Xanax and Adderall Access Is Being Blocked by Secret Drug Limits
bloomberg.com
bloomberg.com
I’ll provide an anecdotal observation…
My SO has narcolepsy and uses Adderall to, quite literally, function. It’s unfortunate that this malady wasn’t referenced in the article but considering it affects (and I’m guessing here) less than 5% of the population, it makes sense. However (and I can appreciate the concern of individuals who suffer from ADHD), an individual who is suffering from narcolepsy and cannot access their medication can result in what could be argued as a zombie like state.
I can, somewhat, appreciate the impetus behind the idea of putting up blockers to prevent the access of recreational drugs. But, as a former opioid addict, I also have found that limiting legitimate access (when a drug maker isn’t influencing the FDA to make up addictive tiers) typically results in a greater crime than what was initially attempted to prevent.
Suffice to say, without getting too political, pick a representative that has more than a hammer when they’re viewing a nail.
They annoying part is I’d love to have a prescription again to see if it works well for me again, or to take breaks from my stimulants - but my doctor says it’ll trigger an audit as I have both Vyvanse and Adderall prescriptions. What exactly that means I don’t know but he doesn’t seem keen.
https://pharmacy.ufl.edu/2015/10/14/uf-researchers-ask-fda-t...
But it's also wrong to arrest grandmothers on drug charges and send them through the system for a violation of some legislator's arbitrary limit. Turns out it didn't solve the meth problem, but it did make the world a little worse to live in.
Also, I think describing the article as "outrage-bait" is in poor taste for this site. A different implication might be that when criminal charges are tied to an action with the intent of limiting an activity, those charges will inevitably be applied to "the wrong people" (maybe you?) for a different activity, and that we should be skeptical of problem-solving-through-force.
So, congrats to you for looking like a fine upstanding person and not like a clandestine drugs manufacturer.
I am sorry, what? Maybe I have just been lucky my entire life, but that has never been my experience. I used to have long hair for many years, and I haven't had a clean-shaven face in years. Dark circles under my eyes is a common thing. I also have ear piercings, and I dress in baggy non-assuming casual clothing most of the time. Not once was I ever questioned about or refused any behind the counter drugs at any of the pharmacies I've been to across multiple states. They do ask for an ID to purchase those behind the counter drugs, but I am pretty sure they are legally obligated to do it for everyone, due to the regulations that the thread is talking about.
Also, I believe you meant to say "methamphetamines". There is no illegal amphetamine manufacturing epidemic (and I am not aware of there ever being one), but there was a methamphetamine one.
The restrictions on pseudoephedrine were mandated by Congress through the Combat Methamphetamine Epidemic Act of 2005 (passed as part of the patriot act) which followed various state legislatures’ passages of similar laws.
The main driving force behind the law was Bush’s White House drug task force and several members of Congress.
Federal agencies very, very, rarely solicit or propose legislation like this. And Congress rarely asks for their input.
Don't forget principa-agent problems.
Yes, the FDA often does what it's told by pharma companies.
This change was passed under special anti-terrorist powers? (Not US so possible misunderstood)
https://www.aclu.org/other/myths-and-realities-about-patriot...
https://en.wikipedia.org/wiki/Combat_Methamphetamine_Epidemi...
It was added as a part of a reauthorization of the original Patriot Act.
US Federal policy making and legislation is a bit like calvinball. And for misc reasons, Congress tends to pass large (omnibus) bills, instead of more reasonable units of work.
As an outsider looking in, I collect and read stuff about "the sausage factory".
Here's one study that looks past the folk theories, to illuminate how some example laws came to be. Similarly comprehensive books could be written about most all major legislation.
SYMPOSIUM: UNORTHODOX LAWMAKING, UNORTHODOX RULEMAKING
https://www.columbialawreview.org/content/unorthodox-lawmaki...
"The Schoolhouse Rock! cartoon version of the conventional legislative process is dead, if it was ever an accurate description in the first place. Major policy today is often the product of “unorthodox lawmaking” and “unorthodox rulemaking”—deviations from traditional process marked by frequent use of omnibus bills and multiple agency implementation; emergency statutes and regulations issued without prior comment; outsourcing to lawmaking commissions and unconventional delegates; process shortcuts outside of emergencies; presidential policymaking; and outside drafters, some nonpartisan and others hyperpartisan. These unorthodoxies are everywhere, and they have shifted the balance in the elected branches and beyond, often centralizing power in actors—like party leadership and the White House—not traditionally part of the core lawmaking and rulemaking processes. These unorthodoxies are the new textbook process."
BOOK: Unorthodox Lawmaking: New Legislative Processes in the U.S. Congress [2017]
FDA having different priorities than you is not the same as them being stupid.
Prior to Vyvanse Shire has signed a generic supplier agreement with TEVA so generic adderall was just the brand drug stamped differently. When they had Vyvanse ready they cancelled the agreement on short notice. That sent TEVA scrambling to stand up a production line.
Standing up a C2 line is a pain because of the DEA approvals and quotas. The quotas also prevent any of the other generic makers from ramping up their own production. The quota setting process is retrospective and by design it can't respond quickly to market changes like this.
So keep an eye out on who has a new patented medication for ADHD coming out and follow the money trail. The big drug companies love to turn a crisis into an opportunity and it wouldn't be surprised if they lobbied to include non-opioids in the settlement to give them cover for this sort of manipulation.
Why the hell do we have a quota on medication?
> Sometimes, they must send patients on frustrating journeys to find pharmacies that haven’t yet exceeded their caps in order to buy prescribed medicines.
Does this then get them put on the secret list of "people with drug seeking behaviors" which apparently includes people who fill prescriptions for their dogs? [0]
[0] https://www.wired.com/story/opioid-drug-addiction-algorithm-...
