Anatomy of the Great Adderall Drought | Hacker News Reader

Anatomy of the Great Adderall Drought

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82 pointspier056 comments

I'm against drug prohibition. I'm also against telling people they have a medical disorder and need to take a recreational drug for it.

And damn right Adderall is a recreational drug, it makes stuff that is boring fun. I've also watched people working while using it, they are easily distracted and then focus 100% of their attention on the distraction. Makes for a good illusion of productivity.

I think a lot of people, for either environment or genetic reasons, just have crappy brain chemistry for succeeding in our modern, deep-focus oriented world.

Back in the day, you work on the farm, you chat with people, you do your regular business. You didn't have to sit still in a large box for 70% of the day, and so it wasn't such a big deal if you were a little "light headed".

I have a wee cousin who has ADHD and she's a problem child from hell. We know this 'cos her father was also a problem child from hell. She literally has an immense problem sitting still.

Once she takes her meds though… it's hard to describe the feeling I had when I realized she had spent the last half an hour quietly colouring a book.

So yeah. Some people pop it to do all nighters; for a lot of other people it's necessary in order for them to achieve the neuronormativity expected of them in say, an office job or 12 years of mandatory schooling.

"in order for them to achieve the neuronormativity expected of them in say, an office job or 12 years of mandatory schooling."

And there are a lot of fields a person might want to enter, entirely on their own initiative (not teacher-imposed), that inherently require you to spend a lot of time doing 'boring' or repetitive things. And if you don't, you'll fail. Or give up painting/piano/whatever early out of frustration.

"a problem child from hell"

It's not unnatural for kids to be all over the place, and subsequently require a lot of parental energy. I've always seen this as a drug for the parent's more so than for the kids, specially at such a young age.

I'm sorry, but this sounds like telling someone with clinical depression to just cheer up. There's a real chemical difference between regular-lack-of-focus and ADD. It's not the fault of real sufferers that faux sufferers cloud the diagnosis.

Regarding focusing attention on a distraction; that is an executive dysfunction disorder, not an attention deficit disorder. One can have both, and adderall would not address the former at all.

I wonder what people did before we had all the fancy names though.

I certainly feel for people who have real chemical imbalances that lead to a different perception of the world. But psychology is not a science. It's extremely subjective.

>I wonder what people did before we had all the fancy names though.

They suffered, just like people with schizophrenia did back when we believed in visions and demonic possession.

>But psychology is not a science. It's extremely subjective.

This is about psychiatry, not psychology. Psychiatry is absolutely a science. (And so is psychology, albeit a tricky one.)

That's pretty easy to say if you don't have ADHD and only anecdotal evidence and no real metrics.

"non-recreational" drugs work for me as well, but the side effects are much worse than "recreational" drugs. I take concerta with bupropion.

And damn right Adderall is a recreational drug, it makes stuff that is boring fun.

As a prescribed user of Adderall, I don't agree. The fact that it can be abused doesn't make it a recreational drug, any more than the fact that cocaine can be abused invalidates its use as a clinical anesthetic. With ADHD, the problem is not necessarily inability to focus: indeed, many people with ADHD are capable of hyperfocus and have no difficulty 'pulling an all-nighter.'

The problem is that achieving this hyperfocus requires minimizing external distractions to an abnormal (and often impractical) degree. The all-nighter is a good example itself; it may be a lot easier to work through the quiet of the night but there are social, psychological, and physiological costs to doing that all the time. Likewise, working in an office or in a particular location for extended periods during critical projects can be very manageable and productive, but may require attenuating familial or emotional relationships during the period in question. Most people need to perform multiple roles in multiple every day, e.g. parent, homemaker, employee, manager, spouse etc. etc.. It's normal to give total focus to some roles some of the time, but one can't do that constantly without creating serious life imbalances, with negative consequences for both oneself and the people one is connected to.

For people with ADHD the mental cost of focus-switching seems to be much higher, because doing so requires constant re-contextualization. Imagine looking at the world through a pair of binoculars or a telephoto lens on a camera. You can see a great deal of detail this way, but shifting your view by more than a few degrees requires re-orienting your view around the new object of attention. With an optical device you can move it away, look at the wider picture, and easily establish your new point of focus. But if you didn't have that option, then re-orienting oneself would be more time-consuming. If your point of view were being shifted about by external forces on a regular basis, it would be problematic. Likewise, navigating a ship or following a map is simple in principle, but changing weather conditions or inaccuracies on the map can make the task considerably more difficult. My experience of using Adderall is not that it makes dull activities fun or effortless, but more that it provides a relatively consistent mental reference point against which one can calibrate one's model of external priorities. In programming terms, it's like the difference between having pointers and having to use global variables.

