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Comment by DontchaKnowit | Hacker News Reader

Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects. There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite.

I take this drug daily. The current supply crunch has meant I've had to take inferior versions of the product for nearly a year now. It fucking sucks. I need it to work but the side effects often mean little sleep, strange repetitive behaviour, absurd hypersexuality, etc.

Its a travesty, not in the best interest of the consumer. If you are on this medication you are treated like dog shit from the doctor to the insurance company to the pharmacy to the pill itself. All in the name of either preventi g addicts from getting it (who cares?) Or making more money for some massive company.

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> There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite.

This is true for the unregulated illicit drug market, but it's most certainly not true for regulated drugs like Adderall.

The ratios of the different isomers in Adderall are well-defined and are part of the drug definition. There are also stimulant variants that are 100% d-amphetamine, which would obviously be in violation of their drug definition if manufacturers starting shipping racemic versions.

> Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects.

This is over-simplifying the matter. The L-isomer has different effects and duration, but it's incorrect to suggest that it's all "side effects". Some patients do better on racemic mixtures with L-amphetamine. Some patients do better on pure D-amphetamine. It's not correct to suggest that one is pure side effects.

>This is true for the unregulated illicit drug market, but it's most certainly not true for regulated drugs like Adderall.

It's not even consistently true for the illicit drug market. You can just Google "amphetamine isomer separation tartrate" to get a bunch of information about it. The l-isomer of amphetamine is very weak, and sellers want return business.

You are correct. After looking it up it seems I was misinformed about the enantiomers in generics thing.

As far as the effevts of l amph- eh. Yes. There is some amount of evidence the the L isomer produces symptom relief similar to d amph. Frankly ive never had the two seperated so I wouldnt know from experience, but I have read repeatedly over the years that L amph is associated with more norepinephrine effects than D, and norepinephrine agonists produce ohysical side effects such as vasoconstriction.

Yeah, naw. You can state the hypothetical way things are supposed to work in the best case -- and you can state so confidentially -- but that doesn't mean that reflects the real world at all.

Look through the FDA warning letters database for manufacturers of adderall (f.e. the "Auro" family of producers). You'll notice a lot of warnings have already been issued for quality control and adulteration issues (and continue to be issued yearly, ad infinitum).

Yeah, the 3rd world factory where these drugs are manufactured, for sure tested their product themselves and found it to be bio-equivalent and within the acceptable FDA variance of "how much of the active drug is actually in each pill, vs. what's stated on the specs."

And yeah, the FDA for sure trusts these factories which are thousands of miles away are always up-to-snuff -- even when they don't have an inspector around.

Your statements about the illicit market aren't true either (pro-tip: the legal and illegal market for the usual, non-exotic synthetic drugs comes from the same source; with minor exceptions in local markets).

And a final pro-tip: if you think the only reason brand drugs are expensive is branding/marketing/some other bullshit -- some of the cost is in proper quality control (they're incentivized to maintain high standards, so people keep coming back to ask for the brand-name -- instead of some nameless generic any fly-by-night shop can manufacture).

I have no doubt this is true after reading about the 8 years of shit quality heart medicine, metropolol, coming out of india, which so many older americans rely on and can cause heart damage if inconsistently taken. It's an outrage.

what warning letter search terms do you suggest to understand the whole scope of FDA amphetamine quality inspection?

are there other DBs I should look in?

I get where you're coming from, but the stereoisomers in the formulation for Adderall are clearly defined, see https://en.m.wikipedia.org/wiki/Adderall

> Combination of

> amphetamine aspartate monohydrate 25% – stimulant (12.5% levo; 12.5% dextro)

> amphetamine sulfate 25% – stimulant (12.5% levo; 12.5% dextro)

> dextroamphetamine saccharate 25% – stimulant (0% levo; 25% dextro)

> dextroamphetamine sulfate 25% – stimulant (0% levo; 25% dextro)

I don't see why there should be no regulation? They are distinct chemicals, in that sense...

Yeah you are right. I wonder how closely this is adhered to in practice. Stranger things have happened in the pharma world.

But yes I was definitely mistaken. Thank you for the correction

There is no regulation for the % of each isomer in the product.

Do you have a source? The FDA label says it's 50% d,l-amphetamine (50/50) plus 50% d-amphetmaine, so you end up with a 3:1 ratio of dextroamphetamine to levoamphetamine.

