/tearoff.html  An excerpt
from this page follows:

 What are stimulants and what are the potential consequences of their
use and abuse?
 
 Stimulants enhance brain activity, increasing alertness, attention,
and energy, raising blood pressure, and elevating heart rate and
respiration. Stimulants such as methylphenidate (Ritalin) and
dextroamphetamine (Dexedrine) are prescribed for the treatment of
narcolepsy, attention-deficit/hyperactivity disorder, and depression
that has not responded to other treatments. They also may be used for
short-term treatment of obesity.
Individuals may become addicted to the sense of well-being and
enhanced energy that stimulants can generate. Taking high doses of
stimulants repeatedly over a short time, however, can lead to feelings
of hostility or paranoia. Additionally, taking high doses of
stimulants may result in dangerously high body temperatures and an
irregular heartbeat.
  The source quoted for the above information is extremely credible.
Copies of the NIDA Research Report "Prescription Drugs: Abuse and
Addiction" may be ordered from the National Clearinghouse for Alcohol
and Drug Information at 1-800-729-6686 or TDD 1-800-487-4889 for the
hearing impaired. Additional information on prescription drug abuse
can be obtained through NIDA's Web site at www.drugabuse.gov.
 There are several other links on
http://www.drugabuse.gov/DrugPages/Prescription.html that are from
scientific sources that may shed some insight into your question.

 Concerning the reference at
http://www.woinfluence.yk.net/drugs/amphetamine.html, once again, I
should have pointed you to the link at the bottom of the page for more
information. Clicking on that link will bring you to a myriad of
articles at this site -
http://www.nida.nih.gov/DrugPages/Methamphetamine.html. Again,
although this is primarily dedicated to the abuse of drugs, I again
re-iterate that abuse is a potential long-term side effect, which is
what you asked about.

 Because the above references concerned drug abuse, I purposely
followed it with the excerpt from
http://www.dbpeds.org/pdf/stimfact.pdf  to highlight the fact that
addiction is rarely a problem when the drug is used as prescribed. I
do agree with you that this article is seemingly an opinion, since we
don’t have the citations on which the doctor’s based their
conclusions. However, given the credentials of the two doctors, and
the source from which the fact sheet came, which is the Pediatric
Behaviour and Development Homepage at http://www.dbpeds.org/, I
thought the reference was worth noting.

 As for the article, “Don’t Stay in the Dark, Get In the Know”…….I
agree with you. There were no references there, and I can’t find out
where they compiled their information from. My fault! Incidentally,
the link has changed to another article overnight!

  The Adverse Reactions which I noted for you at
http://members.fortunecity.com/siriusw/dexedrine.htm , though not
specifically long-term reactions, are still important to note,
especially since some may become long-term the longer you take the
medication. The Physician’s Desk Reference is one of the most
respected, scientifically based references you can find. You will find
it in almost every Physician’s office. Therefore, I would not discount
or doubt any possible side-effects mentioned in that resource. I find
it of no relevence that the Physicians Desk Reference was cited on a
site with a link to Masquelier. Note that the site also has excerpts
from the People’s Pharmacy and “The Essential Guide to Psychiatric
Drugs.” I might be skeptical if the references were something along
the lines of “The Dummies Guide to Drugs and Drug Paraphanalia.”!

  As for the links to Masquelier on several websites……I reiterate
again, I know nothing about the product. My 20-year old son was on
Ritalin for quite awhile, and I never even knew about such a product,
nor looked into alternatives. I would also stress that many of these
companies pay for links on web pages…….that does not necessarily make
the information on the web page disreputable.

 As for the other references listed at the bottom…they were just meant
as additional reading, not as medical references. Guess I added too
much, which caused more displeasure than thankfulness.