"For people with ADHD the mental cost of focus-switching seems to be much higher, because doing so requires constant re-contextualization. Imagine looking at the world through a pair of binoculars or a telephoto lens on a camera."

Spot on.

I've tried to draw comparisons before to ADHD about what I can see with / without my glasses being extremely nearsighted. If something's close enough to my face, I can see it very well. If it's not, finding that thing is hopeless.

In fact, I can see tiny details that most people go without noticing like: single-pixel oddities in font rendering or anti-aliasing, and I am so bothered by 60 Hz refresh rates on monitors that I'm unable to use them.

As it happens, I am also acutely short-sighted, something which was diagnosed about my 4th year in school. I often wonder to what extent (if any) the ADD might have been a compensating mechanism for the visual imbalance; the brain's very plastic at that age.

It's interesting that you bring this up. I first had vision problems diagnosed a little later, around age 14-15, and my symptoms of ADHD ballooned within 2-3 years following that.

>I'm also against telling people they have a medical disorder and need to take a recreational drug for it.

Why? Do you not believe medical disorders exist, or do you just not think that people should be told when they have them?

> And damn right Adderall is a recreational drug

So? DXM is a recreational drug, and it is also an effective cough suppressant. Caffeine is a recreational drug and it's also an effective alertness aid. Cannabis is a recreational drug and is also an effective analgesic, helps in the treatment of glaucoma, and relieves nausea.

That something can be used recreationally is irrelevant to its medical utility.

One of the greatest coups corporatism can pull in modern times is to get a patent on something and then get the government to mandate its use and restrict all substitutes. Its 100%, grade A, screw society, corporate win.

There are so many examples of this it's infuriating. Recent examples include patent holders for those automobile rear-view cameras lobbying to mandate they be added to all vehicles and Michael Chertoff lobbying to get his client's full body scanners in every airport in America.

I'm curious as to the pricing structure in less corporatist countries, especially in places with public health care where (unlike the US), the government has the legal right to bargain prices and doesn't just satisfy any arbitrary price set by a manufacturer.

It's flatter, but patients are given their medicine and told to take it rather than being invited to select from a menu. Pharmaceutical companies don't advertise direct to the public and doctors make all the decisions about which version of a drug patients should be taking, based on the clinical outcome (eg whether the side effects of a generic are well-tolerated or problematic). In the US you have to be a lot more knowledgeable about what you're taking and the information is much more available, so in that sense the patient has more control, and arguably more freedom; on the other hand most of us are not doctors and spending time becoming expert on the finer points of your meds is perhaps like becoming an expert on the difference between Coke and Pepsi - you may strongly prefer one over the other, but is it really making any difference to your nutritional outcome?

In other countries the win for the drug companies is predictability; the government will negotiate far more aggressively but will then contract to purchase a certain amount for the next x years, providing the drug companies with a predictable revenue stream. Where public healthcare is the norm, the government also absorbs a lot of the insurance/liability costs; if a drug is approved for sale but later turns out to have problematic side-effects, the government will compensate or support the affected patients, on the theory that since it approved the medicine for sale it accepted the potential risks as well. Obviously, there are exceptions, such as if a manufacturer had data on clinical risks that it concealed to get approval, but those cases are a minority.

Two comments:

1) If you have a better idea for drug development then the current patent system, I'm all ears.

2) Do you really think Shire likes selling a drug under DEA regulations? Do you have any idea what a burden that is? Companies fight tooth and nail to keep their drugs off of the CSA schedules.

Another great example of a gov't regulation that isn't in sync with the marketplace.

If you are a company that produces product A and product B, and the gov't says you can only produce a limited amount of A+B, why wouldn't you automatically shift all of your production to the product with the highest profit margin. This is economics 101!

Assuming that Shire has a patent on Vyvanse, then this is more like limit production of A+B and create product C that is more expensive and has an artificial monopoly (patent). This will then drive everyone that needs products A or B to your new product C. Profit!

I didn't get a sense from reading the article that Shire is limiting production of their branded amphetamine salts. However, you do have a point in that having more patients on a branded therapy makes a move to Vyvanse more likely.