My 1 year old dog (who is batshit insane, but we still love her) had to have part of her tail amputated because she kept breaking it open, the vet had us giving her 3x painkillers 2x a day. The pharmacy tech insisted they weren't going to fill a followup script because she had already been prescribed 60 pills, 10 days before and refused to perform basic math. (3*2*10=60)
I'm all for trying to address our opioid issues, but it feels like instead of addressing the issue of doctors running pill mills, over-prescribing these drugs, they are focused on just not allowing them to be prescribed at all... Even for people who genuinely need them.
A: Time limited access to narcotics is safe and effective pain management for severe but temporary injuries and I don't exist to suffer in this world -- give me the good stuff.
B: If I can reduce my pain into "bearable" with nsiad painkillers then I don't want to take narcotics.
I think one of the dangers of B in the real world is that for severe pain doctors are terrified of prescribing narcotics that they put you on the nsaid cycle with extremely high doses which can wreck your stomach lining and liver.
When I was recovering from surgery they gave me Xanax, Vallium and Tylenol to basically sedate me for 2 straight weeks because of this nonsense and it was miserable. Just trading one kind of high for another but the new way you mostly keep the pain.
I am saying that many kinds of pain can be managed with OTC medication. There aren’t necessarily two schools of thought. It’s more that if let’s say ibuprofen isn’t helping the pain, it may just be that you aren’t taking enough of it. It is a very effective pain medicine.
I’m not at all suggesting ibuprofen for pain management of cancer patients or people immediately after major surgery.
But for a big chunk of outpatient procedures enough OTC pain meds will actually work just fine.
I’m not some granola advocate here. Nor am I trying to say that everyone should just tough it out. But you can’t seriously say that 800mg ibuprofen is more dangerous or less effective than opioids for wisdom teeth removal
We don't have an opioid crisis anymore.
Pain is a fact of life. The problem in the US is that there's the expectation to work the next day. It's ok to be in pain, it's also ok to miss out on work.
If you accept these two basic facts you don't have an opioid crisis anymore.
Some other people may die, but that is a price I'm willing to pay.
I see you have never been in any real pain, ever. What do you get for cancer in Germany? Still ibuprofen?
There's a reason opioids exist and were such a revolution in medicine. They really work. Ibuprofen et al are fine for what they are, but anti-inflammatories can only do so much. We should be able to solve the over-prescribing and addiction issues as a society without throwing the baby out with the bathwater.
I guess not. My point still stands though. Americans in Germany whine all the time about not getting "proper" pain medication. It's an attitude problem.
I have been in pain multiple times, mostly broken bones, wisdom teeth, tendons and the like, and in the moment it doesn't feel good to only get ibuprofen.
But most pain is not too much to take and it's ok for you to feel it. It's better than getting an addiction problem for life.
As you say it's an over-prescribing issue. Keep opioids only for extreme pain. Not for normal pain.
> If you accept these two basic facts you don't have an opioid crisis anymore.
This is an incredibly simplistic view of a very complex issue.
If you didn't read my response why should I care?
>This is an incredibly simplistic view of a very complex issue.
It's backed by facts though. You can't give out opioids like candy and expect people to be responsible with them.
People don’t give ibuprofen enough credit.
"I've had some back pain and got prescribed opiates, now i'm addicted"
We're not talking about getting some opiates after surgery or severe and mostly rare things. Americans get opiates for all kinds of small inconveniences, like a wisdom tooth removal, or some back pain. Opiates don't heal or fix back pains. They just mask the symptoms and create a new problem.
I've been in a lot of pain in my life and never took any opiates, because they are reserved for extreme situations where i live. In america, i would have had easy access to prescriptions for those in most cases.
We have no opiate crisis here.
I really don’t think forcing needless suffering on everyone is the answer to this problem.
Source: had six very painful teeth extractions, with bone grafts and two sinus repairs. I was almost pain-free on 600mg ibuprofen + 600mg acetaminophen every 6 or so hours. I say "almost" because I was not dumb enough to try any type of exercise, or eating crunchy cereal, but I had no problem falling and staying asleep or going back to work in 24 hours.
So I am not entirely sure why you think opiates were necessary or provided you the type of relief that OTC meds could not provide. My double-board-certified, extremely expensive dental surgeon doesn't seem to think so.
I also had abdominal surgery, for which I can concur opiates do help quite a bit, which is entirely separate story.
Sweden sounds the same as germany, you get 800mg ibuprofen and normal 500mg paracetamol.
We DO have opioids for cancer pain.
I actually have mild PTSD about that incident. It was the second-worst pain I've experienced in my life, and it wouldn't stop.
Question 2: what makes you think opioids treat infections?
2. I expect opioids treat the pain from infection. it was the weekend and I had to suffer through the weekend before seeing the dentist.
[1] https://www.fiercehealthcare.com/finance/federal-jury-holds-...
That depends on who is doing the limiting — if the pharmacy corporations are self-limiting then I would understand they are limiting their potential exposure/liability to whatever risk level they are comfortable with. I’ll still be able to find my necessary drugs at another chain which doesn’t limit.
If the government is doing the limiting, then yes, that would be surprising. That seems to be the case here, and I think it’s a very inappropriate response — totally attacks the wrong part of the system.
That the government is threatening defiance of edicts with fines and jail time and not using direct means to stop additional production is not a distinction worth making - the government is limiting the supply of these medications.
Agency rule making should be public and published in federal register. I don't know what the effective recourse would be. The easy track is to go to Mexico and load up on what your Dr. prescribed.
The medications described are Schedule II, which is defined as "The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions."
