Talk:Adderall/Archive 4

Page contents not supported in other languages.
From Wikipedia, the free encyclopedia
Archive 1 Archive 2 Archive 3 Archive 4 Archive 5

New Management and Bias

I'm not super pleased with the new management this page is under. The section discussing its value as a medication is markedly biased, downplaying its efficacy and using wp:weasel words to suggest it might be useless. Additionally, much valuable information has been removed, despite the fact that it was cited. I don't generally default to pointing fingers, but it seems that User:Seppi333 is being overzealous in their editing. Opinions? Exercisephys (talk) 01:17, 1 October 2013 (UTC)

If you can be more specific, preferably with some examples of my edits, it'd help me figure out what you're talking about. I'm not intentionally misrepresenting anything for or against a particular viewpoint in my edits; moreover, I don't update this particular article very often compared to the one I'm trying to promote to GA/FA (ie amph). That said, I'm not sure making a public thread about this on an article page is the most appropriate way to bring this issue to my attention.Seppi333 (talk) 01:45, 1 October 2013 (UTC)
I think it's good to have a discussion here, since the topic is the overall slant of the article. Exercisephys's comment prompted me to look over recent edits, and I think they are right about the article slant, but wrong to point the finger at Seppi333. The biggest problem I see is with the censored text under "Medical use." That text was actually added by Seppi333 and reverted by Jmh649, whereupon Seppi333 re-added it in commented-out form, presumably as a temporary measure while seeking consensus.
Seppi333, I think it's time to remove the HTML comments. Personally I wouldn't have added them in the first place since it appears to be censorship (as you note), but your patience is commendable. If another editor disagrees with the content, they can correct it instead of censoring it.
It might be worth looking over the article to verify that it's not slanted in other ways. As I mentioned earlier, I don't think that public health concerns are sufficient cause for censorship. Proxyma (talk) 16:53, 1 October 2013 (UTC)
I've discussed all of JMH's concerns with him on his talk page, but I'm too lazy to search his archive for the sections. For the Milchap cited material, I'll remove the censor and replace it with the equivalent content from the amphetamine page when I get home (I'm typing this on my phone, which is a pain to edit Wikipedia with).Seppi333 (talk) 17:28, 1 October 2013 (UTC)
Thanks! Looks better with that restored. Proxyma (talk) 04:39, 3 October 2013 (UTC)

Copy-merge from amphetamine

I just merged a lot of content from amphetamine. It could use some minor copy-editing to replace amphetamine with adderall in the appropriate places. It may also be a good idea for someone else to go through the updates and try to spot any material which isn't conveyed, at least not through rewording, in the updated sections - I'll copy that material to amphetamine if any form of MEDRS-cited material is found. I appended any relevant, cited existing content that wasn't in the update material as I did it, but I may have oversighted something. Seppi333 (talk) 02:08, 13 October 2013 (UTC)

Prevalence Wikitable

This is only my second attempt at a wikitable; improvement/beautification from anyone with more experience would be much appreciated. Exercisephys (talk) 00:20, 3 November 2013 (UTC)

Contradictory information?

Information in the very beginning of the article seems to be contradictory: in the main text, it mentions a 3:1 ratio, and it mentions "levoamphetamine". However, in the caption for the drawing of the chemical compound, it doesn't appear to show a 3:1 ratio, and it doesn't mention "levoamphetamine".

[text]

There is a single commercial formulation only as of 2013, which contains a 3:1 ratio of dextroamphetamine (the dextrorotary or "right-handed" enantiomer) to levoamphetamine (the levorotary or "left-handed" enantiomer[1]).

[caption]

Combination of

amphetamine aspartate (25%) psychostimulant
amphetamine sulfate (25%) psychostimulant
dextroamphetamine saccharate (25%) psychostimulant
dextroamphetamine sulfate (25%) psychostimulant

Don Quixote de la Mancha (talk) 16:19, 16 November 2013 (UTC)

Ah, I suppose this should be clarified in the article. "Racemic amphetamine" or just "amphetamine" refers to equal parts of dextroamphetamine and levoamphetamine. Seppi333 (talk) 06:56, 18 November 2013 (UTC)

Section imports

I just imported several sections from amphetamine. The change expanded several subsections and fixed a lot of formatting issues as well as a few citation issues (e.g. the TrevorKatzung ref didn't support any of the content it cited). If anyone has an issue with the removal of certain parts of the text in this replacement, please address it in this thread. Seppi333 (talk) 09:29, 28 November 2013 (UTC)

In the event anyone is concerned, I combined all the information from the removed sections from this article with the content in amphetamine before I GA nominated and began heavily revising the amphetamine article - this is mostly why there's commonality with the named refs in this article. Seppi333 (talk) 09:43, 28 November 2013 (UTC)

RE: Adderall move

Given the issues initially raised from the first move discussion, some facts that have come to light in the meantime (Talk:Amphetamine/Archive 4#Adderall vs. amphetamine mixed salts), and the fact that en.wikipedia is the odd-man-out, would anyone care if I moved this page back to what it was a few months ago? Seppi333 (Insert 2¢) 10:46, 15 December 2013 (UTC)

Support – for the reasons that I have previously given. Adderall is shorter, simpler, and more precise. Furthermore because of its wide spread usage, Adderall (like Coke) has effectively become a generic name. Boghog (talk) 05:51, 16 December 2013 (UTC)
  • Comment I've declined the request to move this page to Adderall because I believe it is contentious at this stage given the prior move and move request. Please establish a consensus first, or at least wait longer than a day. Callanecc (talk • contribs • logs) 13:10, 16 December 2013 (UTC)
    • Note to reviewing admin on Dec. 29: I've left this thread open for two weeks and this move is still uncontested. This is my second/final attempt at a technical move request. I'd prefer a move over a merge because the latter is much sloppier with respect to the edit history. Seppi333 (Insert 2¢) 18:37, 29 December 2013 (UTC)
  • Oppose for now. What will be done when this med becomes generic? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:41, 30 December 2013 (UTC)
This medication has already become generic however I still believe that it should be still be called Adderall. Calling it amphetamine mixed salts is sloppy and imprecise since mixed salts part of the name is ambiguous. Furthermore as pointed out above, strictly speaking, this article should be named after the non-proprietary name "dextroamphetamine saccharate and amphetamine aspartate monohydrate and dextroamphetamine sulfate and amphetamine sulfate" which is bit ridiculous for an article name. Adderall is accurate and concise as well as being the most commonly recognized name. Boghog (talk) 02:29, 30 December 2013 (UTC)
  • Adderall IR (labeled as Adderall) has been generic since 2002. Adderall XR (labeled as Adderall XR) has been generic since 2009. Source is this page. If proprietary name=nonproprietary name, it's a generic formulation. If dosage formname is "Tablet", it's brand or generic Adderall (IR). If it's "Capsule...", then it's Adderall XR. The value in the column titled "Start Marketing Date" is more or less a proxy for when the brand/generic formulation was approved. There's also apparently 3 companies that produce generic Adderall XR (Teva, Actavis, and Barr) at the moment under the 12 word non-proprietary name mentioned above. Ref for this: NOTE: This is a .csv file. Seppi333 (Insert 2¢) 04:39, 30 December 2013 (UTC)

Repeated content

Under "Medical" the reference to the Swedish study is included twice. Looks like the author has an attention deficit. — Preceding unsigned comment added by 99.231.136.199 (talk) 21:55, 28 January 2014 (UTC)  Fixed

Reader feedback: Please say what a normal and...

98.254.32.94 posted this comment on 27 January 2014 (view all feedback).

Please say what a normal and abnormal dose is. Please explain how to stop its use, how to diminish dosage.

Any thoughts?