I was going off of this:

  Luckily, Shire had magically possessed enough amphetamines from
  their DEA quota to produce plenty of their new ADHD medication,
  Vyvanse. In fact, Shire doubled its third quarter profits from 2010
  to 2011, with most of that increase resulting from Vyvanse sales.
  During this time, coinciding nicely with the Adderall shortage,
  Shire hiked the price of Vyvanse.

It makes sense to want everyone move to Vyvanse which is still protected by patent, but if you can game the system so that people are still forced to buy brand-name Adderall even though the patent is expired, that works too.

(Worth noting that Shire makes money on all three -- including the generic version of Adderall. Which seems more than a little suspicious)

The thing is, there is reason to believe that these shortages are exactly what the DEA wants. Shire Pharmaceuticals has convinced the DEA that Vyvanse is the solution to the adderall abuse problem, and the DEA apparently doesn't understand that the American healthcare system simply doesn't allow everybody on generics to switch to an expensive name-brand medication. They're basically trying to manipulate the marketplace in order to force patients to switch to a drug that they expect to be easier to control. Of course, economics aside, Vyvanse is not a drop in replacement for adderall, and many people find it less effective or more prone to side effects.

So it's also a good example of a government regulation that isn't in sync with medical science.

"The marketplace" isn't a market at all -- it's a bunch of people, with and without a medical condition, who get a third party to purchase a medication for them.

That infographic tells the story -- 50% more Iowan children need amphetamines to function as compared to New Yorkers?

IMO, this is a case where the DEA is doing the right thing. Improve the guidance for prescribing this stuff, and the folks who need it will be fine.

>That infographic tells the story -- 50% more Iowan children need amphetamines to function as compared to New Yorkers?

Why assume that there is overdiagnosis in Iowa rather than underdiagnosis in NY?

>and the folks who need it will be fine

...if they have health insurance and Vyvanse works for them.

Read the comment and think before posting a response that doesn't make sense.

I assume there's an over-diagnosis because the abuse of these drugs is both blatant and widespread.

Look at the infographic and you'll see that there is a very wide variance between states. NY and Iowa just two examples. If you have a medical condition that affects broad swaths of society and is being diagnosed so inconsistently that you have these huge variances, something is wrong.

If doctors stopped supplying prescriptions to people who want speed, as opposed to people who need to treat a recognized medical condition, there would be no supply problem.

The government centrally controls the production of narcotics, and people are wondering why there are shortages? It is obvious the purpose of their central control is not working, people who need the drug can't get it, and people who want to "abuse" it are still able to acquire the drug. I doubt we will see the sane solution of just stopping control on the production of these drugs.

Technically, "narcotic" means "opiate" (or more generally, a sleep-inducing drug), which Adderall is not. I think you meant "schedule II controlled substance", or something.

The legal and medical definitions of narcotic are not the same, unfortunately.

The shortage is caused by our society's schizophrenic position on these kinds of drugs in general.

We're restricting production as if drugs like Adderall are special-case prescriptions, yet we're prescribing them regularly.

The problem that needs to be solved is the inconsistency, not the particular method used to enact policy.

If the government didn't insist on controlling production, there would be no inconsistency. Someone else's opinion about whether I "should" be taking Adderall would not affect me. The only reason the opinion of "society" matters is that "society", via the government, insists on micromanaging people's lives. And of course the people who are going to abuse the drug just circumvent the controls, so the ones that actually suffer are the ones who genuinely need it and can't get it.

Take the libertarian claptrap somewhere else, please. The person entitled to determine whether you should take Adderall is your doctor.

But you decide on your doctor, so ultimately, it's your decision.

Of course you can shop around for a doctor who will diagnose and prescribe what you want. All you have to do is find someone who will completely disregard medical ethics in the name of being paid to give you expensive happy pills.

And there are plenty of doctors that will do this.

I'm not making a value judgement, I'm just making an observation. The way I see it, the less drugs needed to keep me operational, the better. So I choose that kind of doctor. But other people like their drugs, and choose doctors that prescribe drugs.

You clearly have sufficient wealth and/or insurance to make such a decision. Most people don't, and either get a short list of approved doctors and procedures, or wait until it gets bad enough to go to the emergency room. These people are not choosing anything.