One citation for the limits being secret are:
Ike Swetlitz, I (2023) "Xanax and Adderall Access Is Being Blocked by Secret Drug Limits". Bloomberg, Online edition. https://www.bloomberg.com/news/articles/2023-04-03/adderall-...
> Xanax and Adderall Access Is Being Blocked by Secret Drug Limits
> The Drug Enforcement Administration regulates the manufacturing, distribution and sale of controlled substances, which can be dangerous when used improperly
> the limits themselves are secret.
> A Cardinal Health document reviewed by Bloomberg News says that limits are calculated on a daily, monthly, and quarterly basis.
As a person with adhd, why would i want to sue my provider? They have nothing to do with why there's been an adderall shortage since october. it seems to me the last thing I want to do is make providers feel averse to treating adhd out of concern for being sued.
This sort of thing is better handled through regulatory and legislative means. Perhaps it's not being handled particularly well at the moment, but the status quo seems preferable to establishing precedent that one can successfully sue a doctor for writing appropriate prescriptions for drugs that are scarce due to supply chain bottlenecks.
I believe you can only do this with unscheduled drugs so it is not a successful strategy for opiates and amphetamine.
I've had pharmacists deny me because I was paying for amphetamine without insurance. They said it was suspicious and refused to call my doctor to confirm that I wasn't some sort of criminal.
That's the kind of unreasonable power that they shouldn't have. Finding bad drug combos? I don't think anyone has an issue with that.
If you find a customer to be suspicious (I was wearing a black t-shirt, to be fair), you should be required to call the customer's doctor office and confirm the prescription.
Then the government should come out and say they will not go after pharmacists for filling any and all prescriptions.
The government wants it both ways, keep doctors and pharmacists liable and randomly nail, but not clearly publish standards of rules so no one can accuse the government of intervening in people’s right to healthcare.
Government gets plausible deniability and someone to throw under the bus. No reason for the people that can get thrown under the bus to stick their neck out.
These secretive DEA limits just underline a weird "moral judgment" of people who have conditions that benefit from stimulant medications. Almost like its our faults for having neurochemistry's that don't uphold the perceptions of a protestant work ethic.
The worse part is that its mostly separated from any particular religion nowadays but agencies like the DEA that essentially self-reinforce this lopsided moral code.
For one thing, pharmacists aren’t just retailers. For example, I take a very powerful medication. It’s essential to get the dose just right.
My health care organization employs a pharmacist who sepecializes in the medication, and sets the doses for patients in the program.
This pharmacist doesn’t dispense medication. She instructs the physicians on what dose to prescribe.
I recently had an extremely painful medical event. I was given hydrocodone, but it didn’t have any effect. A pharmacist was called in, and they figured out a drug cocktail that addresses the pain.
Pharmacists really are medical experts and a knowledgeable part of the care team. Doctors should use their expertise more than they do. And it’s completely appropriate for a pharmacist to assertively demand an explanation for what’s going on.
I guess I’m confused - are you saying pharmacists should not be able to refuse to fill a script or they are not able?
As it stands they are able, and can be held accountable for doing so.
Maybe the law should change to where pharmacists are simply agents of the prescribed. But that’s not current law or custom.
[1] https://www.goodrx.com/healthcare-access/pharmacies/why-phar...
Short of life and death situations I don't think I will be seeking any kind of medical care in the US. If it isn't urgent I'll make a vacation out of it and travel to cheaper more humane countries.
Must be nice to have a professional organization that acts like a cartel and makes lesser people pay for the sins of all but the worst of the worst actors.
Seems like they’d make dispensing it harder rather than just cut off the supply to everyone.
Not meant to argue, I just don’t want to unnecessarily dissuade people who might be having trouble filling Adderall and weighing the possibility of temporarily substituting so they have something to fill the gap.
The wonderful medical experts at the DEA have my gratitude for coming up with such an excellent solution to the scourge of telehealth. I’m sure they did a thorough analysis weighing disrupting/ending millions of stable ADHD patients’ treatment against the possibility of someone getting medication they might not need.
All to say maybe try the cheaper dexadrine twice a day.
I like Vyvanse because it does not affect my heart or blood pressure. It's like coffee for the brain without the jitters. And since it takes hours to peak, there is never a come up feeling one might associate with it and derive pleasure from. I take it, and eventually after a couple hours I find I am well awake and present more than any coffee, yet still feeling very calm and at ease.
That said, I take the lowest effective amount (20+20mg) which requires good sleep and good diet to be effective. So it never turns me into a productive robot, and I have to accept that some days are a bit lower-energy.
I had long suspected I had ADHD. After covid, my brain became wrecked. I wanted to go with something non-addictive due to my checkered past. Easily would recommend, as long as you don't have terribly low blood pressure. NAD.
I had researched the brain fog with covid 19 and found a lot of research pointing to NAD+ / mitochondrial disruptions as source of brain fatigue [eg 1]. NAD+ supplements are well studied for anti-aging too. So it seemed to have a high probability of helping.
Trypsin is not exactly a common supplement, but you might consider looking into which kinds of foods can inhibit or encourage its production. Grains and cereals will probably inhibit it, unfortunately.
It’s massively fucking annoying to take nearly three hours out of my day to pick up my meds. And it’s massively fucking annoying to have to worry about losing a critical medication every month and sometimes also having to spend literally half a day calling around to find a place that has it in stock.
Fuck the DEA
I was on Adderall XR 20mg for 10 years and then switched to Vyvanse 50mg. For me, Vyvanse lasts longer, doesn't have as much of a narcotic peak, and feels like it's more consistently strong for the whole curve.
Just putting it out there because some people have suggested that it was an inferior alternative (and it may be for some people). Some people definitely prefer Vyvanse.
As usual, start with half a pill on these kinds of drugs. Mix it into water so you can easily drink 50% of it one day, 75% of it another day depending on how you feel.