 Anyway, as I have been writing this clarification, I notice several
comments have been posted. I agree with the comment that you must have
written the longest rating on record…….and all to tell me why I was a
1-star researcher. Oh well, what can I say? I hope you will review
this clarification and find some useful suggestions.

umiat-ga

Below I will repost the comment I made when rating the answer:

Hi,

Thanks for your time and effort.  However, your response is not useful
to me, because I am looking for studies.  The information you have
provided in your answer generally consists of statements without
references to supporting studies.  I am looking for references to
medical journal articles.

I looked at your answer carefully to find any information that would
be useful to me.  Here is my analysis, if you're interested:

1.)  As a preface you present some general information about ADD, and
you reference

<http://www.etenet.com/Apps/Library/Corporate.asp?ID=23>

I didn�t ask for this information, but thanks anyway.

2)
�The habit-forming potential is high. Psychological and physical
dependence is possible. Addiction is rare in children but a problem
with adults.� Refer to <http://www.psyweb.com/Drughtm/dexed.html>.
Also,
please note the rare (though not necessarily long-term) side effects
of taking Dexadrine.

This is basically the same information that pharmacies give me
whenever I get a prescription filled. Not what I asked for, but
thanks.

3).
�It is important to note that the Drug Enforcement Administration
(DEA), and all other drug enforcement agencies worldwide, classify
methylphenidate (the generic name for Ritalin) and amphetamine
(Dexedrine and Adderall) in the same Schedule II category as
methamphetamine, cocaine, and the most potent opiates and
barbiturates. Schedule II includes only those drugs with the very
highest potential for addiction and abuse.� Read �Why to Avoid
Dexedrine and Ritalin� at
<http://www.healthysource.com/dexedrine.html>

I�ve seen this article before. The website which you cite,
Healthysource.com, appears to be associated with the makers of Flavay
and Masquelier.  These products are presented as an alternative to
Dexedrine. In fact, the article you cite, �Why to Avoid Dexedrine and
Ritalin�, ends with what amounts to an advertisement for Flavay. 
Therefore I consider any information from this website to be
potentially biased.  However, the reference section of this article
looks like it might contain some references to some useful studies and
reviews; I�ll have to look at it more closely to find out.

4)

Other long-term side effects noted are irregular heartbeat, heart
failure and lethal seizures, hostility, and paranoia. Read
�Prescription Drugs: Most Commonly Abused.� Metropolitan Drug
Commission at <http://www.metrodrug.org/prescription_drugs.html>
 
I found this statement on the web page you cite.  There are no
references to studies or any indication whatsoever on the website as
to what the original source of this information is.

Also, the website is focused on preventing drug abuse.  I don�t want
to suggest that there is anything wrong with preventing drug abuse,
but this focus gives the website an anti-drug bias, since it has a
goal of convincing people to avoid illegal drugs.

5)

A somewhat alarming article on the effects of Amphetamines, which
includes Dexedrine, mentions these long-term side effects:
  Long term effects: Malnutrition, fatigue, sleeplessness, Severe
anxiety, tension, high blood pressure, Lowered resistance to disease,
Long term users may also exhibit bizarre or violent behavior,
Amphetamine Psychosis may develop in long term heavy users. This
condition is similar to paranoid schizophrenia and includes symptoms
such as hallucinations, paranoid delusions and compulsive behavior. It
usually disappears when the user stops taking the drug.
 Read �Amphetamines and Methamphetamines� at
<http://www.woinfluence.yk.net/drugs/amphetamine.html>

Once again, there is no indication as to what studies produced this
information.

Also, this (again) is a drug abuse prevention website.  The article
you mention above goes on to warn that �there is no control over the
purity or quality of street drugs,� and warns about �Contracting HIV,
AIDS or other diseases through unclean and shared needles.�  So its
not clear to me that this information is intended to apply to
prescription drugs taken as prescribed.

