Doctors should be legally allowed to try mind-altering drugs they prescribe

[Poit]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

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[samac]

This is the stupidest thing I’ve ever read.

 

[deleted480308]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

nope

 

[Poit]

This is the stupidest thing I’ve ever read.

Why?

 

[pbandje]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

That makes no sense. What is the benefit in trying Adderall if you don't have ADHD? It won't have the same effect on you as it does on someone with ADHD. I'm not a physician yet, but I don't think I have to be one to tell you that this will probably be true for other drugs as well.

 

[Mad Jack]

Psychiatrists actually used to do this for this very reason, it's not as crazy as it sounds

 

[lalalaaaaaa]

Psychiatrists actually used to do this for this very reason, it's not as crazy as it sounds

Yes it is. There is a reason they don't do this now. Otherwise, y'all should definitely try the antibiotics and chemotherapeutic drugs too.

Taking meds all have side effects. You shouldn't just be experimenting with them. There are clinical trials to test drugs with evidince based medicine. Not recreational drug use.

 

[Tenk]

Yeah this has never gone wrong with anesthesia or anything.

 

[Gilakend]

Do it and report back

 

[Mad Jack]

Yes it is. There is a reason they don't do this now. Otherwise, y'all should definitely try the antibiotics and chemotherapeutic drugs too.

Taking meds all have side effects. You shouldn't just be experimenting with them. There are clinical trials to test drugs with evidince based medicine. Not recreational drug use.

It wouldn't be recreational. Old school psychiatrists did this specifically so that they understood the particular brand of misery associated with each drug, allowing them to better describe the effects to patients (as many side effects are predictable and not highly valuable from patient to patient) and hopefully improve adherence through improved empathy and understanding. Basically some of the same reasons behind former addicts being far better at substance abuse treatment- they actually get what they're talking about and can work with patients accordingly. Whether the approach has merit or not would require research, but I wouldn't write it off as being ineffective without evidence.

 

[lalalaaaaaa]

It wouldn't be recreational. Old school psychiatrists did this specifically so that they understood the particular brand of misery associated with each drug, allowing them to better describe the effects to patients (as many side effects are predictable and not highly valuable from patient to patient) and hopefully improve adherence through improved empathy and understanding. Basically some of the same reasons behind former addicts being far better at substance abuse treatment- they actually get what they're talking about and can work with patients accordingly. Whether the approach has merit or not would require research, but I wouldn't write it off as being ineffective without evidence.

It does not have merit. This is literally the opposite of evidence based medicine. Moreover, doctors like Freud and Halstead had serious drug abuse issues because they used cocaine (an anesthetic at the time) and morphine.

 

[Goro]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

Should transplant surgeons be allowed to operate on themselves? Asking for a friend.

 

[Poit]

Should transplant surgeons be allowed to operate on themselves? Asking for a friend.

They are allowed to operate on themselves. Whether that would help them perform surgeries any better is an entirely different question.

 

[Poit]

It does not have merit. This is literally the opposite of evidence based medicine. Moreover, doctors like Freud and Halstead had serious drug abuse issues because they used cocaine (an anesthetic at the time) and morphine.

There isn't any evidence against its efficacy, either. I think it should be studied.

 

[Goro]

They are allowed to operate on themselves. Whether that would help them perform surgeries any better is an entirely different question.

Kinda hard to get a kidney off the waiting list to a healthy surgeon for a self operation.

 

[Mad Jack]

It does not have merit. This is literally the opposite of evidence based medicine. Moreover, doctors like Freud and Halstead had serious drug abuse issues because they used cocaine (an anesthetic at the time) and morphine.

I'm not saying physicians should do be doing anything with abuse potential. And saying something is "literally the opposite of evidence based medicine" in the absence of research is literly the opposite of evidence based medicine. To have an evidence base, one would have to study the outcomes of physicians who used such an approach to those that didn't with quality measures like adherence

 

[Poit]

Kinda hard to get a kidney off the waiting list to a healthy surgeon for a self operation.

All about who you know

 

[premeddestiny]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

Try self-administering vancomycin and find out it doesn't do the same thing for a healthy person as someone with an infection like MRSA + perpetuating antibiotic resistance.

 

[Poit]

Try self-administering vancomycin and find out it doesn't do the same thing for a healthy person as someone with an infection like MRSA + perpetuating antibiotic resistance.