- Vyvanse 50 is roughly twice the dosage of Adderall 20
- It’s generally not a good idea to split the XR pills, but they won’t split the same way. As I understand it: Adderall XR and its generics are typically designed as a dual release (either two immediate doses, one delayed; or one immediate and one gradual; both can have the peak/drop off effect). Vyvanse has a more continuous release because its release mechanism depends on digestive enzymes to convert the chemical itself. (If I’ve got any of this wrong, my apologies, but I do think it’s appropriate to caution about splitting the XR pills unless you understand what that entails. Ideally this is a conversation with your doctor, not randos on the internet)
One annoying thing about stimulants is that your first day taking it is a lot different than your 15th day in a row. I always end up ramping up until there’s some equilibrium with tolerance, else day 1 is way too strong, or day 15 is too weak.
In any case if you were taking Adderall XR “20” and it was actually two doses (40) that would be equivalent to the Vyvanse.
I have idiopathic hypersomnia and not ADHD, though.
Thanks for reminding me which medication[1] I forgot to take... again.
My ADHD[3] must've made me very addicted to Adderall, huh.
Perhaps consider that people with ADHD tend to thrive in creative professions, especially if they allow an opportunity to hyperfocus (the disorder is named awfully[2]), have somewhat flexible schedules, and excel in emergencies / high stress situations.
That's to stay, there's a correlation between people in tech (especially the startup scene) and ADHD people who benefit greatly from stimulants.
So here's a clue: people like you using phrases like Adderall addicts only perpetuates the stigma, and leads to the current situation with hidden limits and other shady bigotry.
Consider clicking the links below, and learning more about what ADHD is, and why and how medication helps people who have it. This is my personal experience, written up specifically for this purpose.
[1]https://romankogan.net/adhd/#Medication
[2]https://romankogan.net/adhd/#Awfully%20Described%20Human%20D...
The fact is that people use ADHD medications recreationally, or off-label to increase their focus e.g. in preparation for exams, in knowledge work, etc. And those people are at high risk of developing addiction.
Like what?
Personally I forget to take it often, but thats because my brain is wonked out with ADHD. I also forget to eat often if I do not take the medication. Life is certainly weird.
I'm on a controlled substance and I am disabled and not able to work without it. I've been extremely lucky thus far, but given how many I know have had issues, it is only a matter of time.
the fuck is wrong with these people
For me getting off a regular dosage just caused a bit of extra sleepiness for a week or two. I drank like 2 redbulls a day for a bit. There is a bit of addictiveness because its nice to be able to function like normal people day to day -- like paying bills on time because your brain has enough dopamine for a boring chore.
Its nothing nearly as addictive or habit forming as SSRI's that are given out like candy.
SSRIs aren't considered addictive at all.
As I mentioned to someone else, please take an earnest visit to https://www.reddit.com/r/StopSpeeding/ and consider the idea that a lot of our ADHD peers struggle with stimulants.
>Perhaps for non-ADHD people.
I've been diagnosed with ADHD twice (childhood and adult) and I can say from experience that speed gets everyone high. That's a myth. Take a double dose of your prescription and report back whether you feel it (sort of kidding, it's a dangerous path).
Knowing the potential risks of stimulants is good, but unduly scaring people or over-restricting access for the majority who use them properly is not helpful.
Please re-read how I presented that link carefully. I've encountered several people here claiming that stimulants don't get you high and that they aren't addictive. The point of sending them to that sub was to demonstrate that others have a different experience. I'm not making a larger argument here that they are harmful for everyone, just that they aren't magic drugs and they might have glowy feelings about them for a less comfortable reason than they think.
People downvoting me for stating simple known facts about these drugs is troubling...
Please be more careful and honest in your assertions. My point is that there are people who struggle with abusing prescription stimulants. I did not make a comparison or suggest a link between harder stims like your strawman suggests.
A 200lb person can get a decent high from as little as 30mg of adderall.
Just because stimulants _can_ get you high and be addictive doesn't mean they will when taken appropriately. The only time I felt any kind of high from my ADHD medicine was the first day I took it. And I quite easily skip taking it on weekends, with the only side effect being that I browse the internet all day and struggle to do anything productive.
To be honest, I don't actually like being on stimulants. Methylphenidate made me feel like I was constantly in low-grade fight-or-flight mode and dextroamphetamine (which I'm on now) gives me mild emotional blunting. Plus both cause slight dry mouth, appetite suppression that I have to forcibly eat through, and insomnia if I take them too late in the day. Not to mention the fundamental hassle of taking pills every day within narrow bands of time, something I regularly procrastinate and/or forget. (Also, I have tried taking higher/double doses as you suggested earlier when I was figuring out my optimal dose. They just made me feel jittery and on edge - not exactly pleasant.)
If I had no ambitions or responsibilities, I would be more than happy to throw my medicine away and sit around on my computer all day every day. Unfortunately, I do have ambitions and responsibilities and medication helps mitigate my crippling, career-threatening inability to get things done. So I'll take that tradeoff.
I'm definitely calling out inappropriate usage, so I don't disagree.
>Plus both cause slight dry mouth, appetite suppression that I have to forcibly eat through, and insomnia if I take them too late in the day. Not to mention the fundamental hassle of taking pills every day within narrow bands of time, something I regularly procrastinate and/or forget.
Yeah the side-effects are not great. Throw in teeth-grinding, compulsive behaviors, irritability, aggressiveness, etc.
>If I had no ambitions or responsibilities, I would be more than happy to throw my medicine away and sit around on my computer all day every day. Unfortunately, I do have ambitions and responsibilities and medication helps mitigate my crippling, career-threatening inability to get things done. So I'll take that tradeoff.