Why would a manufacturer do more work to change the 50/50 mix? And why would it vary from batch to batch? The FDA has requirements on manufacturing that each lot is made to the same specifications.

The more reasonable explanation is that the binding agents changed, which may change the rate at which the drug dissolves and is absorbed.

This actually happened a while back with generic bupropion. Generic manufacturers made a 300 mg version, which had 300 mg of drug in it. However, the medicine was absorbed much more quickly leading to a rash of side effect complaints from patients. The FDA eventually recalled the drug.

If you want to read how generics are tested and approved, Derek Lowe did a nice blog post on it: https://www.science.org/content/blog-post/generic-wellbutrin...

"In that study, the results of which became available in August 2012, Budeprion XL 300 mg failed to demonstrate bioequivalence to Wellbutrin XL 300 mg."

Frankly, ive done all kinds of amphetamines, ingested them by every means except iv.

It is not a matter of the rate of absorption. The experience is qualitatively different. Perhaps I am wrong about the stereoisomer mixture - but amphetamine salts are NOT racemic in the first place - so some amount of seperation is happening- I am quite certain that the different brands do not contain the same proportions.

> Frankly, ive done all kinds of amphetamines, ingested them by every means except iv.

I hate to say it, but recreational amphetamine use and abuse via different ROAs is very likely the explanation for why amphetamine feels different for you now.

Abusing stimulants, especially through different routes of ingestion, will cause various forms of tolerance (as I'm sure you're well aware).

Amphetamines dont "feel different to me now" - different preperations of the same drug feel markedly different. Name brand adderall and sandoz generic feel the same as they always have. Actavis feels like I am geeked the fuck out. Honestly feels quite similar to the effect of eating the cotton out of benzedrex inhalers (please, no judgement, I was very interested in drug experimentation as a youth)

I did look into the stereoisomers of generics per your comment - you are correct, the fda does regulate the specific enantiomers present in a mediciation. So I am at a loss. I am certain Actavis specifically is chemically different. Perhaps there is an inactive ingredient that is modulating the effects? Or perhaps Actavis is just lying to the FDA.

I would love to find some 3rd party which does evaluations of chemical makeup for generics. Was unable to find such a thing, if you know of something like that, id be very interested.

I do believe not enough attention is paid to the "inactive" ingredients. We have had too many reports of things like finding vitamin tablets in the septic tank--they contained the right stuff but didn't dissolve like they were supposed to.

Man, this helps me understand so much of what I’m experiencing. I had to switch to cheap stuff about two months ago and I’ve been all over the place. Absolutely terrible sleep, too.

My understanding is much of the difference between name brand and generics is the excipients used, as they effect drug delivery. Not all generics will use the same and the name brands generally have patents on the ones they use. For psychoactive compounds this can make a considerable difference in how the drug functions for an individual. YSK that lisdexaphetamine has come off patent this year, and is purely a dextroamphetamine prodrug. It might provide more consistent results compared to adderall even in a generic formulation.

Thank you so much. I had no Idea. I used to take vyvanse but my insurance no longer covers it. It was far superior to adderall so Ill see if my doc can get me back on it. Thanks!

> preventi g addicts from getting it (who cares?)

I presume the families and loved ones of the addicts probably care...

If a drug is available and there is addicts of said drug, the addicts don't suddenly stop being addicts just because the drug is not available, they'll just move on to a different drug. The problem is that addicts are not being treated, not that a specific drug is available or not.

They can't become addicts if they don't start abusing the drug in the first place.

We all have addictions. For some it is substances, other relationships, power, sex, gambling, food, etc. What if yours suddenly became really difficult to manage within the societal-framework-du-jour? Just don't start doing it?

I think it's trivializing the concept to say "we all have addictions," since by definition an addiction is meant to be a significant impediment to living a normal life. And I'm not sure how you're answering the concern here. Like yeah, a lot of people get addicted to gambling -- that's a compelling argument against legalizing gambling.

My point was more an attempt to point at an empathetic response as a possibility. "don't start abusing the drug in the first place", to me, felt like a way to dismiss the reality that it can be really easy to fall into addiction, because most of us are broken in our own peculiar ways and have our own vulnerabilities. What if someone else's response to one's own brokenness was "just don't do that"? It doesn't really help much, because the reasons for it are valid, and the need itself needs to be seen.

My own comment was a knee-jerk reactive comment in reply to what I felt in your post, which may or may not have been a real thing.

