Drug shortages have worsened and may only increase in the future, experts say
cidrap.umn.edu
cidrap.umn.edu
The Wegovy shortage is because it was recently approved to treat obesity. The number of new prescriptions was larger than Novo Nordisk predicted, so they're still ramping up production.
1. https://www.federalregister.gov/documents/2021/12/02/2021-26...
2. https://www.federalregister.gov/documents/2022/12/02/2022-26...
https://www.federalregister.gov/d/2022-26351/p-16
> According to DEA's data, manufacturers have not fully utilized the APQ for amphetamine in support of domestic manufacturing, reserve stocks, and export requirements for the past three calendar years 2020, 2021 and 2022.
> Based on this trend, DEA has not implemented an increase to the APQ for amphetamine at this time.
Which suggests that the DEA's quota for adderall is not (yet) to blame.
“The majority” “legitimate patient medical needs” sounds like a bunch of trippy legalese. If it’s the majority of the manufacturers they contacted, doesn’t that mean that there’s at least one that has exhausted their production? Could that one perhaps be the largest one, like Teva?
If that’s the case, then yes, there could be a shortage. And they’re not increasing it because there’s been a surge of “illegitimate” shops that have popped up and prescribed remotely since Covid that the DEA is investigating and/or shutting down.
And that may not even be the real reason. Could be the understaffing issues quoted in august. Either way, that answer from the register is a non-answer.
maybe, but from my experience with governmental writing it probably means that there are a bunch of companies and some smaller companies they don't want to point out for some reason have exhausted production. If it was the largest company exhausted I would expect it to say something like
"although the majority of smaller companies still have not exhausted their productive capabilities, the larger suppliers report that they cannot produce more at this time"
Also - I would generally expect that largest suppliers exhaust their capabilities after the smaller suppliers exhaust theirs - although I guess some supply chain studies probably exist that would say if my expectation is off.
Also, if any one doesn’t have enough, that increases the amount needed for legitimate patient needs for all the others: either (1) they all have enough for legitimate patient needs, or (2) none of them do.
And, here’s the thing, if there are patients with prescriptions who aren’t able to get them, or are having to scramble to call around to different pharmacy chains with different contracted suppliers to find one that isn’t out and unable to restock the particular dosage capsule (because they aren’t fungible) of the particular drug they are prescribed, then, no, there aren’t enough for legitimate patient needs.
“But some prescriptions are illegitimate” – maybe, but supply constraints don’t fix that or target illegitimate prescriptions, they just make it (well, until all supply is exhausted, then everyone is SOL) a lottery for every patient, regardless of legitimacy of their prescription. It adds a whole new problem, rather than solving the notionally motivating problem, and it is so obvious that this is the case that either the people adopting the policy are the biggest fucking idiots in the world, or the policy is outright malicious and not directed at the problem that supposedly justifies it. (Since its part of the War on Drugs, the second option is guaranteed to be part of it.)
https://www.bloomberg.com/news/articles/2023-04-03/adderall-...
previous discussion:
I don't know anything about politics nor medicine but this reminds me a plan economy of my native Soviet Union.
Whether the problem is how much is prescribed or how little is produced is up for debate.
Even without all the usual overhead of government bureaucracy its not reasonable to assume a central authority could accurately predict supply needs for legitimate prescriptions, let alone keep that number up to date over time.
They're always going to be wrong with their estimates. Unless there's proveable intent behind them underestimsting, what's the problem?
The problem is wrong estimates harm people. And the estimates are more wrong than they were. And the purpose of a system is what it does.
Count me in, that's almost always the right direction to move towards these days.
It leads you to an argument for less regulation and smaller federal government because you need no leading. People who prefer more nuance may not follow.
I.e. do we have evidence the DEA purposely underestimated, and that they did it to harm individuals by making it harder to fill legal prescriptioms?
> I mostly ignored the assertion it would be impossible to revise quotas promptly seemed secondary and was unsupported.
I honestly just didn't think support was needed with regards to the slow, inefficient process of our federal government. We only attempt to run the national census once every 10 years and do a piss poor job at it. The IRS, which is literally responsible for a enforcing a primary revenue driver for the government, can't manage to catch blatant (rhoguh elaborate) tax evasion by corporations and the rich. The FAA asked Boeing how safe their new plane was and was months late grounding the Max after an obvious issue.
The list can go on, but suffice it to say there are plenty of examples where entities in our federal government completely failed to regulate the very industries they were responsible for and seemed to be the last to know when things weren't working.
I'm not wvwn trying to defend the DEA here. I simply don't get what we could expect them to do if thwybare tasked with keeping supply inoine with demand without underestimating at all. That's an impossible needle to thread and seems to shows that granting that power to them is only a losing scenario.
Estimates should include some factor of safety so they are still adequate even with the error, and they should be regularly reevaluated so that discrepancies do not persist long enough to result in production shortages. As previously noted, the DEA's restrictions have been significantly too low for years.
If error is unavoidable and any underestimate is untenable, the regulation isn't feasible and the DEA (and the federal government in general) simply shouldn't have this power.
They did not say any underestimate is untenable. They suggested resolving underestimates promptly.
Covid was a sobering event for me and it made me realize just how fragile our global economy / supply chain are. I want to be able to exist and survive even in a total collapse (which, tinfoil hat be damned is becoming a more and more realistic possibility). Step 1 was giving up the amphetamine salts.
Any tips for just going cold turkey? I can't wait any longer for my psychiatrist to prescribe an alternative.
To get by without, you have two options: incredible discipline and force of will, and overcompensating with other stimulants.
Meditate, exercise, do anything it takes to force yourself into whatever structure fits your life. I'm talking to-do lists for your to-do lists and scheduling your daily time down to brushing your teeth. You have to force structure onto your life to contain your attention and energy. You have to make some truly profound changes in your life.
Or drink way too much caffeine, smoke too many cigarettes and try very hard to not think about the damage you're doing.
The only shortcut I know of is to get enough black market adderall for a couple of months and use that to keep yourself functional long enough to build the systems and habits that can keep you going without.
See the Getting Things Done method, pomodoro, and find a good task management system. Write everything down, find a system for keeping notes. Also try keeping a diary.
Also try to reduce your phone and computer usage. If your phone supports it, use monochrome mode. Push yourself to read more books instead of watching videos or playing games.
This doesn't help when I try to get out of bed in the morning and my body does not move. Does not move. I can't do it.
Happens with basically everything.
I'm not going to tell you that happy thoughts and a motivational poster will fix you. I will say that once you get past the stage you're in and have the ability to make those big life changes, this part will happen less often and you'll find it easier to break through. When you're generally healthy, it's easier to recover when you're sick. Applies just the same to mental illness as it does to an infection.
