The FDA has officially declared a shortage of Adderall | Hacker News Reader

The FDA has officially declared a shortage of Adderall

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It’s affecting me pretty bad.

There are a few root causes: telemedicine rapidly increasing prescriptions, the mentioned Teva production issues. But one of the main problems is that the DEA tries to project the amount of adderall that’s allowed to be made/imported per year, which makes it so companies can’t quickly scale up production or hold inventories to smooth over supply issues.

IMO, the DEA should not have any input whatsoever in how much of a medicine can be produced or imported per year. Why should people who need medicine suffer just in case someone else might abuse it?

It’s hard enough as it is to manage these prescriptions because of them being controlled substances. Now it’s 10x harder because I have to play middle man between pharmacy and physician (if they only have 15mg XR in stock I can’t just get that filled to replace my 15mg IR without resending a prescription - by the time my physician sends something over they might be out of stock of that dose already) and pound pavement to find pharmacies with stock at all. Plus you have to deal with all the pharmacy staff that’s pissed at all the other people in the same boat calling in to try to get their prescriptions filled, on top of the regular baseline judgment against people with controlled substance prescriptions

> Why should people who need medicine suffer just in case someone else might abuse it?

This, in direct literal terms, was the argument made in favor of OxyContin.

The DEA could still go after pill mills or over-prescribers without supply limits. The main thing supply limits do is just make it inconvenient for everybody prescribed a particular medication to get it filled.

No, the argument for OxyContin was two-fold and targeted at doctors:

1. “Pain is the fifth vital sign.” You are a Bad Doctor if you do not consider pain.

2. OxyContin is not habit-forming.

1 is a little more complicated. I believe as part of the ACA hospitals were actually evaluated on subjective pain management as reported by patients with financial implications if it seemed pain was not being managed.

Also, a lot of people got started on Oxy after a surgery in which they were given it on their way out. They either started taking it and liked it, or didn’t take it and possibly had it diverted to acquaintances/family. With adderall you have to get it prescribed for ADHD or (more rarely) narcolepsy - of course it could still get diverted, but it’s not something that’s being routinely given to the general population like painkillers.

It's a lot easier to tell a GP you have ADHD than to get a surgery.

Not if you actually need a surgery. If you need a surgery you can generally get one pretty quickly and with little complication. Getting a prescription for Adderall from a responsible doctor when you actually need it can take months and multiple visits to a psychiatrist.

This was 15 years before the ACA

And it's a good one. Opiates have life-changing efficacy, it's the implementation that failed. Doctors weren't clever, if even actively malicious, about duration and tapering.

They're doing the same thing today with benzos, it's just less marked on society.

There's room in between full removal and liberal prescribing.

And it's still the correct argument. One person abusing something isn't a reason to harm another. I really do feel for people that are dealing with opioid addiction issues. It's been something that's hit close to me as well. But the ridiculous levels of interference in proper medical treatment is a strong driver of the very addition problems its attempting to solve.

Getting proper pain management requires going to "pain specialists" which may or may not be pill mills since their entire business is now built on pain management rather than general medical care. Getting your medications is heavily restricted and complicated. You can't fill a script for more than a month. You can't fill more than 2-3 days before the date on the script. You can't stock up for a trip, and you can't even start the process of trying to get it early in a shortage situation. The fear of DEA / government means your normal providers won't touch it, and it means if you're dealing with a bad provider (say you wound up at a pill mill and you're trying to get out) other providers won't want to take you on. It means if you've been mis-managed, rather than trying to help you wean down, you're more likely to have a new provider cut you off cold turkey and then treat you as an addict when your withdrawl symptoms kick in. An uncomfortable number of addicts have the same basic history, of being put on pain meds for some reason or another and being cut off cold turkey by some other provider without consideration for their current dependency levels or their actual pain needs. And that doesn't even begin to get into how impossible it becomes to get proper help if you are an addict.

Addiction is an awful thing, and it's an issue that needs to be dealt with. Dealing with it by making it harder for non-addicts and addicts alike to get the help they need is not the answer.

And I still think it’s a good one. Someone who wants to get a Rx of painkillers specifically to abuse it themselves or sell it to other abusers isn’t what we should really care about too much about outside of getting them into rehab. Someone might be a drug seeker is not a good reason to let someone who isn’t suffer.

Accidentally getting someone who had no intention of abusing it addicted without recognizing it was/is the much bigger issue and availability doesn’t really help that.

There was a shortage about a decade ago, right? I remember because my partner had ADHD and had trouble getting adderall. I remember it was definitely a rough time, even after getting it back. Getting re-acclimated was not easy - the break definitely made the unpleasant parts of being on adderall 7 days a week apparent.

