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Comment by sepositus | Hacker News Reader

I'm constantly having to fight for my child's ADHD meds (as in, they are never available at any pharmacies around me). It's been such a nightmare ever since they were diagnosed. To know people can go around faking it for, presumably, free access to Adderall is even more frustrating.

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Yeah it’s pretty weird. What is the production constraint they are hitting? Why can’t they keep up with demand? It’s not a new drug, you’d think amphetamine production would be easy by now. Curious if anyone knows what’s up with that.

ADHD meds contain controlled substances, and there's an annual production quota for them set by the DEA. The quota is intentionally set very tightly, so it's easy to hit it when the demand increases even slightly above projections.

Most international pharmaceutical companies have some presence in the US, so the US quota has a world-wide effect.

Additionally, prescriptions are for very specific doses of specific variants of the meds. Because it's a controlled substance, pharmacies aren't allowed to use any substitutes (not even something common-sense like dispensing 2x30mg for a 60mg prescription). This makes shortages happen even before all of the quota runs out, because some commonly used doses run out sooner.

Okay so the DEA is causing people with legitimate prescriptions to not have access to medication.

Are they doing anything about that? Seems like a very tractable problem.

Why would they do anything about that? It’s their job to set and enforce quotas, not to ensure access. From their perspective, I’d imagine that tight quotas make them feel reassured that they’ve got a lid on diversion concerns.

It does sound like the quota-setting system was designed for an era where the “legitimate” growth wasn’t on the order of “10% a year for 15 years”:

https://www.additudemag.com/adderall-shortage-dea-stimulants...

You're right that the DEA's quota system prioritizes diversion control over access, and it's clearly stuck in a bygone era unfit for todays demand growth. But it's baffling that Big Pharma, with its lobbying muscle, hasn't pushed Congress to modernize this bottleneck. Surely they'd profit from looser quotas.

Instead of hoping for a Trump EO to nuke the DEA (literally or figuratively), why not redistribute Controlled Substance Act enforcement? Agencies like the FBI or HHS already handle overlapping domains. The DEA's rigid gatekeeping, especially on research and quotas, stifles innovation more than it curbs abuse.

Or if the court overturned Wickard v Filburn. The Federal power to regulate substances like this at all is based on a butterfly effect version of the commerce clause.

There are alternatives that are not on the EU list for controlled substances. Like for example:

https://en.wikipedia.org/wiki/Lisdexamfetamine

Lisdexamfetamine is still a C2 in the US, as somebody with a script for it the headaches of pharmacies running out is real.

Vyvanse never hit the same the one month my doc wanted me to try it out :(

Everyone who wants it should have access. There's no reason production should be limited to the point you're having trouble accessing it. Illicit amphetamine has been cheap and readily available for decades.

This is largely my opinion (weakly held, however).

What's also common is ADHD in adults being self-medicated with things like caffeine and nicotine. I'm not saying that this will help their kid, but clearly we're ok with some things that are medicinal being uncontrolled.

This has already been tried. During the 1930s to 1950s, amphetamine was available over-the-counter under the trade name Benzedrine, but it was made prescription-only following rampant abuse. By then, it had garnered a significant reputation, and the folk proto-punk band "The Fugs" sang about it in their song "New Amphetamine Shriek".

The real issue with increasing legal access to speed is that you're never fully aware of the impairment that amphetamines cause, because they make the user feel cognitively-enhanced, regardless of reality. In contrast, with alcohol and cannabis, the user is generally well-aware that they are not safe to drive or operate heavy machinery.

I have known SO many people on prescribed amphetamines who either wrecked their cars or narrowly avoided doing so. When I was on it, I narrowly avoided rear-ending multiple different cars before it finally occurred to me that I probably shouldn't be driving. Until that happened, I felt like my driving was being made better by the amphetamine, and for repetitive aspects of driving it probably was. For reaction time and spatial awareness, amphetamine was impairing.

Think of the profound-seeming drivel-filled essay written by a college student cranking out an essay last-minute while high on Adderall and now imagine these people all over the place, driving large pickup trucks with similar misplaced confidence in their cognitive abilities.

Way worse than immediate cognative impairment - e.g. impaired driving is the slow mental degredation that comes from constant amphetamine use. It really, really fucks you up. Changes your personality, sense of humor, sexuality, etc. Over time. And usually youre having so much fun whjle youre high on it you dont even realize how fucked everything gets

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