LeadSongDog come howl! 22:30, 31 January 2014 (UTC)

We don't go into dosages on any drug. This one should not be an exception. LeadSongDog come howl! 22:30, 31 January 2014 (UTC)
@LeadSongDog:, I think it's reasonable to mention typical prescription doses and maximum allowed FDA doses, along with what pill sizes are available. Exercisephys (talk) 05:23, 1 February 2014 (UTC)
See wp:MOSMED's section on drugs and the detailed section linked there. If you think it is wrong, please make your case on the associated talk page. There's no reason this drug should be a special case. LeadSongDog come howl! 06:27, 1 February 2014 (UTC)
We do not give drug dosing info. We are a general encyclopedia. Consensus is that this information goes beyond that. We do link to drug.com in the infobox of every medication article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:51, 1 February 2014 (UTC)

Lead

See also: Talk:Amphetamine § 5-HT toxidrome

There needs to be a new root for this page that summarises the article, rather than pulling in facts. The precise nature of the racemic mixture isn't the most important thing to know abut this drug. What we do need to know is the class, the generic name, route, uses, effects and dangers. This is to be used by everyone, but is currently targeted more at concerned parents. I am a medical student in the uk, and was looking up what on earth adderall is. The very fact that i had to check another article to be sure means that this article is not working as intended. I never have to do that with any other. I would fix it myself but i'm not very familiar with pharmaceutical uses of amphetamine. I did know a guy at school that would stay up for two weeks straight on this stuff before he slept. Nasty nastynasty. ---- Jack

Thanks for your comments. Until very recently, the lead did list one of the common names for Adderall, amphetamine mixed salts. This name has now been now restored. As already noted by others above, I agree that the current lead does not do a very good job of summarizing the entire article. Boghog (talk) 13:31, 16 March 2014 (UTC)
I agree with Jack in the way, that it's superflous to write the amount of salts there, because the salts are inactive ingredients. There isn't written which and how many other inactive additives are a in Adderal. The type of drug (racemic amphetamine with an odd D:L ratio does matter) That does not affect mentioning the name amphetamine mixed salts --Richard (talk) 12:38, 18 March 2014 (UTC)
I added this source/quote of this ratio on amphetamine. Without a direct quote of the percentages you keep revising, you are committing WP:SYNTH. Seppi333 (Insert 2¢ | Maintained) 17:20, 18 March 2014 (UTC)
The 72.7% dextroamphetamine where at least mentioned in The Amphetamine Debate, although I'm rather sceptic about the quality of the statement there, cause it mistakes dexamphetamine and lisdexamphetamine (might be a typo /autocorrect of a typo as well as bad quality) (Moore, Elaine.The Amphetamine Debate: The Use of Adderall, Ritalin and Related Drugs for Behavior Modification, Neuroenhancement and Anti-Aging Purposes. McFarland, 2010, p. 90.). I myself calculated it therefore, see Talk:Dextroamphetamine#Dextro_:_Levo_ratio_in_Adderall, and got different values. I asked user:Edward_Bower who introduced this ratio first. He seems to be inactive, so he can't tell what his source was. --Richard (talk) 22:18, 18 March 2014 (UTC)

information Note:To keep this conversation in one place, reply at: WT:MED#WP:SYNTH on amphetamine articles

The lead

The lead of this article isn't really adequate. I don't really have the time to write/expand it at the moment, but if anyone is interested, it could use another paragraph or two to (adequately) summarize the article. Refer to WP:LEAD if interested. The lead of amphetamine might be useful as well since the articles now have several identical sections - I've imported every relevant section from that article. Seppi333 (talk) 10:12, 28 November 2013 (UTC)

 Done Seppi333 (Insert 2¢ | Maintained) 17:03, 15 June 2014 (UTC)

Transclusions

I've transcluded as many sections as I think are necessary to keep this page up-to-date. I'd like to keep this page a little more accessible to the layperson than the amphetamine article, so I don't intend to transclude the more technical sections like pharmacology. I'd appreciate feedback related to the section transclusions, so feel free to post it here if you have any for me. Seppi333 (Insert 2¢ | Maintained) 20:52, 21 May 2014 (UTC)

Interactions

According to the citation, a basic GI pH (such as that caused by H2 blockers or PPIs) increases the absorption rate of Adderall, and a basic urinary pH causes decreased excretion. As far as I can tell, the current statement written is incorrectly.98.116.134.143 (talk) 12:31, 5 August 2014 (UTC)Mike

 Fixed - Thanks for pointing that out. Seppi333 (Insert 2¢ | Maintained) 18:31, 5 August 2014 (UTC)

Changing Title Back to "Amphetamine Mixed Salts"

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.
There is a general consensus against renaming the article

@Seppi333: @Boghog: @Callanecc: @Jmh649: I'm the one who got this page moved from "Adderall" to "Amphetamine mixed salts" a few months ago. I wasn't made aware that this change was being reverted. I very strongly believe that it should be moved back for the following reasons:

  • There was no consensus and, had I been notified, there may have been a consensus against it. Callanecc suggested to wait for consensus but that advice wasn't followed.
  • In most countries, including the United States, amphetamine salts are available as a generic and required to by law to be filled as a generic unless the patient demands the brand.
  • Seppi333 wrote "'Dextroamphetamine saccharate and amphetamine aspartate monohydrate and dextroamphetamine sulfate and amphetamine sulfate' per PHARMMOS? Personally, I prefer "Adderall" to a 12 word name.", but those obviously aren't the only two options (we were using another, more reasonable option then).
  • When filled as a generic, the medication is labeled "amphetamine salts" or some variant of that.
  • The other wiki sites can be changed to the generic name, and they should, considering that it makes more sense.
  • I don't know of a single example of a medication currently available as a generic (and primarily filled as a generic) that is listed under its brand name.
  • Because of generics laws, pharmaceutical brand names like that are going to become decreasingly relevant.
  • Ritalin is probably the best precedent. The brand name "Ritalin" is probably more ubiquitous than "Adderall", and "methylphenidate" is surely more arcane than "amphetamine" (or some variant thereof). Regardless, the article is titled methylphenidate.

Exercisephys (talk) 15:20, 31 January 2014 (UTC)

I would support seeing it moved back. We really need to stay with more generic names. This ref refers to it as a mixed salt [1] Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:24, 31 January 2014 (UTC)
  • Strong Oppose : Amphetamine mixed salts is not a generic name for this drug. There is/was no citation anywhere on the page that this name is even in use. There is no basis for using this as a common name. Might as well rename other drug pages to some pseudo-generic name if this is used as a precedent. Seppi333 (Insert 2¢ | Maintained) 21:57, 31 January 2014 (UTC)
  • Strong Oppose. WP:PHARMOS advises that drug article names be named after the International Nonproprietary Name (INN) if one exists. However no INN has been assigned to Adderall. One possible fall back is the United States Adopted Name (USAN), but no USAN has been assigned to Adderall either.
There are no generally agreed upon generic names for Adderall. Ones that are in common use include:
  • amphetamine/dextroamphetamine mixed salts (rxlist.com)
  • dextroamphetamine mixed salts of a single-entity amphetamine product (FDA)
  • dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate and amphetamine sulfate (dailymed)
The only name given above that is precise is the last one, but this name is far too long to be used as an article title.
Wikipedia article naming criteria include naturalness (one that readers are likely search for), precision (unambiguously identify the article's subject), and conciseness (title is no longer than necessary to identify the article's subject). "Adderall" fulfills all of the criteria whereas "ampethamine mixed salts" fulfills none. Boghog (talk) 00:54, 1 February 2014 (UTC)
  • Oppose I find Boghog's rationale the best representative of WP naming policy. While I strongly agree with Doc James that we should stick with generic names, in this particular case that doesn't (currently) work. -- Scray (talk) 02:35, 1 February 2014 (UTC)
  • Strong Oppose. User:Exercisephys wrote: I don't know of a single example of a medication currently available as a generic (and primarily filled as a generic) that is listed under its brand name. Heroin is a good counter-example. Also, I agree with User:Boghog and User:Seppi333 KMeyer (talk) 19:28, 19 February 2014 (UTC)
@KMeyer: This issue has long been settled, but just because I found your statement a little ridiculous, I'd like to point out that heroin is almost exclusively a black-market narcotic. Amphetamine salts, on the other hand, are exclusively prescription because who the hell would bother synthesizing this specific mixture of enantiomers and salts. Exercisephys (talk) 21:06, 19 February 2014 (UTC)
@Exercisephys: I'm not sure I see your point -- Adderall also plays a role as a black-market narcotic. Heroin is the trademark name for (what is generically known as) diamorphine, and yet Diamorphine redirects to Heroin. "Amphetamine Mixed Salts" is so vague it probably does describe (impure) black-market speed or meth. KMeyer (talk) 13:14, 20 February 2014 (UTC)
@KMeyer: My point is that heroin exists mainly as a completely black-market drug, including manufacture. While it's technically available by prescription in some European countries, it isn't really a prescription drug anymore. Also, "amphetamine mixed salts" is only used to refer to this formulation, not street speed. I can promise that you won't find a meth dealer on a street-corner offering you "amphetamine mixed salts".
@Exercisephys: Not sure how you conclude that "it isn't really a prescription drug anymore" after preceding the statement with "it's technically available by prescription in some European countries." Doublethink? You will absolutely find people selling Adderall on black markets, and they name it "adderall" and not "amphetamine mixed salts." If black market naming is good enough to say low-quality speed is not named ampheta-mixed-salts, it's good enough to say adderall is named adderall. This discussion is getting pointless as the rename request is denied.
  • Oppose "Adderall" is what people are searching for, it's the common name, and unlike most other drugs, there is no encyclopedia-title-friendly generic name. Methylphenidate is on par with "amphetamine", but "amphetamine mixed salts" and any variation thereof is atrociously awkward. In addition, in my experience in a hospital environment, doctors refer to it as adderall almost exclusively. Contrast this to something like diazepam, which is referred to as such and not as Valium. Noformation Talk 21:57, 19 February 2014 (UTC)
@Noformation: To be fair, how many people search for "Cannabis (drug)"? Part of the title is the statement it makes, the implications it has, and the things it supports. Exercisephys (talk) 01:09, 20 February 2014 (UTC)
If I understand your implication correctly, it's a fair enough point, but I don't know that it would change my outlook in a general sense. Just to be clear: I think that "adderall" is the exception, and by no means the rule. Noformation Talk 11:31, 20 February 2014 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