False equivalence foul, on the defense. 15 yard penalty. There is a reason that I specified drugs that are mind-altering. (and yes, I do realize that vanc has a slight risk of causing some ams)

 

[GoSpursGo]

Strongly considered just closing this, but on the off chance there's some meaningful discussion to be had I'm moving to TIH since at a minimum it has nothing to do with medical school.

 

[lalalaaaaaa]

False equivalence foul, on the defense. 15 yard penalty. There is a reason that I specified drugs that are mind-altering. (and yes, I do realize that vanc has a slight risk of causing some ams)

Just go do drugs if you want to instead of making this crazy debate.

 

[VA Hopeful Dr]

Psychiatrists actually used to do this for this very reason, it's not as crazy as it sounds

And we used to taste the urine of diabetics to guesstimate blood glucose levels. Things we used to do had good reasons but there's also good reasons we don't do things the same way anymore.

For all of the non-controlled drugs you could go out and try them. Most pharmacies will let you write prozac and wellbutrin for yourself. Its a fairly stupid idea, but there's very little stopping a physician from doing so.

 

[lalalaaaaaa]

I take it back, this is a great idea! I'll start with trying that dilaudid PCA for a few days to get a sense of what patients experience. Hit me up with some haloperidol the next day. Gonna get a ketamine drip after that. Should probably slap on some fentanyl patches for research purposes. I hear there is some evidence shrooms are good for depression so that will be a very important experience as part of my residency. Finish off with 6 months of SSRIs, and sprinkle a little lamotrigine in there. I'm going to be the most empathetic doc around. Who wants to help with writing the IRB? Also where is the nearest dispensary for medical marijuana?

 

[Mad Jack]

And we used to taste the urine of diabetics to guesstimate blood glucose levels. Things we used to do had good reasons but there's also good reasons we don't do things the same way anymore.

For all of the non-controlled drugs you could go out and try them. Most pharmacies will let you write prozac and wellbutrin for yourself. Its a fairly stupid idea, but there's very little stopping a physician from doing so.

I agree that it is stupid, certainly. Just saying I could see the argument for it. There is no approximation for personal experience in psychiatry that can be gathered from simply reading papers

 

[QofQuimica]

You can read all about the effects and side effects of strattera vs Adderall, welbutrin vs SSRI, but can you really know how these drugs feel unless you try them personally? I think that as long as there is medical clearance, a doctor should be able to "experiment" in a controlled/safe setting. I honestly think it would benefit patients.

It's definitely not completely crazy as an idea, and I can tell you that there are plenty of people working in the addiction community who are in recovery themselves (including many of the docs!). Some people might even argue that a doc in recovery understands what an addicted patient is going through way better than a doc like myself who has never had a substance use disorder.

One major problem with your proposal is that people's experiences with mind-altering drugs have a large element of subjectivity and idiosyncrasy to them. For example, some people who take ketamine think it's great and abuse it recreationally. Other people have horrible emergence reactions. I remember once telling a patient in the latter category that some people like to take this drug for fun, and her response to me was a vehement, "They're crazy!"

People also vary in terms of their risks of addiction and other substance use disorders. Plenty of people binge drink until they pass out every weekend, and not just college students. Many of them "grow out" of this behavior and eventually stop. Unfortunately, some of these people eventually progress into full-blown alcoholism. Why don't they all become alcoholics? It's a great question. Likewise, we really cannot predict in advance who is at risk of becoming an opioid addict if they take a Norco, and who isn't. We really don't understand why some people go on to progress to addiction, and others do not.

Given the risk of serious harm that can come from experimenting with mind-altering drugs, including addiction and SUD, I think that any benefits to be gained from hands-on experiential knowledge would likely be outweighed by the risks. Even knowing that I have pretty strong aversion reactions - I don't even like the feeling of being buzzed from alcohol - I would not want to take the risk personally. And I doubt too many of my colleagues who are in recovery themselves would be in favor of your proposal for exactly that reason.

P.S. You are probably already aware of the health issues that can come from abusing/misusing amphetamines like Adderall. If you weren't already aware of this, bupropion (or Wellbutrin) is a cathinone. Meaning, it's basically a legal "bath salt." Atomoxetine (Strattera) can cause psychosis and SI (not to mention CV events and sudden death). And, there is even a significant body of literature regarding possible withdrawal syndromes from SSRIs. Basically, the body adapts to whatever you do to it, and there is no free lunch out there when it comes to tweaking the mind, my friend.