They've long since stopped taking medication - but that was after we both decided the software industry is, for lack of a better word, stupid and de-prioritized it generally. We still make good money off it, but we do a worse job and have more free time for what matters in life. Thank goodness for remote work :)

I've found exercise (minimum of 5 hrs a week) to work better than any substance for curing depression, anxiety, and concentration.

Individual results may vary.

Careful with this. I was “self-medicating” my ADHD with exercise for years simply thinking I just liked exercise and not ever realizing that I had worked up to 25-30 hours a week just to function. Exercise absolutely does 100% work but meds that raise your baseline so you don’t have to exercise is a much healthier relationship with it.

There are a lot of habits that ADHD people fall into to “stim.” Whether or not it’s a healthy way of managing it is up to the person.

Evidence points to exercise and meds being a good idea most of the time for ADHD.

Can't stand meds though.

seems really bizarre to claim taking a light form of meth several times a day is healthier than exercising.

We all breathe a light form of fire several times per minute. Putting things in spooky terms is deceptive.

> Exercise absolutely does 100% work

Exercise works for you, but we should be careful about overbroad generalizations. Exercise is a pretty good thing for just about everyone with lots of benefits, and it likely can help many with ADHD, but it's never going to be enough for some people. I doubt there's anything that will 100% work for everyone. Even stimulants can't help everyone with ADHD, and for those who do benefit from medication some medications will work better than others.

Ultimately it's a lifelong process to figure out what helps with symptoms, what makes them worse, and what doesn't do much if anything at all. It's probably worth giving exercise shot for people who aren't already active enough, but don't expect miracles.

Personally, I've found jogging to be excellent for curing cancer, solving world hunger and balancing the checkbook. It truly is a miracle cure.

To be less sardonic, I'm not sure what this has to do with the topic at hand. It feels like people like to kramer into any discussion about medication to offer their unsolicited advice. Just about anyone that's gone through what you've mentioned have heard that same advice 10x over.

I’m kind of surprised by this. I thought a lot of folks switched over to Vyvanse over the past decade.

And if you also have depression and anxiety I’ve seen a few doctors use Wellbutrin.

That’s wild. I would be very concerned if my psychiatrist treated all phenylethylamines as interchangeable. I guess people have to make do with what is available though.

Vyvanse is definitely better than Adderall, but it can be annoying to get insurance on board.

Also, is there an instant release Vyvanse? I thought it was just extended release.

As far as I understand it, Vyvanse is specifically designed not to be instant release. It is amphetamine attached to lysine that only becomes active after the lysine is cleaved from it in your gut.

Dexedrine

I can't do Vyvanse. Lasts too long. I take 2x 30mg instant release mixed amphetamine a day. Well, usually just one a day but I'm prescribed two.

Not everyone needs long lasting meds.

While this is too bad, maybe it will push people toward effective alternatives.

Monoamine oxidase inhibitors help me more than ADHD stimulants ever did, and they aren’t known to be neurotoxic like Adderall.

Maoi have serious side effects, dangerous interactions with other drugs (and food!) and have withdrawal effects. These do not combine well with ADHD symptoms, and are not a first line treatment for a good reason.

They also don’t cause emotional flattening or weight gain like every other mental health medication. On top of that, they’re some of the most effective medications available, commonly polled much higher than SSRIs, SNRIs, or tricyclics.

Setting aside blue cheese and kombucha was an easy choice for me.

None of those medications are primay treatments for ADHD, nor do the side effects you list map to Adderal or Ritalin, which are.

I'm glad your sample size of 1 MAOI use is working well, but your statements are at best uninformed, if not blatantly spreading misinformation.

You’re right, it’s not scientific or authoritative information. Anecdotally, though, MAOIs solve my attention issues where Ritalin and Adderall failed.

I was going to say the same thing but for Modafinil. It has been demonstrated to be not only non-neurotoxic but neuroprotective, you don't need to sleep sixteen hours when you cycle off, and it doesn't change your personality.

I'm diagnosed ADHD and Modafinil has been saving my life (defined as my ability to hold a high paying professional job in tech and provide for my family) for a decade and a half.

Thanks for sharing this! I have always figured I’d try it at some point, but I seem to have a system that works. If that changes, I’ll keep this in mind.

is adderall neurotoxic and modafinil neuroprotective?

> MAOI

Ah yes, just don't eat blue cheese, drink grapefruit juice, or ingest one the thousands of otherwise innocuous drugs with MAOI contraindications unless you want to die a horrible death.

It’s less of a problem than you make it sound like. I don’t ever eat blue cheese and I don’t take arbitrary drugs. It’s been a lifesaver for me, and it has none of the weight gain or emotional flattening side effects of most other mental health medications. MAOIs are also commonly polled with a much higher efficacy rate.

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