Idk. My hunch is that we are all addicted to something, and if you don't see what it is yet, then either you or society (or both) must not have much of a problem with that particular addiction, and that can always change.

My point is that seeking to prevent abuse of amphetamines is a way to avoid creating addicts in the first place.

> since by definition an addiction is meant to be a significant impediment to living a normal life.

Wrong.

The definition of addiction is "physically and mentally dependent on a particular substance." (Oxford Dictionary)

I am addicted to coffee. I get mild physical withdrawal symptoms if I quit. In no way is it an impediment to living my normal life.

Here is how Wikipedia defines it:

> Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences.

In fact, the article goes on to specifically refute the argument you are making:

> The term addiction is frequently misused when referring to other compulsive behaviors or disorders, particularly dependence, in news media. An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of withdrawal, which can lead to further drug use. Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal. Addiction can occur in the absence of dependence, and dependence can occur in the absence of addiction, although the two can occur together.

Citation very much needed.

Actually, this is EXACTLY how many addicts KICK. They make a decision.

Not sure what you are saying here exactly, but ive heard far more stories of someone ruining their life because they turned to black market subsitutes for drugs they were previously able to obtain legally than stories of people who just decided to quit when it was no longer available.

The latter doesn't make for as exciting a story.

So what? None of my business or yours. People should be allowed to destroy themselves by any means of their choosing.

Dismissing people’s pain and sadness is a pretty cynical thing to do…

I'm not - I think its wrong and cynical to gatekeep someones usage of a drug : whos to say what is theraputic and what is degenerate junky usage?

You know what is cynical? Putting up barrier after barrier that makes it hard for ANYONE to obtain a medication that can genuinely help people because we dissapprove of how some people use the drug on their own bodies.

Criminalizing the possession if a drug doesnt do jack shit to help people who are addicted - it just drives them into sketchy situations to obtain it and throws them in jail if theyre caught. And to top it all off it makes it incredibly difficult to obtain it even if you play by the rules.

Okay but there are addicts out there, they have families, and your glib reply was offensive to those people, to me.

I did not intend to be glib or offensive. But I do not apologize for my assertion that humans ought to have sovereignty over their own bodies. It is not the job of the governmemt to concern itself with what the citizenry does to their own bodies.

That’s not what I commented about, your lack of empathy towards other human beings is callous. Don’t fall for that trap.

I'm not lacking empathy. I think it is more harmful than helpful to deny addicts the drug they are addicted to than to provide them legal means to obtain it.

Especiallu in the case of something like amphetamine, which does not directly cause bodily harm (an argument could be made that things like heroin and alcohol, which can and do directly kill, should be withheld)

When you prevent an addict from obtaining via legal means, all you are doing is forcing them to find illegal means, which may involve interacting with dangerous individuals or outright theft.

I do not believe my comment about allowing people to destroy themselves displays a lack of empathy - I dont think a family member or friend should not intervene if someone is engaging in self destructive behaviour.

But I do think it is immoral for the government to prevent someone from destreying themselves. It is not the mamdate of the government to prevent self harm.

I think addiction is not an issue in a vacuum. It is caused by underlying issues. We need to learn to accept addicts as they are. You cannot help someone when their needs are not met. To an addict, the drug is a need. That need must be met before deeper issues can be addressed. It is a fallacy (and dare I say a lack of compassion) to push addicts to the fringe of society by denying them legal means to carry on with their addiction.

Alcohol actually is relevant--and note what happened when we were stupid and tried banning it.

Opiates used at a sustained level are actually not that harmful--the danger comes from those who are deliberately seeking the extremes (things like crushing the time-release pills and snorting them) and from the lack of quality control of the illegal marketplace. We don't see the chronic pain patients keeling over left and right from ODs--except when we try to deny them the relief and drive them to the illegal market or to suicide. If the cause of their pain doesn't otherwise mess them up they can often lead reasonably normal lives.

We also have a problem with confusing habituation with addiction. A patient who needs controlled substances will likely habituate and be in a bad way if they're denied but that doesn't mean they are addicts--you can seek the relief the drugs bring without seeking the drugs themselves. If the underlying problem is resolved you taper them off and it's not an issue. Part of the opioid crisis was the doctors being deceived into thinking the tapering wasn't needed. The CDC has finally realized that cutting them too quickly is medically bad--but the system is still geared to persecute drug seekers and catches too many innocents in the loop. Woe to the patient that loses the doc that has been handling the drugs! (And it's not always because they were going to a pill mill. Doctors are human, they retire, they get sick, they die. And the DEA likes to pressure pain management docs into retirement.)