GA Review

GA toolbox
Reviewing
This review is transcluded from Talk:Adderall/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Jaguar (talk · contribs) 16:09, 2 December 2014 (UTC)


I note that this review has been taken earlier and deleted, so I'll have this one up within 48 hours. ☠ Jaguar ☠ 16:09, 2 December 2014 (UTC)

GA review – see WP:WIAGA for criteria

  1. Is it reasonably well written?
    A. Prose is "clear and concise", without copyvios, or spelling and grammar errors:
    B. MoS compliance for lead, layout, words to watch, fiction, and lists:
  2. Is it factually accurate and verifiable?
    A. Has an appropriate reference section:
    B. Citation to reliable sources where necessary:
    C. No original research:
  3. Is it broad in its coverage?
    A. Major aspects:
    B. Focused:
  4. Is it neutral?
    Fair representation without bias:
  5. Is it stable?
    No edit wars, etc:
  6. Does it contain images to illustrate the topic?
    A. Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:
    B. Images are provided if possible and are relevant to the topic, and have suitable captions:
  7. Overall:
    Pass or Fail:

Initial comments

  • The prose in this article is generally very good. However I notice a concern of WP:OVERLINK problems, especially in the lead section. Obvious terms such as performance and fast heartbeat could be unlinked
 Done - pruned 2 others I thought were unnecessary as well
  • Is it OK for most parts of this article to be transcluded from Amphetamine?
information Note: This isn't done often, so there isn't a policy governing the way article-article transclusions are applied. The only reason I did this is because there's so much content overlap between amphetamine, adderall, dextroamphetamine, and lisdexamfetamine (each of which is notable in its own right) that I decided it was simpler to just update 1 page instead of all 4 whenever I needed to change something common to all pages. Nonetheless, there's actually a quite a few of {{if pagename}} templates in the source code of amphetamine that tailors the transcluded text to each article, where appropriate (for example, the first sentence of medical uses in each article). Adderall has the most content overlap with amphetamine, so I decided to write this article as a simpler, more lay-readable version of that article in the more technical sections (primarily pharmacology; the addiction sections also differ a little to improve accessibility in this article - Adderall has a glossary of terms, while Amphetamine has a very technical signal transduction diagram.
  • More overlinking in the Contraindications section; depression and blood pressure could be lost. Also, it would be best to explain that "severely elevated blood pressure" is hypertension in this section
 Done
  • "Addiction is a serious risk" - I would unlink addiction and refer it to something like "increase of substance dependence" in order to extend prose
information Note: I deleted the "substance dependence" text and replaced it with Drug addiction for consitency with the addiction glossary terms. I've recently started standardizing the mixed terminology involving dependence/addiction in various addiction articles for reasons I noted at the end of this thread: WT:MED#Lead containing a large glossary of terms. Funny how I didn't notice it here. :P
  • "Adderall has been banned in the National Football League (NFL), Major League Baseball (MLB), National Basketball Association (NBA)" - some of these could be linked?
 Done - linked all 3
  • "ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise" - natural rewards?
information Note: I wikilinked the term, though I can also indicate that these refer to behaviors if you think it's worth doing so. Natural rewards are simply rewarding behaviors (these were named as such to make a distinction between drug rewards - the "unnatural" kind - and behavioral rewards)
  • "The effects of amphetamine on gene regulation are both dose- and route-dependent" - hyphens should be removed here
information Note: The phrase "dose-dependent" is typically hyphenated (the source cited in that sentence follows this convention), I merely hyphenated route since I assume it follows the same grammar rule. I don't really care about how the sentence is written though, so if you prefer I can just rephrase it as "dependent upon dose and route of administration" or the like.
  • "The maximum penalty for unauthorized possession is 5 years in prison" - would put this as five (for figures lower than ten)
 Done

Thanks for being thorough! Seppi333 (Insert 2¢ | Maintained) 18:35, 3 December 2014 (UTC)

References

  • Ref 107 should be deleted, it redirects to a Japanese website
  • Other than that all references are in working order
  • Citations (there are a lot) are all in the correct places, so this meets the GA criteria
I deleted that ref; I'd have removed it sooner had I noticed that it was a bare url. Seppi333 (Insert 2¢ | Maintained) 18:35, 3 December 2014 (UTC)

On hold

I have to admit I'm not well versed on the subject of prescription drugs but from a copyediting point of view this article is well written, comprehensive and other than the fact of most of it being trascluded from amphetamine it is near GA material. I am also not sure why the last GAR was cancelled, but in its current form there seem to be few problems. The points I mentioned above were only technical and minor, so I'll put this on hold for the standard seven days until those have been addressed. Thanks, ☠ Jaguar ☠ 17:16, 3 December 2014 (UTC)

Close - promoted

@Seppi333: thanks for addressing them! I agree with you and am relieved regarding the transclusion with amphetamine, there is no problem with any policy on any overlap of information. In fact it is better that one article contains so much information instead of having four articles contain the same amount of content. The prose in this article was already very good which explains the review being on the short side. It's comprehensive, well written, well references and stable. The images are also interesting. Regarding the phrase "dose-dependent", if it's ok I'll leave it to you what you think is best? Anyway, well done on the GA ☠ Jaguar ☠ 20:00, 3 December 2014 (UTC)

Trial FAC run

@AmericanLemming and Boghog: First off, I want to thank both of you for all the work you two did to help promote the amphetamine article to FA status. Getting that article through FAC was an endless and massive pain in the ass and I doubt it would have been promoted without the assistance each of you provided.

As for this article, after some consideration of AmericanLemming's suggestion to nominate the article, I've decided to do a trial run at FAC to see how things go. Hopefully I won't encounter another Shudde...

I don't think this article is actually comprehensive at the moment since it lacks a pharmacokinetics section. It was deleted a while back IIRC. For that particular section, I'll probably just copy/paste the Adderall-relevant content from amphetamine into this article and then simplify the text to make it more accessible than the amphetamine section. Other than that section, do either of you think the article needs any further expansion or restructuring to be FA quality?

Besides the restructuring, I need to do some prose copyediting in the non-transcluded sections before nominating this; as far as I can tell, the article easily conforms to the other FA criteria. Seppi333 (Insert 2¢ | Maintained) 19:20, 29 January 2015 (UTC)

Huge problem!

This article says "there is no systemic evidence that amphetamines produce aggression or hostility" or something to that effect--but the source says that while that is the case, the patient SHOULD BE AWARE FOR SIGNS OF AGGRESSION AND HOSTILITY, REGARDLESS, while taking Addderall. Check the citation yourself and you will see.

This is a CRUCIAL part of information that has been excluded from that article. — Preceding unsigned comment added by 72.93.170.241 (talk • contribs) 00:06, 15 March 2015‎ (UTC)

"Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility."
This literally states that there's an effect associated with ADHD individuals to watch for, nothing more. Stimulants may, in fact, reduce aggression in ADHD individuals, but there's no systematic evidence of that either. That said, there's no reason to change the sentence. Seppi333 (Insert 2¢ | Maintained) 04:53, 15 March 2015 (UTC)

"Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility."

My friend, do you not see the implication that stimulant treatment may worsen the symptoms? It's very clear. That's why they begin with "although"--because even though there's no "systematic" evidence, it's still a possibility.