Should the kind fashion experts at JC Penny's mandate what you wear, comrade? Should your mechanic prescribe your car, along with the distance you are allowed to drive and at what intervals? Constrained by common sense government guidelines, of course; backed by bureaucratic approval and studies designed to prove whatever the bureaucrats want.

I can't imagine someone voluntarily giving away their freedom to choose what to put in their bodies, but people like you do it every day. It's a shame that your misguided decisions take away my freedom as well.

The government does what the voters tell it. And so long as the voters are supporting the war on drugs -- so long as they demand drug abuse problems be tackled by trying to control drug use -- the government is required to be involved.

And it simply does not matter whether the policy is enforced via a hard cap on production quantity, a hard cap on production licenses, a soft cap on prescriptions, pressure on the psychiatric industry to self-limit prescriptions, or a legal requirement that certain prescriptions need to go through a second-opinion or review board process.

The result of all of those is the same: voter opinion on drug policy has interfered with what you and your doctor feel is right for you.

Who cares whether you can't get Adderall because the manufacturing capacity isn't there, or your doctor was forced to ration his prescription allowance in case a more-severe case walks through his door, or a second-opinion review disagreed with your doctor? If the motivation is the same and the end result is the same, the method is irrelevant.

That's why I say that arguing against government control of production is beside the point.

It's worth noting that the government clampdown on this drug also happens to be extremely advantageous to the pharmaceutical giant who makes these drugs. I don't think Shire is blameless here.

Shire doesn't make the generics, Barr does.

Nope. It's called an "authorized generic. It's marketed by Barr, but it's still made by Shire.

From Wikipedia on Adderall: "Authorized generics are exactly the same as the brand name product both in active and inactive ingredients—they go through exactly the same brand manufacturing line, yet different labels are put on at the end of the manufacturing process."

There is only the illusion of competition. I'm honestly not sure how they get away with it.

This article ignores an important point about Vyvanse. It's a pro-drug: it's metabolized into one of the components of Adderall, but at a constant rate. That means you can't crush and snort it (well, you can, but the constant rate of conversion does not change).

As such, it has less abuse potential than Adderall XR (though not zero abuse potential). In states like Florida where there has been more scrutiny on prescription of controlled substances, these details can be important.

I live in Turkey and I am using concerta for about 5 years now, if you have ADHD the drug calms you and makes focusing and completing tasks easy, it also unfortunately makes you immune to coffee no matter how much coffee you drink, you can still drink more :).

When somone without ADHD uses the drug it causes tachycardia, high blood pressure, restlessness and sometimes paranoia, not all of them though, it migth be a recreational drug to someone but I need it to function in my daily life and I'm not using it to have fun in any way, I had periods ( at most 6 months) which, I had not taken any concerta of methylphenidate derivative and results were not good for my productivity.

It is also a type II controlled substance here in Turkey You are prescribed one pill for one day and you cannot have more even if you want to, but we dont have any quotas on the precursors and drug use in Turkey is very low considering Europe and US.

How much money is a 30 day supply?

85$

I find this absolutely startling: "It’s well known that many college students use Adderall to give themselves an extra edge for getting work done whether they’re prescribed or not ... Furthermore, a 2009 study on non-medical use (defined as use of a prescription drug without a doctor’s order) of Adderall among full-time college students showed that subjects aged 18 to 22 were twice as likely as their counterparts, who were not full-time college students, to have used Adderall."

Along with: "Stephanie Lee found her freshman year of college unusually difficult. She had trouble adjusting to the levels of stress she encountered." And: "Without Adderall, you might feel bored by your math homework or unable to focus on the multiple steps needed to reach a solution, but on Adderall you might literally feel like you’re in love with math."

So many people are taking this drug to deal with the fact that they cannot handle the type of work, or the stress. I find it fascinating that people have come to assume that the problem is with them because they find the work uninteresting, or they find school stressful, and not because that is how the systems (colleges) and the work (math, science) are designed. Instead of telling people how they are not designed properly for the work, perhaps we should take some time to reflect on how the work is repetitive and not creative, and not fulfilling, and that is perhaps the issue.

Note: I do think math and science and intellectual work can be creative when at a high level. But at a learning level you're treated more like a machine designed to learn and repeat.