The thing is the primary harm comes not from the drugs but from the illegal market and from the controls that are put in place. This is especially true of the drugs that are both therapeutic and recreational.

I believe most people here would not argue against the right to autonomy. Furthermore, if the government itself was against it, people who attempt suicide would be charged as criminals. The issue when it comes to substance use is that people under the influence will potentially cause harm to others. Substance abuse is often a symptom of other problems, particularly with mental health, and instead of simply loosening restrictions on meds it's better to direct individuals through the healthcare system for proper diagnosis, treatment and monitoring. Most of your comments just read like you are frustrated and need to vent, which is fine, but remember your audience on this forum is strongly deliberative.

Some of the rules around prescribed controlled substances seem to have no legitimate purpose in actually "preventing addicts from getting it" though.

Not US, Australia, but wouldn't be surprised if same rules apply there – suppose you are prescribed 50mg Vyvanse. You start to feel like 50mg is too much (the side effects are too bad), and you want to try 40mg instead. Can the pharmacist dispense you 40mg instead of 50mg? No. Because it is a controlled substance (or "Schedule 8" as it is called in Australia), the pharmacist can only legally dispense the exact thing you were prescribed – they'll tell you to go back to the prescriber and get a new prescription. If it wasn't a controlled substance, the pharmacist would have more flexibility; in the past, I've gotten pharmacists to dispense prescription drugs without a prescription because I hadn't got around to getting a new script – something they are legally allowed to do (at least here in Australia) for non-controlled substances. They can't do that again and again – it is important the prescriber is kept in the loop – but as a short-term once-off, it does no harm. But going back to the prescriber involves getting another appointment, taking the time out of one's day to attend it, paying for it, etc. In the end one might just decide to put up with the side effects–which is a clearly less than optimal health outcome. Or, one can be reduced to trying to cut the dosage one's self – open the capsule, dissolve the contents in a measured quantity of liquid, then measure out the liquid – which will seem like too much effort to bother with.

I can understand how someone who is prescribed 50mg asking for 60mg or 70mg could be a sign of a developing addiction, but asking for less than one is prescribed is the complete opposite of how an addicted person behaves. So why isn't it allowed? Because the rules only have a rather diffuse relationship with preventing addiction (or other health harms). I think, to a great extent, the rules have come to exist for their own sake, not for the sake of anyone's health.

Couldnt agree more. Also, try telling your doc ypu cut open the pill and took less. Id say 3 out of 10 docs in the US will immediately terminate their primary care relationship with you and refuse you any further prescriptions. Might even put you on a "list" for being a drug seeker. At the very least they will be pissed. (Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now)

Other regulations that hurt legit patients more than "drug seekers" : you cannot transfer a script between pharmacies, so if the pharmacy is out, you have to have your doc cancel the script and send to a diff pharmacy, a process which can take several days at worst. Some pharmacys say they are not legally allowed to disclose their stock over the phone, so you may need to repeat this process many times.

If you are in a different state, pharmacys will not fill your script from your home state, so good luck traveling anywhere if your script ends during your travels. And some docs/pharmacies will let you fill early to avoid this problem, but they may label you a drug seeker and put you on a list.

> Most docs are megalomaniacs that cannot fathom a patient being as intellectually capable or informed as them, or having agency over their own bodies, but im off on a tangent now

I don’t know what most American doctors are like. But my mother, brother, late grandfather, uncle, aunt, and two of my cousins are all doctors. (My uncle used to work in the US, but an Australian doctor working in the US probably isn’t very representative of the average American doctor.) I often mention this (without as much detail), in part because I suspect it makes them treat me better. Plus I’m unafraid of medical jargon, which probably helps too

A lot of my personal complaints are about the system and its rules, not the people who work in it, the vast majority of whom have absolutely zero input into what the rules are

Ive just had very poor experiences with doctors. They always seem to think they know more than me, but never really even listen to what I have to say.

For example I went to a derm once because I had a spot which looked like cancer for nearly a year. I went in, explained and asked for a biospy. He refused to even look at it, gave me a script for doxycycline to treat me acne (which I did not even mention) and sent me home telling me to come back if the spot was atill there in 8 months. When I came back and he looked at the spot he admonished me for not coming in sooner to have it biopsied.