I'm happy to hear about your self control. I wish I were effective as a person naturally, I'm sure you can relate. Unfortunately they don't work for me as well as they once did.
Actually, my self control is really quite bad. I'm terrible at doing difficult or unpleasant things and am very prone to low-effort, self-destructive hedonism. But as a result I have a very intense fear of addiction because I know I would struggle to pull myself back from it - I've never drank alcohol or done any recreational drugs for that exact reason. I was very hesitant about pursuing potentially lifelong medication, I requested the smallest possible starting dose from my doctor, and I don't intend to ever increase it beyond what I currently take (10mg/day).
On a philosophical level I still don't _like_ that I'm taking medication, but the benefits are significant enough that I tolerate it. And perhaps ironically, ADHD medicine actually helps me push past my lazy hedonism and do things that are necessary but dull.
(I would note that it doesn't make me _want_ to do boring things, nor do I think it's supposed to if dosed correctly. Even on medication, I'd still rather play video games than do work. But it at least makes it possible for me to sit down and work anyway. Whereas before, every day was an exercise in staring futilely at the screen while begging my brain to do literally anything.)
> I wish I were effective as a person naturally, I'm sure you can relate.
Very much so. I really wish my productivity wasn't dependent on medicine that
a) I need to remember to even take
b) Has annoying negative side effects
c) Is a controlled substance, with all the hassle that brings
But unfortunately, I guess that wasn't meant to be.
And thats BS. It's completely physically and psychologically addictive for many people with severe withdrawal symptoms. If they're not considered addictive then thats an issue with the DSM and inconsistent metrics used by medical fields.
> As I mentioned to someone else, please take an earnest visit to https://www.reddit.com/r/StopSpeeding/ and consider the idea that a lot of our ADHD peers struggle with stimulants.
I'm sure many do struggle with abusing stimulants. They're not silver bullets, and do need appropriate care and monitoring by a medical professional. Especially when starting a new treatment.
However, I find that link is also full of things like "Bob was addicted to Adderal, and took 30mg everyday for 8 years". To me thats sounds like a successful therapeutic treatment without other supporting info like "Bob would use his monthly supply in a week". Few would consider "Bob took a normal dosage of an SSRI for 8 years" as an addiction.
> That's a myth. Take a double dose of your prescription and report back whether you feel it (sort of kidding, it's a dangerous path).
To clarify, I'm sure some do get a mild high. Many don't. Maybe I'd get one on a higher dose, but I've got no desire to do so as I get much more enjoyment over just feeling awake and being able to focus. Though I definitely get a "mild high" if I accidentally take an extra dose of my SSRI.
>However, I find that link is also full of things like "Bob was addicted to Adderal, and took 30mg everyday for 8 years". To me thats sounds like a successful therapeutic treatment without other supporting info like "Bob would use his monthly supply in a week". Few would consider "Bob took a normal dosage of an SSRI for 8 years" as an addiction.
Of course there are a mix of experiences described there. If someone decides they have a problem with a drug and are struggling to stop, can we decide if it's not true? I doubt it. I don't think people are LARPing as stim addicts, but also I'm sure there are some people who struggle more than others.
>To clarify, I'm sure some do get a mild high. Many don't. Maybe I'd get one on a higher dose, but I've got no desire to do so as I get much more enjoyment over just feeling awake and being able to focus. Though I definitely get a "mild high" if I accidentally take an extra dose of my SSRI.
I'm glad you are able to keep them in a healthy place in your life. Thanks for sharing your experiences.
I have ADHD[1].
Taking 2x dosage of Adderall[3] makes me.. calmer and sleepy, and that's about it. As does too much coffee[2].
So much for "myth".
[1]https://romankogan.net/adhd
Yes, I am experiencing a very common phenomena where drugs impact the people with the condition the drug is prescribed for differently than those without it.
Is is it so hard to make this leap?
These drugs were not designed and created for ADHD. They were discovered separately. They alleviate some of the symptoms of ADHD, but it doesn't suddenly make you act and think like a neurotypical. You act and think like an ADHD person on speed. Also, a lot of people who take them have very positive and unrealistic beliefs about them because they are high on the drug.
Adderall is an appetite suppressant, but that doesn’t always translate to weight loss.
I’ve forgotten to eat for an entire day, but made up for it (and then some) the next.
It suppresses your appetite, sure, but it doesn't shield you from the effects of not eating all day. I often force myself to eat something for lunch or I'll just end up tired and annoyed in the afternoon/evening (edit: I don't eat breakfast).
Plus, once the medicine wears off at night (or on weekends when I skip taking it), I usually get ravenously hungry and easily make up any caloric deficit.
i feel like dependency on a prescription stimulant is asking for trouble, at least for me personally.
Every other prescription I've had has an adult (anti-acids, urinary meds, SSRI, buproprion) was eventually cut off from refills because I didn't do the followup appointments. At least I can get OTC pepcid these days, I lost a lot of weight and don't need as much.
Best to just continuing wallowing in unemployment.
I’ve been diagnosed three times. At ages 6 , 18, and 23. Taking every drug. Adderall, vyvance, strattera, etc.
The diagnosing is hogwash. There isn’t a scientific test. All ‘psychiatrists’ do is take you in for a visit or two, listen to your story, and write you the prescription.
I used to be ‘unable to focus’, and took pills for it. I even see people addicted to them to the point they take sleeping medication and other pills to make up for those side effects. No thanks!
These are intense drugs, and not the good kind like DMT, LSD, or Marijuana. Which those, actually had a profound effect on me and my way of thinking. For example, weed makes me productive - and makes otherwise shit work - amazing.