6)

Contrary to the above articles is a reference by William Coleman MD
and Henry Shapiro MD. Again, the article refers to childhood use of
stimulant medications including Dexadrine. As quoted from the article:
 �There are no dangerous, irreversible long-term side effects when the
medication is appropriately prescribed�..�  �Stimulant medications do
not cause addiction or lead to drug or alcohol abuse.�
Read �Stimulant Medication Fact Sheet� at
<http://www.dbpeds.org/pdf/stimfact.pdf>
 
Again, the article does not say on what research these opinions are
based.  This is the kind of thing that led me to say in my original
question: �I'm not particularly interested in opinions and anecdotes
-- the ones I've come across seem to contradict one another.�

7)

As another article mentions, �The people who need actual
prescriptions for amphetamines (which includes Dexedrine) rarely
develop addictions because their brains start out with a lack of the
natural �speedy� chemicals. Read �Don�t Stay in the Dark, Get in the
Know.� at <http://www.syndistar.com/pdf/amphetamine.pdf>

This is a pamphlet for use in school drug-prevention programs, and it
contains no references to sources.

8)

Though not specifically listed under long-term side effects, I would
feel irresponsible if I did not include this list of adverse reactions
for your consideration along with potential long-term effects:
ADVERSE REACTIONS 
Cardiovascular: Palpitations, tachycardia, elevation of blood
pressure.
Central Nervous System: Psychotic episodes at recommended doses
(rare), overstimulation, restlessness, dizziness, insomnia, euphoria,
dyskinesia, dysphoria, tremor, headache, exacerbation of motor and
phonic tics and Tourette's syndrome.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea,
constipation, other gastrointestinal disturbances. Anorexia or weight
loss may occur as undesirable effects when amphetamines are used for
other than the anorectic effect.
Allergic: Urticaria. 
Endocrine: Impotence, changes in libido.(**This may be a concern for
you in the long run!)
DRUG ABUSE AND DEPENDENCE  
Dextroamphetamine sulfate (DEXEDRINE) is a Schedule II controlled
substance.
Amphetamines have been extensively abused. Tolerance, extreme
psychological dependence, and severe social disability have occurred."
 Read �Dexedrine..Excerpt from the Physician�s Desk Reference� at
<http://members.fortunecity.com/siriusw/dexedrine.htm>

As you note, this is not the long-term information I was looking for,
but thanks anyway.  This is basically the same information that
pharmacies give me whenever I get a prescription filled, and the
website you sited has the same information as 2) above.

Interestingly, this article ends with a link to Healthlx.com, which
turns out to be another advertising site for Flavay and Masquelier.

9)

No significant lasting improvement in behaviour has been shown to
result from the use of Dexedrine.
  �Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD. Read �Why to Avoid Dexedrine and
Ritalin� at <http://www.healthysource.com/dexedrine.html>

Again, Healthysource.com appears to be an advertising site for Flavay
and Masquelier, products that compete with Dexedrine.  See my comment
for 3) above.  I will, however, check out the references this article
cites (references 22, 25, and 26).

10)

Although the following excerpt is a reference to children, I believe
it is worth noting as an answer to your question: "Until recently, the
most important question concerning Ritalin or Amphetamine
administration has not been asked. Do these drugs make a difference in
the long-term outcome of the minimal brain dysfunction? A
comprehensive examination of this subject carried out at the Montreal
Children's Hospital discovered a startling fact. At the end of five
years, hyper kinetic children who received drugs (either Ritalin or
Chlorpromazine) did not differ significantly from children who had not
received. Although it appeared that hyperactive kids treated with
Ritalin were initially more manageable, the degree of improvement and
emotional adjustment was essentially identical at the end of five
years to that seen in a group of kids who had received no medication
at all. Read �Adderall� at <http://pychealth.com/adderall.html>
 
This is much closer to what I�m looking for.  Even though the Montreal
study is about Ritalin, not Dexedrine, this study might be helpful to
look at.  However, the article on the website does not cite this study
directly; it cites a book called �The People�s Pharmacy�.  If I can
find this book in the library or a bookstore it might lead to a
reference to the study.  That�s what I�m looking for, references to
studies.

Interestingly enough, this website, pychealth.com, appears to be yet
another site associated with Flavay and Masquelier.  So I�ll remain
skeptical until I find the actual study.