Unfortunately, you're in the hardest part. Or at least it feels that way in the moment. I don't have any good advice other than to seek help and do whatever gets you to the next day. Try your best to make small improvements when you can. It is okay to not make progress every day, but you also have to not let that be an excuse. You really have to push yourself. It might be the hardest thing you'll ever do, but you aren't the first to have done it.
Sorry all I have is the same pithy nonsense you get on Facebook. At the core, it's good advice, but you have to know the limits. There are some battles you can't fight. Sometimes you are in a truly impossible situation. No internet comment can help you with that, but you can find help if you can bring yourself to ask for it.
Good luck
Well... I did seek help, and ended up on dextroamphetamine, which helps me more than any routine possibly could. It's just that my tolerance got bad enough in just 3 months that now I can't take it more than once every few days, or else it completely stops working.
I can't take more because my body already requires a dangerously high dose (30mg/day) and raising it any further causes heart issues. (I tried)
Regarding inability to get out of bed: I empathize completely and have been there, even while on medication. There's not really a magic solution, but if you are getting off medication, you just need to give it time and eventually (could be months) your dopamine levels will return to normal.
Also, I think it's important to recognize the difference between motivation and willpower. If you have ADHD, I'm probably preaching to the choir here. But for me, "motivation" is a long term drive more akin to ambition, whereas willpower is a short term muscle that I have trouble exercising. That's what makes ADHD so frustrating: I have an abundance of ambition and motivation, but a dearth of willpower. I know what I should be doing, but I just can't do it. This is a distinction that someone suffering from ADHD will recognize immediately, but a neurotypical person can only understand in the abstract, if at all.
Getting out of bed is about willpower, but it can also be about motivation - it's worth examining your life trajectory to see if you're moving in a direction you're happy with, because if the cause is lack of motivation, then pills will hardly help (other than a desire to take them driving you to get out of bed). Pills can fix a lack of willpower, but no pharmaceutical can give you motivation. That's a long term drive that you need to seek for yourself.
I thrived without meds during my time in the Army. The structure, being told what to wear, when to show up, and the clearly defined expectations were great.
Attempting to emulate this personally as a civilian has yielded mixed results.
The market is ripe for a First Sergeant as Service solution.
When you put it this way, I think you're absolutely right about this - those kinks are exactly what one should expect to have a "halo" around them, of people unknowingly self-medicating their undiagnosed ADHD.
Love the way you worded something I've been imagining for years. Let's build one.
Right. I'm not even trying, even though I highly suspect it would've helped me if it worked - because I know it won't, because my brain is able to tell when I'm trying to trick it, and will refuse to cooperate.
Actual military? That could work, because the order and structure would be beyond my control. Self-imposed? It's hard enough on drugs, impossible without. Asking someone else to impose some structure on me, as an adult? My brain knows it's even easier to cancel the deal, weasel off of the agreement - especially if it has literally no other purpose and meaning than trying to trick myself into functioning.
So yeah, I'd be up for becoming a paying customer of some First Seregant as a Service thing, but I can't imagine how you could structure it so it doesn't feel artificial and voluntary, making me unable to stick to it any more that I can to exercising (a highly beneficial activity that my brain recognizes as artificial and bullshit, and refuses to allow it).
2 pills of BodyBio PC (phosphatidylcholine + 3 other phospholipids) 3g MSM 1g DHA 140mg elemental Magnesium Threonate
Optionally: 1g Taurine + 100mg caffiene pill
Another optionally 50mg provigil/modafinil (typical dose is 200mg)
=============
Most folks are focusing on dopamine increasers (amphetamines, provigil, dopa mucuna, caffiene, sugar) as dopamine stimulants, but too much has its rough points as others have pointed out.
But focusing on supplying underlying nutrition has had pretty profound effects on my mental ability to get things done and focus.
I was hoping for "this one weird trick" life hack silver bullet to save the day.
My wife and I are expecting our first child later this year. It's becoming apparent the only way to minimize my reliance on a capricious and inconstant system is to pull off the bandaid now and chart my path out of these woods.
LOL I can only dream of ordering my meds to my door from a site that looks like Amazon.
Which is incredibly unfortunate, because my prescription started at 30mg/day because my body is just resistant to stimulants for some reason. Going any higher causes a hypertensive crisis, but tolerance is evil.
Why does homeostasis want me to have ADHD again? Wish someone could find the genetic crap that controls this and fix it.
So my sleep schedule starts to get stupid again.
My current routine seems to work around this by re-fixing my sleep schedule every 3 days or so.
Before tolerance, I could wake up at 4AM without an alarm, stay up until 8PM or so, then sleep until 4AM the next day, and repeat that for a month or two. Good times. Internal clock actually worked and everything was running smoothly. Makes me wish I didn't require such a dangerously high dose.
Do what no-med you wants to do?
One of the big problems with ADHD is usually that you can't complete personal goals and tasks because it's too much effort to switch to it. For example, hobby projects and such.
ADHD sort of... disagrees with you over what it finds worth doing versus what you want to do. It can make you feel like you're not in control of your own body, and that can lead to dysphoria and depression, or at the very least intrusive thoughts that you're not doing something that you should be.
For example, I've been working on an image upscaler for the past three weeks or so. Would I have been able to do that without my meds? Probably not. I will probably even end up finishing it soon.
While I'm writing this comment (and indeed, while I hung out on HN all day today) I've been thinking of the work I'm not doing and then just... being okay with it, because I'm on my meds and I know I'll be able to get to it.
I've even been making little steps throughout the day whenever I felt like a moment, but I'm not afraid to take breaks or do what I enjoy at the moment, because I know I have a choice.
If I weren't on my meds... it'd be a different story. I'd be at the mercy of whatever my ADHD felt was worth doing, and it'd feel a lot less reassuring.
Being medicated during leisure time is important, too.
To folks reading this who don't have ADHD- none of this is hyperbole or exaggeration. It can be a maddening condition to live with.
To be totally transparent however, there are a lot of other things I do because I’ve learned that they contribute essentially to my medication working and I waited to respond to give you a full response.
Exercise is one. I don’t need a lot of it, I always try to get it done before taking medication that day and it’s a mix of long distance running and personal training. I know the latter is very expensive so if I had to recommend an alternative, I would say something like p90x is good. Great even. It’s almost a full hour of working out, full body, cardio mixed with weights, never very heavy either…you really feel like you did something afterwards.
Make sure to follow that up with a day at a lower dosage or no dosage if the medication is murdering your appetite. I think part of the rest medications don’t always work is honestly lack of glycogen from reduced appetite. Or the inability to use it? We’re entering bro science here for sure.