Look at this citation from one of the largest licensed pharmacies in the USA: Adderall may cause mental problems, such as new or worse behavior and thought problems, including increased aggressive or hostile behavior. People with bipolar disorder need special care when taking Adderall. http://www.cvs.com/drug/adderall/side-effects

Why not include the entire sentence from the FDA page, instead of a portion of it? It won't hurt the article. One could simply include the rest of the sentence for the sake of clarity. — Preceding unsigned comment added by 72.93.170.241 (talk) 14:46, 15 March 2015 (UTC)

The reason why I'm not is because: "stimulants may, in fact, reduce aggression in ADHD individuals, but there's no systematic evidence of that either."
The other material is all covered in the contraindications section. Seppi333 (Insert 2¢ | Maintained) 18:04, 15 March 2015 (UTC)

repeated content

Many sections of this article are repeated several times, making the page incredibly long. (e.g. the "addiction" paragraph appears 5 times in the table of content, each pointing to duplicate instance of the content) It must be some sort of editing glitch, I imagine. — Preceding unsigned comment added by 70.36.142.232 (talk) 06:39, 23 March 2015 (UTC)

The problem is all the transcluded templates that copy in material from amphetamine. Some of them are apparently broken. This complex structure makes it difficult for editors to edit and maintain this article. IMHO, these templates should be substituted and redundant material between articles should be minimized. {{main}} templates pointing to the relevant sections of amphetamine should be sufficient for readers interested in more information. Boghog (talk) 07:46, 23 March 2015 (UTC)
Whenever a transclusion breaks on this page, the amphetamine page should just be reverted until someone can address the changes that the reverted edit(s) made. In this case, it was this edit that removed the selective transclusion parameters (the triple bracketed text), which made every selective transclusion on this page a full-page transclusion. This is why it repeated multiple sections. Seppi333 (Insert 2¢ | Maintained) 17:45, 23 March 2015 (UTC)
Sorry for being so harsh, but this page is over engineered and unmaintainable. How on earth is some one supposed to figure which edit on amphetamine is supposed to be undone? At a bare minimum, the cross links should be documented with in-line warnings of unintended consequences if these templates are edited. However it would be much better to substitute these templates so that such warning become unnecessary. Finally these transclusions are needlessly duplicating material. Boghog (talk) 19:05, 23 March 2015 (UTC)

The syntax is actually pretty simple. Any material that is nested between "onlyinclude" tags in the amphetamine article is a selective transclusion. The following two lines create a selective transclusion from amphetamine:

  1. <onlyinclude>{{#ifeq:{{{transcludesection|section-name}}}|section-name|
    Article text goes here...
  2. }}</onlyinclude>

In this example, the target article would then transclude this particular content using {{:amphetamine|transcludesection=section-name}}

That's literally all there is to it. Every transclusion error that has occurred up to this point has arisen from the closing syntax being deleted (i.e., the "}}</onlyinclude>") or the parameter syntax (i.e., the "{{{transcludesection|section-name}}}") being deleted. That's really the only part of the source code that needs to be checked to address/fix transclusion errors. Seppi333 (Insert 2¢ | Maintained) 20:40, 23 March 2015 (UTC)

Added: the only reason these transclusions exist is because of content overlap in lisdexamfetamine, dextroamphetamine, this article, and amphetamine. Seppi333 (Insert 2¢ | Maintained) 21:08, 23 March 2015 (UTC)

Chemical Study Aid

Why is there no Controversy section for this article? For a number of years Adderall (and now the web-sold Addium) have been abused by college students using its stimulant effects for a chemical study aid:

When you combine the above with the existing brief section about Adderall and athletes it seems to me there really ought to be a Controversy section. Opinions? 172.88.146.9 (talk) 15:11, 12 July 2015 (UTC)


Please accept my apologies in advance if I'm replying to your question the wrong way. I just clicked on "edit source".

I never care what the newspapers say, however, I do care about what evidence based medicine says. In my personal opinion, Addium is nothing but a glorified vitamin. Please take a look at its active ingredients, and you'll notice that it's basically caffeine, L-tyrosine, GABA, and a bunch of other controversial herbals that have zero science behind them (Huperzine A comes to mind). The company is essentially saying that "well, we know the precursors to dopamine in the brain - let's dump them together and make a pill out of it, and cross our fingers and hope that they get converted to dopamine".

With that being said, it almost makes me sound like I'm saying that Adderall is even a dopamine-reuptake inhibitor, which it isn't - it's so much more complicated, particularly when we start talking about trace amine-associated receptor 1 (TAAR1) and vesicular monoamine transporter 2 (VMAT2). And still, there is still research going on about how Adderall works. There is some very heavy science behind it. But I don't know if what I'm saying means that you're not right and that Addium shouldn't be added to the article. I have no idea honestly. I can just tell you that there is science behind Adderall, and pretty much nothing backing up Addium. Heck, if I swallowed a whole bottle of Addium, I'd be surprised if I get anything more than some mild diarrhea.

An article worth looking into:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020278/

As I mentioned though, I am not sure if this means that a "Controversy" section shouldn't be opened. It's just that when I see people abusing these vitamins, I can't help but laugh at them because you'd be surprised how powerful a placebo effect can be. I guess I just feel like it's almost an insult to the many years of biochemical research it took to make Adderall by mentioning some glorified vitamin in the same article. But this is just my personal opinion and I don't agree or disagree with you about adding the section. I'm just not too familiar with the way people decide on adding sections or what the requirements are. Have a good rest of the weekend!

Boonshofter (talk) 15:50, 12 July 2015 (UTC)

@172.88.146.9, Wikipedia strongly discourages Controversy sections because everyone who has an ax to grind adds to it and it becomes overbloated in violation of WP:WEIGHT. Instead, criticisms should be discussed in other relevant sections of an article, which is the case here. There are also criticisms of this and other stimulant medications in other ADHD-related artciles. ADHD in general is a complex and controversial topic. Look around at related articles; you'll find information on controversies. Secondly, this is a medical article, and the sources you link do not meet the standards of WP:MEDRS. Sundayclose (talk) 16:05, 12 July 2015 (UTC)
Actually Sundayclose, respectfully, the sources I provided DO meet the standards of WP:MEDRS. Please note:
The popular press is generally not a reliable source for scientific and medical information in articles. Most medical news articles fail to discuss important issues such as evidence quality,[21] costs, and risks versus benefits,[22] and news articles too often convey wrong or misleading information about health care.[23] Articles in newspapers and popular magazines generally lack the context to judge experimental results. They tend to overemphasize the certainty of any result, for instance, presenting a new and experimental treatment as "the cure" for a disease or an every-day substance as "the cause" of a disease. Newspapers and magazines may also publish articles about scientific results before those results have been published in a peer reviewed journal or reproduced by other experimenters. Such articles may be based uncritically on a press release, which can be a biased source even when issued by an academic medical center.[24] News articles also tend neither to report adequately on the scientific methodology and the experimental error, nor to express risk in meaningful terms. For Wikipedia's purposes, articles in the popular press are generally considered independent, primary sources.
A news article should therefore not be used as a sole source for a medical fact or figure. Editors are encouraged to seek out the scholarly research behind the news story. One possibility is to cite a higher-quality source along with a more-accessible popular source, for example, with the |laysummary= parameter of {{cite journal}}: Empty citation (help).
Conversely, the high-quality popular press can be a good source for social, biographical, current-affairs, financial, and historical information in a medical article. [emphasis added]
The wide-spread abuse of this medication is definitely both a social and a current-affairs topic appropriate to be in this article. 172.88.146.9 (talk) 12:37, 15 July 2015 (UTC)

I couldn't possibly agree more with your assessment. They were all newspaper articles that were quoting Addium. I didn't even bother reading them honestly. My cousin is doing her biochemistry thesis on one of those receptors, which is why I felt that I had to chime in. She's been through hell and back to get actual results she can now publish after 4 years. She defends her thesis in a few weeks actually. Thanks for your input :)

Boonshofter (talk) 16:22, 12 July 2015 (UTC)

Actually the illicit use of Adderall by students is already briefly mentioned in the Adderall#Performance-enhancing and cites Adderall#cite_note-pmid16999660-50. Perhaps this could be expanded a bit with this more recent review:
Boghog (talk) 17:58, 12 July 2015 (UTC)

Yes this is a great article, from a respectable journal. I actually read it before... but I believe that the original person who asked to create the "controversy" section was more interested in talking about Addium. But I agree, it's a very well established article in the scientific community.

Boonshofter (talk) 18:02, 12 July 2015 (UTC)

It is pretty clear that the original editor who started this thread was more interested in Adderall than Addium. All the four links provided at the beginning of this thread concern Adderall and not Addium. Addium was only mentioned in passing. Finally to state the obvious, this article (and talk page) is about Adderall and not Addium. Boghog (talk) 19:01, 12 July 2015 (UTC)

Frankly, I wasn't taught my medicine from newspaper articles - we were taught evidence based medicine in medical school - residency was based on solid peer-reviewed articles. So the second I noticed he was quoting sites like CNN, I didn't bother even looking at them. I was also under the impression that he was more interested in Addium than Adderall, and it seems I misread what he was trying to say (which I apologize for).

Regardless, I never intended to offend, and please accept my apologies if I did. Your point is very well taken, and your insight is very much appreciated.