11)

Tolerance develops with regular use of a drug. As a person develops
tolerance to a drug, they need to take more and more of the drug to
get the same effects they once got from smaller amounts. Users develop
tolerance to amphetamines fairly quickly, even with taking only low
doses of the drug. Read �Amphetamines and Methamphetamines� at
<http://www.woinfluence.yk.net/drugs/amphetamine.html>
 
See my comment about 5) above.


12)

  In terms of whether the effectiveness of stimulant drugs like
Dexedrine increase or decrease over time, it may be of interest to
read the following excerpt which highlights the fact that the drugs
may have no real lasting benefits. (again, this refers primarily to
children, but should be of interest to adults using the medicine for
ADD as well)
  �Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD.
 A compilation of all the review studies published over the last
twenty years on the effects of stimulant medication for ADD/ADHD
showed that the medications only temporarily managed the symptoms of
overactivity, inattention and impulsivity, as well as increased
compliance, effort, and academic productivity, decreased aggression
and negative behaviors.
 Published research has found the long-term value of Ritalin
disappointing. Studies beginning in the 1960s showed that children who
took stimulants for hyperactivity (the name for ADD at the time) over
several years did just as poorly in later life as the group of
hyperactive children who took no medication. Compared to children
without hyperactivity, both groups were less likely to have finished
high school or to be employed, and more likely to have had trouble
with the law or to have drug or alcohol problems. A large percentage
of the hyperactive group, medicated or not, did relatively well, but
overall those in this category wound up struggling much more
frequently than their normal peers.�
 Read �Ritalin, Side Effects and Warnings� at
<http://pychealth.com/ritalin.html>
    
See my comment for 9) above.  This is a variation of the same article,
and cites the same references.

13)

For what it�s worth, if you are interested in reading about a
natural alternative to Dexedrine that keeps popping up in my search,
you might go to the Health-n-Nutrition Website and read about a
product called Masquelier's OPCs. I am not advocating it as I know
nothing about it! The website is at
<http://health-n-nutrition.com/add>
 
Wow, yet another Flavay/Masquelier website.  I believe you when you
say that you�re not advocating this product, but I�m surprised that
you didn�t realize that much of the information you�ve presented in
your answer came from websites that appear to be advertising sites for
this product!

I also know nothing about Masquelier�s OPCs or Flavay.  But I do know
that information presented by a company, about a product they see as a
competitor, should be taken with a grain of salt.

14)

Additional Reading 
  �Prescription Drugs: Abuse and Addiction.� National Institute on
Drug Abuse.(2/21/2002) at
http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.html
  �Adults with ADD,� by Betsy Van Dorn. familyeducation.com at
<http://www.familyeducation.com/article/0,1120,5-251,00.html>
  �The Role of Medication in Attention Deficit Disorder,� by Dr. John
D. Murray. Add Toronto (4/2 2002) at
<http://www.add-toronto.org/art_medication.html>
 
There are no studies cited in any of these articles.


Conclusion

The bottom line is that I will look at the following references that
are cited by the article �Why to Avoid Dexedrine and Ritalin�.  But
frankly only one of them (27) looks promising.  And I already had �Why
to Avoid Dexedrine and Ritalin� before I asked my question.  Although
I appreciate your effort, your answer has not helped me.

Hi,

Thanks for your time and effort.  However, your response is not useful
to me, because I am looking for studies.  The information you have
provided in your answer generally consists of statements without
references to supporting studies.  I am looking for references to
medical journal articles.

I looked at your answer carefully to find any information that would
be useful to me.  Here is my analysis, if you're interested:

1.)  As a preface you present some general information about ADD, and
you reference

<http://www.etenet.com/Apps/Library/Corporate.asp?ID=23>

I didn’t ask for this information, but thanks anyway.

2)
“The habit-forming potential is high. Psychological and physical
dependence is possible. Addiction is rare in children but a problem
with adults.” Refer to <http://www.psyweb.com/Drughtm/dexed.html>.
Also,
please note the rare (though not necessarily long-term) side effects
of taking Dexadrine.