This is just one example in a long line of medicial professionals refusing to listen carefully to what I have to say. They always think they know better

Oh for an even better example -

My mom gets pneumonia fairly frequently and gets very severe cases of it. She is an absolute tank who could be on deaths door and would look normal.

She currently is extremely ill with pneumonia. She went to her doctor last week and told them she was coming down with it, and explained to them that everytime she gets pneumonia she has to have X Y and Z medications in order to treat it. The doctor refused to prescribe them, gave her a much much weaker antibiotic and no steroids, and sent her home instead. She came back two days later after not feeling better and they sent her home again. She finally came back a 3rd time and waz given meds X and Y but not Z. Still not better, she went a 4th time and was given X and Y again without Z. She has fought tooth and nail to be properly treated and has STILL not been given the meds that she knows will help her. She is currently on hour 35 of sleep in 48 hours and is still sick as a dog.

This is just routine for american docs in my experience. Perhaps I live in a medical care desert, but this is just not even remotely unusual.

Doctors ignore your cincerns, fail to address them, and then when you play thr squeeky wheel in order to get some grease, act like you are a burden on their ability to care for other patients.

Do you come across as not very respectable looking or sounding? Or do you come across as aggressive?

My experiences really don't match yours at all. From working as a tech a couple years back I know 1000% that every pharmacist I worked with made judgment calls on whether or not to help people out.

If you had a sketchy vibe, you weren't helped out. If you were a regular and amicable enough to be liked we'd figure out something we could do for you if it was legally possible. You can see how this falls apart when you're traveling or going to a non-usual pharmacy because of how subjective it all is.

(Ex: for Texas if it was actually illegal to say CII stock over the phone it wouldn't be "some pharmacies", it would be "all". I don't know of anyone that would fill a CII early, too much professional risk. I've also only met a single pharmacist that would do 90 day CIIs despite that being legal if written exactly for that. Pharmacists are generally very risk adverse.)

My experiences as a patient don't match yours either, at worst I went to a clinic that had on-site drug tests very infrequently. Never had any issues with doctors or PAs telling them how I actually took the meds, but I also wasn't dumb in the way I went about telling them.

I also never ran through primary care physicians for any of this. The fact that you said 3/10 of them would terminate the relationship just makes me wonder how much personal experience you have with that exact situation. It just feels extremely sketchy.

Ive never had a doc terminate the relationship but I did have one threaten to do so after I told him that I tried my cousins adderall in an attempt to self diagnose my adhd. 100% my fault there, ill admit, that is not appropriate.

That some doc later prescribed me 2mg ativan and told me to "keep taking it till you feel it" which is how I ended up passing out in missouri and waking up in florida 48 hours later.

That same doctor gave me mometesone and after nearly 2 years of using it told me "oh by the way forgot to tell you : dont use that for more than 2 weeks consecutively because it can be life threatening"

My experience with healthcare professionals is consistantly that they do an awful job of listening and seem to think they can tell you more about how you feel than you can.

I am unusually educated about pharmacology and I think some doctors are suspicious of that. Fair enough I guess.

Also I would just like to say that I find it absolutely disgusting that "do you look respectable" is some kind of proxy for the quality of medical care someone deserves, or the level of suspicion or ire a person deserves.

No, I do not look sketchy or aggressive. I am literally just a normal looking dude. Rather healthy, rather well kempt. Now what the fuck should that have to do with my medical care? I sure am glad I can afford nice clothes, glad I was raised to speak proper english, and glad I have adequate dental care, cause it sounds you are suggesting pharmacists will not work with you if you are an "undersireable". I think that is pretty fucking gross. If you gave 50 junkies their drugs but it meant you didnt hassle even 1 legit patient Id call it a win. What bizarre moral high grounds peoppe take.

Also I was at no point complaining about pharmacists - theyve always been super helpful to me, as much as they legally could anyway. I was complaining about the law itself, and complaining about primary care physicians.

And you are correct I should have said "some states" instead of "some pharmacies" - it was, in fact, in Texas where this happened to me and you are correct, The first pharmacy I called told me that no texas pharmacy could legally fill the script from an out of state doctor.

From a pharmacy POV that doesn't address your problems with Healthcare in general:

Everyone gets a baseline minimum level of care, but there are varying levels of "working with" when problems arise when you have a fixed amount of time you can get everything done in.