Besides breaks and exercise I find that some supplements work really well and become necessary to balance the whole experience out. A lot of people will recommend magnesium (glycinate for better absorption). I take it in the form of ZMA (with zinc), alongside it tyrosine seems to really help, fish oil, b complex (to make up for bad appetite) and recently added this other mixture of citrulline, arginine and dipotassium phosphate (6% dv/serving).
That last one is supposed to improve circulation and the potassium I find helps me relax. Takes the edge off of the medication.
Besides that, pay close attention to the side effects. Eating a big meal almost always has a positive effect on me. If I’m not thermoregulating well I look at circulation and exercise. I’ve been monitoring my blood glucose levels too and they seem ok throughout the day but sometimes I wake up at I get readings of 100 (forget the unit here, ng/dl?) so I’ll talk to my doctor about that.
Let me know if you have any questions about anything here. I’m more than happy to answer them. I know how hard it can be to take such an effective yet punishing medication.
I also take magnesium (threonate, in my case), although I did that initially to help prevent migraines, along with fish oil, zinc & B vitamins.
I have not tried citrulline, arginine, or dipotassium phosphate. What benefits would you say those provide?
They have this drink there called electrolit and I remember it making me feel super relaxed, to the point where flying in turbulence didn't bother me anymore (I'm a nervous flyer). The only thing that stood out was its potassium content clocking in at 7% d/v in one bottle...really hard to get those kinds of numbers from even a potassium supplement, which come in at 1% per pill in the US. I guess it's because overdosing on it can potentially be fatal and slow down your heart too much? But for someone taking a stimulant it might be really good.
Then the citrulline/arginine is meant to help w/ vasodilation, which I think is hampered by the drugs and presents itself in the form of cold extremities. It's a lot of stuff to take just to be able to function but for me the difference is night and day. Off of it, I've been expelled from every school I've ever attended, on it, I've published half a dozen scientific papers and made a career for myself, so I'm never stopping.
Long term though, my goals are to eliminate or reduce my dosage and supplements by training to get my resting heart rate down a few points. It's what I'm working on with my personal trainer and so far it's been working.
Many who practice regular meditation find that they can subsequently live drug-free lifestyles, because drugs are a crutch for the body, but meditation is an enduring and efficacious cure for what ails the spirit.
Meditation reduces the urge to actually use drugs to fix problems if you no longer perceive any problems to fix. It's just getting to this point that people have trouble with.
Accepting yourself and working within your flaws rather than trying to achieve perfection.
I’ve been on and off heavy stimulant meds since 2012. They only work for a short period of time. Dosage needs to go up. Consequences need to be managed. At some point you’ll hit a ceiling and they will no longer be effective. It’s just a matter of time.
Even if the meds would stop working entirely after couple of months, that couple of months of improved ability to function is a lot - enough to regain lost self-esteem, and introduce lifestyle changes that will remain even when the drugs are gone or no longer effective.
I'm a month in and just hoping it can stay effective without constantly needing to raise the dosages
Everyone i know that had to stop ended up abusing it. They took it at night to study or party. They took an extra dose if they needed to work extra hard.
Im not going to go up in dose so i have no reason to think my experience now will change in 5 years
And no, I don’t (intentionally, ADHD is a real bitch to habits) take med vacations.
Meds still make the difference between executive dysfunction hell and being capable of earning an income and having relatively stable hobbies.
I'd say that's a pretty clear sign they "fragile" supply chains is not the root cause. Somehow you can easily buy something that's had to be smuggled into the country in who knows what way, but not a legally manufactured product.
The fact the system treats you like a ‘crack addict’ is the problem. Could you imagine how absurd it would be if say, type 1 diabetics got treated like addicts because they depended on insulin?
The system around ADHD drugs is just fucked and needs to change.
Insulin can't be abused in this way, which probably explains why you can just go and buy it at walmart.
Maybe some elevated cardiovascular problems across society as a whole?
Maybe some psychosis in serious chronic abusers?
Why don't we just do this?
Honestly I agree with you. I think drugs like this should be sold OTC because it's basically just like food. It is a substance you put into your body. Just like psychedelics.
And imagine the lives that would be saved if the drug propaganda did not desensitize everyone to actual help. This is the whole reason "harm reduction" forums exist.
But, you know how it is, where the government doesn't trust anyone to use substances responsibly.
Man, what I would give for a "responsible enough to buy drugs OTC" license or whatever. I get dextroamphetamine on prescription, but I also really like LSD and would love to be able to buy that OTC, legally, so I'd know the supply is safe and I'm not going to jail.
Although, I'm pretty sure certain drugs like heroin compromise judgement to a great degree, which makes it very difficult to use responsibly, but honestly there are more creative ways to deal with this that society just hasn't explored because of the whole "war on drugs" ridiculousness.
To think it's taken until ~2021-2022 for a federal administration in the US to finally admit there needs to be better solutions in place, it's absurd! All those deaths could have been prevented.
Some people legitimately need the caffeine just like some people legitimately need ADHD medication, but some people became dependent on caffeine when they didn't necessarily have to be.
People being cranky in the morning is nothing compared to the damage alcohol or drugs do to society.
I don't drink coffee to wake up, I wake up to drink coffee. Let me have my foamy cappuccino and the glorious poop that follows.
Honestly, if someone chooses to be dependent on caffeine because they know and consent to it, that's fine I guess, though unfortunate. The problem is that caffeine use is so normalized that people seem to have forgotten that one even can become addicted or dependent on it—I would say "glorified" but that's a bit far.
FWIW, I have some friends who are trying to quit caffeine. Not because I told them it was an issue, but because they independently decided that. I am somewhat biased by seeing cases of actual caffeine addiction and dependence, whereas most people only see the benefits of taking it. This is probably how the normalization happens, some people just don't know any better.
Seems like the solution is better education on the effects of caffeine and not putting it into the same category as drugs and alcohol. So far I'm yet to hear of people who's lives were ruined by coffee addiction.
The fact that it makes you uncomfortable that people are dependent on coffee is kind of irelevant IMHO. We live in a free society. Let people have their coffee if they want it.
Once you get harassed or mugged by someone on coffee withdrawal who needed a fix, then we can talk about regulating it.
I... regret to inform you that caffeine is literally a drug, stimulant class.
> So far I'm yet to hear of people who's lives were ruined by coffee addiction.
I'm not really sure what your point is here, as I'm not saying caffeine addiction ruins lives, just that it's a thing that could be avoided more than it is now.