This is basically the same information that pharmacies give me
whenever I get a prescription filled. Not what I asked for, but
thanks.

3).
“It is important to note that the Drug Enforcement Administration
(DEA), and all other drug enforcement agencies worldwide, classify
methylphenidate (the generic name for Ritalin) and amphetamine
(Dexedrine and Adderall) in the same Schedule II category as
methamphetamine, cocaine, and the most potent opiates and
barbiturates. Schedule II includes only those drugs with the very
highest potential for addiction and abuse.” Read “Why to Avoid
Dexedrine and Ritalin” at
<http://www.healthysource.com/dexedrine.html>

I’ve seen this article before. The website which you cite,
Healthysource.com, appears to be associated with the makers of Flavay
and Masquelier.  These products are presented as an alternative to
Dexedrine. In fact, the article you cite, “Why to Avoid Dexedrine and
Ritalin”, ends with what amounts to an advertisement for Flavay. 
Therefore I consider any information from this website to be
potentially biased.  However, the reference section of this article
looks like it might contain some references to some useful studies and
reviews; I’ll have to look at it more closely to find out.

4)

Other long-term side effects noted are irregular heartbeat, heart
failure and lethal seizures, hostility, and paranoia. Read
“Prescription Drugs: Most Commonly Abused.” Metropolitan Drug
Commission at <http://www.metrodrug.org/prescription_drugs.html>
 
I found this statement on the web page you cite.  There are no
references to studies or any indication whatsoever on the website as
to what the original source of this information is.

Also, the website is focused on preventing drug abuse.  I don’t want
to suggest that there is anything wrong with preventing drug abuse,
but this focus gives the website an anti-drug bias, since it has a
goal of convincing people to avoid illegal drugs.

5)

A somewhat alarming article on the effects of Amphetamines, which
includes Dexedrine, mentions these long-term side effects:
  Long term effects: Malnutrition, fatigue, sleeplessness, Severe
anxiety, tension, high blood pressure, Lowered resistance to disease,
Long term users may also exhibit bizarre or violent behavior,
Amphetamine Psychosis may develop in long term heavy users. This
condition is similar to paranoid schizophrenia and includes symptoms
such as hallucinations, paranoid delusions and compulsive behavior. It
usually disappears when the user stops taking the drug.
 Read “Amphetamines and Methamphetamines” at
<http://www.woinfluence.yk.net/drugs/amphetamine.html>

Once again, there is no indication as to what studies produced this
information.

Also, this (again) is a drug abuse prevention website.  The article
you mention above goes on to warn that “there is no control over the
purity or quality of street drugs,” and warns about “Contracting HIV,
AIDS or other diseases through unclean and shared needles.”  So its
not clear to me that this information is intended to apply to
prescription drugs taken as prescribed.

6)

Contrary to the above articles is a reference by William Coleman MD
and Henry Shapiro MD. Again, the article refers to childhood use of
stimulant medications including Dexadrine. As quoted from the article:
 “There are no dangerous, irreversible long-term side effects when the
medication is appropriately prescribed…..”  “Stimulant medications do
not cause addiction or lead to drug or alcohol abuse.”
Read “Stimulant Medication Fact Sheet” at
<http://www.dbpeds.org/pdf/stimfact.pdf>
 
Again, the article does not say on what research these opinions are
based.  This is the kind of thing that led me to say in my original
question: “I'm not particularly interested in opinions and anecdotes
-- the ones I've come across seem to contradict one another.”

7)

As another article mentions, “The people who need actual
prescriptions for amphetamines (which includes Dexedrine) rarely
develop addictions because their brains start out with a lack of the
natural “speedy” chemicals. Read “Don’t Stay in the Dark, Get in the
Know.” at <http://www.syndistar.com/pdf/amphetamine.pdf>

This is a pamphlet for use in school drug-prevention programs, and it
contains no references to sources.

