Internet Communities and Self Medication Among Young Adults with ADHD

Beth Krone, Ph.D.
Icahn School of Medicine at Mount Sinai

In March 2017, a group of young adults emailed me a link to a crowd-funding website to ask my thoughts on a new, direct to consumer health drink being marketed as a cognition boosting, anxiolytic, nutritional supplement. The makers were a group of neuroscience students without clinical licensure. Their all natural product was listed as being a mixture of antioxidants, b-vitamins, and Phenibut.

So what is Phenibut?
Phenibut is a Latvian produced, Soviet developed pharmaceutical that has not been licensed in the United States. In 2018, Australia joined several European nations in regulating Phenibut. Since it has not been licensed in the U.S., it remains unregulated. This means that a quick Google search will lead to a variety of Phenibut products for sale from U.S. based internet merchants or health food stores, since it is not illegal to buy, sell, or possess it.

Phenibut is a gabapentinoid, β-phenyl-γ-aminobutyric acid (β-phenyl-GABA), or a GABA analogue. Known to cross the blood–brain barrier, it is dopamine enhancing in the striatum, has some effects similar to benzodiazepines, may induce euphoria, and there is mixed information about its potential for inducing seizure activity based on its effects on calcium channel activity. There is also mixed information regarding the addiction potential of Phenibut, with at least one published case study supporting many anecdotal reports of it being highly addictive with quick tolerance and intense withdrawal symptoms. When overdosed, Phenibut has also been implicated in Eosinophilia and some fairly severe kidney and liver problems.

With its known side effect profile and abuse potential, Phenibut is a fairly potent psychotropic with pharmalogical properties that require dosing by age and health status. Certainly a health professional would expect this to preferably be done by a competent clinician with prescription privileges and with some type of compliance monitoring for safety.

Bulletin boards and a self-medication community
A quick review of some of the most often used bulletin board sites like Reddit and drugs-forum.com, though clearly shows that young adults do not necessarily share this perspective. Although some users name their preferred formulations, these sites do not advertise a particular drug, company, or formulation. People form communities in support of self-medication on these sites. Lacking resources or unhappy with the care they have received for their ADHD and comorbidities, they share information about unregulated psychotropics. They recount personal experiences of their trials. They freely discuss tweaking their medication regimens with various combinations of prescribed drugs, unregulated supplements, and illicit drugs.

Their discussions are, from a clinical management perspective, very educational. From a developmental or social psychological perspective, it is not surprising that young adults would accept prescribing information from peers without clinical degrees (or names), who often provide quite sophisticated scientific sounding information without references. From a systems or health literacy perspective, though, this highlights the enormity of the clinician’s task in building trust, reaching, and successfully serving the unserved or underserved who cannot find relief through safer channels. This task may be increasingly difficult in context of the larger social conflicts between the medical imperative to prescribe approved and well validated treatments, and the perspectives of a vocal and growing population of people outside the medical community.

To see what some of your patients are reading, check out:
https://www.reddit.com/r/phenibut/comments/4kvbq3/the_beginners_guide_to_phenibut/
https://drugs-forum.com/threads/pharmaceutical-phenibut-physician-patient-instructions-translated-from-russian.221041/
https://nootropicuniverse.com/phenibut-legal-status/

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