> The fact that it makes you uncomfortable that people are dependent on coffee is kind of irelevant IMHO.
I said "unfortunate", not "uncomfortable".
I regret to inform you that not everything classified as a drug is equally bad as all the other drugs, in fact many drugs are useful in certain situations.
It's not black and white, "drugs are bad m-kay", as you want it to be. Which is why coffee is tolerated.
So I don't get your hissy fit on people consuming this particular drug. If you don't want it, then don't drink it, just let others enjoy it, since it has no negative effect on you.
Regularly consuming large amounts of caffeine while barely feeling any effect (beyond getting jitters / bowel issues) or feeling calmed by it, is actually indicative of ADHD.
At 28 I stopped Adderall because I honestly don't care for the side effects, and felt like I had good enough habits to do without it.
That worked for a while, but I was at a job that wasn't too challenging for 6 years (and very underpaid as a result of not being more ambitious/focused)
Switched to another job, ended up getting promoted to lead, then everything came crashing down. Couldn't focus, and as I fell further behind I'd feel more stressed and overwhelmed constantly.
I had been drinking coffee the whole time, but it wasn't helping that much. Irritated my bowels pretty badly though (I ended up needing surgery for a complication of what turned out to be Crohns, though my symptoms are incredibly mild when I'm not drinking over 4 cups of coffee per day).
Finally got back on Adderall after ~10 years unmedicated and was able to just stop coffee. My entire life has improved. I can focus during work hours and even have some free time during the day, since I'm not spending the entire day struggling to get work done.
I can honestly say that Adderall is much more helpful for me, and has minimal physical side effects compared to copious coffee (though I do have mental/emotional side effects, which are honestly less negative than the stress that accompanied being constantly overwhelmed, exhausted, and sleep-deprived)
The process to get my prescription in Canada took almost 2 years (in part because of my poor ability to navigate the labyrinthine health care system due to said ADHD)
But wow, has it already improved my quality of life significantly in the ~1 month I've been back on it. I agree with other posters here that we should just let people get it OTC or allow diagnosed individuals to just get a lifetime prescription
You clearly haven't been paying attention to my comments if you think I'm saying anything like "drugs are bad".
I'm saying undue dependence on something that you didn't need to be dependent on, is unfortunate. As in, it's unfortunate how people can accidentally fall into caffeine dependence without knowing what they are getting into, because it's not that people don't think caffeine is evil, it's that people think caffeine is completely harmless.
> hissy fit
this discussion is over
Fun fact: Did you know hunger is basically just carbohydrate withdrawal? If you stop eating carbs for around 1-2 days, your hunger will go away. Obviously, if you want to stay that way, you will have to find some way to sustain yourself without carbs, but it's a relatively safe experiment to fast for a few days and see what happens.
It's fun to think of food in that way because actually... food is just a pile of substances! Carbs, fats and proteins.
It's just that food is generally safe to eat when you're hungry, but drugs are especially powerful substances that can be dangerous if misused. But still stuff that you can put into your body, through basically the exact same mechanisms as food.
I'm all for caution and research and responsibility and informed consent and all that—all good things. But I don't think drugs are inherently so much different than food that you don't deserve some level of autonomy with them.
In other words, I think the amphetamines and stuff should be OTC. Like... legalize them all, legalize everything. Not only would this make the supply safer for people who are already taking those substances, since they can be made by reputable, professional companies, but this would help get rid of the taboo around sharing safe dosage and supplement information, which would seriously help a lot of people (harm reduction!).
All the FUD around the war on drugs is just causing harm to the world. It's causing people to go to jail just from putting things into their own body, it's denying people access to safe medical information, it's barring medical professionals from helping people with substances that happen to be illegal, it's denying people a safe supply of their favorite drugs (which usually results in people going to shady sources, not abstaining completely), ... the list goes on.
Yeah, amphetamines aren't food, but it's nice to imagine a world where they're available freely and used responsibly. Unfortunately I'm not sure if that's a possible future.
Would be nice if only people who are against drugs would pay some additional tax to sustain the whole prison-industrial-DEA-complex though. I don't do illegal drugs, but the fact that I'm forced to sponsor that due to other people's self-righteous puritanism is just stupid.
Problems caused by drug abuse != problems caused by drug availability.
Meth is neurotoxic, we know this now. So are all stimulants, to a degree. I take magnesium supplements with my ADHD meds because it depletes my brain of natural magnesium—I have had blood tests confirm this. But meth can be particularly dangerous, especially due to how addictive it is and how neurotoxic it gets when abused, compared to even the other amphetamines like dextroamphetamine.
All this is not to say that it shouldn't be widely available. Just that proper, responsible usage information should also be widely available. Which it is not.
If people knew how to take meth properly and responsibly, maybe there would be less cases of it getting out of control.
Too bad all people have to go off of is anti-drug propaganda that says all drugs are bad. Leads to them ignoring all advice altogether, even if it could've otherwise helped them.
Drugs like opioids and stimulants are great in that they work well at masking lots of symptoms, but our bodies adapt to them and the need for them feeds the physical dependence.
The mental abuse factors amplify as well availability. Bookies and sports betting isn’t novel. Legalized betting on smartphones is; so now billions are spent on marketing to vacuum up many billions of dollars of bets.
Humans are wired the way they are wired. Education about risk only benefits people capable of managing the risk - not the people likely to get addicted in the first place.
Sure, but people likely to get addicted are sometimes also in the presence of people who would benefit from a proper drug education in order to help protect the more vulnerable.
Am I saying people will stop using drugs if they stop being illegal? No way, the opposite actually. But if drug use wasn't considered indiscriminately bad, that wouldn't necessarily be a bad thing anyway.
Looks like it was scheduled in the US in 1971.
Adderall is a mix of 3:1 dextroamphetamine to levoamphetamine. It is not "plain old amphetamine", also known as racemic or "free-base" amphetamine (equal mix of dextro- and levo-).
I can't take levoamphetamine, and need dextroamphetamine directly. Unsure if that was ever sold OTC on its own.
I think Dexedrine was sold OTC in the 50s and 60s, hard to be sure, sources I can find talk about it being popular for use by anyone and everyone, from dieting housewives to truck drivers and athletes, but don't specifically mention it being OTC or prescription.
Any sort of source to back this up?
I'm not arguing for dexedrine etc to be freely available, FYI, just discussing that it used to be.
I'm not saying I don't find it plausible, but a warning message on the box isn't exactly the confirmation I was looking for.
Sounds more like correlation to me than causation.
You know that feeling that most impressive leaps in engineering and technology in general all happened in the 20th century, especially between 1950s and 1980s, and that we've somehow lost the ability to do big things?