8)

Though not specifically listed under long-term side effects, I would
feel irresponsible if I did not include this list of adverse reactions
for your consideration along with potential long-term effects:
ADVERSE REACTIONS 
Cardiovascular: Palpitations, tachycardia, elevation of blood
pressure.
Central Nervous System: Psychotic episodes at recommended doses
(rare), overstimulation, restlessness, dizziness, insomnia, euphoria,
dyskinesia, dysphoria, tremor, headache, exacerbation of motor and
phonic tics and Tourette's syndrome.
Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea,
constipation, other gastrointestinal disturbances. Anorexia or weight
loss may occur as undesirable effects when amphetamines are used for
other than the anorectic effect.
Allergic: Urticaria. 
Endocrine: Impotence, changes in libido.(**This may be a concern for
you in the long run!)
DRUG ABUSE AND DEPENDENCE  
Dextroamphetamine sulfate (DEXEDRINE) is a Schedule II controlled
substance.
Amphetamines have been extensively abused. Tolerance, extreme
psychological dependence, and severe social disability have occurred."
 Read “Dexedrine..Excerpt from the Physician’s Desk Reference” at
<http://members.fortunecity.com/siriusw/dexedrine.htm>

As you note, this is not the long-term information I was looking for,
but thanks anyway.  This is basically the same information that
pharmacies give me whenever I get a prescription filled, and the
website you sited has the same information as 2) above.

Interestingly, this article ends with a link to Healthlx.com, which
turns out to be another advertising site for Flavay and Masquelier.

9)

No significant lasting improvement in behaviour has been shown to
result from the use of Dexedrine.
  “Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD. Read “Why to Avoid Dexedrine and
Ritalin” at <http://www.healthysource.com/dexedrine.html>

Again, Healthysource.com appears to be an advertising site for Flavay
and Masquelier, products that compete with Dexedrine.  See my comment
for 3) above.  I will, however, check out the references this article
cites (references 22, 25, and 26).

10)

Although the following excerpt is a reference to children, I believe
it is worth noting as an answer to your question: "Until recently, the
most important question concerning Ritalin or Amphetamine
administration has not been asked. Do these drugs make a difference in
the long-term outcome of the minimal brain dysfunction? A
comprehensive examination of this subject carried out at the Montreal
Children's Hospital discovered a startling fact. At the end of five
years, hyper kinetic children who received drugs (either Ritalin or
Chlorpromazine) did not differ significantly from children who had not
received. Although it appeared that hyperactive kids treated with
Ritalin were initially more manageable, the degree of improvement and
emotional adjustment was essentially identical at the end of five
years to that seen in a group of kids who had received no medication
at all. Read “Adderall” at <http://pychealth.com/adderall.html>
 
This is much closer to what I’m looking for.  Even though the Montreal
study is about Ritalin, not Dexedrine, this study might be helpful to
look at.  However, the article on the website does not cite this study
directly; it cites a book called “The People’s Pharmacy”.  If I can
find this book in the library or a bookstore it might lead to a
reference to the study.  That’s what I’m looking for, references to
studies.

Interestingly enough, this website, pychealth.com, appears to be yet
another site associated with Flavay and Masquelier.  So I’ll remain
skeptical until I find the actual study.

11)

Tolerance develops with regular use of a drug. As a person develops
tolerance to a drug, they need to take more and more of the drug to
get the same effects they once got from smaller amounts. Users develop
tolerance to amphetamines fairly quickly, even with taking only low
doses of the drug. Read “Amphetamines and Methamphetamines” at
<http://www.woinfluence.yk.net/drugs/amphetamine.html>
 
See my comment about 5) above.