Boonshofter (talk) 19:17, 12 July 2015 (UTC)

Sorry for being so terse. I just wanted to make sure that the discussion on this talk page remained focused on Adderall. Cheers. Boghog (talk) 19:40, 12 July 2015 (UTC)
I really don't see how this drug is controversial. It has well-established ergogenic and nootropic effects and associated adverse effects, which are all comprehensively covered in this article and cited to current reviews of medical research. Unlike the 4 sources at the top of this section, this article does not include value-based opinions as to whether or not a certain behavior (i.e., recreational drug use, doping in sports, or the use of diverted controlled substances as a nootropic) should be practiced, based upon cultural norms and the author's perception of the risks/benefits. As these behaviors aren't specific to this drug, any content relevant to one of these 3 uses would be more appropriate in the associated article than in this one. That said, any medical claims/justifications added to an article would still require WP:MEDRS compliance for the citation. Seppi333 (Insert 2¢) 21:00, 12 July 2015 (UTC)
The increasing illicit use of Adderall to enhance academic performance is certainly notable and is somewhat unique to this drug. Furthermore just stating the prevalence of this use is not a medical claim, but nevertheless, there is a MEDRS complaint source (PMID 22694135) that can be used to support this statement. Finally this article already mentions this use in the Adderall#Performance-enhancing section. I agree that we do not need to create a separate controversy section, but instead expand the existing performance-enhancing section. Boghog (talk) 21:19, 12 July 2015 (UTC)
Sounds reasonable. I'll read through it over the next day or two and update either this page or the amphetamine transclusion, depending on what it says. Seppi333 (Insert 2¢) 22:14, 12 July 2015 (UTC)
May I suggest that if the current Performance-enhancing section is modified that it include named subsections of Academic Enhancement and Athletic Enhancement for ease of access to these topics by non-medical readers looking for information on these issues. We also could refactor the article entirely to group both Performance enhancing and Recreational use under an umbrella topic of Non-prescription use or Illicit use (Are there any cases of Adderall being used for performance enhancement under medical supervision?). If agreeable I would be willing to do the section reorganization work myself. 172.88.146.9 (talk) 13:41, 15 July 2015 (UTC)

Respectfully, I realize that this is primarily a medical article but knowledge does not live in a vacuum. This medical substance has real-world effects on human behaviour and human lives. That information is found in newspaper articles and should not be excluded just because it is not strictly medical in nature. I selected only well established and vetted journalistic news sources for reference. WP is not a medical encyclopedia, it is a comprehensive encyclopedia.

As for my sources not meeting the standards of WP:MEDRS please see my comment above in response to user Sundayclose.

The drug itself is not controversial as far as I can determine, but the human abuse of the drug in both sports and academia is. I am fine with avoiding a section labeled Controversy as long as the topic is given its due weight in light of the scope and scale of the abuse issue. How much weight would be given to such a topic if the same number of people were being harmed by a side-effect rather than by abuse?

One thing to keep in mind is that people come to Wikipedia for information. They may not be medically oriented readers. Imagine a high school kid comes to WP looking for information on the use of Adderall for sports enhancement or getting good grades. How easy is it going to be for that kid to find the information he needs to realize that such uses are both illegal and unsafe? No, we are not trying to be social workers, just an information provider, but we need to make that information accessible to ALL types of readers, not just subject specialists.

172.88.146.9 (talk) 11:43, 15 July 2015 (UTC)

Wikipedia is not a medical encyclopedia, but by long-standing consensus it has certain standards for medical articles. And those standards are not intended for the article to be only for "specialists"; they are intended to maintain unbiased accuracy (as much as is possible within current scientific research) that does not put undue weight on current newspaper and magazine articles which are very prone to publishing information without enough scientific validity. Medical review articles in peer reviewed journals are far more likely to reflect the current status of a particular medical topic compared to the headlines of newspapers and magazines. Wikipedia is not written for specialists only, but it also is not written for high school students who rely on an encyclopedia rather than medical advice to make a decision about drug use. I also oppose dividing the Performance-enhancing section. It is not a lengthy section, and it gives adequate WP:WEIGHT to the topic. Additionally, as has been pointed out (but largely ignored) Adderall is one of a number of drugs related to ADHD. Controversies are included in those related articles. Our goal is not to concentrate all of the discussion of controversies into the Adderall article, but it is to provide an overview of those issues with links for the reader to follow for more details. Sundayclose (talk) 14:26, 15 July 2015 (UTC)
The fact that Adderall is being illicitly used by students as a academic performance enhancing drug is not a medical claim and hence is outside the scope of WP:MEDRS. Adderall appears to be one of the most widely used drugs for this purpose and that statement is backed up by a reliable secondary source (see PMID 22694135) and hence is fair game to included in this article. Sources like the New York Times are also acceptable sources to support this statement. Boghog (talk) 15:53, 15 July 2015 (UTC)
@Boghog, I don't disagree with a well sourced statement about Adderall being one of the most widely used drugs by students as an academic performance enhancing drug. But I emphasize one statement; not a paragraph and certainly not a separate subsection, per WP:WEIGHT. Sundayclose (talk) 17:28, 15 July 2015 (UTC)

I think what Boghog mentioned about a brief statement on diversion prevalence is worth adding simply because some readers (including me) would probably be interested in knowing about it. I downloaded the paper Boghog linked, but I haven't read through it yet. I'll get around to this soon though. Anyway, I think it's probably fairly obvious to readers that both the recreational use and the diversion of Adderall (or any other drug) is controversial; I actually can't think of any victimless crime that doesn't involve some form of controversy at the moment. Seppi333 (Insert 2¢) 19:22, 15 July 2015 (UTC)

I've added the diversion prevalence data to that statement. Seppi333 (Insert 2¢) 12:44, 18 July 2015 (UTC)

Clarification: Adderall vs Addium

I just wanted to clarify a small point in my original post: Above some of the Editors seem to have keyed in on my parenthesised comment, "(and now the web-sold Addium)", as if that was my primary concern, for the record it is not. Respectfully the very fact that my comment was in parentheses should have been a clue about the level of significance I attached to the sub-topic. Furthermore, contrary Boonshofter's comment about the four source links ("They were all newspaper articles that were quoting Addium.") NONE of these articles even mention Addium by name, though there is a brief mention about "fake Adderall" in one of them.

The sole reason I mentioned Addium in passing is because it is being called "legal Adderall" in web advertisements and email spams for the product. In fact the reason why I came to this article was to find out what Adderall is. Prior to seeing one of these spams I didn't even know about the history of the abuse issue. I would suspect that our "customers" (people who come to the encyclopedia looking for information) would likely do much the same. 172.88.146.9 (talk) 11:16, 15 July 2015 (UTC)

We got it (see our follow-up comments above). Boghog (talk) 12:45, 15 July 2015 (UTC)
Ooops! missed that. Thanks Boghog. 172.88.146.9 (talk) 12:52, 15 July 2015 (UTC)
Wow, I'm honestly blown away - although there's disagreement at times as I read the comments above, I love the professionalism, and I love even more how passionate everyone is in making Wikipedia a better resource. I have no clue how I would've gone through medical school if it weren't for Wikipedia. I'm not very technologically savvy, so I felt bad that I couldn't do edits like everyone else (without screwing up the article somehow). So when I graduated from medical school, I decided to make a huge donation to Wikipedia instead -- to make up for my lack of edits. I just felt so bad. At the end of the day, it boils down to each and every one of you guys making these comments above - you guys are the reason Wikipedia has been my primary source (and literally the source of every medical student in my class, and probably the majority of students in any discipline across the country). Thank you for being so passionate about your opinions and not backing down, regardless if someone disagrees with you or not. It's all about respecting each others' opinions. Boghog, you were not terse at all -- you were passionate about your opinion, and that alone deserves a lot of respect. Thanks again! Boonshofter (talk) 17:17, 15 July 2015 (UTC)

Mixamphetamine

The article "mixamphetamine" is basically just a copy of this article but with a different name. It was decided earlier that the brand name "Adderall" should be used to describe the drug. Andrea Carter (at your service | my evil deads) 23:02, 3 August 2015 (UTC)

Mixamphetamine is a made up word that is not supported by reliable sources. Furthermore mixamphetamine is almost an exact copy of Adderall, so there is nothing to merge. Rather than "merging" with a redirect left behind, mixamphetamine should be simply deleted (and salted to prevent it from being recreated). Boghog (talk) 23:52, 3 August 2015 (UTC)
Agreed. Seppi333 (Insert 2¢) 04:35, 16 August 2015 (UTC)

Is Adderall a psychoactive drug itself or a mixture of psychoactive drugs?