> Looks like it was scheduled in the US in 1971.
Maybe that's the answer.
I generally support making more stuff OTC. For instance, in many countries low dosage codeine tablets are available OTC.
Similarly, given that the already have a plethora of bars, I see no harm in airports adding Valium vending machines.
But boy does it come in handy for other things. It’s the best cold symptom medication there is. Need to drive late at night when you should be tired? Pop 5mg and you can actually drive safely for a few hours. It’s a shame we have it locked away.
That said, it’s dangerous to think other people would act like you. People would definitely abuse it (more than they already do). I come down on your idea like I do in most drug legalization questions. Conceptually I think we should be able to do whatever the hell we want to our bodies. Realistically I don’t know if that works for society.
Sounds like an incredibly miserable way to live, honestly.
My favourite junk food, and one that puts me KO for 3 days is a double cheese pizza.
Makes me depressed and despondent, bloated and my ADHD meds stop being effective (but my usual dose is quite low on purpose). But that's because of my physiology, the opioid effect is in the strong craving, and how lovely the first bite is, and how I hate myself after the first bite, for having succumbed to its allure once again.
Gluten and casein are under-researched. The fact that there is a so called "gluten sensitivity" fad is not a shared hallucination, but some effect we haven't identified or understood yet.
Aren't you the one who's been comparing ADHD treatment to crack addiction all throughout this comments section?
There is no reasoning with that kind of people. I just hate they keep the stigma around ADHD and its very effective medication alive so we keep being branded as druggies.
These are all things that I greatly enjoy and do whenever possible. And I think it's okay to enjoy things in life. I also think it's okay to enjoy drugs in life. Because while my meds finally let me relax and stop getting so painfully bored, they don't detract from my life, don't cause any adverse side effects (besides urinary retention, which is basically harmless), and don't even cause any adverse withdrawal symptoms.
I even take them around every 3 days now because sleeping for 15 hours in between feels nice. I don't have any obligations, so why take them every day if I can enjoy some really nice and comfy sleep in between? I don't get enough sleep on my meds anyway, 7 hours is the usual max I can get every night, so catching up is probably healthy too. Not to mention that my meds cause my preferences to flip a bit; I prefer entertainment while off meds, and productivity while on meds, and I want to keep both sides in my life.
I don't think anyone could make a convincing case that this is a bad thing. I am enjoying my life right now, and not harming myself or others, so~
Euphoria stops happening the second day you are on meds, and when they wear off there is no feeling whatsoever to redose. I honestly just feel I have done a lot and it's time to rest for the day. I am lucky it wears completely off by bed time, so sleep has been great.
In my experience, caffeine feels 10x as addictive than dexamfetamine.
It didn't for me. It lasted something like two weeks. And after months it still sort of happens. The euphoria doesn't come directly from the drug, it comes from feeling free and relaxed and in control. From being able to lay in bed and do nothing and feel good about it. Without ever getting bored like what happens all the time without meds.
Boredom isn't supposed to be so painful all the time, but it normally is for me. Being free from that is euphoric regardless of the substance I'm taking, honestly.
Not to say responsible people don't exist, but rather that without a framework to support them, it's all their own personal responsibility. And there's also preliminary studies showing meth being somewhat neuroprotective at low doses, so if someone is using it purely for productivity, and taking the right supplements, it's possible that they could avoid damaging themselves too much.
But this is all theoretical and basically I don't fully believe in self-medicating for an ADHD case that you could be getting a real prescription for. I do believe in self-medicating using psychedelics and the like because there's no prescription treatment for that (yet), but as soon as you're allowed to ask a medical professional to help, I think you should.
FWIW even once psilocybin clinics become a thing, I'm still going to be taking LSD at home, because home has my toys and my friends, and clinics have neither. But if one day I can be prescribed LSD to take home and use on my own terms, I'd be glad to ask a professional for advice on it, and get a prescription. Just has to, you know, be legal first.
It might still be easier to get MAID (medically assisted suicide) here in Canada than Adderall. What a shitshow
Is there anything a random USAian could legally do to help your situation? I don't have a ton of financial resources, but if having someone in your corner helps, I might be able to do that for you.
In another comment here I mentioned the process took about 2 years for me (even though I was first diagnosed with ADHD in the U.S. in 1994 or so)
I really appreciate the offer though, very kind of you
But the recreational use thing is huge indeed—the fact that adderall is so potent, desirable and dangerous is what earned it a spot on Schedule II. The reason why people are "treated like addicts" is because people think all addicts are the same.
There are different reasons to be addicted to a substance, and not all of them are bad. Say, if the substance legitimately helps you by making your brain function properly, as does ADHD treatment, it should be okay to be addicted. Who wouldn't be addicted to feeling like their brain is finally working properly?
But being addicted to a substance just because it feels good, with no regard for your personal safety or health (i.e. overdosing constantly) is reckless and dangerous, and this is what people think of when they think "addict". This is also, unfortunately, what comes to mind whenever one sees someone enjoying their ADHD medication.
They compare it to the enjoyment of someone who is well and truly fucking themselves with some neurotoxic substance like meth or cocaine—short-lived euphoria that goes away once the drug stops manufacturing good feelings for them, not true satisfaction with their self.
It's sad, really. Though I'm not surprised that people can't see the nuance.
How large % of the ADHD population could be fixed environmentally, e.g. by just going to the damn gym? How much can be attributed to our modern lifestyles?
ADHD exists, but to say that there's something wrong with "the system" just because 100% of people in society don't take it as a serious diagnosis is a big stretch.
Another big stretch is comparing ADHD with type 1 diabetes. Come on...
It's complicated. I think a decent percentage could be helped by going to the gym, because I think the fact that SNRIs help so many people shows that norepinephrine can be the main issue in some cases, and exercise should help with that.
But then there are the cases that can only be helped by stimulants that are DRIs (like me, with dextroamphetamine), and most NRIs actually make things worse (e.g. my body can't handle the levoamphetamine in adderall).
I would love to know the distribution here, honestly.
As for the modern lifestyle, I think the modern tech world is trying to exploit ADHD-like behaviors in everyone. The whole thing about social media trying to maximize dopamine and instant gratification and endless scrolling and etc. is a real thing that happens to try to take advantage of even people who don't have ADHD... but it hits people with ADHD the hardest, because due to their disorder, deviously-crafted social media can actually overshadow the rest of their life.
I'm almost definitely addicted to chatting on Discord for example, ever since the platform first came out, but mainly because it facilitates chatting with my closest friends. I pick a DM and talk to people, and it's very direct, and I don't feel manipulated at all. But that's how it gets you; I know the majority of my time is spent chatting, and the majority of my time procrastinating is spent chatting. The only question is whether my decision is truly informed or not. I think it is.