12)

  In terms of whether the effectiveness of stimulant drugs like
Dexedrine increase or decrease over time, it may be of interest to
read the following excerpt which highlights the fact that the drugs
may have no real lasting benefits. (again, this refers primarily to
children, but should be of interest to adults using the medicine for
ADD as well)
  “Short-term learning benefits have been achieved with these
medications, but no lasting improvement has been shown. Stimulant
drugs were found to have a short-term effectiveness of 60 to 80
percent in reducing the hyperactivity, distractibility, and
impulsiveness of school-age children. Similar rates of success have
been found in adults with ADD.
 A compilation of all the review studies published over the last
twenty years on the effects of stimulant medication for ADD/ADHD
showed that the medications only temporarily managed the symptoms of
overactivity, inattention and impulsivity, as well as increased
compliance, effort, and academic productivity, decreased aggression
and negative behaviors.
 Published research has found the long-term value of Ritalin
disappointing. Studies beginning in the 1960s showed that children who
took stimulants for hyperactivity (the name for ADD at the time) over
several years did just as poorly in later life as the group of
hyperactive children who took no medication. Compared to children
without hyperactivity, both groups were less likely to have finished
high school or to be employed, and more likely to have had trouble
with the law or to have drug or alcohol problems. A large percentage
of the hyperactive group, medicated or not, did relatively well, but
overall those in this category wound up struggling much more
frequently than their normal peers.”
 Read “Ritalin, Side Effects and Warnings” at
<http://pychealth.com/ritalin.html>
    
See my comment for 9) above.  This is a variation of the same article,
and cites the same references.

13)

For what it’s worth, if you are interested in reading about a
natural alternative to Dexedrine that keeps popping up in my search,
you might go to the Health-n-Nutrition Website and read about a
product called Masquelier's OPCs. I am not advocating it as I know
nothing about it! The website is at
<http://health-n-nutrition.com/add>
 
Wow, yet another Flavay/Masquelier website.  I believe you when you
say that you’re not advocating this product, but I’m surprised that
you didn’t realize that much of the information you’ve presented in
your answer came from websites that appear to be advertising sites for
this product!

I also know nothing about Masquelier’s OPCs or Flavay.  But I do know
that information presented by a company, about a product they see as a
competitor, should be taken with a grain of salt.

14)

Additional Reading 
  “Prescription Drugs: Abuse and Addiction.” National Institute on
Drug Abuse.(2/21/2002) at
http://www.drugabuse.gov/ResearchReports/Prescription/prescription8.html
  “Adults with ADD,” by Betsy Van Dorn. familyeducation.com at
<http://www.familyeducation.com/article/0,1120,5-251,00.html>
  “The Role of Medication in Attention Deficit Disorder,” by Dr. John
D. Murray. Add Toronto (4/2 2002) at
<http://www.add-toronto.org/art_medication.html>
 
There are no studies cited in any of these articles.


Conclusion

The bottom line is that I will look at a few of the references that
are cited by the article “Why to Avoid Dexedrine and Ritalin”.  But
frankly only one of them (27) looks promising.  And I already had “Why
to Avoid Dexedrine and Ritalin” before I asked my question.  Although
I appreciate your effort, your answer has not helped me.

Have you tried your own PubMed search? With a few keywords like "ADHD
treatment adult human dexedrine effects," you can quickly gather
citations for research on your topic.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

I did a bit of research on this last night but couldn't complete it. 
It seems everything I read pointed to the "more studies are needed"
category.  I also looked at the drug from the narcolepsy angle since
dexedrine is also long-term prescribed for that diagnosis.

Here are a couple links for your review:
http://www.acnp.org/G4/GN401000166/CH162.htm (quite the technical
article)
http://archpsyc.ama-assn.org/issues/v58n8/abs/yoa9442.html (pay per
view article)

Search terms:
long-term effects of dexedrine/dextroamphetamine
narcolepsy+dexedrine/dextroamphetamine

Well I am not sure why but I read much of what "Umiat" the GA
consultant wrote
 and also what was in the ratings response as well from the original
questioner;which I suspect was also the longest ratings response on
record in terms of number of words used. I was just wondering if
questioner is now satisfied and found the specific info  he/she was
after; i.e the actual direct references and testimonies to the claims
etc being made and promoted by the various professionals, companies
and individuals.