If you don't have time, you have to use SOME other heuristic to determine priority. (Mainly speaking to how much leg work the patient wants the pharmacy to put in, vs themselves)

From other Healthcare POV:

There's a reason why so many people burn out. The people that make a career out of it without getting jaded are actually incredible.

>If you gave 50 junkies their drugs but it meant you didnt hassle even 1 legit patient Id call it a win.

But the other moral hazard comes into place when you're the one okaying questionable prescriptions that could result in someone's death.

Insulin syringes was another case where junkies would lie to your face about what they were using them for. I worked with a pharmacist that wouldn't sell them to people that didn't have a reasonable way of proving that they needed them for legitimate purposes. Why? A junkie ODed outside his pharmacy after buying them.

How many junkies would you have to kill before changing your own personal policy? If you don't care about killing people, it's extremely easy to just say you'll sell them to everyone.

>I was complaining about the law itself, and complaining about primary care physicians.

My point was some of the blame should be on the pharmacists or techs when they aren't telling you the full truth. (And it felt like they weren't when I read your post)

The out of state script is a good example of what I'm talking about.

If it was a CII paper script they couldn't legally fill it.

But they could have also told you that an out of state doctor could eScribe in a CII if they really cared to do so.[1] And if it wasn't a CII but still scheduled they might have been legally able to fill it anyways based on the criteria in the link I posted.

I've gotten hassled for even out of city CII scripts, and it's the same play where they create just enough friction to make it easier for you to go somewhere else.

1. https://www.pharmacy.texas.gov/files_pdf/QUICK_REFERENCE_GUI...

huh interesting. Thanks for the reply.

I understand the perspective of not wanting to give out material that may result in a drug overdose/death. I get it on an emotional level, but it just doesn't really make sense to me. For example, what is safer for a junky - to recieve prescription grade norco, or to sniff a pile of heroin that came from god knows where cut with god knows what? so in the case of a pharmacy sweating people about the legitimacy of their need for a norco, my way of thinking is just give the damn things out. If its a junky, so what, they just got a cleaner safer high. And if its legit, then you have just helped someone who you would have otherwise burdened with the inability to get their drugs.

...So ask your pharmacist to compound it into a liquid, and reduce the dosage on your own...

Compounding adds cost and turnaround time. Not all pharmacies do it. Rules saying all repeats have to be filled by the same pharmacy can prevent compounding if that pharmacy doesn’t do it

But there is no rational reason why a pharmacist shouldn’t be legally allowed to dispense a patient with a prescription for a controlled substance with a lower dose than prescribed. Prohibitions on them doing so are just pointless bureaucracy which have nothing to do with preventing addiction. They achieve nothing except harming patients

There is no pharmacist near me that will perform this, as far as I know.

And I actually only learned that this was possible from a comercial I saw yesterday (Im out of town currently) weirdly enough.

US here. Once had a pharmacist not fill a script for Vyvanse because my doctor's instructions were "take half tablet daily as needed". These were chewables with perforation marks on them, but apparently it didn't explicitly say on the Vyvanse instructions that you could split them or not.

In the US, when purchasing Vyvanse with cash (most insurance won't cover it), the price is dictated by number of pills, NOT by the dosage of those pills. So, it is half the cost to get 15 pills that you take a half of daily versus a standard 30 day supply.

I think the 30 day supply was somewhere in the realm of $400 by the way.

Vyvanse patent expired last month, so hopefully a generic product comes out soon!

My next door neighbor (who has since moved away, but I see his kids around the neighborhood still) is a very successful salesman and takes 120mg of Adderall “to get out of bed in the morning”. Which I thought was crazy considering I take 15-30mg in a day, but he didn’t seem like a bad guy or to have any ill effects from it (aside from assumably spending a good chunk of change a month buying Adderall off friends/dealers).

I think there’s way worse things to be addicted to than Adderall and feel like this guy is a “worst case scenario” but he’s still a productive contributing member of society.

Believe it or not you can be prescribed that much adderall. It takes a doc that is willing to go there, but I knew someone with a 200mg daily prescription.

I suppose he could have been gaming the system somehow by going to multiple places but I thought it was all from the same doc

By inferior, do you mean you’ve switched to a different “brand”? Or to a generic from a “label”, or..?

I was previously consistantly using a generic that I tolerated well. In the last year I have had several months (maybe 6) where I was only able to obtain generics produced by actavis or amneal. These 2 absolutely suck compared to sandoz, teva (which I think may be exactly the same) or shire. The side effects are overwhelming

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