Structural differences in brain chemistry don't get fixed by going to the gym.
People with untreated ADHD are 3x more likely to be in a car accident. Going to the gym won't fix that.
50% of people with untreated ADHD have issues with substance abuse. 50%. Going to the gym won't help with that.
Divorce rates for people with ADHD are up to 2x population averages, a few hours a week lifting weights won't help with that.
> How much can be attributed to our modern lifestyles?
Risk factors for developing ADHD are heavily linked to exposure to the industrial pollutants that are a result from modern society. It isn't the largest factor, but it is a contributing one.
That is going to be the only "modern lifestyle" link you find.
People with ADHD don't just have problems sitting in a chair (that tends to go away as people age anyway), ADHD impacts emotional regulation, the ability to perceive time, and basically all other aspects of executive function.
ADHD isn't just "can't focus", that is just the most obvious symptom. ADHD is, aside from being horribly misnamed, a disorder of the executing functioning part of the brain that is responsible for controlling large swaths of higher order brain functions.
To tl;dr it, having ADHD fucks with everything.
ADHD is both under and over diagnosed. It is under diagnosed in women, minorities, and people who are poor, and those facebook ads advertising 30 minute online questionnaire diagnoses are certainly pill mills, though I would also not call them a diagnosis.
Like most things in life, there isn't a simple yes or no answer.
My understanding has always been that plenty of people use it, and if anything that is over prescribed. What exactly have you seen that's so bad it's being treated similar to a schedule 2 narcotic?
Guess the question is whether a person really is at as high a risk for dependence when on Adderall vs. opiods and other schedule 2s.
It's a bit of a long read, but it's very good. The author is a psychiatrist who deals with this sort of thing frequently.
I can't really comment on the relative risk of dependence for Adderall vs opioids, except from my personal experience. A real addict probably wouldn't even (literally) get out of bed in order to take my daily dose of Adderall (25 mg XR).
I've been taking it for almost 10 years now, and in that time, I've had one dosage increase, from 20 to 25 mg. I've accidentally taken it twice in a day, and I can say with certainty that I do not enjoy the experience when that happens. I honestly can't fathom how anyone would want to take the kinds of doses that addicts take. It's not a fun drug at all, as far as I can tell. If I didn't have to take it to function somewhat normally, I wouldn't take it at all.
This is an awful thing to casually throw out there in the faces of people who rely on ADHD medication to manage their ADHD.
What would you do if something like WWIII started and all non-vital drug manufacturing stopped? Or any conceivable scenario where suddenly these meds are not available. Everything is more fragile than you realize. Look at baby formula or other products that are produced by literally one single supplier. The system works until it doesn’t.
So let’s pretend adhd meds cease to exist. What will you do? Give up on life and cry about it? You need to be prepared for any circumstance.
Don’t get me wrong I’m struggling and I miss it constantly but I’ve also had to reset my mindset and expectations. People tend to adopt adhd as an identity but it’s not something that should be done. We all struggle to varying degrees with executive dysfunction and it’s silly to hide behind this crutch. Outside this high paced world people with adhd are just fine. But in this environment they are “disabled”
No, it's not fair to equate people treating their ADHD to crack addicts. Because treating ADHD and being addicted to crack are two different things.
People treating their ADHD have an actual physical deficiency in their brain that takes away capacity to function, and this is a disability, no matter what term you do or do not use for it in "this high paced world".
Usage of ADHD medication to address that deficiency is not at all the same as crack addiction. Because crack addiction is not addressing a deficiency, it's trying to add recreational pleasure to a perfectly normal and functional brain.
ADHD medication is trying to avoid the executive dysfunction that ADHD causes. Which no, is not something that "we all struggle to varying degrees" with; ADHD is worse. For example my body literally will not move if I try to do something that I don't want to do. Even if it's something that I need to do, or something that will have dire consequences if I don't. I won't be able to move, even if I try. The signals just do not reach the rest of my brain.
People with ADHD cannot just suck it up. They can't. You are being incredibly disrespectful and undermining a legitimate disability by acting like being dependent on ADHD medication is anything like being addicted to crack.
If you can suck it up and live without it, fine, good for you. If you can just change your lifestyle to work around your ADHD, fine. But not everybody can do this. And it's not their fault if they can't. It's not their fault that they were born with a brain that is not working as it should. And it's not their fault for wanting to fix it.
People who treat their ADHD don't want euphoria or pleasure or a fun time. They just want to live their fucking life without suffering from boredom and executive dysfunction and all the involuntary coping mechanisms that ADHD promotes.
Keep your incredibly insulting views to yourself. Comments like this help no one.
We've got the mental equivalent of a person born missing their legs, so we need a wheelchair for the mind. With mind wheelchairs to make up for our missing executive function and other deficits, we can even sometimes outperform neurotypicals, but without it we're crawling on the ground with no legs. But having the wheelchair to use is so much better than crawling around on the ground.
Now that we've found this wheelchair that enables me to have a job and a life that I actually want, I'm not going to throw it away just because someone could come along and steal it. That's mental!
It's a lie that people with adhd are fine outside of our fast paced world. Can you imagine being a farmer with no executive function? How are you going plan ahead to grow crops so you don't starve over the winter. Can you imagine trying to plan a woolly mammoth hunt? Just how do you plan on killing the thing without executive function? Our brains would just be Step 1. Find woolly mammoth. Step 6. Eat woolly mammoth meat. You don't get to step 6 without figuring out the missing steps!
We're not the only ones in this boat, and it sucks to be disabled, but we don't have the technology to fix our brains, so we just have to accept it. Just like those with hypertension have to live with needing heart medication, or diabetics need insulin, or rheumatoid arthritis sufferers need their DMARDs, or AIDs patients need their ARTs, or epileptics need their anti-seizure medication, or hypothyroidism sufferers need their synthetic thyroid medication.
Hell, if gasoline magically disappeared, society would be fucked. Not sure if anyone is prepared for that circumstance. Because it's ludicrous. The world's gasoline won't magically disappear in an instant. Stop watching so many movies.
I don’t know. Chaotic environments seem to be where my ADHD mind operates best when not on medication. I’m by far at my most productive when shit is on fire and everyone is panicking and doesn’t know what to do. I don’t think most ADHD folks would need medication if it wasn’t for modern working environments. When I’m dragged into WW3, my inability to pay bills on time or my complete lack of ability to start putting together that architecture until the deadline is looming will no longer be my greatest weaknesses.