Another thing is eating healthy, organic foods, vegetables, and pasture raised meats, along with exercise. These do wonders for your state of mind. Organic foods (and pasture raised meats, eggs, dairy) have up to 200x the nutrient levels compared to non-organic.
Lastly, self discipline. I had to learn to master my mind and truly discipline myself for my actions. And to make the effort to constantly ‘make it happen’, no matter what. It’s a set of values instilled and the courage to back up your own values when no one else is to judge you but your own mind. Don’t let you mind off the hook for so many things - “oh I didn’t make the bed…it’s fine” no, it’s not fine.
Also, you know, multiple years of intense study.
Does eating well and exercise matter? Of course. I feel way better when I'm in the gym regularly. It does not in any way fix the problem with my brain chemistry, though - medication does.
You do you, but don't shit on people who've finally found a way to be normal.
No. Hogwash is what your comment is. Please stop spreading this falsehood.
My name is Roman Kogan, and I have ADHD[1].
Patients are forced to call the overwhelmed PCP , to get a new RX to be sent to a new pharmacy, while the patient is busy with life/work....in the hopes that patient meds will be found at the new location when the RX finally arrives to the pharmacy. And then patient must repeat the dance in 30 days!
It is absolutely bonkers.
Look at what StackOverflow posted not long ago: https://stackoverflow.blog/2023/02/19/developer-with-adhd-yo...
ADHD is supposed to be a disability, yet the post suggests it makes you a better programmer! Of course, if ADHD requires symptom-blunting medication, then is the post arguing that only un- or partially-medicated ADHD patients make better programmers? Or that fully-medicated ADHD patients, with some residual ADHD symptoms, make better programmers? Please. The post reads like amphetamine abusers trying to convince each other (and potential employers) that they're the best at what they do, despite not being able to do it without drugs.
> I didn’t realize how much of a psychiatrist’s time was spent gatekeeping Adderall.
It would help to understand why you feel that it’s immoral; my interpretation is that you are saying it gives people an advantage at a cost that you don’t want to be forced into paying yourself in order to compete.
It's not just moral; do you think there are no externalities to an ever-widening culture of rampant amphetamine abuse?
Yeah, that's potentially very dangerous. Drugs have different release rates, and sometimes have a coating to control when first release starts.
I'd bet the number of surgeries significantly increased after we discovered anesthesia and sanitation. Not because more people were needing it, but because the outcomes were suddenly much better.
Just. Like. Oxy.
If you told me I was going to take a standardized test where only the top 10% make the cut, and everyone serious about winning is taking a mental PED, then yeah I am going to feel intrinsic pressure to step-up and also engage in that mental arms race. I would've been just as happy to not do that if I were given a more level playing field.
It's no secret that there is a war going on to commoditize attention. I want to live in a world where people hone their ability to push back against having their attention leeched not one where everyone raises their baseline to cope temporarily.
I also have to think that, long term, it's kind of disrespectful to those with ADHD. If expectations of attention rise due to uptake in mental PEDs then where does that leave those who were originally disadvantaged? They lose their ability to exist on a more level playing field.
Bit of a tangent, but many years ago when I was wrapping up college, I was in a Calc III class over summer. The course was being taught at an advanced pace and basically everyone in the class was struggling after the first exam. The professor addressed the class about the poor performance and then called out a student in the front row. The professor said, "You! You did well on the exam. What was your secret to studying?" and, not missing a beat, the student responded, "Adderall!" I took the hint, bought some from a friend, and suddenly found myself passing the class with flying colors. It felt good in the moment, but honestly only because I wasn't being graded on a curve. It would've been wildly demoralizing if I'd been in direct competition with my peers.
I know life isn't fair and it's a pipedream to clamber on about desiring a level playing field, but surely we can agree that physical fitness competitions are more interesting when they are separated between "natty" and "enhanced" competitors? And that if we eliminated that separation that those without PEDs are disadvantaged? I don't see society making that sort of separation for mental fitness and so I am concerned about letting stimulants loose on the population.
They already have been. It's not hard at all to get an Adderall prescription. Just Google "ADHD symptoms" (the main one being trouble focusing) then go to your doctor and tell them you have those.
I want to move on with my life, instead I need to play games every couple weeks filling my prescribed meds because people are resentful that their peers back in college might have studied longer for a test? Are you fucking kidding me.
That's not a thing. Nobody is getting grilled coming in early for their stimulant medications. They just say "come back in a couple days" and "have a nice day." I've filled multiple stimulant meds in a period of 2 weeks from the same doc and same pharmacist. Neither care (I dumped out a drug that had side effects so I needed something else).
If people double up, after they run out they just don't have pills for a few days until they get another fill.
So running out of meds is something that's highly disruptive to my life and I'll always try and minimize gaps if they do occur.
You said " Nobody is getting grilled coming in early for their stimulant medications" ?
Okay then.
Unlike, say, antidepressants, there's no real backswing on off days: you just revert to your pre-medication attention levels which, especially in the case of people who got diagnosed later than usual, they have coping mechanisms for.
This results in the average ADD-medicated patient having a couple pills leftover each month.
And honestly? Why is this even being discussed, as if college kids getting adderall to study for math tests is some societal scourge ruining lives or something? Who gives a shit and why is it an issue that justifies making life difficult for people who are prescribed it?
What possibly would be left over?
This is not "just. like. Oxy." in so many cases. Many of these were people in pain management with zero deceit involved on the side of the patient.
Basically all stimulants can be categorized by a level of euphoric rush, and a level of focus they provide. Caffeine sucks at both, methamphetamine rocks at both, cocaine's good for a body rush but isn't very good for focus, and amphetamine comes with relatively little euphoria for a methamphetamine-comparable level of focus.