@Sundayclose, Seppi333, and Garzfoth: With this diff I proposed identifying Adderall as a mixture of salts of levoamphetamine and dextroamphetamine rather than as a psychoactive drug. Sundayclose subsequently reverted so I am opening this discussion. Possibly this is splitting hairs but I am under the impression that Adderall refers to a specific mixture of amphetamine salts. Adderall being psychoactive follows from it containing these salts. Hence dextroamphetamine and levoamphetamine are the psychoactive drugs in Adderall while Adderall refers to mixture. Essentially it is the difference between whether Adderall "is" a psychoactive drug or Adderall "contains" psychoactive drugs. Sizeofint (talk) 19:17, 20 October 2015 (UTC)

I reverted your edit and accidentally did not leave an edit summary (apologies). I reverted for two reasons. First, you removed "a psychostimulant drug of the phenethylamine class", and there is no reason to remove it. "Psychostimulant of the phenethylamine class" should remain regardless of whether we call it a drug or a mixture. Secondly, Adderall is considered a brand-name drug by the U.S. FDA and should be identified as a drug. Other drug mixtures are identified by their brand-name rather than their individual components (e.g., Percocet). There's no reason Adderall should be an exception. Thanks for discussing here. Sundayclose (talk) 21:55, 20 October 2015 (UTC)
Okay, I agree with the first reason, we should definitely make sure to include that bit. However, you are completely wrong about how drug mixtures are handled, and your comment is actually extremely relevant given what I was discussing above in the renaming section, it's a great example that just reinforces my point even further. Garzfoth (talk) 23:08, 20 October 2015 (UTC)
I cut that portion because it is in the relevant constituent drug articles but the article can be phrased to keep it. Percocet is in bad shape but we currently never explicitly identify it as a drug. Currently the drug article says drugs are [[chemical substance]s which are differentiated from mixtures. It may be there is a technical sense to the word drug referring to chemical substances and a colloquial sense referring to chemical substances and mixtures. In any case I think we should stay consistent with the drug article. There is also combination drug which would seem to apply here given the fixed ratio. Sizeofint (talk) 02:11, 21 October 2015 (UTC)
You're correct Sizeofint, Adderall is a drug product but not a drug, so the current version is clearly wrong. Garzfoth (talk) 23:27, 20 October 2015 (UTC)
I don't feel strongly about the drug vs. mixture issue, so I don't object if someone wants to change it. Sundayclose (talk) 00:47, 21 October 2015 (UTC)
Adderall is a drug. Adderall is a drug product. Adderall is psychoactive. Let's not be overly pedantic. Seppi333 (Insert 2¢) 06:15, 23 October 2015 (UTC)

Use in e-sports as performance enhancer

Now that it is becoming a common controversy in e-sports, I think it should be noted under the Performance enhancing section that some professional e-sports players have also been using Aderrall as a performance enhancer.

Citations to one known incident regarding a counter-strike e-sports team being on Aderral

Wightwulf1944 (talk) 15:08, 28 November 2015 (UTC)

That's excessive for this article. Discuss this at Talk:Amphetamine, which is the article linked in the Adderall article. And generally for a medical article, popular press articles about one incident don't meet the guidelines at WP:MEDRS. Sundayclose (talk) 16:31, 28 November 2015 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified one external link on Adderall. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

When you have finished reviewing my changes, please set the checked parameter below to true or failed to let others know (documentation at {{Sourcecheck}}).

checkY An editor has reviewed this edit and fixed any errors that were found.

  • If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
  • If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—cyberbot IITalk to my owner:Online 07:27, 27 May 2016 (UTC)

Orphaned references in Adderall

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Adderall's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "Adderall IR":

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 08:27, 18 July 2016 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified 2 external links on Adderall. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

When you have finished reviewing my changes, please set the checked parameter below to true or failed to let others know (documentation at {{Sourcecheck}}).

This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 18 January 2022).

  • If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
  • If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—InternetArchiveBot (Report bug) 03:31, 4 October 2016 (UTC)

PHARMA EDITORS TO THIS PAGE

This page paints adderall way too much more positively than is accurate. I believe pharma people may be editing this page! Please check! — Preceding unsigned comment added by 209.2.213.191 (talk) 06:57, 15 November 2016 (UTC)

You need to be a little more specific about what you believe the problem is here. Seppi333 (Insert 2¢) 17:30, 15 November 2016 (UTC)
This article in not neutral in tone! The article repeatedly refers to therapeutic doses in a positive and comforting tone, e.g. "Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD." in the part on medical uses and " The review indicated that withdrawal symptoms are associated with the degree of dependence, suggesting that therapeutic use would result in far milder discontinuation symptoms." in under dependence and withdrawal. The first statement is far too certain in my opinion and the second one seems to me to be trying to comfort a reader by being weaselly. These articles show there is some doubt about the safety of long term adderall consumption (at near therapeutic dosage) and that there is some concern about the effects of adderall on young children: https://www.ncbi.nlm.nih.gov/pubmed/27579185, http://jpet.aspetjournals.org/content/315/1/91.long, http://journal.frontiersin.org/article/10.3389/fnsys.2014.00038/full. The article is not neutral in tone and it gives undue weight to a pro-adderall POV. Forgot to sign: I am a rock (and an island) (talk) 14:32, 18 November 2016 (UTC)
Also, while this probably isn't a good Wikipedia source, this link has a fair amount of information: https://www.quora.com/What-are-the-long-term-effects-of-Adderall-Dexedrine-or-Ritalin-use. I am a rock (and an island) (talk) 14:46, 18 November 2016 (UTC)


@I am a rock (and an island): I've attempted to address your concerns accordingly:
  • The case report that you cited on the cardiovascular implications of stimulant medications for adult ADHD discusses the cardiovascular effects of amphetamine pharmaceuticals in adults who have been prescribed these drugs in spite of evidence suggesting that they have a preexisting cardiovascular condition. As noted in this article, heart disease is an absolute contraindication for any pharmaceutical amphetamine, meaning these drugs should not be prescribed to individuals with these conditions under ANY circumstances. The article currently indicates that amphetamine pharmaceuticals do not increase the risk of serious adverse cardiovascular events in children, young adults, or adults and cites two FDA-commissioned studies and the two associated FDA information pages on the cardiovascular effects of these drugs in those age groups (the current statement in the article's "Side effects" section: USFDA-commissioned studies from 2011 indicate that in children, young adults, and adults there is no association between serious adverse cardiovascular events (sudden death, heart attack, and stroke) and the medical use of amphetamine or other ADHD stimulants.[sources 1]). Since this article already covers the cardiovascular disease contraindication and does not suggest anywhere that the use of amphetamine pharmaceuticals in individuals with preexisting cardiovascular conditions is safe, there doesn't appear to be anything in this study that the article doesn't already assert. I unfortunately can't cite the case report study itself since it's not a medical literature review (see WP:MEDRS, the Wikipedia policy that covers the type of medical studies which can be used as references for medical information); however, I have attempted to clarify the current article text in that section by stating that amphetamine pharmaceuticals are still contraindicated in individuals with preexisting cardiovascular disease, citing more appropriate medical sources (revised in special:diff/750280759/750281192).
  • Since the latter clause in the sentence on dependence that you mentioned doesn't appear to be directly supported by the cited reference, I've revised the sentence accordingly (revised in special:diff/749932190/750277107); however, the former clause is directly supported by the cited reference (quote from the cited Cochrane review: "The severity of withdrawal symptoms is greater in amphetamine dependent individuals who are older and who have more extensive amphetamine use disorders (McGregor 2005).").
  • The paragraph in this article which covers the safety and efficacy of stimulant medications for ADHD, including the particular sentence that you mentioned (Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD.[5][6][7]), is directly supported by all of its references. The first reference for that sentence is a professional level textbook that covers the safety and efficacy of ADHD medications in several sections of the textbook that are dedicated to those topics; the latter two references for the sentence are medical reviews which examine the long-term efficacy (2nd ref) and long-term safety+efficacy (3rd ref) of ADHD stimulants. All three references base their conclusions on randomized controlled trials (RCTs) that studied the safety and efficacy of stimulants medications for ADHD in humans; RCTs are the type of primary source which provide the best evidence for drawing conclusions on the safety and efficacy of pharmaceuticals (see WP:MEDRS#Assess evidence quality). Since all three references are fairly conclusive and base their conclusions on high quality evidence, I'd need to cite a review or meta-analysis of RCTs which contains a contradictory conclusion about the safety and efficacy of amphetamine pharmaceuticals for the treatment of ADHD in order to make a contradictory assertion in this article. I am open to revising that sentence based upon what is stated in these references though. If you need access to any of the three refs, let me know and I'll upload the article to an external website and provide a link or (in the case of the textbook) quote the relevant sections for you.
  • The study you linked which covers the effects of amphetamine in adult nonhuman primates ("Amphetamine Treatment Similar to That Used in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder Damages Dopaminergic Nerve Endings in the Striatum of Adult Nonhuman Primates") is a primary source which can't be cited directly, per WP:MEDRS; however this article currently covers the findings of this study, citing a medical review which included the study, in the "Medical uses" section, which states:

    Long-term amphetamine exposure at sufficiently high doses in some animal species is known to produce abnormal dopamine system development or nerve damage,[8][9] but, in humans with ADHD, pharmaceutical amphetamines appear to improve brain development and nerve growth.[10][11][12] Reviews of magnetic resonance imaging (MRI) studies suggest that long-term treatment with amphetamine decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia.[10][11][12]