I was recently chatting with another student about how classes here are just becoming increasingly demanding. In looking at computer science classes as an example, the complexity of even the basic computer science classes has grown with time, and nothing has been removed. Every one of our professors expects us to spend 10-15 hours per week just on their class. And it's obviously not possible. Instead of trying to find ways to optimize time, people are trying to optimize their minds to be something that is not creative, but rather very much like a machine. College is not designed around passionate work, it is designed to be a grind on you and force you to do a lot of work you hate. Every four months you take all the previous work you did and throw it out and start over. How is any part of that designed to be gratifying? I don't necessarily share entirely positive views of college. It's an institution designed to meld and mold people to fit into our economic model.

I have spent some time thinking about this trend and have come to the conclusion that it could be a real damage to creativity and individuality when you can medicate your mind into a machine.

I'm also surprised that they're taking adderall for an off-label use, when there's not much research supporting that use, and that they're not taking anti-anxiety medication (diazepam, lorazepam, etc (but addictive potential is worrying)) or taking a known placebo such as homeopathic tablets. Why aren't dealers pushing homeopathic pills as "street adderall"?

Because Adderall is cheap, easy to get, amphetamine works, and it's worlds different from things that are not amphetamine (homeopathic pills?!).

> easy to get

In response to something titled "the drought" ?

> amphetamine works, and it's worlds different from things that are not amphetamine (homeopathic pills?!).

I would love to see placebo controlled trials for this particular use case (students needing a bit of help to concentrate).

*... it could be a real damage to creativity and individuality when you can medicate your mind into a machine.

OTOH, if it is a temporary state of mind, it can be a real boon.

Sometimes, before you can be creative with a tool, you need to get past some initial learning of possible quite boring fundamentals. Being able to slip into a different state of mind while learning this is an aid to moving on to where you then have the resources to start using what you know to create new things.

Yet again the government tramples it's citizens freedom and desires and tells THEM how to live. Doesn't matter if this drug helps countless people across the country function in their day-to-day.

Have any of you been diagnosed with ADHD? How dose it get diagnosed? I am really wondering how much is known about this ailment.

Attention deficit is a conduct disorder, which means that its diagnosis relies entirely on assessment of patient's behavioural patterns. Since it's next to impossible to keep a patient under 24/7 observation, secondary sources have to be used. In most cases, the diagnostic process reduces to an "intake session" interview with a patient and a few multiple-choice diagnostic questionnaires.

So an AD* diagnosis is trivial to hack. Moreover, it's impossible to design a diagnostic process that's not easily hackable because, ultimately, everything will boil down to a subjective assessment of patient's behaviour, i.e. a "doctor's call". Furthermore, the more you restrict prescriptions and tighten the diagnostic criteria, the more you increase the risk of denying medication to "legitimate" sufferers. Since the guiding philosophy of the medical community prioritizes "helping people" over "prescription security", the problem of how to keep people from getting "illegitimate" prescriptions is ultimately intractable.

Yes. you go to a psychiatrist who is familiar with the condition and are evaluated via a checklist, essentially - there is no blood test or technical diagnostic. Of course, it's not as simple as saying 'yes I am easily distracted, no I cannot concentrate, now gimme a prescription/disability parking sticker/get out of jail free card.' A good psychiatrist will look at the whole person's medical history and ask a lot of questions to check the consistency of the diagnosis, and may be slow to give a diagnosis immediately.Given our limited understanding of how the brain works, it's an inherently tricky process.

Regarding the claims of the article, I would like to see a lot more supporting evidence. I take generic Adderall (instant release) and have noticed no systematic supply interruptions. Nor have my pharmacist or psychiatrist mentioned any difficulties with availability, although I am used to reviewing the branded vs. generic options and pricing. Mine is manufactured by a firm called Corepharma, which isn't even mentioned in the article. Apparently some people find this version of drug inferior due to side effects or inadequacy of primary effect and prefer not to use it. For me the side effects have been very marginal so I have not bothered to seek out competing products. I presume that for people who are sensitive to a particular ingredient or characteristic the version of the medication they take matters a good deal, but in my own experience it's like preferring a specific flavor of coffee - others don't taste as great as my favorite, but they're hardly undrinkable.

The fact that other brands of the same generic drug go entirely unmentioned in the article makes me question the whole premise. If medication were simply unavailable as a result of manufacturing quotas that would certainly be a bad thing, but from here it sounds like 'it ain't coffee unless it tastes like Starbucks.'

What a scam. People don't even understand how these drugs work in the first place, and now the government, insurance, and pharm industries combine to screw people out of the things they're convinced they need for their brains to work. Gross.

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