Yeah, this is fear mongering; and I doubt any abuse you are seeing is actually happening on any sort of scale. To imply adderall is more fun than Cocaine/Cocaethylene is a completely strange assertion given cocaine's continued and greater penetration despite the fact it's a highly controlled schedule 2 drug. If you could have more fun with adderall, why would you spend more money on cocaine?
Not to take the wind out of your sails but adderall is also schedule II.
OP was correct, cocaine is much more highly controlled despite sharing the same legal category. It’s only used in certain surgical procedures. You can’t get a prescription for it.
I mean I'm sure your diabetes is horrible but try telling someone taking insulin to stop. They won't. They depend on not being in a diabetic coma too much! And not slipping into a diabetic coma becomes a part of their personality.
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ADHD doesn't mean hyperactivity despite hyperactivity being in the name. For me not taking ADHD medication results in what your proclivity for drug abuse was gaining you: the super human ability to focus on one thing for hours and hours at a time.
The difference is when the drugs you were abusing wore off, you'd go back to being able to do other things. I'd just keep being prisoner of whatever I'm doing indefinitely. It's an awful feeling to know you have to do something else, you really need to switch tasks right now, but it's like you're a prisoner in your own mind, just stuck.
So subjecting myself to that isn't really something I'd willingly... is that surprising?
I mean I've personally requested lower doses of medications, leaned towards less "intrusive" delivery methods like metabolized extended release versions, and stopped when I was injured and unable to do much (being stuck mentally wasn't a big deal when I was physically stuck)
But even if someone else dealing with this doesn't want to do that, I don't blame them. It's an awful disease that deserves proper treatment. Some dumb drug abusing kid isn't going to change that.
The thing about the drugs being different is the results on people's lives. Off medication and unmanaged, people suffering from ADHD go into depressive slumps of executive dysfunction and are unable to perform their EDLs (EveryDay Living activities; showering, putting on clothes, feeding one's self, using the bathroom, exercising), never mind things like cleaning, holding down a job or paying rent. Most are able to keep at the same dosage for the majority of their lives.
That's not what people happens to people chemically addicted to Oxy. They need more and more to get the same effect, and chase after it to the point that many have become hooked on heroin, absent a prescribed supply of Oxycontin. While on the drug their lives turn to shambles, getting fired from work and losing their jobs and then their housing and end up living on the street.
That difference is entirely material to the discussion. If people are able to make more of themselves on a particular medication, society is able to accept that a medication is good, rather than bad. That may be a tough pill for some to swallow, especially those that want to reject traditional societal norms for judging a person's life. Another tough pill is that the idea that Adderall blunts a person should really be considered a fringe belief these days, given how many people use Adderall to better their lives.
Are their people that abuse Adderall? Sure. Are their many more people that don't, and live much richer lives thanks to prescribed medication from a doctor? Absolutely.
Additionally, Adderall and the like aren't just like +2 INT boosts - the stimulants have a different affect on most people with ADHD than it would on a regular person... so whatever you've experienced abusing the medication is probably quite a bit different from what I'll experience using it.
https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
That's quite the mischaracterization. Stimulants even at low doses increase the dopamine in the brain and lead to a mild high. I don't think I've ever heard anyone ever call Adderall "boring" before either. That's like calling alcohol boring, maybe someone may not like the experience, but they both have immediate and noticeable effects and it's not just "I love studying" either.
Even Scott's article has examples of this, here's a story of a little girl becoming very high from a prescription stimulant:
"A spontaneous report from the manufacturer of Strattera (atomoxetine) described a 7-year-old girl who received 18 mg daily of atomoxetine for the treatment of ADHD. Within hours of taking the first dose, the patient started talking nonstop and stated that she was happy. The next morning the child was still elated."
I can't speak for every person who abuses prescription stimulants but I've met people that do and they always had a meth or other addiction in their past and were either buying from dealers or seeing multiple doctors/pharmacies. It's been a while since I've run into someone with that problem though so I don't even know if the latter strategy is effective anymore. I assume the feds maintain some kind of database these days.
Not disagreeing with you wrt atomexetine but really should compare apples to apples.
A lot of people are critical of prescription stimulants without presenting a comparable alternative that will allow disordered people (particularly adults) to maintain the ability to function, be productive and maintain happiness in our current society with it's expectations and capability requirements.
I don't think that would be that hard to disprove, but I was trying to pull a quote from the article they linked.
Wikiopedia says Strattera can lead to increases in dopamine, whether that's relevant to that case I don't know.
Saying that appropriately dosed amphetamine and methamphetamine don't have a "big" difference is like saying appropriately dosed chocolate and coffee don't have a "big" difference. The difference is clearly massive.
Pointing to the methyl group is completely missing the point; I am not talking about the absolute chemistry, but the pharmacology.
Exactly. The diagnosis is a tool for the system to give it a veneer of scientific legitimacy. There is no truth only power. In living memory, being gay was a diagnoseable disorder. In some countries political dissidents would be deemed insane and committed to institutions. Psychiatrists used to hand out lobotomies and electric shocks to anyone they felt like.
It's quite obvious when a troublesome kid has been misdiagnosed: they act as you would expect a child on stimulants to act. The behavior changes are mostly only useful if the child does have adhd. A non-adhd problem child on amphetamines is a powerful source of chaos.
The flip side of this is that being unable to thrive in the system they're in is effectively dooming them to a substandard, more difficult life. If you think the system is broken, fix it, but ripping off the bandage before you have any sutures on hand is the opposite of a solution.
If I had started on medication younger, I undoubtedly would have done better in high school. If I had done better in high school, I would have gone to a better college, better college, better job etc. On the flip side, had I not gotten medicated in college, I very well could have flunked out.