It's easy to frame the demands of modern working environments as the problem, but it's really the other way around. Modern society is so luxurious, so privileged, there's just so much excess, that bills don't rise to the level of emergency that my lizard brain is able to comprehend. Consciously, yes, I need to pay my bills, but it's nothing bad happens immediately the instant my power bill is late. Even when the power company does send somebody out, they don't ring my doorbell and start yelling at me for not paying. If someone I didn't know came by and yelled at me I'd be way more able to remember to pay my bill. (SYayaS? Stranger yelling at you as a service?) But that's rude and unpleasant and no one wants that.
Meanwhile, outside the trappings of modern society, you don't have a plan for catching the woolly mammoth until you're too hungry to think, and then you can't think (not that you were great at planning to begin with) so you starve and die.
This whole "it's modern society that's the problem with my ADHD" is a stupid myth that needs to die.
I also wouldn't have thousands of completely meaningless distractions. It's not like the choice was doom scroll Twitter or go hunt that woolly mammoth. You also get hungry long before your body falls apart due to starvation. I can't imagine anyone's ADHD making them lay around until their body was too emaciated to hunt. If the tribe is unsure of how to take out a woolly mammoth, that sounds like the sort of problem I'd (involuntarily) ideate on instead of twisting all that cordage. For me to accept this as a myth, I'd need something far more compelling.
I'm friendlier, my thought process is more clear and less scattered, I don't surprise people with chatty behavior some of the day and then ghost them other times of the day, and I'm more aware of my overall health and energy levels. If I stop running, lifting weights, eating a really clean diet, sleeping restfully, or start smoking/drinking - I feel it now and there's no hiding from it. While on Adderall, all of my bad health habits were just a slight adjustment to a dosage away from being a non-issue for another month, but the downward health spiral from ignoring all the extra care I could be doing for myself really started adding up.
Looking back at that time, I really thought I was being hyper productive while on it, but I think it was more like I was spinning my wheels really fast, not going very far, and feeling unreasonably good about the progress I was making because all my brain's reward centers were constantly firing. I could do an endless amount of simple work, and actively sought out that type of work, but the real deep critical thinking stuff I started to balk at and look for ways to justify avoiding - usually by doing double or triple the amount of simple stuff. It's odd that it made me feel so dang confident in my abilities.
No hate to those who have ADHD and take it, but, for me who was taking it illicitly at low dosages (1mg-5mg), all the negative side-effects drastically outweighed the benefits and I only really saw that once I found it inside me to stop.
Definitely sucks having to re-train my willpower though. It was just so damn easy to delegate all of that to the drug. It took a few months before I felt I could really convince my brain to work hard on its own, but now I'm back!
Good luck and best wishes to all those out there that see a bit of themselves in this post :)
What the actual fuck.
If you are friendlier off amphetamine, either you don't have ADHD or you're taking way too much, dude.
If you have scattered thoughts on amphetamine, either you don't have ADHD or you're taking way too much, dude.
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Comments like this makes me furious. Because of misdiagnosis, or inept psychiatrists, y'all keep making the life of actual people with correctly dosed ADHD medication hell with your abuse or repeating the same story that it makes you robotic and makes you jump of the wall.
I have been 35 years unmedicated, I am on the same dosage for a year, with routine 2 or 3 days long breaks. On days off, I am perhaps a little more lazy, but as scatter brained, as slow, as tired and as unmotivated as I have been my entire life.
When I am medicated, on the least effective dose, because that is how titration should work, my mind is silent. I am more attentive to people, more patient, there is space to think and to plan. When I am medicated, I go to bed proud of what I have accomplished today. This small thing has turned my bloody life and mental health the right side up.
Jesus, every time there is an ADHD post on this forum the misinformation and ignorance around a very well researched medication abounds. It has taken me 35 years to know there was a solution to the mismatch between what I thought I could do and what I did, because of posts like this, saying ADHD meds makes you scatter brained, it is very addictive, it is hard to quit, it is ineffective, etc.
I did not claim to have an ADHD diagnosis. I stated I was taking off-prescription and shared the dosage - well below a typical adult prescription amount. It's entirely possible I do not have ADHD, but I did see significant benefits, the ones you describe like a silent mind, attentiveness, patience, for a period of time. Then those things faded away, I stopped taking, and experienced side-effects as my body normalized to not taking.
Is there a way I could've shared my story that would've been less upsetting?
This is exactly how someone without ADHD is affected by Adderall. The medication has two functions: increased alertness and focus, which you build a tolerance to, and improved executive control, which is only relevant for folks with ADHD, and your body generally doesn't build a tolerance to.
Maybe don't tell other people what they should be experiencing from their medication
No offense, but alternative read of this is: you're probably spending a huge part of your life on coping mechanisms for a problem that can be better corrected with a pill.
It's either that, or you're one of those legendary superhumans I keep hearing about on the Internet, who can simultaneously run, hike, hit the gym every other day, home-cook meals or otherwise obsess about "healthy eating" and fitness, and then also hold a full-time job, have a spouse and children, run a side hustle, volunteer in the community, drive kids to soccer matches and still sleep 8 hours a day.
It's different because you aren't going to end up incarcerated and made a felon with drug convictions on your record for taking your medicine. Your dose is theoretically metered so that you can't exactly abuse it to the point where you're shooting it or taking absurd psychosis triggering doses. Theoretically, your doctor will prevent you from taking higher doses just to get high as your tolerance to it builds up over time. It has the potential to be a much less life ruining/ending situation.
My dosage is 25mg of Adderall XR per day. Not only can you not shoot up with it, the fact that it's extended release really puts a damper on how high you can get on it. I honestly doubt an addict would get much out of taking my entire month's prescription all at once.
If it was the instant release pills instead of extended release capsules, then, maybe they could get a couple good highs out of it. But the point is that you're right: I'm not prescribed enough to even get addicted, much less sustain an addiction.
IIRC you can crush up the adderall XR and insufflate it, so I imagine you could shoot it as well
You can shoot anything, but unless you're really careful and spend the time with "proper" technique, filters, etc, shooting pill binders is the fast lane to serious heart damage.
If you're at the point where you're considering shooting pills, you are also probably making other desperate decisions that don't involve proper technique, filters, etc.
The real proper technique is never injecting pills in the first place.
See also perverse incentives.
For medical supplies there should be a specific tax exemption for maintaining emergency supplies. Or a law, or both.
I would also expand that to include any drugs that require a tapering off period should require an emergency supply as well. We can't have people keeling over from methadone withdrawals because you decided to piss off your only vendor.
In fact I might go so far as to say that you can't institute a price hike without a grace period either, which may or may not include one final prescription renewal at the old price.