  • The quora source that you linked doesn't satisfy WP:MEDRS (it's not a medical source) or even WP:RS for that matter, so it can't be used to cite any medical or even non-medical statements in this article.
  • The study that you cited on the use of amphetamine pharmaceuticals as a nootropic (Performance enhancement at the cost of potential brain plasticity: neural ramifications of nootropic drugs in the healthy developing brain.) is a medical review, so it can be used to cite statements in this article; however, I'm not sure what statement(s) you'd like to see added to this article from the information that is covered in this review. Can you clarify?
Let me know if the changes that I've made have addressed your concerns. I also need your input to address potential content additions related to the last bullet above. If you have any other suggestions for content additions in the article, it would help if you familiarize yourself with WP:MEDRS so that you know what citations can be used to cite medical information in Wikipedia articles. To very briefly summarize the relevant sections of that policy, acceptable sources for citing medical statements in Wikipedia articles include: peer-reviewed medical reviews and meta-analyses that have been recently published in a pubmed-indexed journal (articles that have been published within the past 5 years are considered ideal - 10 years is typically considered the upper age limit), recently published (again, ideally up to 5 years old, 10 year limit) college/graduate/professional level academic textbooks, and content that is published on the websites of most professional medical organizations (e.g., the USFDA, the WHO, NICE, etc.).
Also, if you'd like to read any of the medical reviews that are cited in this article but require payment to access, I'd be happy to upload those reviews to an external website and provide a link for you to download or read them; just let me know which sources you need. Seppi333 (Insert 2¢) 22:35, 18 November 2016 (UTC)
@Seppi333: Thank you for replying so quickly. Also, I'm sorry I didn't familiarise myself with WP:MEDRS before I decided to criticise an article which, having skimmed your profile, I now know that you wrote.
  • The first change you made balances things out with regard to the first sentence I initially mentioned, IMO. The second change increases neutrality, but to me it does seem to decrease clarity. It is very briefly being unclear what the association between the degree of dependence and withdrawal symptoms might be. Could the sentence be changed again to read: "The review indicated that the severity of withdrawal symptoms is high or low in people with correspondingly high or low degree of dependence." Or something similar?
  • Adderall is not mentioned specifically in the review in my first reply to you. In the conclusion the author expresses uncertainty about the safety of stimulants in general for adolescents and children, which is relevant to the 'safety and effectiveness' sentence. On the other hand, the article in question is not about adderall, so the cherry picking would probably not constitute a reliable source.
  • The second source[6] cited for the efficacy and safety sentence in my opinion is fairly conclusive but this is a quote from the conclusion:
"This suggests that effects of treatment are greatest near the time when treatment has occurred, consistent with a recent review that analyzed data from five randomized controlled trials, including the MTA study, and concluded that there is moderate to strong evidence for improvement in academic outcomes for follow-up times up to 14 months but that effect sizes may decrease thereafter."
This quote and the fact that the article uses studies that measure the effectiveness of treatment while the treatment is taking place or not too long after the treatment has finished suggest to me that we should draw from this study that treatment (drug or combination) is effective while it is taking place and shortly after. Also, effectiveness in the review is not specified to be about ADHD symptoms and I feel this should be made clear. As well as this, there are a significant number of studies in most of the breakdowns that show no statistically significant benefit of treatment with stimulants so I think the statement should be modified so it sounds less clear cut.
I do not have access to either of the other sources, but thank you for offering to upload them externally but it is not necessary.
Having said that, I realise the abstract of a review does not contain the whole review. However, in the abstract of the other review that is cited for this sentence, the only statement about efficacy and safety is one about this for up to two years (of treatment?).
  • I am not sure what the sentence should be changed to but I think it should be changed. I haven't looked at the sources very thoroughly so I can imagine we might disagree further. Also, please review the new, terrible phrasing of the sentence I amended above. I would understand if that sentence was kept as it is. Apologies for such a long reply and taking so long to reply.— Preceding unsigned comment added by ‎I am a rock (and an island) (talk • contribs) BallenaBlanca (Talk) 23:57, 19 November 2016 (UTC)
Thank you to the person who signed for me. I just realised I am probably being quite rude and I don't know very much about this subject. I did not write the first comment in this subsection, but when I was reading the article it struck me as being quite biased. Sorry if I am being rude. Also sorry for apologising ten times. I am a rock (and an island) (talk) 03:55, 20 November 2016 (UTC)
I think this revision should address your concerns about the ambiguity in the sentence on dependence: Special:diff/750435406/750621547; if not, let me know. I'll respond to your other points sometime later today or tomorrow - need to log off for now. Seppi333 (Insert 2¢) 22:18, 20 November 2016 (UTC)
Sorry about the delayed reply. I haven't forgotten about this. I'll follow up once I get home later tonight. Seppi333 (Insert 2¢) 23:37, 22 November 2016 (UTC)
I think it would be reasonable to state that the improvements in functional outcomes (e.g., academic, self-esteem, social function, etc.) that result from long-term stimulant therapy may decrease over time after treatment has stopped. The current article text is referring to the safety and efficacy of continuous stimulant therapy over arbitrarily long time horizons (e.g., lifelong treatment), so that should probably be clarified as well.
I also think that it would be reasonable to say that most but not all ADHD-related treatment outcomes improve with long-term stimulant therapy, per the review's conclusion.
While the review you've read doesn't examine the efficacy of pharmacotherapy for core ADHD symptoms, the other review which cites that sentence does cover the long-term efficacy of continuous stimulant therapy for core ADHD symptoms. Per its conclusion: Recent studies have demonstrated that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for more than 2-year treatment periods with few and tolerable adverse effects. The effectiveness of long-term therapy includes not only the core symptoms of ADHD, but also improved quality of life and academic achievements. The most concerning short-term adverse effects of stimulants, such as elevated blood pressure and heart rate, waned in long-term follow-up studies. The current data do not support the potential impact of stimulants on the worsening or development of tics or substance abuse into adulthood. In the longest follow-up study (of more than 10 years), lifetime stimulant treatment for ADHD was effective and protective against the development of adverse psychiatric disorders.
Anyway, I'll make these changes sometime within the next day or two and follow up here once I'm done. Seppi333 (Insert 2¢) 08:02, 23 November 2016 (UTC)
Thank you for uploading the other review and for putting up with my being annoying. I agree with what you've said about functional outcomes, ADHD-related outcomes and ADHD core symptoms outcomes. With respect to continuous treatment over a very long period of time, the reviews give the impression to me that outcomes would be similar to outcomes of treatment over a long period of time, but in the study you have uploaded, there is the following quote: There are very few controlled long-term studies of more than 5 years of treatment for childhood ADHD, and from Table III the maximum duration of treatment referred to in the review is about 12 years. There is a similar statement about adult ADHD and the maximum duration of treatment mentioned is 2 years. The review concludes in both cases that treatment is safe and effective within these time frames. In the other review the mean duration of treatment for studies included is 7.1 years and I cannot find the maximum length of treatment duration, but since it is not made clear what this is, I think it is fair to assume the review doesn't intend to draw conclusions about treatment over very long periods of time? I am very aware that I am being incredibly annoying, but I do think it is reasonable to make clear that it is believed by the scientists who conducted these reviews (which it does seem to be?) that continuous treatment is safe and effective over very long periods but that this is not an established fact.
Thanks for hearing me out on this. I am a rock (and an island) (talk) 21:12, 23 November 2016 (UTC)

@I am a rock (and an island): I'm really sorry for the long-delayed follow up. I've been really busy since I last posted due to the US thanksgiving holiday and work; I intend to update the article by tomorrow night at the latest on Friday (edit: as of Friday afternoon, I'll no longer be preoccupied with off-wiki responsibilities). In any event, I agree with you; the statements about long-term efficacy should be clarified to reflect what you and I have mentioned above. I expect that it'll take me 15-30 minutes to cover what we have discussed once I start working on this, depending upon how much detail I go into. Seppi333 (Insert 2¢) 01:16, 1 December 2016 (UTC); Updated 04:44, 2 December 2016 (UTC)

@I am a rock (and an island): I've made a first attempt at addressing the issues we've discussed: Special:diff/751010255/752868507. Do you have any comments on what I've added or have any specific suggestions for revision or other additions? I expect to revise this further later. Also, following up on your last reply: I don't really have a problem with saying that the safety+efficacy of stimulant therapy beyond the maximum study duration aren't established, but I can't actually state this unless one of the cited reviews makes this statement due to the WP:Verifiability policy. In order to cover this, we'd need a review that states that the long(er)-term effects of stimulant therapy for ADHD beyond time X are unknown. Seppi333 (Insert 2¢) 21:56, 3 December 2016 (UTC)