So, yeah, it's a fucked up that the system doesn't accommodate for people slightly outside neurotypical-ness, requiring stimulant use to thrive, just like it's fucked up that it doesn't accommodate deaf people, making cochlear implants an extremely valuable treatment. But so long as that system is in place, restricting access to harm mitigation from that system because the system is fucked is unquestionably wrong.
So - you're wrong. And with that stupid insult you added at the end, you look even dumber.
In the field of biochemistry, this is virtually meaningless. A single substitution group is capable of producing wild changes in pharmacokinetics. The left and right-handed enantiomers of these molecules don't even act the same way in the body, and these aren't even positional isomers. The similarities with AMP and MAMP begin and end with being TAAR1 agonists. Off the top of my head, MAMP is also a potent agonist for sigma 1 & 2 receptors, and is generally more promiscuous.
Methamphetamine is a substituted amphetamine, not a "derivative". They're both simple substituted phenylethylamines, another TAAR1 agonist that is extremely prolific in your neurochemistry as we speak, and an incredibly diverse family of monoamines that range from lethal neurotoxin to serotonergic hallucinogen. The difference between the two is often as simple as a single atom moved 2 or 3 substitution points over. When you lack basic domain knowledge, please don't call other people dumb as you try (and fail) to correct them.
Amphetamines and methamphetamine are closely related drugs, as methamphetamine is a type of amphetamine. They both work in a similar way by increasing the release and blocking the reuptake of certain neurotransmitters, such as dopamine, norepinephrine, and serotonin, in the brain. As a result, they both have similar effect.
All you're doing is microdosing a terrible drug and calling it treatment. Addicts defend this, not logical healthy people.
> Methamphetamine is not a substitution for amphetamine.
I did not say it was a "substitution" which means something entirely different in this context, I said it was a substituted amphetamine. The rest of this comment reads like boilerplate drivel that completely ignores everything I actually wrote.
So are ethanol (vodka) and methanol (poisonous fuel). The difference is exactly the same - one methyl group (CH3).
If you think that it's a small difference, try drinking methanol instead of alcohol, and see for yourself.
(Or, rather, not see for yourself, given the side effects of methanol poisoning).
This is the bottom line. It’s a drug, it’s not good for you. That euphoria is not treatment, your being drugged. Only addicts defend long term use
This is what the problem was for you. It's quite a leap from there to assume that all children on ADHD medications also happen to have the same problem.
For many people with ADHD, the difficulty is beyond "the system they're in". Being regularly late to events, zoning out when talking to someone, living in a chaotic/messy living space etc. (common problems with those with ADHD) will still be a problem in a hypothetical better school system or post-scarcity communism society.
>take meth
Ah yes, the good old "Adderall is meth" ridiculousness.
Sure, Adderall is amphetamine, and meth is methamphetamine, just one methyl group of a difference - practically the same thing, right?
Just like ethanol (aka vodka) and methanol (deadly poison, makes you blind) - one one ethyl group difference, practically the same thing!
Please stop referring to medication[1] many people rely on as "meth".
Or if you must do so - consider having a shot of methanol next time you go for a drink.
If it's the same to you, then why not?
While it could be that somehow we've got an epidemic of left-handedness that blossomed in the 1920s, what's much more likely is that we've gotten more accommodating and understanding of left handed people, so there was less incentive to fit the mold of right handed folks.
I'm sure there were people who were alarmed at that rise, who felt that we didn't really need left handed tools and accommodations for the "2% of people who are left handed", but when you made those things available, we stabilized at about 12%.
Antidepressants and ADHD meds are, imo, in a similar place -- we've increased our understanding, we've increased our accommodations, we no longer force the people who experience those maladies into the stress of acting 'normal'.
Once you remove demonization, of course diagnosis are going to skyrocket. When it's no longer a scary thing to admit depression, ADHD, or autism, it becomes easier to get evaluated and care for them. I experience depression, I am on an SSRI, it helps me a TON. Historically, I might have been involuntarily committed or been told to "deal with it". I guarantee you I would not be as successful as I am now if I didn't have the support I do.
(Similarly, I expect you see a lot more people being "out" in the LGBTQ+ community as a result of a similar phenomena. Once it's no longer criminal or "get lynched" territory, we see numbers of gay and trans folks increase.)
These things seem like fads. They usually aren't, they are usually the case of a particular mode of people being pressured to be silent and invisible. When you remove that negative stigma, the revert to the mean can be dramatic, but it will stabilize at a new normal level.
From the outside one of the biggest concerns I have is one of these supply chain failures will put them in even worse place than had they never taken them, as I've personally seen their withdrawal symptoms look far worse than their unmedicated baseline. It seems to be a "better day to day" with the added risk of extreme withdrawal and associated risks during these few in a lifetime supply failures.
I’ve been allergic to milk for at least 15 years. I didn’t know it until 3 years ago. Now that I’m not ingesting a toxic substance every day, any accidental consumption has an extremely bad reaction.
It’s similar with my bipolar medication. Now that I don’t spend half of every day trying to not kill myself, I don’t have the tolerance I used to for paranoia, psychosis, and compulsive thoughts.
This mere observation is not meant to advise someone for or against taking SSRIs.
The idea of creating generations after generations unable to function without drugs seems a social disaster.
It's so odd, and also very specific to US.
So really, it's a question of improving accuracy overall, not just "let's make things stricter" (which would make it even harder from those are not diagnosed yet).
(I know you mentioned prescribing, not diagnosing, but I think it's a broader issue beyond just the drug).
I don’t even think it’s worth stopping people from taking it personally, anybody willing to fake the medical system could just as easily take street meth instead, which will be a lot worse for society. Reminds me of when the heroin epidemic went into overdrive after the DEA cracked down on pain clinics, then leading to the fentanyl epidemic, and how many deaths? I’m sure it was worth it though