I'm an anesthesiologist. Almost all of our drugs are generic. But there have been shortages of one or another for most of the last 15 years. Why? Among other things, the federal government limited price hikes to a percentage per quarter that Medicare and Medicaid would pay (gross oversimplification, but close enough).
This sounds like a great idea. But when you can't do a 100% price hike on a drug that sells for 40 cents per ampule, you can't pay overtime and do increased-tempo maintenance to keep a line running almost 24/7. So if one generic manufacturer quits making a drug that only has 2-3 sources, the others simply can't fill in the gap. Sometimes they stop making it because it's no longer profitable, sometimes because other factors (failing to pass an inspection, e.g.) cause a temporary shutdown. But if you can't double the price of a dirt-cheap drug, you often can't double your output (because the drug is cheap - it's the labor, packaging, and regulatory compliance that are expensive, and they scale per dose, not per kg made).
This is a very different world from the famous cases you see in newspapers about huge increases in price for medications that have been generic for a long time, but it is there and it really does hit us.
These drugs can literally save lives from chaos and tragic ends. If these drugs help you live a more normal life, you are not an addict or an abuser.
The cosmic tragedy here is that this type of medication is practically impossible to become dependent on if you have ADHD. If anything the problem is usually remembering to even take the medication. I fear that abuse will hamstring any efforts to lift production limits.
My perspective on this is:
- The process for getting prescribed Adderall is not objective. One is allowed to see multiple specialists and continue searching until one's perspective is seen and respected. Yes, there are objective differences in the brain, but brain scans aren't being used as the basis for issuing prescriptions.
- Adderall, like all drugs, comes with a set of benefits and drawbacks. It's up to the user to decide if those are resulting in a net positive and they are allowed to change their mind at any time. So, it's reasonable to believe that someone who is undiagnosed may still either be, or believe they are, benefiting from the drug - and then change their mind later. Changing their mind does not mean that they retroactively become an abuser.
- I would like a source for "practically impossible to become dependent if you have ADHD." There are plenty of studies that show addiction does not occur with statistical significance in those with ADHD + monitoring, but addiction is not the same as dependence. Dependence is implicit after continuous use, but, depending on baseline brain chemistry, different people revert to different baselines after discontinuation.
- I feel your concern is more with the U.S. war on drugs in general - not specific users. I believe you want everyone who may benefit from stimulants to be able to find out if they benefit from them as easily as possible. The path to this is legalization - not stricter enforcement.
On a more personal note, I have several friends who, by all external appearances, were doing just fine mentally, but did not make their physical health a priority. They got masters degrees, bought houses, held down solid white collar jobs. As we aged, continually ignoring their physical fitness and diet resulted in their bodies operating less efficiently, which began impacting their work, and so they sought legal help - and got it. Their personalities have now shifted to ones where they are always talking about their stimulants and how life is harder for them due to their diagnosis, but they still do not care for their bodies. They constantly search for the right dosage to make them magically better and become defensive when it's suggested that best results are achieved with both medical support and prioritization of personal health. It's really challenging for me to be supportive of this sort of behavior because I do not feel they are giving their bodies a fighting chance. I am now able to empathize with this mindset more fully having taken stimulants for a period of time. I felt firsthand how easy it was to ignore my health when there was a guaranteed window of time each day where I was able to live life fully attentive and stimulated.
I feel that it is entirely possible that I have ADHD. I have some neurodivergent tendencies, but I see myself as strong, independent, successful, and not the sort of person who is interested in convincing a medical professional to greenlight my behavior. So, I researched and explored for myself, thought that stimulant use was potentially beneficial for a period of time, and then changed my mind when I reflected on the actual results. Was it illegal? Yes. Does that make it implicitly morally unjust? I don't feel that way. I felt morally worse convincing a doctor to prescribe me medical marijuana when California was still in the process of legalizing it recreationally even though the symptoms I stated, such as trouble falling asleep, were valid and "prescription worthy." Of course, you're fully entitled to see things differently, but it was important to me to fully share my perspective since I felt what I said prior was upsetting.
Would love to hear your take on things. Cheers.
Not necessarily... in fact, the hope of knowing it could solve everything made it possible for me to work through the stupid medical system in the first place. And now that I have it, and know it definitely works for me, I don't think I could ever forget to take it.
If I'm an addict, I'm very bad at it.
These aren't very good examples.
2 of those are relatively new drugs, 1 with runaway demand (Wegovy has the same ingredient as Ozempic) and the other, Pluvicto is a radiopharmaceutical with a short shelf life (so any manufacturing problems have immediate effects).
DEA regulations regulate how much amphetamine can be manufactured for production of Adderall, along with 30 day script limits, so there's not going to be a lot of slack in the distribution system, nor in patient's pill bottles.
Oh so it’s not just Canada that does silly stuff like this. My doctor has to remember to write “300 pills dispensed 60 at a time” rather than “5 repeats” or else I have to go waste his time for refills.
Congratulations, America. You have re-created the Soviet economy. All of the problems of centralized planning & production, and with none of the benefits.
If the applicant misses the production rate for one quarter, they agree to work with a second source drug producer to prepare for production. If they miss the next quarter's quota, the second source is allowed to sell the drug for no less than three years.
Even if the original company decides to move production to another facility, it can take 6-12 months to run test batches, tests and submit it all to the FDA for approval.
I’m not sure drug companies need much incentive to not have supply issues. That’s lost sales.
If you dig into the actual causes it’s usually because of DEA limits (Adderal) or massive off-label use (Wegovy) or the fact that the drug is generic and the margins as so small nobody is all that interested in selling it.
Americans choose shortages because they think bureaucracy gets them quality. Instead what it gets them is a lack of baby formula and military planes importing it from Europe (presumably only the few cans that would cause children to not instantaneously drop dead like they do in Europe where they don't put FDA labels on them).
There is no shortage, just weird regulation issues
Honestly, I don’t care about the details of each individual problem, which are complicated and ultimately unenlightening. The big picture answer is this: America is becoming a failed state.
Generally that happens because a small group of economic and political elites get too much power, and their interests begin to conflict with the interests of the general population. That’s the big picture. It’s just not in the narrow short term interests of the ruling class to actually solve these problems. And as long as that remains true, they will continue to get worse.
The government can and will seize patents at will. Only a handful of people need to be "convinced" to share their knowledge on production, and there are enough laws and spying that anyone can be "convinced".
If a hard left president of the US decided the US wanted to produce drugs, it would produce drugs and that would be the end of it. If children start dying because of drug shortages, this will happen.
Well that’s never going to happen.
Yes I've heard that centrally planned economies are great at delivering goods.