Arbitrary section break

I think the changes you have made so far are quite fair, but I would like to see it mentioned that the improvement of non-core symptoms might lessen once treatment has stopped as we discussed above. Also, I agree that the need for verifiability means that it can't be said that the level of safety and efficacy isn't known past a certain duration of treatment, but I also think it is not possible to verify that continuous treatment is always effective as I think the article currently implies, because as in my last reply neither of the reviews cited currently can confirm this. Could the 'safety and efficacy statement' (at least in the Adderall article) be changed, maybe to read: "...continuous amphetamine use over time periods reviewed for..." in view of this? I am genuinely not trying to draw this out unnecessarily by the way. Having said that (sorry), do you think it is reasonable to include in the introduction that Adderall is a brand name? In these similar articles (1,2,3,4) brand names are mentioned and called brand names in the introduction. I am a rock (and an island) (talk) 16:59, 4 December 2016 (UTC)
@I am a rock (and an island): Thanks for the feedback!
  • W.r.t. the long-term safety and efficacy of continuous treatment, this is not something that we are stating as our own original conclusions based upon other research; it's what the cited reviews explicitly state as a conclusion based upon primary research and that we are repeating in our own words. The key here is to ensure that we faithfully and accurately restate what is explicitly concluded in the cited review(s) so that our statements are directly supported by and consistent with the cited review(s). This is why I wrote "based upon the longest follow-up studies conducted to date, lifetime stimulant therapy that begins during childhood is continuously effective for controlling ADHD symptoms and reduces the risk of developing a substance use disorder as an adult" instead of the same sentence without the underlined clause. The review which cites that sentence is not implying that longitudinal cohort-based studies have been conducted from childhood to the time of death in ADHD individuals; rather, it states in its conclusion (In the longest follow-up study (of more than 10 years), lifetime stimulant treatment for ADHD was effective and protective against the development of adverse psychiatric disorders) that, based upon the longest 12 year study, these drugs do not lose efficacy and therefore there's no clear reason to assume that from anytime during 13 years of treatment onward, these drugs somehow lose efficacy for controlling the core symptoms of ADHD. It seems very odd to me to assume otherwise as well considering that after 12 years of treatment, most children that started using stimulants are adults (i.e., at least 18 years old) who are probably in their early 20s. By that time, an individual's brain is no longer in its developmental stages, although the brain does still change throughout the remainder of an adult's life through activity-dependent neuroplasticity and drug/trauma/pathogen/disease-induced neuroplasticity (the latter form of plasticity is typically but not necessarily pathological).
    With that in mind, I'd be okay with rephrasing the underlined clause from above as "based upon the longest follow-up studies with durations of up to 12 years" instead of "based upon the longest follow-up studies conducted to date" if you believe that this would be an improvement.
  • I think it would be a bit confusing to state that Adderall is a brand name because it's also commonly used to refer to all generic mixtures which contain the same ratio of salts which compose Adderall (these are the 4 [technically 3] salts listed beneath "Combination of" in the drugbox). Generic Adderall doesn't have a standardized nonproprietary name, which is why this article doesn't refer to generic Adderall as anything but "generic Adderall". Most brand name drugs that have internationally accepted medical uses or are FDA-approved respectively have an international nonproprietary name (INN) or United States Adopted Name (USAN). Adderall is an exception, since it does not have either an INN or a USAN (for this reason, this article uses a brand name instead of a generic name as the page title; normally drug articles use the INN as the page title, per MOS:PHARM). It's is worth noting that Adderall's FDA-listed generic name is dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate and amphetamine aspartate, which is indicated in the note next to the word "Adderall" in the 1st lead sentence.
    With that in mind, would it suffice if we were to state that Adderall is a brand name and a term which refers to generic drugs which contain the same ratio of amphetamine salts that compose brand name Adderall? I believe that I could cite that statement using the FDA-approved prescribing information for brand-name and generic Adderall IR pharmaceuticals, but I'd need to double check.
    @I am a rock (and an island): Follow-up comment: Facepalm Facepalm ... Nevermind what I said previously, I just realized that I actually did what you asked in the amphetamine article, but not this article. I've replaced note 1 in this article with the relevant note from the amphetamine article. See Special:diff/753370797/753374547. Seppi333 (Insert 2¢) 20:04, 6 December 2016 (UTC)
  • W.r.t. the reduction in outcome improvements from long-term stimulant therapy following the cessation of pharmacotherapy, this is something that I still intend to add to the article. I didn't include it in my last edit because I couldn't figure out a way to fit it in without making the section read clumsily (aside: the amphetamine article is a WP:featured article, so I can't add content without regard to the readability of the prose). I still intend to cover this once I reorganize the content in the 2nd/3rd paragraphs of the Amphetamine#Medical section. I'll ping you once I get around to reorganizing this and adding that content.
Also, I really don't mind discussions like this as long as the intended aim of the discussion is to improve the article (e.g., improve the accuracy/readability/clarity of the article text in this or other sections), so please don't apologize! I'm happy to work with you here as long as this is our mutual goal. So, if you have any additional suggestions, concerns, comments, or questions about the article text, feel free to mention them. I really don't mind. Seppi333 (Insert 2¢) 17:36, 5 December 2016 (UTC)
@Seppi333: Sorry for taking so long to reply--I put one thing off and then I end up putting everything off. Also, I appreciate what you've said in the last paragraph of the above reply! I think our goals agree. Having read what you've written in the first bullet point above and from the perspective of readability and honest representation of facts, I don't think we should change the sentence. It seems like an honest enough representation of the facts as it is and adding the longest study's duration could be a bit distracting. I am a rock (and an island) (talk) 19:58, 7 December 2016 (UTC)

Section references

Grouped references
  1. ^ [1][2][3][4]
References
  1. ^ "FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children and young adults". United States Food and Drug Administration. 20 December 2011. Retrieved 4 November 2013.
  2. ^ Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O'Duffy A, Connell FA, Ray WA (November 2011). "ADHD drugs and serious cardiovascular events in children and young adults". N. Engl. J. Med. 365 (20): 1896–1904. doi:10.1056/NEJMoa1110212. PMID 22043968.
  3. ^ "FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults". United States Food and Drug Administration. 15 December 2011. Retrieved 4 November 2013.
  4. ^ Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV (December 2011). "ADHD medications and risk of serious cardiovascular events in young and middle-aged adults". JAMA. 306 (24): 2673–2683. doi:10.1001/jama.2011.1830. PMC 3350308. PMID 22161946.
  5. ^ Millichap JG (2010). "Chapter 9: Medications for ADHD". In Millichap JG (ed.). Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD (2nd ed.). New York, USA: Springer. pp. 121–123, 125–127. ISBN 9781441913968. Ongoing research has provided answers to many of the parents' concerns, and has confirmed the effectiveness and safety of the long-term use of medication.
  6. ^ a b Arnold LE, Hodgkins P, Caci H, Kahle J, Young S (February 2015). "Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review". PLoS ONE. 10 (2): e0116407. doi:10.1371/journal.pone.0116407. PMC 4340791. PMID 25714373. The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  7. ^ Huang YS, Tsai MH (July 2011). "Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge". CNS Drugs. 25 (7): 539–554. doi:10.2165/11589380-000000000-00000. PMID 21699268. Recent studies have demonstrated that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for more than 2-year treatment periods with few and tolerable adverse effects. The effectiveness of long-term therapy includes not only the core symptoms of ADHD, but also improved quality of life and academic achievements. The most concerning short-term adverse effects of stimulants, such as elevated blood pressure and heart rate, waned in long-term follow-up studies.
  8. ^ Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remião F, Carvalho F, Bastos Mde L (August 2012). "Toxicity of amphetamines: an update". Arch. Toxicol. 86 (8): 1167–1231. doi:10.1007/s00204-012-0815-5. PMID 22392347.
  9. ^ Berman S, O'Neill J, Fears S, Bartzokis G, London ED (October 2008). "Abuse of amphetamines and structural abnormalities in the brain". Ann. N. Y. Acad. Sci. 1141: 195–220. doi:10.1196/annals.1441.031. PMC 2769923. PMID 18991959.
  10. ^ a b Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K (February 2013). "Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects". JAMA Psychiatry. 70 (2): 185–198. doi:10.1001/jamapsychiatry.2013.277. PMID 23247506.
  11. ^ a b Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J (September 2013). "Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies". J. Clin. Psychiatry. 74 (9): 902–917. doi:10.4088/JCP.12r08287. PMC 3801446. PMID 24107764.
  12. ^ a b Frodl T, Skokauskas N (February 2012). "Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects". Acta psychiatrica Scand. 125 (2): 114–126. doi:10.1111/j.1600-0447.2011.01786.x. PMID 22118249. Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Talk:Adderall/Archive_4&oldid=1136288748"